Demonstration of the Blood-Stage Plasmodium falciparum Controlled Human Malaria Infection Model to Assess Efficacy of the P. falciparum Apical Membrane Antigen 1 Vaccine, FMP2.1/AS01

We study whether the relationship between the state unemployment rate at the time of conception and infant health, infant mortality and maternal characteristics in the United States has changed over the years 1980-2004. We use microdata on births and deaths for years 1980-2004 and find that the relationship between the state unemployment rate at the time of conception and infant mortality and birthweight changes over time and is stronger for blacks than whites. For years 1980-1989 increases in the state unemployment rate are associated with a decline in infant mortality among blacks, an effect driven by mortality from gestational development and birth weight, and complications of placenta while in utero. In contrast, state economic conditions are unrelated to black infant mortality in years 1990-2004 and white infant mortality in any period, although effects vary by cause of death. We explore potential mechanisms for our findings and, including mothers younger than 18 in the analysis, uncover evidence of age-related maternal selection in response to the business cycle. In particular, in years 1980-1989 an increase in the unemployment rate at the time of conception is associated with fewer babies born to young mothers. The magnitude and direction of the relationship between business cycles and infant mortality differs by race and period. Age-related selection into motherhood in response to the business cycle is a possible explanation for this changing relationship

Bilineal inheritance of PKD1 abnormalities mimicking autosomal recessive polycystic disease

BACKGROUND: Dominant polycystic kidney disease is common and usually presents clinically in adulthood. Recessive polycystic kidney disease is much less common and frequently presents antenatally or in the neonatal period with severe renal involvement. These are usually thought of as clinically distinct entities but diagnostic confusion is not infrequent.CASE-DIAGNOSIS/TREATMENT: We describe an infant with antenatally diagnosed massive renal enlargement and oligohydramnios with no resolvable cysts on ultrasound scanning. He underwent bilateral nephrectomy because of respiratory compromise and poor renal function but died subsequently of overwhelming sepsis. Genetic analysis revealed that he had bilineal inheritance of abnormalities of PKD1 and no demonstrable abnormalities of PKD2 or PKHD1.CONCLUSIONS: Biallelic inheritance of abnormalities of PKD1 may cause extremely severe disease resembling autosomal dominant polycystic kidney disease (ADPKD) which can result in diagnostic confusion. Accurate diagnosis is essential for genetic counseling

Extremes of age are associated with indeterminate QuantiFERON-TB Gold assay results

Results from 3263 QuantiFERON-TB Gold-in-Tube (QFT-GIT) assays were analyzed to determine the impact of age on test performance. The proportion of indeterminate results was significantly higher in pediatric and elderly (9.1% and 7.4%, respectively), than in adult patients (2.6%; chi-quare p&lt;0.0001). A detailed analysis of indeterminate QFT-GIT results is presented.<br/

Depressive symptoms among mothers with hospitalized children in South Asia and sub-Saharan Africa

Background: Poor maternal mental health during childhood hospitalization is associated with post-discharge child mortality. We aimed to establish if maternal PHQ-9 scores during hospitalization are associated with acute stressors or longer trends in mental health status. Method: Mothers of children admitted to nine hospitals in six countries completed a PHQ-9 assessment during hospitalization and 45-days post-discharge. Community participants were recruited from homes near the hospitalized children. The prevalence and correlates of high PHQ-9 scores among hospitalized and community mothers were compared. Outcomes: Among 2762 mothers of hospitalized children, 514 (19 %) had PHQ-9 scores ≥10, significantly more than the 116 (10 %, p < 0·001) of 1159 community participants. Recruitment site and food insecurity were PHQ-9 correlates in both groups. Correlates of higher mean PHQ-9 scores among the hospitalized cohort included maternal illness (mean difference [MD]: 1·27, 95%CI: 0·77, 1·77), pregnancy (MD: 0·77, 95%CI: 0·27, 1·28), child HIV-infection (MD: 2·51. 95%CI: 1·55, 3·52), and lower child weight-for-height (MD: 0·21, 95%CI: 0·32, 0·11). Marriage (MD −0·92, 95%CI: −1·36, −0·48) and a positive malaria test (MD: −0·63, 95%CI: −1·15, −0·10) were associated with lower PHQ-9 scores among mothers of hospitalized children. Among mothers with PHQ-9 ≥10 during admission, 410 had repeat assessments 45-days after their child's discharge, and 108 (26 %) continued to meet the high PHQ-9 criterion. Interpretation: Among mothers of hospitalized children, there are subgroups with transient and persistent depressive symptoms. Interventions tailored to address acute stressors may improve post-discharge pediatric and maternal health outcomes. Funding: Bill & Melinda Gates Foundation OPP1131320

Pediatric Inpatient Antibiotic Prescription Practices in the Chain Network Hospitals at Baseline

