Bridging the divide? Integrating stakeholder values into energy system models

Delivering just energy transitions in sub-Saharan Africa requires careful planning and consideration of diverse objectives. Recently in Energy Research and Social Science, Baker et al. provide a useful method for eliciting stakeholder preferences in Ghana; however, they do not take the next step and show how this evidence may be integrated into quantitative energy models

Health Care Transitions for Adolescents and Young Adults With Special Health Care Needs: Where Are We Now?

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to draw attention to this important issue, review the rationale behind current recommendations and report the current status of transitional programs in North America. Moreover, the steps that individual clinicians, practices and health systems may take to plan for successful health care transitions are discussed

The parasitological and serological prevalence of tsetse-transmitted bovine trypanosomosis in the Eastern Caprivi (Caprivi district, Namibia)

Between August 1995 and June 1997 a survey to determine the distribution of tsetse-transmitted trypanosomosis was conducted in the Eastern Caprivi (Caprivi District, Namibia). A total of 1 481 adult cattle was examined at 33 sampling sites. Direct parasitological diagnostic tests were used and eluted blood spots were screened for the presence of anti-trypanosomal antibodies. Tsetse-transmitted trypanosomal infections were detected in 66 animals (4 .5 %) from 14 different locations. The parasitological and serological prevalence of trypanosomosis was highest in the Mamili area. Trypanosomosis was virtually absent in the Linyanti/Chobe area and the target barrier along the Kwando River had significantly reduced the prevalence of trypanosomosis in cattle grazing to the east of it. This suggests that anti-trypanosomaI antibody prevalence data can be used to evaluate and monitor the effectiveness of tsetse control measures. Survey results suggest that in the Katima Mulilo area trypanosomal infections were being acquired when cattle grazed along the Zambezi River. Moreover survey results indicate that tsetse have not been able to establish themselves in the Katima Mulilo area. The parasitological prevalence in a herd and the respective prevalence of anti-trypanosomal antibodies was significantly correlated to the percentage of anaemic animals in that herd. Furthermore the parasitological prevalence in a herd was positively correlated with the prevalence of anti-trypanosomal antibodies of that herd. It is concluded that the prevalence of anti-trypanosomaI antibodies in a herd can be used as an additional indicator of the extent of infection in that particular herd.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.6th European Development fund through the Regional Tsetse and Trypanosomiasis Control Programme.mn201

Prospective Cohort Study on Performance of Cerebrospinal Fluid (CSF) Xpert MTB/RIF, CSF Lipoarabinomannan (LAM) Lateral Flow Assay (LFA), and Urine LAM LFA for Diagnosis of Tuberculous Meningitis in Zambia.

Tuberculous meningitis (TBM) is a devastating infection of the central nervous system lacking an adequate point-of-care diagnostic test. We conducted a prospective cohort study of 550 Zambian adults with suspected TBM to determine the diagnostic accuracy of cerebrospinal fluid (CSF) Xpert MTB/RIF, CSF lipoarabinomannan (LAM), urine LAM, CSF total protein, and CSF glucose compared with the gold standard of CSF culture. We categorized patients with a positive CSF tuberculosis (TB) culture as definite TBM. We also assessed inpatient and 1-year mortality on definite TBM patients when CSF Xpert MTB/RIF results were available in real time to treating physicians relative to a historical comparison cohort in whom Xpert results were not available in real time. Of the 550 patients, 474 (86.2%) were HIV-infected and 105/550 (19.1%) had definite TBM based on a positive CSF culture. The sensitivity/specificity of the diagnostic tests were CSF Xpert MTB/RIF, 52.9%/94.2%; CSF LAM, 21.9%/94.2%; urine LAM, 24.1%/76.1%; and CSF glucose 100 mg/dl, 66.3%/90%. A model including CSF Xpert MTB/RIF, CSF LAM, CSF glucose, and CSF total protein demonstrated an area under the receiver operating curve of 0.90. The inpatient and 1-year mortality for definite TBM was 43% and 57%, respectively. There was low sensitivity for the diagnosis of TBM across all diagnostics tests. CSF Xpert MTB/RIF and CSF LAM are highly specific for the diagnosis of TBM. Despite the use of Xpert MTB/RIF for diagnostic purpose in real time, TBM was still associated with a high mortality in Zambian patients

Characterisation of the Wildlife Reservoir Community for Human and Animal Trypanosomiasis in the Luangwa Valley, Zambia

