Beyond good intentions: lessons on equipment donation from an African hospital.

OBJECTIVE: In 2000, a referral hospital in the Gambia accepted a donation of oxygen concentrators to help maintain oxygen supplies. The concentrators broke down and were put into storage. A case study was done to find the reasons for the problem and to draw lessons to help improve both oxygen supplies and the success of future equipment donations. METHODS: A technical assessment of the concentrators was carried out by a biomedical engineer with relevant expertise. Semi-structured interviews were undertaken with key informants, and content analysis and inductive approaches were applied to construct the history of the episode and the reasons for the failure. FINDINGS: Interviews confirmed the importance of technical problems with the equipment. They also revealed that the donation process was flawed, and that the hospital did not have the expertise to assess or maintain the equipment. Technical assessment showed that all units had the wrong voltage and frequency, leading to overheating and breakdown. Subsequently a hospital donations committee was established to oversee the donations process. On-site biomedical engineering expertise was arranged with a nongovernmental organization (NGO) partner. CONCLUSION: Appropriate donations of medical equipment, including oxygen concentrators, can be of benefit to hospitals in resource-poor settings, but recipients and donors need to actively manage donations to ensure that the donations are beneficial. Success requires planning, technical expertise and local participation. Partners with relevant skills and resources may also be needed. In 2002, WHO produced guidelines for medical equipment donations, which address problems that might be encountered. These guidelines should be publicized and used

Non-invasive computer-assisted measurement of knee alignment

The quantification of knee alignment is a routine part of orthopaedic practice and is important for monitoring disease progression, planning interventional strategies, and follow-up of patients. Currently available technologies such as radiographic measurements have a number of drawbacks. The aim of this study was to validate a potentially improved technique for measuring knee alignment under different conditions. An image-free navigation system was adapted for non-invasive use through the development of external infrared tracker mountings. Stability was assessed by comparing the variance (F-test) of repeated mechanical femoro-tibial (MFT) angle measurements for a volunteer and a leg model. MFT angles were then measured supine, standing and with varus-valgus stress in asymptomatic volunteers who each underwent two separate registrations and repeated measurements for each condition. The mean difference and 95% limits of agreement were used to assess intra-registration and inter-registration repeatability. For multiple registrations the range of measurements for the external mountings was 1° larger than for the rigid model with statistically similar variance (p=0.34). Thirty volunteers were assessed (19 males, 11 females) with a mean age of 41 years (range: 20-65) and a mean BMI of 26 (range: 19-34). For intra-registration repeatability, consecutive coronal alignment readings agreed to almost ±1°, with up to ±0.5° loss of repeatability for coronal alignment measured before and after stress maneuvers, and a ±0.2° loss following stance trials. Sagittal alignment measurements were less repeatable overall by an approximate factor of two. Inter-registration agreement limits for coronal and sagittal supine MFT angles were ±1.6° and ±2.3°, respectively. Varus and valgus stress measurements agreed to within ±1.3° and ±1.1°, respectively. Agreement limits for standing MFT angles were ±2.9° (coronal) and ±5.0° (sagittal), which may have reflected a variation in stance between measurements. The system provided repeatable, real-time measurements of coronal and sagittal knee alignment under a number of dynamic, real-time conditions, offering a potential alternative to radiographs

Preventive measures in infancy to reduce under-five mortality: a case-control study in The Gambia.

OBJECTIVE: To investigate the relationship between child mortality and common preventive interventions: vaccination, trained birthing attendants, tetanus toxoid during pregnancy, breastfeeding and vitamin A supplementation. METHODS: Case-control study in a population under demographic surveillance. Cases (n = 141) were children under five who died. Each was age and sex-matched to five controls (n = 705). Information was gathered by interviewing primary caregivers. RESULTS: All but one of the interventions - whether the mother had received tetanus toxoid during pregnancy - were protective against child mortality after multivariate analysis. Having a trained person assisting at child birth (OR 0.2 95% CI 0.1-0.4), receiving all vaccinations by 9 months of age (OR 0.1; 95% CI 0.01-0.3), being breastfed for more than 12 months (Children breastfed between 13 and 24 months OR 0.1 95% CI 0.03-0.3, more than 25 months OR 0.1 95% CI 0.01-0.5) and receiving vitamin A supplementation at or after 6 months of age (OR 0.05; 95% CI 0.01-0.2) were protective against child death. CONCLUSIONS: This study confirms the value of at least four available interventions in the prevention of under-five death in The Gambia. It is now important to identify those who are not receiving them and why, and to intervene to improve coverage across the population

Neither phylogenomic nor palaeontological data support a Palaeogene origin of placental mammals.