This analysis describes adherence to antibiotic guidelines during the first 48 hours of admission. Adherence was defined as a regimen consistent with institutional, national, or international recommendations.Antimicrobial resistance (AMR) is a growing global concern. Antibiotic stewardship is being promoted to reduce AMR. However, few studies have documented inpatient antibiotic prescription practices in low resource settings. We audited the 240 clinical notes of 2-23 month-old inpatient children in Bangladesh (2), Kenya (3), Malawi (1), Pakistan (1) and Uganda (1) as part of a baseline assessment in a study to identify risk factors for mortality in acutely ill inpatients, particularly in undernourished children. This analysis describes adherence to antibiotic guidelines during the first 48 hours of admission. Adherence was defined as a regimen consistent with institutional, national, or international recommendations. The cases reviewed included diagnoses of diarrhea (n:107), severe acute malnutrition (n:101), pneumonia (n:76), malaria (n:35), sepsis (n:25), meningitis (n:12), and shock (n:8). Antibiotics were prescribed to 98% with at least one documented indication for antibiotics (n:173); 80% of these were consistent with recommended regimens. Antibiotics were prescribed in 93% of admitted diarrhea cases, 85% of whom had a comorbidity warranting antimicrobials (n:85) or dysentery (n:1). Among children with malaria noted as a diagnosis and without a documented indication for antibiotics (n:22), those who did not receive a malaria test (n:6) were all prescribed antibiotics. In comparison, 63% of those with a documented positive malaria test (n:16) were prescribed antibiotics without indication. Among those with diarrhea (n:15) and malaria (n:16) without a documented indication for antibiotics, 58% were prescribed an antimicrobial regimen consistent with treatment for a severe bacterial infection. Antibiotics were almost universally prescribed when indicated and adherence to a recommend regimen was comparable to other studie

Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study

<p>See legend to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0090940#pone-0090940-t002" target="_blank">Table 2</a>.</p>a<p>The ratio of genomes with and without the NAP is unbalanced (>10 or <0.1).</p>b<p>Fis can form both bridges and bends.</p>c<p>Dps and CbpA have not been confirmed to form bridges or bends.</p

A mixed method multi-country assessment of barriers to implementing pediatric inpatient care guidelines.

INTRODUCTION:Accelerating progress in reducing child deaths is needed in order to achieve the Sustainable Development Goal child mortality target. This will require a focus on vulnerable children-including young children, those who are undernourished or with acute illnesses requiring hospitalization. Improving adherence to inpatient guidelines may be an important strategy to reduce child mortality, including among the most vulnerable. The aim of our assessment of nine sub-Saharan African and South Asian hospitals was to determine adherence to pediatric inpatient care recommendations, in addition to capacity for and barriers to implementation of guideline-adherent care prior to commencing the Childhood Acute Illness and Nutrition (CHAIN) Cohort study. The CHAIN Cohort study aims to identify modifiable risk factors for poor inpatient and post discharge outcomes above and beyond implementation of guidelines. METHODS:Hospital infrastructure, staffing, durable equipment, and consumable supplies such as medicines and laboratory reagents, were evaluated through observation and key informant interviews. Inpatient medical records of 2-23 month old children were assessed for adherence to national and international guidelines. The records of children with severe acute malnutrition (SAM) were oversampled to reflect the CHAIN study population. Seven core adherence indicators were examined: oximetry and oxygen therapy, fluids, anemia diagnosis and transfusion, antibiotics, malaria testing and antimalarials, nutritional assessment and management, and HIV testing. RESULTS:All sites had facilities and equipment necessary to implement care consistent with World Health Organization and national guidelines. However, stockouts of essential medicines and laboratory reagents were reported to be common at some sites, even though they were mostly present during the assessment visits. Doctor and nurse to patient ratios varied widely. We reviewed the notes of 261 children with admission diagnoses of sepsis (17), malaria (47), pneumonia (70), diarrhea (106), and SAM (119); 115 had multiple diagnoses. Adherence to oxygen therapy, antimalarial, and malnutrition refeeding guidelines was >75%. Appropriate antimicrobials were prescribed for 75% of antibiotic-indicative conditions. However, 20/23 (87%) diarrhea and 20/27 (74%) malaria cases without a documented indication were prescribed antibiotics. Only 23/122 (19%) with hemoglobin levels meeting anemia criteria had recorded anemia diagnoses. HIV test results were infrequently documented even at hospitals with universal screening policies (66/173, 38%). Informants at all sites attributed inconsistent guideline implementation to inadequate staffing. CONCLUSION:Assessed hospitals had the infrastructure and equipment to implement guideline-consistent care. While fluids, appropriate antimalarials and antibiotics, and malnutrition refeeding adherence was comparable to published estimates from low- and high-resource settings, there were inconsistencies in implementation of some other recommendations. Stockouts of essential therapeutics and laboratory reagents were a noted barrier, but facility staff perceived inadequate human resources as the primary constraint to consistent guideline implementation