Severity Assessment of Lower Respiratory Tract Infection in Malawi: Derivation of a Novel Index (SWAT-Bp) Which Outperforms CRB-65

OBJECTIVE: To assess the validity of CRB-65 (Confusion, Respiratory rate >30 breaths/min, BP<90/60 mmHg, age >65 years) as a pneumonia severity index in a Malawian hospital population, and determine whether an alternative score has greater accuracy in this setting. DESIGN: Forty three variables were prospectively recorded during the first 48 hours of admission in all patients admitted to Queen Elizabeth Central Hospital, Malawi, for management of lower respiratory tract infection over a two month period (N = 240). Calculation of sensitivity and specificity for CRB-65 in predicting mortality was followed by multivariate modeling to create a score with superior performance in this population. RESULTS: Median age 37, HIV prevalence 79.9%, overall mortality 18.3%. CRB-65 predicted mortality poorly, indicated by the area under the ROC curve of 0.649. Independent predictors of death were: Male sex, “S” (AOR 2.6); Wasting, “W” (AOR 6.6); non-ambulatory, “A” (AOR 2.5); Temp >38°C or <35°C, “T” (AOR 3.2); BP<100/60, “Bp” (AOR 3.7). Combining these factors to form a severity index (SWAT-Bp) predicted mortality with high sensitivity and specificity (AUC: 0.867). Mortality for scores 0–5 was 0%, 3.3%, 7.4%, 29.2%, 61.5% and 87.5% respectively. A score ≥3 was 84% sensitive and 77% specific for mortality prediction, with a negative predictive value of 95.8%. CONCLUSION: CRB-65 performs poorly in this population. The SWAT-Bp score can accurately stratify patients; ≤2 indicates non-severe infection (mortality 4.4%) and ≥3 severe illness (mortality 45%)

Universality, limits and predictability of gold-medal performances at the Olympic Games

Inspired by the Games held in ancient Greece, modern Olympics represent the world's largest pageant of athletic skill and competitive spirit. Performances of athletes at the Olympic Games mirror, since 1896, human potentialities in sports, and thus provide an optimal source of information for studying the evolution of sport achievements and predicting the limits that athletes can reach. Unfortunately, the models introduced so far for the description of athlete performances at the Olympics are either sophisticated or unrealistic, and more importantly, do not provide a unified theory for sport performances. Here, we address this issue by showing that relative performance improvements of medal winners at the Olympics are normally distributed, implying that the evolution of performance values can be described in good approximation as an exponential approach to an a priori unknown limiting performance value. This law holds for all specialties in athletics-including running, jumping, and throwing-and swimming. We present a self-consistent method, based on normality hypothesis testing, able to predict limiting performance values in all specialties. We further quantify the most likely years in which athletes will breach challenging performance walls in running, jumping, throwing, and swimming events, as well as the probability that new world records will be established at the next edition of the Olympic Games.Comment: 8 pages, 3 figures, 1 table. Supporting information files and data are available at filrad.homelinux.or

Of “sluts” and “arseholes”: Antagonistic desire and the production of sexual vigilance

This article examines a contemporary antagonism in gendered safety discourses—the imperative to be free in public space against the obligation to be safe and “properly” feminine. We argue that this produces (and is produced by) contemporary rape culture, which might be contested through recourse to an agonistic ethic. Using qualitative interview data, we examine how participants contest victim-blaming discourses, while limiting how far they will accept the female body’s right to occupy public space. This article has significant implications for approaching social justice, in particular justice for women and their right to occupy public space

Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.

BACKGROUND: In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda. METHODS AND FINDINGS: Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045). CONCLUSION: Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART

For the benefit of all? Developing a critical perspective in mega-event leverage

The purpose of this article is to bring to light the need for developing a critical leveraging perspective on mega-events and propose a research agenda that extends the focus of the leverage concept towards this direction. Current research on leverage focuses on the attainment and magnification of mega-event outcomes. A critical lens of inquiry however is needed to move forward and take into account the influence of power structures and social-ordering processes on developing and implementing strategic leveraging programs. Such a perspective can help examine if and how the benefits of mega-events are fairly delivered to host communities, equally distributed among stakeholders and then sustained, while negative impacts are minimised. Ten research themes are brought forward to help build a robust ground for a critical mega-event leveraging perspective

Barriers to and enablers of sustainable practices: insights from ethnic minority migrants

Migration from the Global South to Global North is a major feature of contemporary population movements, and provides a lived experiment of the implications of moving from less resource-intensive modes of living towards more resource-intensive ones. Pre-migration practices come together in complex ways post-migration with established norms and infrastructures in destination countries. Here we examine the barriers to and enablers of sustainable practices, synthesising in-depth research from nine different studies in south-eastern Australia in relation to household water use, food growing and transport. The total sample includes 323 migrants from 33 countries. The main barriers include infrastructure and broader patterns of work and society. The main enablers are cultural norms of frugality and preferences for public transport. Barriers and enablers interact in diverse ways. We show that migrants are important contributors to inadvertent sustainabilities, but their contributions may be weakened by infrastructural, structural and cultural barriers. Addressing the diverse capacities of migrants would enhance system change for everyone

Sending Granny to Chiang Mai: debating global outsourcing of care for the elderly

This article ties in with existing discussions on global care chains, family separation and the devaluation of social-reproductive work. We explore the new trend of outsourcing care for the elderly to countries with lower wages. We base our analysis on the debate in the German press and supplement it with insights from ethnographic field observations in two care homes in Thailand. We identify a discourse of abandonment, which shows how outsourcing the care of the elderly unsettles the privilege of sedentarism that is often taken for granted in the Global North. Furthermore, the newspaper articles tend to villainize people who seek care for their loved ones abroad. We argue that both discourses foster a neoliberal rationale of individualized responsibility and obfuscate the deep systemic roots of the care crisis in the Global North. However, by extending the discussion on outsourcing care for the elderly beyond the dominant media discourses, we envisage a rich potential for provoking political debate on the revaluation of care

Facial Skin Coloration Affects Perceived Health of Human Faces

Numerous researchers have examined the effects of skin condition, including texture and color, on the perception of health, age, and attractiveness in human faces. They have focused on facial color distribution, homogeneity of pigmentation, or skin quality. We here investigate the role of overall skin color in determining perceptions of health from faces by allowing participants to manipulate the skin portions of color-calibrated Caucasian face photographs along CIELab color axes. To enhance healthy appearance, participants increased skin redness (a*), providing additional support for previous findings that skin blood color enhances the healthy appearance of faces. Participants also increased skin yellowness (b*) and lightness (L*), suggesting a role for high carotenoid and low melanin coloration in the healthy appearance of faces. The color preferences described here resemble the red and yellow color cues to health displayed by many species of nonhuman animals