Nutrition in children with long-term health conditions

Long-term health conditions (LTHCs) in children may affect nutrition and growth by means of multiple mechanisms. Both undernutrition and overweight/obesity are risk factors. Direct effects of the condition that may cause undernutrition include increased resting energy expenditure, excess losses through malabsorption, difficulty ingesting food, and decreased appetite. Indirect effects of LTHCs may be mediated by learnt or adaptive behaviours, secondary anorexia, inappropriate diets, or conditions that aggravate existing social nutritional risks to the child. Undernutrition may have significant consequences for the child, including reduced life expectancy. Overweight is a particular risk in children with neurological LTHCs. Regular clinical assessment, including anthropometry, is required to prevent and detect malnutrition. Anticipatory nutritional guidance to the child and caregivers is required and must be adapted to the specific LTHC. Controlling the disease processes that contribute to malnutrition and optimising energy intake are fundamental elements of prevention and management. Interventional feeding regimens, such as surgical approaches, may be required. A mutidisciplinary team, which includes a dietitian, should manage complex LTHCs and LTHC-associated malnutrition

Rehydration in acute gastro-enteritis - the value of going rapid and enteral

Acute gastro-enteritis (AGE) is a leading post-neonatal cause of death among South Africa's children. Almost all these deaths are caused by the consequences of dehydration. Many of these deaths occur in hospitals. AGE is also a significant nutritional insult at a critical time of growth. When the literature on therapy for AGE is reviewed, only four interventions recommend themselves for universal application for uncomplicated disease: rapid rehydration within 4 - 6 hours with hypotonic solutions, preferably via the gut; continuation of breastfeeding throughout the episode; early re-introduction of full-strength feeds; and zinc therapy. This article explores the first of these, but will show how its application enhances the positive effects of feeding on the diarrhoea as well as the child's nutritional status

Methods for suspensions of passive and active filaments

Flexible filaments and fibres are essential components of important complex fluids that appear in many biological and industrial settings. Direct simulations of these systems that capture the motion and deformation of many immersed filaments in suspension remain a formidable computational challenge due to the complex, coupled fluid--structure interactions of all filaments, the numerical stiffness associated with filament bending, and the various constraints that must be maintained as the filaments deform. In this paper, we address these challenges by describing filament kinematics using quaternions to resolve both bending and twisting, applying implicit time-integration to alleviate numerical stiffness, and using quasi-Newton methods to obtain solutions to the resulting system of nonlinear equations. In particular, we employ geometric time integration to ensure that the quaternions remain unit as the filaments move. We also show that our framework can be used with a variety of models and methods, including matrix-free fast methods, that resolve low Reynolds number hydrodynamic interactions. We provide a series of tests and example simulations to demonstrate the performance and possible applications of our method. Finally, we provide a link to a MATLAB/Octave implementation of our framework that can be used to learn more about our approach and as a tool for filament simulation

A Method of Comparing Differences in Tumour Growth Rates Applied to a Study of the Increasing Growth Capacity of Mouse Carcinomata

A method of comparing differences in growth rates of tumours in small groups of animals is described. A common slope can be fitted to the growth curves of a given tumour in a group of isogeneic animals. Differences between growth potentials can be demonstrated by comparing the common slope for a given tumour against that of another tumour (or the same tumour at a later stage of development)

An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

Objective. To evaluate the efficacy of an adapted Emergency Triage Assessment and Treatment (ETAT) tool at a children’s hospital. Design. A two-armed descriptive study. Setting. Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Methods. Triage data on 1 309 children from October 2007 and July 2009 were analysed. The number of children in each triage category (red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated. Results. 1. The October 2007 series: 902 children aged 5 days - 15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 - 50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category were discharged (478/530), while 32.5% of children triaged orange (110/338) and 52.9% of children triaged red (18/34) were admitted. There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 - 3.1). 2. The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 - 53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 - 4.1). Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resource-constrained countries and could be evaluated further in community emergency settings

An adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation

Objective. To evaluate the efficacy of an adapted Emergency Triage Assessment and Treatment (ETAT) tool at a children’s hospital. Design. A two-armed descriptive study. Setting. Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Methods. Triage data on 1 309 children from October 2007 and July 2009 were analysed. The number of children in each triage category (red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated. Results. 1. The October 2007 series: 902 children aged 5 days - 15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 - 50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category were discharged (478/530), while 32.5% of children triaged orange (110/338) and 52.9% of children triaged red (18/34) were admitted. There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 - 3.1). 2. The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 - 53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 - 4.1). Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resource-constrained countries and could be evaluated further in community emergency settings

Paediatric admissions to hospitals in the Cape Town Metro district: A survey

A point prevalence survey of 381 paediatric medical inpatients in the 11 public hospitals in Cape Town in November 2007 showed that 70% of them were in central hospitals, with 39.4% requiring level 3 (sub-specialist) care. Numbers of children in hospital and their levels of health care requirement did not vary by sub-district of residence. Seventy-seven per cent of patients were under 5 years of age; 5% were teenagers. Few patients changed level of care during admission, but 10% did not need to be in hospital at the time of review. Median length of stay was 4 days, with children with level 3 needs having the longest lengths of stay. An under-provision of level 1 beds was demonstrated. HIV infection had been identified in 12% of admissions. While children with level 3 problems were well catered for in terms of bed provision, level 1 and step-down/home care provision were deficient or inefficiently utilised

Sustainable and Regenerable Alkali Metal-Containing Carbons Derived from Seaweed for CO2 Post-Combustion Capture

Alkali-based CO2 sorbents were prepared from a novel material (i.e., Laminaria hyperborea). The use of this feedstock, naturally containing alkali metals, enabled a simple, green and low-cost route to be pursued. In particular, raw macroalgae was pyrolyzed at 800 °C. The resulting biochar was activated with either CO2 or KOH. KOH–activated carbon (AC) had the largest surface area and attained the highest CO2 uptake at 35 °C and 1 bar. In contrast, despite much lower porosity, the seaweed-derived char and its CO2-activated counterpart outweighed the CO2 sorption performance of KOH–AC and commercial carbon under simulated post-combustion conditions (53 °C and 0.15 bar). This was ascribed to the greater basicity of char and CO2–AC due to the presence of alkali metal-based functionalities (i.e., MgO) within their structure. These were responsible for a sorption of CO2 at lower partial pressure and higher temperature. In particular, the CO2–AC exhibited fast sorption kinetics, facile regeneration and good durability over 10 working cycles. Results presented in the current article will be of help for enhancing the design of sustainable alkali metal-containing CO2 captors

Paediatric triage in South Africa

Reducing child mortality is a high priority in sub-Saharan Africa, and swift, appropriate triage can make an important contribution to this goal. There has been a lot of interest and work in the field of triage of sick children in South Africa over the past few years. Despite this, in many parts of South Africa no formal system for triage of children in acute and emergency settings is used. This article aims to explain some of the key paediatric triage tools being considered and developed in South Africa. The triage tools discussed are the World Health Organization Emergency Triage Assessment and Treatment (ETAT), the South African adaptation of this tool known as ETAT-SA, the South African Triage Scale (SATS), and the Revised Paediatric SATS (P-SATS). The article describes how they were developed and their relevance to the country

Molecular diagnosis of cystic fibrosis in South African populations

Cystic fibrosis (CF) is present in all South African population groups. In a significant proportion of patients a diagnosis of CF can be confirmed by DNAanalysis and the detection of two CF transmembrane conductance regulator (CFTR) mutations, using the panels of mutations developed in this study. The index of suspicion will also be raised in patients with a single CFTR mutation. DNAtesting is important, especially in region s without access to reliable sweat tests, and should be considered an aid to diagnosis. In addition to receiving appropriate treatment, patients and their families can receive more accurate genetic counselling, CF carrier testing and prenatal diagnosis