Neonatal resuscitation practices in Uganda: a video observational study

Background Neonatal mortality, often due to birth asphyxia, remains stubbornly high in sub-Saharan Africa. Guidelines for neonatal resuscitation, where achieving adequate positive pressure ventilation (PPV) is key, have been implemented in low-resource settings. However, the actual clinical practices of neonatal resuscitation have rarely been examined in these settings. The primary aim of this prospective observational study was to detail the cumulative proportion of time with ventilation during the first minute on the resuscitation table of neonates needing PPV at the Mulago National Referral Hospital in Kampala, Uganda. Methods From November 2015 to January 2016, resuscitations of non-breathing neonates by birth attendants were video-recorded using motion sensor cameras. The resuscitation practices were analysed using the application NeoTapAS and compared between those taking place in the labour ward and those in theatre through Fisher’s exact test and Wilcoxon rank-sum test. Results From 141 recorded resuscitations, 99 were included for analysis. The time to initiation of PPV was 66 (42–102) s overall, and there was minimal PPV during the first minute in both groups with 0 (0–10) s and 0 (0–12) s of PPV, respectively. After initiating PPV the overall duration of interruptions during the first minute was 28 (18–37) s. Majority of interruptions were caused by stimulation (28%), unknown reasons (25%) and suction (22%). Conclusions Our findings show a low adherence to standard resuscitation practices in 2015–2016. This emphasises the need for continuous educational efforts and investments in staff and adequate resources to increase the quality of clinical neonatal resuscitation practices in low-resource settings.publishedVersio

Modeling the Solar Cycle: What the Future Holds

Stellar magnetic fields are produced by a magnetohydrodynamic dynamo mechanism working in their interior -- which relies on the interaction between plasma flows and magnetic fields. The Sun, being a well-observed star, offers an unique opportunity to test theoretical ideas and models of stellar magnetic field generation. Solar magnetic fields produce sunspots, whose number increases and decreases with a 11 year periodicity -- giving rise to what is known as the solar cycle. Dynamo models of the solar cycle seek to understand its origin, variation and evolution with time. In this review, I summarize observations of the solar cycle and describe theoretical ideas and dynamo modeling efforts to address its origin. I end with a discussion on the future of solar cycle modeling -- emphasizing the importance of a close synergy between observational data assimilation, kinematic dynamo models and full magnetohydrodynamic models of the solar interior.Comment: 10 Pages, 3 Figures, Invited Review, Proceedings of IAU Symposium 286 on "Comparative Magnetic Minima: Characterizing quiet times in the Sun and stars", to be published by Cambridge University Pres

Neonatal resuscitation using a supraglottic airway device for improved mortality and morbidity outcomes in a low-income country: Study protocol for a randomized trial.

Background Intrapartum-related death is the third leading cause of under-5 mortality. Effective ventilation during neonatal resuscitation has the potential to reduce 40% of these deaths. Face-mask ventilation performed by midwives is globally the most common method of resuscitating neonates. It requires considerable operator skills and continuous training because of its complexity. The i-gel® is a cuffless supraglottic airway which is easy to insert and provides an efficient seal that prevents air leakage; it has the potential to enhance performance in neonatal resuscitation. A pilot study in Uganda demonstrated that midwives could safely resuscitate newborns with the i-gel® after a short training session. The aim of the present trial is to investigate whether the use of a cuffless supraglottic airway device compared with face-mask ventilation during neonatal resuscitation can reduce mortality and morbidity in asphyxiated neonates. Methods A randomized phase III open-label superiority controlled clinical trial will be conducted at Mulago Hospital, Kampala, Uganda, in asphyxiated neonates in the delivery units. Prior to the intervention, health staff performing resuscitation will receive training in accordance with the Helping Babies Breathe curriculum with a special module for training on supraglottic airway insertion. A total of 1150 to 1240 babies (depending on cluster size) that need positive pressure ventilation and that have an expected gestational age of more than 34 weeks and an expected birth weight of more than 2000 g will be ventilated by daily unmasked randomization with a supraglottic airway device (i-gel®) (intervention group) or with a face mask (control group). The primary outcome will be a composite outcome of 7-day mortality and admission to neonatal intensive care unit (NICU) with neonatal encephalopathy. Discussion Although indications for the beneficial effect of a supraglottic airway device in the context of neonatal resuscitation exist, so far no large studies powered to assess mortality and morbidity have been carried out. We hypothesize that effective ventilation will be easier to achieve with a supraglottic airway device than with a face mask, decreasing early neonatal mortality and brain injury from neonatal encephalopathy. The findings of this trial will be important for low and middle-resource settings where the majority of intrapartum-related events occur.publishedVersio

Children Immunization App (CIMA): A Non-randomized Controlled Trial Among Syrian Refugees in Zaatari Camp, Jordan

Approximately 20 million children are not vaccinated, especially among refugees. There is a growing access to smartphones, among refugees, which can help in improving their vaccination. We assessed the impact of an app for the vaccination follow-up visit among refugees in Jordan. We developed an app and tested it through a non-randomized trial at the Zaatari refugees camp in Jordan. The study was conducted during March – December 2019 at three vaccination clinics inside the camp. The study included two study groups (intervention and control groups) for refugees living at the camp. The intervention group included parents who own an Android smartphone and have one newborn that require between one and four first vaccination doses and they accepted to participate in the study, during their regular visit to the vaccination clinics. The control group was for the usual care. We compared both study groups for returning back to one follow-up visit, using Kaplan-Meier survival analysis. We recruited 936 babies (n = 471; 50.3% in the intervention group, both study groups were similar at baseline). The majority of mothers were literate (94.2%) with a median age of 24. The majority of the babies had a vaccination card (n= 878, 94%). One quarter (26%) of mother-babies pairs of the intervention group came back within one week (versus 22% for control group); When it comes to lost-follow-up, 22% and 28% did not have a history of returning back (intervention and control groups respectively, <p = 0.06) (Relative risk reduction: 19%). The Kaplan-Meier Survival Analysis showed a statistically significant progressive reduction in the duration of coming back late for the follow-up vaccine visit. We tested a vaccination app for the first time, in a refugee population setting. The app can be used as a reminder for parents to come back on time for their children’s vaccine follow-up visits

