One in four die from acute infectious illness in an emergency department in Eastern Cape Province, South Africa

Background. Despite the breadth of data supporting evidence-based practice for sepsis care in high-resource settings, there are relatively few data to guide the management of sepsis in low-resource settings, particularly in areas where HIV and tuberculosis (TB) are prevalent. Furthermore, few studies had broadened sepsis parameters to include all patients with acute infectious illness or followed patients up after hospital discharge. Understanding the epidemiology and outcomes of acute infections in a local context is the critical first step to developing locally informed targeted management strategies.Objectives. To quantify and describe the incidence of and risk factors for mortality in a cohort of patients with undifferentiated acute infectious illnesses who presented to an emergency department (ED) in the Eastern Cape region of South Africa (SA).Methods. In this prospective cohort study, patients with suspected acute infectious illness were enrolled at a district casualty ward in Mthatha, SA, between 1 July and 1 September 2017. Demographic data, interventions, diagnostic studies and disposition were prospectively collected during the initial encounter and during the hospital stay. Follow-up was conducted both in hospital and via phone interviews 30 days after the index visit.Results. A total of 301 patients presented to the ED with acute infectious illness during the study period, of whom 54.8% had complete 30-day follow-up. Of the study population, only 5.7% had a complete set of vital signs (heart rate, respiratory rate, blood pressure and temperature) documented. Of the cohort, 51.8% had HIV and 32.9% active or treated TB; 25.2% of patients died within 30 days. Accounting for medical history, diagnosis and ED interventions, risk of mortality was independently associated with age (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.00 - 1.06), HIV-positive status (OR 4.10; 95% CI 1.44 - 11.67) and Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score (OR 1.90; 95% CI 1.14 - 3.19) in an adjusted model. No ED interventions were protective for mortality, with intravenous fluid administration associated with increased 30-day mortality in this cohort (OR 3.65; 95% CI 1.38 - 9.62).Conclusions. Among adults with suspected acute infectious illness in Mthatha, SA, 30-day mortality was concerningly high. Mortality was highest in patients with concomitant HIV infection. In particular, vital sign assessment to identify possible sepsis in this cohort is crucial, as it affects mortality to a meaningful extent, yet is often unavailable. Future research is needed on the management of sepsis in low-resource settings, particularly in HIV-positive individuals

Smart Cities: Towards a New Citizenship Regime? A Discourse Analysis of the British Smart City Standard

Growing practice interest in smart cities has led to calls for a less technology-oriented and more citizen-centric approach. In response, this articles investigates the citizenship mode promulgated by the smart city standard of the British Standards Institution. The analysis uses the concept of citizenship regime and a mixture of quantitative and qualitative methods to discern key discursive frames defining the smart city and the particular citizenship dimensions brought into play. The results confirm an explicit citizenship rationale guiding the smart city (standard), although this displays some substantive shortcomings and contradictions. The article concludes with recommendations for both further theory and practice development

Molecules in the disk orbiting the twin young suns of V4046 Sgr

We report the results of a mm-wave molecular line survey of the nearby (D ~ 70 pc), 12 Myr-old system V4046 Sgr -- a tight (9 R_sun separation), short-period (2.42 day) binary with nearly equal component masses of ~0.9 M_sun -- conducted with the 30 m telescope of the Institut de Radio Astronomie Millimetrique (IRAM). We detected rotational transitions of 12CO 13CO, HCN, CN, and HCO+. The double-peaked CO line profiles of V4046 Sgr are well fit by a model invoking a Keplerian disk with outer radius of ~250 AU that is viewed at an inclination i = 35 degrees. We infer minimum disk gas and dust masses of ~13 and ~20 Earth masses from the V4046 Sgr CO line and submm continuum fluxes, respectively. The actual disk gas mass could be much larger if the gas-phase CO is highly depleted and/or 13CO is very optically thick. The overall similarity of the circumbinary disk of V4046 Sgr to the disk orbiting the single, ~8 Myr-old star TW Hya -- a star/disk system often regarded as representative of the early solar nebula -- indicates that gas giant planets are likely commonplace among close binary star systems. Given the relatively advanced age and proximity of V4046 Sgr, these results provide strong motivation for future high-resolution imaging designed to ascertain whether a planetary system now orbits its twin suns.Comment: 5 pages, 3 figures; to appear in Astronomy & Astrophysic

Scalar Field Quantum Inequalities in Static Spacetimes

We discuss quantum inequalities for minimally coupled scalar fields in static spacetimes. These are inequalities which place limits on the magnitude and duration of negative energy densities. We derive a general expression for the quantum inequality for a static observer in terms of a Euclidean two-point function. In a short sampling time limit, the quantum inequality can be written as the flat space form plus subdominant correction terms dependent upon the geometric properties of the spacetime. This supports the use of flat space quantum inequalities to constrain negative energy effects in curved spacetime. Using the exact Euclidean two-point function method, we develop the quantum inequalities for perfectly reflecting planar mirrors in flat spacetime. We then look at the quantum inequalities in static de~Sitter spacetime, Rindler spacetime and two- and four-dimensional black holes. In the case of a four-dimensional Schwarzschild black hole, explicit forms of the inequality are found for static observers near the horizon and at large distances. It is show that there is a quantum averaged weak energy condition (QAWEC), which states that the energy density averaged over the entire worldline of a static observer is bounded below by the vacuum energy of the spacetime. In particular, for an observer at a fixed radial distance away from a black hole, the QAWEC says that the averaged energy density can never be less than the Boulware vacuum energy density.Comment: 27 pages, 2 Encapsulated Postscript figures, uses epsf.tex, typeset in RevTe

