Modelling the effect of education-based intervention in the control of malaria

In this study, we propose a mathematical model for the transmission dynamics of malaria by incorporating behavioural change via education as a control strategy against the spread of malaria. Analytical study is carried out to investigate the local stability of the system, given a threshold parameter known as the basic reproduction number R0, which is obtained using the next generation matrix method. Result showed that disease-free equilibrium of the system is locally asymptotically stable if R0 < 1 . Numerical simulation carried out on the system shows that behavioural change significantly alters the dynamics of malaria infection towards achieving a malaria-free society in finite time.Keywords: Education, behavioural change, Disease-Free Equilibrium, Basic reproduction number, Local stabilit

The Persistent Southern Disadvantage in Us Early Life Mortality, 1965‒2014

Background: Recent studies of US adult mortality demonstrate a growing disadvantage among southern states. Few studies have examined long-term trends and geographic patterns in US early life (ages 1 to 24) mortality, ages at which key risk factors and causes of death are quite different than among adults. Objective: This article examines trends and variations in early life mortality rates across US states and census divisions. We assess whether those variations have changed over a 50-year time period and which causes of death contribute to contemporary geographic disparities. Methods: We calculate all-cause and cause-specific death rates using death certificate data from the Multiple Cause of Death files, combining public-use files from 1965‒2004 and restricted data with state geographic identifiers from 2005‒2014. State population (denominator) data come from US decennial censuses or intercensal estimates. Results: Results demonstrate a persistent mortality disadvantage for young people (ages 1 to 24) living in southern states over the last 50 years, particularly those located in the East South Central and West South Central divisions. Motor vehicle accidents and homicide by firearm account for most of the contemporary southern disadvantage in US early life mortality. Contribution: Our results illustrate that US children and youth living in the southern United States have long suffered from higher levels of mortality than children and youth living in other parts of the country. Our findings also suggest the contemporary southern disadvantage in US early life mortality could potentially be reduced with state-level policies designed to prevent deaths involving motor vehicles and firearms

Changes in biomechanical properties of chemotherapy bone cement after a year in saline storage

Introduction: Acrylic based bone cements are a versatile treatment modality in Orthopaedic surgery due to their wide variety of uses and tolerance to high degree of customization. Bone cement can be used to repair and stabilize pathologic fractures and may potentially prevent recurrence post tumor resection. Chemotherapeutic bone cements are favorable because they can potentially minimize systemic side effects and the need for radiation. Cements can be combined with soluble fillers such as polyethylene glycol (PEG) to optimize drug elution. Even though studies have measured the mechanical properties of bone cement in dry state, the exact change in the mechanical properties of bone cement after drug/soluble filler elution is largely unknown. This study investigates the change in mechanical properties of commercially available bone cements modified with PEG fillers after one year of storage in drug elution medium. Methods: Confidence Ultra, Vertebroplastic, and Palacos cement were used and mixed with varying amounts (0–50%) of PEG and chemotherapy agents (methotrexate or doxorubicin). Bone cement specimens were stored in a saline solution for one year after which they were tested in compression at 1 mm/min until failure. Results: The modulus and compression strength of bone cements decreased with increase in soluble filler composition. Although soluble fillers were shown to weaken the mechanical properties of the bone cement, Palacos and Vertebroplastic cements retained their mechanical properties better than Confidence. Discussion: When using chemotherapeutic bone cements, combining soluble fillers enhances drug elution at the expense of mechanical properties. However, the results showed that mechanical properties of different commercially available bone cements behave differently with similar percentages of soluble filler and drug added making it difficult to predict changes in mechanical properties of bone cement intraoperatively. This elucidates the need for well characterized bone cement optimized for chemotherapy drug delivery

Extracellular cytolysis by activated macrophages and granulocytes. II. Hydrogen peroxide as a mediator of cytotoxicity

