Health facility-based maternal death audit in Tigray, Ethiopia

Background: Maternal deaths are often unrecognized and improperly documented in the health system. Objective: To identify causes of maternal death occurring in hospitals and determine avoidability of maternal death. Methods: The study assessed each death for the cause and surrounding circumstances as well as avoidable factors, by reviewing two years patient and facility records and interviewing individuals who were involved in caring for the deceased. Data were collected between December 2005 and May 2006. Result: A total of 34 maternal deaths were identified in five public hospitals in Tigray over a period of two years, of which 12 (35.2%) were reported to have been avoidable. The leading causes of death were infection, haemorrhage and hypertensive disorders. Avoidable factors were mainly related to hospital service or medical factors such as lack of blood for transfusion, delay in transfusion, and inappropriate treatment. Lack of transportation and delayed careseeking also contributed to avoidable maternal deaths. The quality of medical records was very poor. Nearly 73.5% of maternal deaths were of rural residents and 20.5% of those who died were under the age of 18, which shows that young girls and rural residents carry significant maternal death risk. Conclusions: Maternal deaths are not properly documented in health facilities. Improper care led to avoidable maternal death. Improving care and information systems is crucial to making pregnancy safer and reducing maternal death.

Implications of groundwater quality to corrosion problem and urban planning in Mekelle area, Northern Ethiopia

Surface and groundwater chemistry being an important factor in urban planning and infrastructure development, present paper tries to present the problems of corrosiveness due to groundwater chemistry in Mekelle city. Iron corrosion in distribution systems and engineering structures are common problems in many urban areas. Corrosiveness of groundwater at different localities in Mekelle and its environs has been evaluated on the basis of AAS-UV spectrophotometer-generated hydro-geochemical data. Corrosiveness of water was estimated by using corrosion indices like Larson Index, LI and Aggressive Index, AI and total dissolved solids, total carbonate hardness, chloride and sulphate data were evaluated to estimate aggressiveness of the water samples on iron pipes. Analyses of the results have shown that most of the samples from boreholes and hand dug wells compared to spring samples, are potentially aggressive. The result shows that 66.7% spring, 81.3% shallow hand dug wells and 81% borehole water samples have a Larson index (LI) above 0.5, a threshold of corrosiveness of water. This study highlights the basic characteristics of surface and groundwater chemistry and its potential hazard for corrosion of pipes, and provides a baseline information and awareness to the city planners for urban management

Photodetachment of cold OH- in a multipole ion trap

The absolute photodetachment cross section of OH- anions at a rotational and translational temperature of 170K is determined by measuring the detachment-induced decay rate of the anions in a multipole radio-frequency ion trap. In comparison with previous results, the obtained cross section shows the importance of the initial rotational state distribution. Using a tomography scan of the photodetachment laser through the trapped ion cloud, the derived cross section is model-independent and thus features a small systematic uncertainty. The tomography also yields the column density of the OH- anions in the 22-pole ion trap in good agreement with the expected trapping potential of a large field free region bound by steep potential walls.Comment: Phys. Rev. Lett., in pres

Impact of Viral Status on Survival in Patients Receiving Sorafenib for Advanced Hepatocellular Cancer: A Meta-Analysis of Randomized Phase III Trials

