Short-term outcomes of inborn v. outborn very-lowbirth- weight neonates (

Background. The Groote Schuur Hospital (GSH) neonatal nursery provides level 3 care for the Metro West Health District in the Western Cape Province of South Africa. Worldwide, very-low-birth-weight (VLBW) neonates delivered in level 3 neonatal units have better outcomes than those transported from other facilities. Objectives. To identify the characteristics and outcomes of VLBW neonates at GSH, with emphasis on differences between inborns and outborns. Methods. This was a retrospective cohort study. VLBW neonates admitted to the GSH neonatal nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed. Results. Of 1 032 VLBW neonates enrolled, 906 (87.8%) were delivered at GSH and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors of mortality and survival without morbidity. The mothers of inborn patients were more likely than those of outborn patients to have received antenatal care (89.1% v. 57.9%; p<0.0001) and antenatal steroids (64.2% v. 15.2%; p<0.0001). Inborns required less ventilatory support (16.2% v. 57.9%; p<0.0001) and surfactant administration than outborns (25.3% v. 65.1%; p<0.0001), and developed less late infection (8.8% v. 23.4%; p<0.0001), severe intraventricular haemorrhage (3.7% v. 13.9%; p<0.0001) and chronic lung disease (5.3% v. 13.4%; p=0.003). The incidence of necrotising enterocolitis was similar in the two groups (5.9% v. 8.7%; p=0.227). The mortality rate was 18.4% for inborns and 33.3% for outborns (p<0.0001). Mortality declined as birth weight increased. Of the survivors, 85.0% of inborns and 70.2% of outborns did not develop serious morbidity (p=0.003). Conclusions. VLBW neonates delivered at GSH had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous transfer in utero and antenatal steroids contributing to excellent outcomes.S Afr Med J 2017;107(10):900-90

Earnings distribution, corporate governance and CEO pay

We investigate the relationship between earnings differentials and the pay of CEOs of 190 British companies between 1970 and 1990. We find that (i) changes in the differential between the 90th and 50th weekly earnings percentiles for non-manual adult male workers [90:50] explain changes in the level of real CEO salary and bonus in our sample of companies; (ii) changes in this differential also account for changes in the elasticity of CEO pay to firm size; (iii) a broader measure of earnings inequality does far worse than 90:50 at explaining changes in both the level and the firm size elasticity of CEO pay; (iv) fitting the model on data for 1970-1983 and predicting pay levels for the period starting with the widespread adoption of executive share option schemes in 1984, we find a structural break in the relationship between lower management pay differentials and the pay of the CEO. We conclude first that top executive pay prior to 1984 was a stable function of both firm size and earnings differentials lower on the administrative ladder, consistent with a hypothesis advanced by Herbert Simon in 1957; and second that the use of share options from 1984 onward represents not simply a change in the mode of top executive compensation, but a de -linking of the pay of top executives and that of their subordinates

Impact of an educational intervention and clinical performance dashboard on neonatal bloodstream infections

Background. Blood cultures are the most direct method of detecting bacteraemia. Reducing contamination rates improves the specificity and positive predictive value of the blood culture. Clinical performance dashboards have been shown to be powerful tools in improving patient care and outcomes.Objectives. To determine whether prospective surveillance of bloodstream infections (BSIs), introduction of an educational intervention and the use of a clinical performance dashboard could reduce BSIs and blood culture contamination rates in a neonatal nursery.Methods. We compared two time periods, before and after an intervention. Blood culture data were extracted from the local microbiology laboratory database. The educational intervention included the establishment of hand-washing protocols, blood culture techniques and video tools. A clinical performance dashboard was developed to demonstrate the monthly positive blood culture and contamination rates, and this was highlighted and referred to weekly at the unit staff meeting.Results. Before the intervention, 1 460 blood cultures were taken; 206 (14.1%) were positive, of which 104 (7.1% of the total) were contaminants. In the period following the intervention, 1 282 blood cultures were taken; 131 (10.2%) were positive, of which 42 (3.3% of the total) were contaminants. The number of positive blood cultures and contamination rates after the intervention were both statistically significantly reduced (p=0.002 and p<0.001, respectively).Conclusion. This study demonstrates that adopting a relatively simple educational tool, making use of a clinical performance dashboard indicator and benchmarking practice can significantly reduce the level of neonatal sepsis while also reducing contaminated blood cultures

Dynamic ploidy changes drive fluconazole resistance in human cryptococcal meningitis.

BACKGROUND: Cryptococcal meningitis (CM) causes an estimated 180,000 deaths annually, predominantly in sub-Saharan Africa, where most patients receive fluconazole (FLC) monotherapy. While relapse after FLC monotherapy with resistant strains is frequently observed, the mechanisms and impact of emergence of FLC resistance in human CM are poorly understood. Heteroresistance (HetR) - a resistant subpopulation within a susceptible strain - is a recently described phenomenon in Cryptococcus neoformans (Cn) and Cryptococcus gattii (Cg), the significance of which has not previously been studied in humans. METHODS: A cohort of 20 patients with HIV-associated CM in Tanzania was prospectively observed during therapy with either FLC monotherapy or in combination with flucytosine (5FC). Total and resistant subpopulations of Cryptococcus spp. were quantified directly from patient cerebrospinal fluid (CSF). Stored isolates underwent whole genome sequencing and phenotypic characterization. RESULTS: Heteroresistance was detectable in Cryptococcus spp. in the CSF of all patients at baseline (i.e., prior to initiation of therapy). During FLC monotherapy, the proportion of resistant colonies in the CSF increased during the first 2 weeks of treatment. In contrast, no resistant subpopulation was detectable in CSF by day 14 in those receiving a combination of FLC and 5FC. Genomic analysis revealed high rates of aneuploidy in heteroresistant colonies as well as in relapse isolates, with chromosome 1 (Chr1) disomy predominating. This is apparently due to the presence on Chr1 of ERG11, which is the FLC drug target, and AFR1, which encodes a drug efflux pump. In vitro efflux levels positively correlated with the level of heteroresistance. CONCLUSION: Our findings demonstrate for what we believe is the first time the presence and emergence of aneuploidy-driven FLC heteroresistance in human CM, association of efflux levels with heteroresistance, and the successful suppression of heteroresistance with 5FC/FLC combination therapy. FUNDING: This work was supported by the Wellcome Trust Strategic Award for Medical Mycology and Fungal Immunology 097377/Z/11/Z and the Daniel Turnberg Travel Fellowship