When deprived of oxygen, Bacille Calmette-Guérin (BCG)-activated macrophages no longer lysed P388 lymphoma cells. Both H2O2 release and cytotoxicity by BCG-activated macrophages and by granulocytes triggered with phorbol myristate acetate (PMA) were markedly inhibited when the glucose concentration in the medium was reduced to 0.03 mM or less, or if glucose were replaced with galactose. Catalase abolished PMA-triggered cytotoxicity by both types of effector cells, whereas superoxide dismutase had no effect. Ferricytochrome C reduced the cytotoxicity of BCG-activated macrophages, an effect which was largely reversed by superoxide dismutase. 10 drugs, thought to quench singlet oxygen and/or scavenge hydroxyl radical, did not affect cytotoxicity in this system. Neither azide nor cyanide reduced cytolysis, but there was marked inhibition by lactoperoxidase and iodide. This suggested that cytotoxicity was not dependent upon myeloperoxidase, and that lactoperoxidase may have diverted H2O2 from the oxidation of target cells to oxidation of substances in serum. Mouse erythrocytes, although sensitive targets, interfered with the cytolysis of lymphoma cells, probably by competition for H2O2. Starch particles with covalently bound glucose oxidase resembled macrophages in their spatial relation to the target cells and in the flux of H2O2 they generated from their surface, but were not expected to produce any other potentially toxic products. Such particles lysed lymphoma cells, and the lysis was prevented by catalase. Neither arginase nor thymidine appeared to be involved in cytolysis by BCG-activated macrophages under the conditions used. These findings demonstrated that release of H2O2 was both necessary and sufficient for cytolysis by BCG-activated macrophages and by granulocytes when pharmacologically triggered

Extracellular cytolysis by activated macrophages and granulocytes. I. Pharmacologic triggering of effector cells and the release of hydrogen peroxide

Lymphoma cells were rapidly lysed by activated macrophages and granulocytes in the presence of PMA. Release of 51Cr from lymphoma cells correlated closely with their destruction as viewed by scanning electron microscopy, and with reduction in the number of trypan blue-excluding cells. The standard assay involved 51 Cr release measured at 4.5 h, but injury appeared to be complete in 1 h. Of eight different types of effector cells tested, only those releasing abundant H2O2 in response to PMA were effective, that, is BCG-, C. parvum-, or casein-activated macrophages, or thioglycollate-elicited granulocytes. Normal macrophages, J774 cells, or macrophages elicited with thioglycollate broth or proteose-peptone were ineffective. BCG-activated macrophages and granulocytes caused 50% specific release of 51Cr from P388 lymphoma cells at E:T ratios between 1.4 and 4.5, and from mouse erythrocytes at E:T ratios of 0.017 to 0.025. 10 types of target cells varied widely in their susceptibility to lysis by reagent H2O2, with one-half maximal lysis occurring at H2O2 concentrations ranging from 3.63 X 10(-6) M to 3.85 X 10(-5) M. Effector cells were expected to generate approximately that much H2O2 during the period of injury. Susceptibility of the target cells to lysis by PMA-triggered granulocytes correlated closely with their sensitivity to H2O2 (r = 0.98). The membrane-active agents LPS and digitonin, which did not trigger H2O2 release, did not trigger cytotoxicity. The dose-response curve for triggering of H2O2 release by PMA was identical to that for triggering cytotoxicity. These results provided strong circumstantial evidence for the importance of H2O2 in extracellular cytolysis by activated macrophages and granulocytes when pharmacologically triggered

Precision control of thermal transport in cryogenic single-crystal silicon devices