O'Leary et al. (O'Leary et al. 2013 Science 339, 662-667. (doi:10.1126/science.1229237)) performed a fossil-only dating analysis of mammals, concluding that the ancestor of placentals post-dated the Cretaceous-Palaeogene boundary, contradicting previous palaeontological and molecular studies that placed the ancestor in the Cretaceous. They incorrectly used fossil ages as species divergence times for crown groups, while in fact the former should merely form minimum-age bounds for the latter. Statistical analyses of the fossil record have shown that crown groups are significantly older than the oldest ingroup fossil, so that fossils do not directly reflect the true ages of clades. Here, we analyse a 20 million nucleotide genome-scale alignment in conjunction with a probabilistic interpretation of the fossil ages from O'Leary et al. Our combined analysis of fossils and molecules demonstrates that Placentalia originated in the Cretaceous.This work was financially supported by BBSRC grant no. BB/J009709/1

A COMPARISON OF HANFORD AND SAVANNAH RIVER SITE HIGH-LEVEL WASTES

This study is a simple comparison of high-level waste from plutonium production stored in tanks at the Hanford and Savannah River sites. Savannah River principally used the PUREX process for plutonium separation. Hanford used the PUREX, Bismuth Phosphate, and REDOX processes, and reprocessed many wastes for recovery of uranium and fission products. Thus, Hanford has 55 distinct waste types, only 17 of which could be at Savannah River. While Hanford and Savannah River wastes both have high concentrations of sodium nitrate, caustic, iron, and aluminum, Hanford wastes have higher concentrations of several key constituents. The factors by which average concentrations are higher in Hanford salt waste than in Savannah River waste are 67 for {sup 241}Am, 4 for aluminum, 18 for chromium, 10 for fluoride, 8 for phosphate, 6 for potassium, and 2 for sulfate. The factors by which average concentrations are higher in Hanford sludges than in Savannah River sludges are 3 for chromium, 19 for fluoride, 67 for phosphate, and 6 for zirconium. Waste composition differences must be considered before a waste processing method is selected: A method may be applicable to one site but not to the other

How Valid Are Measures of Children’s Self-Concept/ Self-Esteem? Factors and Content Validity in Three Widely Used Scales

Children’s self-esteem/self-concept, a core psychological construct, has been measured in an overwhelming number of studies, and the widespread use of such measures should indicate they have well-established content validity, internal consistency and factor structures. This study, sampling a demographically representative cohort in late childhood/early adolescence in Dublin, Ireland (total n = 651), examined three major self-esteem/self-concept scales designed for late childhood/early adolescence: Piers-Harris Self-Concept Scale for Children 2 (Piers et al. 2002), Self-Description Questionnaire I (Marsh 1992) and Self-Perception Profile for Children (Harter 1985). It also examined findings in light of the salient self factors identified by participants in a linked mixed-methods study. The factor structure of Piers-Harris Self-Concept Scale was not replicated. The Self-Description Questionnaire I and Self-Perception Profile for Children were replicated only in part although in similar ways. In all three scales, a global/ appearance self evaluation factor accounted for the largest variance in factor analyses. Sport/athletic ability, school ability, school enjoyment, maths and reading ability/enjoyment, behaviour, peer popularity, and parent factors were also identified but did not always reflect existing scale structures. Notably, the factors extracted, or items present in these scales, often did not reflect young people’s priorities, such as friendship over popularity, the importance of family and extended family members, and the significance of incremental personal mastery in activities rather than assessing oneself as comparatively good at preferred activities. The findings raise questions about how self-esteem/self-concept scales are used and interpreted in research with children and young people

Monitoring the introduction of pneumococcal conjugate vaccines into West Africa: design and implementation of a population-based surveillance system.

Routine use of pneumococcal conjugate vaccines (PCVs) in developing countries is expected to lead to a significant reduction in childhood deaths. However, PCVs have been associated with replacement disease with non-vaccine serotypes. We established a population-based surveillance system to document the direct and indirect impact of PCVs on the incidence of invasive pneumococcal disease (IPD) and radiological pneumonia in those aged 2 months and older in The Gambia, and to monitor changes in serotype-specific IPD. Here we describe how this surveillance system was set up and is being operated as a partnership between the Medical Research Council Unit and the Gambian Government. This surveillance system is expected to provide crucial information for immunisation policy and serves as a potential model for those introducing routine PCV vaccination in diverse settings

Etiology of severe childhood pneumonia in the Gambia, West Africa, determined by conventional and molecular microbiological analyses of lung and pleural aspirate samples.

Molecular analyses of lung aspirates from Gambian children with severe pneumonia detected pathogens more frequently than did culture and showed a predominance of bacteria, principally Streptococcus pneumoniae, >75% being of serotypes covered by current pneumococcal conjugate vaccines. Multiple pathogens were detected frequently, notably Haemophilus influenzae (mostly nontypeable) together with S. pneumoniae

Non-invasive imaging of high-risk coronary plaque: the role of computed tomography and positron emission tomography

Despite recent advances, cardiovascular disease remains the leading cause of death globally. As such, there is a need to optimise our current diagnostic and risk stratification pathways in order to better deliver individualised preventative therapies. Non-invasive imaging of coronary artery plaque can interrogate multiple aspects of coronary atherosclerotic disease, including plaque morphology, anatomy and flow. More recently, disease activity is being assessed to provide mechanistic insights into in vivo atherosclerosis biology. Molecular imaging using positron emission tomography is unique in this field, with the potential to identify specific biological processes using either bespoke or re-purposed radiotracers. This review provides an overview of non-invasive vulnerable plaque detection and molecular imaging of coronary atherosclerosis