Exploring Charity Worker Perceptions of the Social Value and Sustainability of Solar Lighting in Malawi, Kenya and Zambia: A Scoping Study

Approximately 600 million people in sub-Saharan Africa have no access to electricity and use kerosene as a source of light. Solar lighting is a safer and cost effective alternative allowing families to study, work and live without the harmful effects of kerosene. Qualitative, semi-structured interviews were undertaken with staff from a United Kingdom (UK) based charity to explore the social value of solar lighting (n=7). These staff were based in the UK, Malawi, Kenya and Zambia. Two overarching themes: ‘The Social Value of Solar Lighting’ and ’Improving the Sustainability and Economic Viability of Solar Lighting’ illustrated perceived multi-faceted and wide reaching benefits on the micro-level creating positive social, economic and environmental outcomes. Future studies may look to identify the impact that solar lights may have upon the macro-level, and medium to long-term outcomes; and estimated social return on investment in different developing countries

Experiences of Sustainable Abstinence-Based Recovery: an Exploratory Study of Three Recovery Communities (RC) in England

Contemporary recovery-models of treatment for substance misuse prioritise community-based support systems that focus on developing individuals’ strengths and quality of life. The research project aimed to explore the perceived mechanisms and processes that underpinned support in three abstinence-based recovery communities (RCs) across England. Focus groups and telephone interviews were conducted with 44 individuals. This was to identify self-prioritised outcomes for members and other key factors contributing to the delivery of an effective recovery community. Data were thematically analysed. Along with a number of other key outcomes, the achievement and maintenance of abstinence by participants was considered to be a key indicator of an effective RC. RC processes were also viewed as underpinning the development of recovery capital. The study provides an insight into the processes of RCs and highlights that development and support of recovery capital is an important aspect of service provision and delivery for those in abstinence-based recovery. © 2018, The Author(s)

Constrained analytical interrelations in neutrino mixing

Hermitian squared mass matrices of charged leptons and light neutrinos in the flavor basis are studied under general additive lowest order perturbations away from the tribimaximal (TBM) limit in which a weak basis with mass diagonal charged leptons is chosen. Simple analytical expressions are found for the three measurable TBM-deviants in terms of perturbation parameters appearing in the neutrino and charged lepton eigenstates in the flavor basis. Taking unnatural cancellations to be absent and charged lepton perturbation parameters to be small, interrelations are derived among masses, mixing angles and the amount of CP-violation.Comment: To be published in the Springer Proceedings in the Physics Series under the heading of the XXI DAE-BRNS Symposium (Guwahati, India

The Golden Ratio Prediction for the Solar Angle from a Natural Model with A5 Flavour Symmetry

We formulate a consistent model predicting, in the leading order approximation, maximal atmospheric mixing angle, vanishing reactor angle and tan {\theta}_12 = 1/{\phi} where {\phi} is the Golden Ratio. The model is based on the flavour symmetry A5 \times Z5 \times Z3, spontaneously broken by a set of flavon fields. By minimizing the scalar potential of the theory up to the next-to-leading order in the symmetry breaking parameter, we demonstrate that this mixing pattern is naturally achieved in a finite portion of the parameter space, through the vacuum alignment of the flavon fields. The leading order approximation is stable against higher-order corrections. We also compare our construction to other models based on discrete symmetry groups.Comment: 28 pages, 2 figures. Minor changes, references added. Corrected typos in Appendix A. Version appeared on JHE

Epigenetic alterations following early postnatal stress: a review on novel aetiological mechanisms of common psychiatric disorders

Stressor exposure during early life has the potential to increase an individual’s susceptibility to a number of neuropsychiatric conditions such as mood and anxiety disorders and schizophrenia in adulthood. This occurs in part due to the dysfunctional stress axis that persists following early adversity impairing stress responsivity across life. The mechanisms underlying the prolonged nature of this vulnerability remain to be established. Alterations in the epigenetic signature of genes involved in stress responsivity may represent one of the neurobiological mechanisms. The overall aim of this review is to provide current evidence demonstrating changes in the epigenetic signature of candidate gene(s) in response to early environmental adversity. More specifically, this review analyses the epigenetic signatures of postnatal adversity such as childhood abuse or maltreatment and later-life psychopathology in human and animal models of early life stress. The results of this review shows that focus to date has been on genes involved in the regulation of hypothalamic-pituitary-adrenal (HPA) axis and its correlation to subsequent neurobiology, for example, the role of glucocorticoid receptor gene. However, epigenetic changes in other candidate genes such as brain-derived neurotrophic factor (BDNF) and serotonin transporter are also implicated in early life stress (ELS) and susceptibility to adult psychiatric disorders. DNA methylation is the predominantly studied epigenetic mark followed by histone modifications specifically acetylation and methylation. Further, these epigenetic changes are cell/tissue-specific in regulating expression of genes, providing potential biomarkers for understanding the trajectory of early stress-induced susceptibility to adult psychiatric disorders