We report on the diffusive-ballistic thermal conductance of multi-moded single-crystal silicon beams measured below 1 K. It is shown that the phonon mean-free-path $\ell$ is a strong function of the surface roughness characteristics of the beams. This effect is enhanced in diffuse beams with lengths much larger than $\ell$, even when the surface is fairly smooth, 5-10 nm rms, and the peak thermal wavelength is 0.6 $\mu$m. Resonant phonon scattering has been observed in beams with a pitted surface morphology and characteristic pit depth of 30 nm. Hence, if the surface roughness is not adequately controlled, the thermal conductance can vary significantly for diffuse beams fabricated across a wafer. In contrast, when the beam length is of order $\ell$, the conductance is dominated by ballistic transport and is effectively set by the beam area. We have demonstrated a uniformity of $\pm$8% in fractional deviation for ballistic beams, and this deviation is largely set by the thermal conductance of diffuse beams that support the micro-electro-mechanical device and electrical leads. In addition, we have found no evidence for excess specific heat in single-crystal silicon membranes. This allows for the precise control of the device heat capacity with normal metal films. We discuss the results in the context of the design and fabrication of large-format arrays of far-infrared and millimeter wavelength cryogenic detectors

Electrocardiographic characteristics in patients with heart failure and normal ejection fraction: a systematic review and meta‐analysis

Background: Little is known about ECG abnormalities in patients with heart failure and normal ejection fraction (HeFNEF) and how they relate to different etiologies or outcomes. Methods and Results: We searched the literature for peer‐reviewed studies describing ECG abnormalities in HeFNEF other than heart rhythm alone. Thirty five studies were identified and 32,006 participants. ECG abnormalities reported in patients with HeFNEF include atrial fibrillation (prevalence 12%–46%), long PR interval (11%–20%), left ventricular hypertrophy (LVH, 10%–30%), pathological Q waves (11%–18%), RBBB (6%–16%), LBBB (0%–8%), and long JTc (3%–4%). Atrial fibrillation is more common in patients with HeFNEF compared to those with heart failure and reduced ejection fraction (HeFREF). In contrast, long PR interval, LVH, Q waves, LBBB, and long JTc are more common in patients with HeFREF. A pooled effect estimate analysis showed that QRS duration ≥120 ms, although uncommon (13%–19%), is associated with worse outcomes in patients with HeFNEF. Conclusions: There is high variability in the prevalence of ECG abnormalities in patients with HeFNEF. Atrial fibrillation is more common in patients with HeFNEF compared to those with HeFREF. QRS duration ≥120 ms is associated with worse outcomes in patients with HeFNEF. Further studies are needed to address whether ECG abnormalities correlate with different phenotypes in HeFNEF

Geographic accessibility and hospital competition for emergency blood transfusion services in Bungoma, Western Kenya

Background Estimating accessibility gaps to essential health interventions helps to allocate and prioritize health resources. Access to blood transfusion represents an important emergency health requirement. Here, we develop geo-spatial models of accessibility and competition to blood transfusion services in Bungoma County, Western Kenya. Methods Hospitals providing blood transfusion services in Bungoma were identified from an up-dated geo-coded facility database. AccessMod was used to define care-seeker’s travel times to the nearest blood transfusion service. A spatial accessibility index for each enumeration area (EA) was defined using modelled travel time, population demand, and supply available at the hospital, assuming a uniform risk of emergency occurrence in the county. To identify populations marginalized from transfusion services, the number of people outside 1-h travel time and those residing in EAs with low accessibility indexes were computed at the sub-county level. Competition between the transfusing hospitals was estimated using a spatial competition index which provided a measure of the level of attractiveness of each hospital. To understand whether highly competitive facilities had better capacity for blood transfusion services, a correlation test between the computed competition metric and the blood units received and transfused at the hospital was done. Results 15 hospitals in Bungoma county provide transfusion services, however these are unevenly distributed across the sub-counties. Average travel time to a blood transfusion centre in the county was 33 min and 5% of the population resided outside 1-h travel time. Based on the accessibility index, 38% of the EAs were classified to have low accessibility, representing 34% of the population, with one sub-county having the highest marginalized population. The computed competition index showed that hospitals in the urban areas had a spatial competitive advantage over those in rural areas. Conclusion The modelled spatial accessibility has provided an improved understanding of health care gaps essential for health planning. Hospital competition has been illustrated to have some degree of influence in provision of health services hence should be considered as a significant external factor impacting the delivery, and re-design of available services