The transition to Earth-like torsional oscillations in magnetoconvection simulations

Evidence for torsional oscillations (TOs) operating within the Earth's fluid outer core has been found in the secular variation of the geomagnetic field. These waves arise via disturbances to the predominant (magnetostrophic) force balance believed to exist in the core. The coupling of the core and mantle allow TOs to affect the length-of-day of the Earth via angular momentum conservation. Encouraged by previous work, where we were able to observe TOs in geodynamo simulations, we perform 3-D magnetoconvection simulations in a spherical shell in order to reach more Earth-like parameter regimes that proved hitherto elusive. At large Ekman numbers we find that TOs can be present but are typically only a small fraction of the overall dynamics and are often driven by Reynolds forcing at various locations throughout the domain. However, as the Ekman number is reduced to more Earth-like values, TOs become more apparent and can make up the dominant portion of the short timescale flow. This coincides with a transition to regimes where excitation is found only at the tangent cylinder, is delivered by the Lorentz force and gives rise to a periodic Earth-like wave pattern, approximately operating on a 4 to 5 year timescale. The core travel times of our waves also become independent of rotation at low Ekman number with many converging to Earth-like values of around 4 years

Etiology of Clinical Community-Acquired Pneumonia in Swedish Children Aged 1-59 Months with High Pneumococcal Vaccine Coverage-The TREND Study

(1) Immunization with pneumococcal conjugate vaccines has decreased the burden of community-acquired pneumonia (CAP) in children and likely led to a shift in CAP etiology. (2) The Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) enrolled children 1-59 months with clinical CAP according to the World Health Organization (WHO) criteria at Sachs' Children and Youth Hospital, Stockholm, Sweden. Children with rhonchi and indrawing underwent "bronchodilator challenge". C-reactive protein and nasopharyngeal PCR detecting 20 respiratory pathogens, were collected from all children. Etiology was defined according to an a priori defined algorithm based on microbiological, biochemical, and radiological findings. (3) Of 327 enrolled children, 107 (32%) required hospitalization; 91 (28%) received antibiotic treatment; 77 (24%) had a chest X-ray performed; and 60 (18%) responded to bronchodilator challenge. 243 (74%) episodes were classified as viral, 11 (3%) as mixed viral-bacterial, five (2%) as bacterial, two (0.6%) as atypical bacterial and 66 (20%) as undetermined etiology. After exclusion of children responding to bronchodilator challenge, the proportion of bacterial and mixed viral-bacterial etiology was 1% and 4%, respectively. (4) The novel TREND etiology algorithm classified the majority of clinical CAP episodes as of viral etiology, whereas bacterial etiology was uncommon. Defining CAP in children <5 years is challenging, and the WHO definition of clinical CAP is not suitable for use in children immunized with pneumococcal conjugate vaccines

Electric current circuits in astrophysics

Cosmic magnetic structures have in common that they are anchored in a dynamo, that an external driver converts kinetic energy into internal magnetic energy, that this magnetic energy is transported as Poynting fl ux across the magnetically dominated structure, and that the magnetic energy is released in the form of particle acceleration, heating, bulk motion, MHD waves, and radiation. The investigation of the electric current system is particularly illuminating as to the course of events and the physics involved. We demonstrate this for the radio pulsar wind, the solar flare, and terrestrial magnetic storms

Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020-October 2021: a retrospective analysis of national surveillance data.

OBJECTIVES: Nigeria reported an upsurge in cholera cases in October 2020, which then transitioned into a large, disseminated epidemic for most of 2021. This study aimed to describe the epidemiology, diagnostic performance of rapid diagnostic test (RDT) kits and the factors associated with mortality during the epidemic. DESIGN: A retrospective analysis of national surveillance data. SETTING: 33 of 37 states (including the Federal Capital Territory) in Nigeria. PARTICIPANTS: Persons who met cholera case definition (a person of any age with acute watery diarrhoea, with or without vomiting) between October 2020 and October 2021 within the Nigeria Centre for Disease Control surveillance data. OUTCOME MEASURES: Attack rate (AR; per 100 000 persons), case fatality rate (CFR; %) and accuracy of RDT performance compared with culture using area under the receiver operating characteristic curve (AUROC). Additionally, individual factors associated with cholera deaths and hospitalisation were presented as adjusted OR with 95% CIs. RESULTS: Overall, 93 598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period. The proportions of cholera cases were higher in men aged 5-14 years and women aged 25-44 years. The overall AR was 46.5 per 100 000 persons. The North-West region recorded the highest AR with 102 per 100 000. Older age, male gender, residency in the North-Central region and severe dehydration significantly increased the odds of cholera deaths. The cholera RDT had excellent diagnostic accuracy (AUROC=0.91; 95% CI 0.87 to 0.96). CONCLUSIONS: Cholera remains a serious public health threat in Nigeria with a high mortality rate. Thus, we recommend making RDT kits more widely accessible for improved surveillance and prompt case management across the country