Clinical and epidemiological aspects of a hepatitis E outbreak in Bangui, Central African Republic

<p>Abstract</p> <p>Background</p> <p>Outbreaks of hepatitis E frequently occur in tropical developing countries during the rainy season due to overflowing drains, short-circuiting of networks of clean water and use of contaminated water from wells. Hepatitis E virus (HEV) infections are usually accompanied by general symptoms of acute liver disease. This study was conducted to define the clinical and epidemiological aspects of the HEV outbreak that occurred in May 2004 in Bangui.</p> <p>Methods</p> <p>Blood samples were collected from 411 patients aged 1-87 years, most of whom presented with jaundice, asthenia or signs of uncomplicated malaria, for a transversal study from June 2004 to September 2005. Patients were recruited at 11 health care centres, including two referral hospitals, after they had given informed consent. The diagnosis of HEV was made with a commercial ELISA test to detect IgM and/or IgG antibodies. HEV RNA was amplified by RT-PCR to confirm the presence of the viral genome.</p> <p>Results</p> <p>The most frequent clinical signs found were jaundice (93.4%), vomiting (50.7%), hepatalgia (47.4%), hepatomegaly (30.9%) and asthenia (26.8%), which are the general clinical signs of hepatic disease. Acute hepatitis E was found in 213 patients (51.8%) who were positive for HEV IgM antibodies. The IgG anti-HEV seroprevalence during this outbreak was high (79.5%). The age group 18-34 years was more frequently infected (91.2%) than those aged 1-17 (78.0%) or over 34 (64.9%) (p < 10^-6). RT-PCR performed on 127 sera from the 213 IgM-HEV-positive patients was amplified, and the presence of the viral genome was found in 65 samples.</p> <p>Conclusion</p> <p>Although no specific clinical signs exist for hepatitis E infection, people presenting with jaundice, vomiting, hepatalgia, asthenia, hepatomegaly or distended abdomen with no signs of uncomplicated malaria in tropical developing countries should be sent to a laboratory for testing for hepatitis E.</p

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries

Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Method: Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. Results: The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Conclusions: Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments

New Strategies in Modeling Electronic Structures and Properties with Applications to Actinides

This chapter discusses contemporary quantum chemical methods and provides general insights into modern electronic structure theory with a focus on heavy-element-containing compounds. We first give a short overview of relativistic Hamiltonians that are frequently applied to account for relativistic effects. Then, we scrutinize various quantum chemistry methods that approximate the $N$-electron wave function. In this respect, we will review the most popular single- and multi-reference approaches that have been developed to model the multi-reference nature of heavy element compounds and their ground- and excited-state electronic structures. Specifically, we introduce various flavors of post-Hartree--Fock methods and optimization schemes like the complete active space self-consistent field method, the configuration interaction approach, the Fock-space coupled cluster model, the pair-coupled cluster doubles ansatz, also known as the antisymmetric product of 1 reference orbital geminal, and the density matrix renormalization group algorithm. Furthermore, we will illustrate how concepts of quantum information theory provide us with a qualitative understanding of complex electronic structures using the picture of interacting orbitals. While modern quantum chemistry facilitates a quantitative description of atoms and molecules as well as their properties, concepts of quantum information theory offer new strategies for a qualitative interpretation that can shed new light onto the chemistry of complex molecular compounds.Comment: 43 pages, 3 figures, Version of Recor

‘Mankind owes to the child the best that it has to give’: Prison conditions and the health situation and rights of circumstantial children incarcerated in Sub Saharan African prisons.

Background: In recent times, sub-Saharan African (SSA) prisons have seen a substantial increase in women prisoners, including those incarcerated with children. Methods: A scoping review mapped what is currently known about the health situation and unique rights violations of children incarcerated with their mothers in SSA prisons. A systematic search collected and reviewed all available and relevant published and grey literature (2000-2018). Following application of exclusion measures, 64 records remained, which represented 27 of the 49 SSA countries. These records were charted and thematically analysed. Results: Four main themes were generated as follows: 1) the prison physical environment; 2) food availability, adequacy and quality; 3) provision of basic necessities and 4) availability and accessibility of health services for incarcerated children. Conclusions: The review highlights the grave situation of children incarcerated with their mothers in SSA prisons, underpinned by the lack of basic necessities, inadequate hygiene, sanitation and safe drinking water, exposure to diseases in overcrowded cells, inadequate nutrition, lack of provision of clothing and bedding, and difficulties accessing paediatric care. Reported paediatric morbidity and mortality associated with such prison conditions is deeply concerning and contrary to international mandates for the rights of the child, right to health and standards of care

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

THREE-STATE CONICAL INTERSECTIONS IN BIOLOGICALLY RELEVANT MOLECULES

Author Institution: Department of Chemistry, Temple University, Philadelphia, PA 19122Three-state conical intersections, actual degeneracies between three electronic states that are not imposed by symmetry, have been shown in recent years to be present in many polyatomic molecules. These features may exist when there are at least five degrees of freedom present in the molecule. Their importance and effect on nonadiabatic dynamics, however, are not well understood. We have investigated the importance of two- and three-state conical intersections in photoinitiated processes of biologically relevant systems, and particularly the nucleic acid bases and their analogs. Three-state conical intersections have been located using multi-reference configuration-interaction ab initio methods. The potential energy surfaces for each base contain many different seams of three-state intersections. Paths along seams from these intersections are shown to be connected to well characterized stationary points involved in radiationless decay pathways. Nonadiabatic coupling terms have also been calculated, and the effects of the proximal third state on these quantities are detailed. In particular, it is shown that when one of these loops incorporates more than one seam point there is a profound and predictable effect on the phase of the nonadiabatic coupling terms, and as such provides a diagnostic for the presence and location of additional seams

Ab initio study of the ground and several excited states of the NLi system

Using mainly CASSCF/cc-pVTZ ab initio methods we have computed the ground X 3Σ- and several excited states of the NLi species. In particular, we calculated full potential energy curves of the X 3Σ-, 5Σ- (dissociative), A 3Π a 1Δ, b 1Σ+, B 3Σ-, c 1Π, C 3Π and d 1Π states. For six of these states the molecular constants ωe, ωe χe, αe and D̄e have also been obtained. For the ground X 3Σ- state a dissociation energy De = 29.5 kcal mol-1 has been calculated at the MR-CISD level

EXCITED STATES OF NON-ISOLATED CHROMOPHORES

Author Institution: Department of Chemistry, Temple University, Philadelphia, PA 19122The photophysical and photochemical behavior of nucleobases is very important because of their biological role as the building blocks in DNA and RNA. Great progress has been made in understanding the excited-state properties of single bases. In order to understand the photophysical properties of nucleobases in complex environments we have investigated their excited states (a) in aqueous solutions and (b) as $\pi$-stacked dimers in DNA. The solvatochromic shifts of the excited states of pyrimidine nucleobases in aqueous solution have been investigated using a combined QM/MM procedure where the quantum mechanical solute is described using high level multireference configuration interaction methods while molecular dynamics simulations are used to obtain the structure of the solvent around the solute in an average way. The excited states of $\pi$-stacked nucleobases have also been investigated using various ab initio methods. The effect of the environment on the excited states and conical intersections is investigated