Purpose: Following the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial, sorafenib has become the standard of care for patients with advanced unresectable hepatocellular carcinoma, but the relation between survival advantage and disease etiology remains unclear. To address this, we undertook an individual patient data meta-analysis of three large prospective randomized trials in which sorafenib was the control arm. Methods: Of a total of 3,256 patients, 1,643 (50%) who received sorafenib were available. The primary end point was overall survival (OS). A Bayesian hierarchical approach for individual patient data meta-analyses was applied using a piecewise exponential model. Results are presented in terms of hazard ratios comparing sorafenib with alternative therapies according to hepatitis C virus (HCV) or hepatitis B virus (HBV) status. Results: Hazard ratios show improved OS for sorafenib in patients who are both HBV negative and HCV positive (log [hazard ratio], −0.27; 95% CI, −0.46 to −0.06). Median unadjusted survival is 12.6 (11.15 to 13.8) months for sorafenib and 10.2 (8.88 to 12.2) months for “other” treatments in this subgroup. There was no evidence of improvement in OS for any other patient subgroups defined by HBV and HCV. Results were consistent across all trials with heterogeneity assessed using Cochran’s Q statistic. Conclusion: There is consistent evidence that the effect of sorafenib on OS is dependent on patients’ hepatitis status. There is an improved OS for patients negative for HBV and positive for HCV when treated with sorafenib. There was no evidence of any improvement in OS attributable to sorafenib for patients positive for HBV and negative for HCV

Fasciolosis: Prevalence, financial losses due to liver condemnation and evaluation of a simple sedimentation diagnostic technique in cattle slaughtered at Hawassa Municipal abattoir, southern Ethiopia

This study was carried out from November 2007 to April 2008 to determine the prevalence of fasciolosis and costs incurred due to liver condemnation and evaluate the sensitivity of direct sedimentation method for diagnosis of fasciolosis in cattle slaughtered at Hawassa Municipal abattoir. A total of 3251 adult indigenous cattle were slaughtered at the abattoir during the study period, of which 931 animals (28.63%) were found to be positive for fasciolosis. There was a statistically significant (χ2 = 33.10; p = 0.004) variation in prevalence between the study months where the highest (35.6%) and lowest (21.03%) prevalence were recorded in February and April, respectively. Fasciola hepatica (58.9%) was the predominant fluke identified compared to F. gigantica (10.6%). Mixed infections by both species and unidentified immature flukes were detected in 14.7% and 15.8% of the affected livers, respectively. The mean fluke burden in the affected livers was 55 flukes per liver. As to the severity of infection, 36.63%, 52.31% and 11.06% were lightly, moderately and severely affected, respectively. Moderately affected livers showed the highest mean fluke count (69 ± 1.91) followed by severely (48 ± 1.71) and lightly affected ones (25 ± 1.75) signifying the presence of acquired resistance and local tissue reaction as chronicity of infection supervenes. Taking liver examination as gold standard for diagnosis of fasciolosis, the sensitivity of the direct sedimentation technique was found to be 67.13% and the specificity 100% with substantial agreement (k = 0.74) between the two methods. The financial loss due to liver condemnation was estimated to be 106,400 Ethiopian birr (8312.5 USD) per annum. In conclusion, the observation of such a level of infection in the dry season, high fluke pathogenicity and substantial financial loss associated with condemnation of infected livers warrants the institution of appropriate control measures. Keywords: Cattle, fasciolosis, financial loss, Hawassa abattoir, prevalence, southern Ethiopi

Electroluminescence from Localized Defects in Zinc Oxide: Toward Electrically Driven Single Photon Sources at Room Temperature

© 2015 American Chemical Society. Single photon sources are required for a wide range of applications in quantum information science, quantum cryptography, and quantum communications. However, the majority of room temperature emitters to date are only excited optically, which limits their proper integration into scalable devices. In this work, we overcome this limitation and present room temperature electrically driven light emission from localized defects in zinc oxide (ZnO) nanoparticles and thin films. The devices emit in the red spectral range and show excellent rectifying behavior. The emission is stable over an extensive period of time, providing an important prerequisite for practical devices. Our results open possibilities for building new ZnO-based quantum integrated devices that incorporate solid-state single photon sources for quantum information technologies. (Graph Presented)

Physician antipsychotic overprescribing letters and cognitive, behavioral, and physical health outcomes among people with dementia: a secondary analysis of a randomized clinical trial

