Hospitalizations and Costs Incurred at the Facility Level After Scale-Up of Malaria Control: Pre-Post Comparisons From Two Hospitals in Zambia

There is little evidence on the impact of malaria control on the health system, particularly at the facility level. Using retrospective, longitudinal facility-level and patient record data from two hospitals in Zambia, we report a pre-post comparison of hospital admissions and outpatient visits for malaria and estimated costs incurred for malaria admissions before and after malaria control scale-up. The results show a substantial reduction in inpatient admissions and outpatient visits for malaria at both hospitals after the scale-up, and malaria cases accounted for a smaller proportion of total hospital visits over time. Hospital spending on malaria admissions also decreased. In one hospital, malaria accounted for 11% of total hospital spending before large-scale malaria control compared with \u3c 1% after malaria control. The findings demonstrate that facility-level resources are freed up as malaria is controlled, potentially making these resources available for other diseases and conditions

The impact of solar radiation on polar mesospheric ice particle formation

Mean temperatures in the polar summer mesopause can drop to 130&thinsp;K. The low temperatures in combination with water vapor mixing ratios of a few parts per million give rise to the formation of ice particles. These ice particles may be observed as polar mesospheric clouds. Mesospheric ice cloud formation is believed to initiate heterogeneously on small aerosol particles (r &lt; 2 nm) composed of recondensed meteoric material, so-called meteoric smoke particles (MSPs). Recently, we investigated the ice activation and growth behavior of MSP analogues under realistic mesopause conditions. Based on these measurements we presented a new activation model which largely reduced the uncertainties in describing ice particle formation. However, this activation model neglected the possibility that MSPs heat up in the low-density mesopause due to absorption of solar and terrestrial irradiation. Radiative heating of the particles may severely reduce their ice formation ability. In this study we expose MSP analogues (Fe2O3 and FexSi1 − xO3) to realistic mesopause temperatures and water vapor concentrations and investigate particle warming under the influence of variable intensities of visible light (405, 488, and 660&thinsp;nm). We show that Mie theory calculations using refractive indices of bulk material from the literature combined with an equilibrium temperature model presented in this work predict the particle warming very well. Additionally, we confirm that the absorption efficiency increases with the iron content of the MSP material. We apply our findings to mesopause conditions and conclude that the impact of solar and terrestrial radiation on ice particle formation is significantly lower than previously assumed.</p

Complex type 4 structure changing dynamics of digital agents: Nash equilibria of a game with arms race in innovations

The new digital economy has renewed interest in how digital agents can innovate. This follows the legacy of John von Neumann dynamical systems theory on complex biological systems as computation. The Gödel-Turing-Post (GTP) logic is shown to be necessary to generate innovation based structure changing Type 4 dynamics of the Wolfram-Chomsky schema. Two syntactic procedures of GTP logic permit digital agents to exit from listable sets of digital technologies to produce novelty and surprises. The first is meta-analyses or offline simulations. The second is a fixed point with a two place encoding of negation or opposition, referred to as the Gödel sentence. It is postulated that in phenomena ranging from the genome to human proteanism, the Gödel sentence is a ubiquitous syntactic construction without which escape from hostile agents qua the Liar is impossible and digital agents become entrained within fixed repertoires. The only recursive best response function of a 2-person adversarial game that can implement strategic innovation in lock-step formation of an arms race is the productive function of the Emil Post [58] set theoretic proof of the Gödel incompleteness result. This overturns the view of game theorists that surprise and innovation cannot be a Nash equilibrium of a game

The role of spectrophotometry in the diagnosis of melanoma

Background. Spectrophotometry (SPT) could represent a promising technique for the diagnosis of cutaneous melanoma (CM) at earlier stages of the disease. Starting from our experience, we further assessed the role of SPT in CM early detection. Methods. During a health campaign for malignant melanoma at National Cancer Institute of Naples, we identified a subset of 54 lesions to be addressed to surgical excision and histological examination. Before surgery, all patients were investigated by clinical and epiluminescence microscopy (ELM) screenings; selected lesions underwent spectrophotometer analysis. For SPT, we used a video spectrophotometer imaging system (Spectroshade® MHT S.p.A., Verona, Italy). Results. Among the 54 patients harbouring cutaneous pigmented lesions, we performed comparison between results from the SPT screening and the histological diagnoses as well as evaluation of both sensitivity and specificity in detecting CM using either SPT or conventional approaches. For all pigmented lesions, agreement between histology and SPT classification was 57.4%. The sensitivity and specificity of SPT in detecting melanoma were 66.6% and 76.2%, respectively. Conclusions. Although SPT is still considered as a valuable diagnostic tool for CM, its low accuracy, sensitivity, and specificity represent the main hamper for the introduction of such a methodology in clinical practice. Dermoscopy remains the best diagnostic tool for the preoperative diagnosis of pigmented skin lesions

Agrarian diet and diseases of affluence – Do evolutionary novel dietary lectins cause leptin resistance?

BACKGROUND: The global pattern of varying prevalence of diseases of affluence, such as obesity, cardiovascular disease and diabetes, suggests that some environmental factor specific to agrarian societies could initiate these diseases. PRESENTATION OF THE HYPOTHESIS: We propose that a cereal-based diet could be such an environmental factor. Through previous studies in archaeology and molecular evolution we conclude that humans and the human leptin system are not specifically adapted to a cereal-based diet, and that leptin resistance associated with diseases of affluence could be a sign of insufficient adaptation to such a diet. We further propose lectins as a cereal constituent with sufficient properties to cause leptin resistance, either through effects on metabolism central to the proper functions of the leptin system, and/or directly through binding to human leptin or human leptin receptor, thereby affecting the function. TESTING THE HYPOTHESIS: Dietary interventions should compare effects of agrarian and non-agrarian diets on incidence of diseases of affluence, related risk factors and leptin resistance. A non-significant (p = 0.10) increase of cardiovascular mortality was noted in patients advised to eat more whole-grain cereals. Our lab conducted a study on 24 domestic pigs in which a cereal-free hunter-gatherer diet promoted significantly higher insulin sensitivity, lower diastolic blood pressure and lower C-reactive protein as compared to a cereal-based swine feed. Testing should also evaluate the effects of grass lectins on the leptin system in vivo by diet interventions, and in vitro in various leptin and leptin receptor models. Our group currently conducts such studies. IMPLICATIONS OF THE HYPOTHESIS: If an agrarian diet initiates diseases of affluence it should be possible to identify the responsible constituents and modify or remove them so as to make an agrarian diet healthier