Stochastic Gravity: A Primer with Applications

Stochastic semiclassical gravity of the 90's is a theory naturally evolved from semiclassical gravity of the 70's and 80's. It improves on the semiclassical Einstein equation with source given by the expectation value of the stress-energy tensor of quantum matter fields in curved spacetimes by incorporating an additional source due to their fluctuations. In stochastic semiclassical gravity the main object of interest is the noise kernel, the vacuum expectation value of the (operator-valued) stress-energy bi-tensor, and the centerpiece is the (stochastic) Einstein-Langevin equation. We describe this new theory via two approaches: the axiomatic and the functional. The axiomatic approach is useful to see the structure of the theory from the framework of semiclassical gravity. The functional approach uses the Feynman-Vernon influence functional and the Schwinger-Keldysh close-time-path effective action methods which are convenient for computations. It also brings out the open systems concepts and the statistical and stochastic contents of the theory such as dissipation, fluctuations, noise and decoherence. We then describe the application of stochastic gravity to the backreaction problems in cosmology and black hole physics. Intended as a first introduction to this subject, this article places more emphasis on pedagogy than completeness.Comment: 46 pages Latex. Intended as a review in {\it Classical and Quantum Gravity

Ancient papillomavirus-host co-speciation in Felidae

The evolutionary rate of feline papillomaviruses is inferred from the phylogenetic analysis of their hosts, providing evidence for long-term virus-host co-speciatio

The role of polyclonal intravenous immunoglobulin in treating HIV-infected children with severe bacterial infections: A retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Mortality among HIV-infected children in developing countries remains high after serious bacterial infections despite the use of antibiotics. Intravenous immunoglobulin (IVIG) has been used as an adjuvant therapy to treat these infections, but little data exists regarding its efficacy, and previous studies have focused on IVIG as a prophylactic agent. We examined the impact of IVIG as an adjuvant therapy in reducing mortality and length of hospital stay in HIV-infected children with serious bacterial infections.</p> <p>Methods</p> <p>This retrospective study focused on pediatric admissions at a large urban hospital between 2002 and 2006. Children between the ages of one month and nine years of age with laboratory confirmed HIV-status, serious bacterial infection, no prior exposure to IVIG, and a hospital length of stay of 5 days or more, were eligible for inclusion.</p> <p>Results</p> <p>A total of 140 children (median age 1.2 years) met inclusion criteria; lower respiratory tract infection was diagnosed in 94 (67%) of the children, while 74 (53%) had bacterial sepsis. Fifty-four (39%) children were receiving antiretroviral therapy and 39 (28%) were receiving tuberculosis treatment. Overall 73 (52%) were treated with IVIG, with the majority (74%) of children receiving a single dose. Thirteen (9%) died during their hospital admission. In crude analysis IVIG was significantly associated with increased mortality was (Odds Ratio (OR): 5.8; 95% Confidence Interval (CI): 1.2–27.1) and this association was weakened by adjustment for other predictors of mortality (OR 4.3, 95% CI 0.7–27.9, p = 0.123). IVIG use was also associated with longer hospital stays.</p> <p>Conclusion</p> <p>Administration of one to three doses of IVIG during the acute phase of illness does not appear to reduce mortality or the length of hospital stays in HIV-infected children with serious bacterial infections. However, the retrospective nature of this study makes confounding by indication difficult to control and further studies regarding the timing, dosing, and method of administration are required. Nonetheless the routine use of IVIG in resource-limited settings should be carefully considered given its high cost.</p

The violence of narrative: embodying responsibility for poverty-related distress

This is the final version. Available on open access from Wiley via the DOI in this record.Narratives of self-responsibility are pervasive in neo-liberally oriented contexts, and have been found to engender feelings of shame and failure amongst those affected by poverty. Here we use findings from research in two low-income communities in south-west England to examine how these narratives become embodied within people’s daily lives when they intersect with systems of welfare support and the current political drive to upscale treatment for common mental health conditions. Drawing on Bourdieu’s notion of symbolic violence, we examine how narratives of self-responsibility and associated welfare reform strategies impact on the mental health of people living in economic hardship. The data show how such narratives inflict, sustain and exacerbate mental distress and suffering, and how they become naturalised and normalised by individuals themselves. We demonstrate how this situation pushes people to seek support from General Practitioners, and how clinical interactions can normalise, and in turn, medicalise, poverty-related distress. Whilst some people actively resist dominant narratives around self-responsibility, we argue that this is insufficient under broader socio- cultural and political circumstances, to free themselves from the harms perpetuated by symbolic violence.Economic and Social Research Council (ESRC