Importance Antipsychotics, such as quetiapine, are frequently prescribed to people with dementia to address behavioral symptoms but can also cause harm in this population. Objective To determine whether warning letters to high prescribers of quetiapine can successfully reduce its use among patients with dementia and to investigate the impacts on patients’ health outcomes. Design, Setting, and Participants This is a secondary analysis of a randomized clinical trial of overprescribing letters that began in April 2015 and included the highest-volume primary care physician (PCP) prescribers of quetiapine in original Medicare. Outcomes of patients with dementia were analyzed in repeated 90-day cross-sections through December 2018. Analyses were conducted from September 2021 to February 2024. Interventions PCPs were randomized to a placebo letter or 3 overprescribing warning letters stating that their prescribing of quetiapine was high and under review by Medicare. Main Outcomes and Measures The primary outcome of this analysis was patients’ total quetiapine use in days per 90-day period (the original trial primary outcome was total quetiapine prescribing by study PCPs). Prespecified secondary outcomes included measures of cognitive function and behavioral symptoms from nursing home assessments, indicators of depression from screening questionnaires in assessments and diagnoses in claims, metabolic diagnoses derived from assessments and claims, indicators of use of the hospital and other health care services, and death. Outcomes were analyzed separately for patients living in nursing homes and in the community. Results Of the 5055 study PCPs, 2528 were randomized to the placebo letter, and 2527 were randomized to the 3 warning letters. A total of 84 881 patients with dementia living in nursing homes and 261 288 community-dwelling patients with dementia were attributed to these PCPs. There were 92 874 baseline patients (mean [SD] age, 81.5 [10.5] years; 64 242 female [69.2%]). The intervention reduced quetiapine use among both nursing home patients (adjusted difference, –0.7 days; 95% CI, −1.3 to −0.1 days; P = .02) and community-dwelling patients (adjusted difference, −1.5 days; 95% CI, −1.8 to −1.1 days; P < .001). There were no detected adverse effects on cognitive function (cognitive function scale adjusted difference, 0.01; 95% CI, −0.01 to 0.03; P = .19), behavioral symptoms (agitated or reactive behavior adjusted difference, −0.2%; 95% CI −1.2% to 0.8% percentage points; P = .72), depression, metabolic diagnoses, or more severe outcomes, including hospitalization and death. Conclusions and Relevance This study found that overprescribing warning letters to PCPs safely reduced quetiapine prescribing to their patients with dementia. This intervention and others like it may be useful for future efforts to promote guideline-concordant care

Demographic and Spatiotemporal Patterns of Avian Influenza Infection at the Continental Scale, and in Relation to Annual Life Cycle of a Migratory Host

Since the spread of highly pathogenic avian influenza (HPAI) H5N1 in the eastern hemisphere, numerous surveillance programs and studies have been undertaken to detect the occurrence, distribution, or spread of avian influenza viruses (AIV) in wild bird populations worldwide. To identify demographic determinants and spatiotemporal patterns of AIV infection in long distance migratory waterfowl in North America, we fitted generalized linear models with binominal distribution to analyze results from 13,574 blue-winged teal (Anas discors, BWTE) sampled in 2007 to 2010 year round during AIV surveillance programs in Canada and the United States. Our analyses revealed that during late summer staging (July-August) and fall migration (September-October), hatch year (HY) birds were more likely to be infected than after hatch year (AHY) birds, however there was no difference between age categories for the remainder of the year (winter, spring migration, and breeding period), likely due to maturing immune systems and newly acquired immunity of HY birds. Probability of infection increased non-linearly with latitude, and was highest in late summer prior to fall migration when densities of birds and the proportion of susceptible HY birds in the population are highest. Birds in the Central and Mississippi flyways were more likely to be infected compared to those in the Atlantic flyway. Seasonal cycles and spatial variation of AIV infection were largely driven by the dynamics of AIV infection in HY birds, which had more prominent cycles and spatial variation in infection compared to AHY birds. Our results demonstrate demographic as well as seasonal, latitudinal and flyway trends across Canada and the US, while illustrating the importance of migratory host life cycle and age in driving cyclical patterns of prevalence