Animal and human trypanosomiasis are constraints to both animal and human health in Sub-Saharan Africa, but there is little recent evidence as to how these parasites circulate in natural hosts in natural ecosystems. A cross-sectional survey of trypanosome prevalence in 418 wildlife hosts was conducted in the Luangwa Valley, Zambia, from 2005 to 2007. The overall prevalence in all species was 13.9%. Infection was significantly more likely to be detected in waterbuck, lion, greater kudu and bushbuck, with a clear pattern apparent of the most important hosts for each trypanosome species. Human infective Trypanosoma brucei rhodesiense parasites were identified for the first time in African buffalo and T. brucei s.l. in leopard. Variation in infection is demonstrated at species level rather than at family or sub-family level. A number of significant risk factors are shown to interact to influence infection rates in wildlife including taxonomy, habitat and blood meal preference. Trypanosoma parasites circulate within a wide and diverse host community in this bio-diverse ecosystem. Consistent land use patterns over the last century have resulted in epidemiological stability, but this may be threatened by the recent influx of people and domesticated livestock into the mid-Luangwa Valley

Sleeping sickness and its relationship with development and biodiversity conservation in the Luangwa valley, Zambia

The Luangwa Valley has a long historical association with Human African trypanosomiasis (HAT) and is a recognised geographical focus of this disease. It is also internationally acclaimed for its high biodiversity and contains many valuable habitats. Local inhabitants of the valley have developed sustainable land use systems in co-existence with wildlife over centuries, based on non-livestock keeping practices largely due to the threat from African Animal Trypanosomiasis. Historical epidemics of human sleeping sickness have influenced how and where communities have settled and have had a profound impact on development in the Valley. Historical attempts to control trypanosomiasis have also had a negative impact on conservation of biodiversity. Centralised control over wildlife utilisation has marginalised local communities from managing the wildlife resource. To some extent this has been reversed by the implementation of community based natural resource management programmes in the latter half of the 20th century and the Luangwa Valley provides some of the earliest examples of such programmes. More recently, there has been significant uncontrolled migration of people into the mid-Luangwa Valley driven by pressure on resources in the eastern plateau region, encouragement from local chiefs and economic development in the tourist centre of Mfuwe. This has brought changing land-use patterns, most notably agricultural development through livestock keeping and cotton production. These changes threaten to alter the endemically stable patterns of HAT transmission and could have significant impacts on ecosystem health and ecosystem services. In this paper we review the history of HAT in the context of conservation and development and consider the impacts current changes may have on this complex social-ecological system. We conclude that improved understanding is required to identify specific circumstances where win-win trade-offs can be achieved between the conservation of biodiversity and the reduction of disease in the human population.Ecosystem Services for Poverty Alleviation (ESPA

Health Care Transitions for Adolescents and Young Adults With Special Health Care Needs: Where Are We Now?

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to draw attention to this important issue, review the rationale behind current recommendations and report the current status of transitional programs in North America. Moreover, the steps that individual clinicians, practices and health systems may take to plan for successful health care transitions are discussed

Health Care Transitions for Adolescents and Young Adults With Special Health Care Needs: Where Are We Now?

Eventually, all adolescents must “graduate” from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children’s hospitals. This topic synopsis aims to draw attention to this important issue, review the rationale behind current recommendations and report the current status of transitional programs in North America. Moreover, the steps that individual clinicians, practices and health systems may take to plan for successful health care transitions are discussed

Antimicrobial susceptibility profile of uropathogens in Maluti Adventist Hospital patients, 2011

Background: Urinary tract infections (UTIs) are amongst the most common infections encountered globally and are usually treated empirically based on bacterial resistance to antibiotics for a given region. Unfortunately in Lesotho, no published studies are available to guide doctors in the treatment of UTIs. Treatment protocols for Western countries have been adopted, which may not be applicable for this region. Aim: To determine the antimicrobial susceptibility profile of uropathogens in outpatients at the Maluti Adventist Hospital. Setting: The study was conducted at the outpatient department of the Maluti Adventist Hospital in Mapoteng, Lesotho. Methods: This was a prospective cross-sectional study using consecutive sampling of patients with clinical symptoms of UTI. Midstream urine samples were screened through chemistry and microscopy, then positive urine samples were cultured. The isolated uropathogens underwent antimicrobial susceptibility testing and inclusion continued until 200 culture samples were obtained. Descriptive statistics were used in the data analysis. Results: The top five cultured uropathogens were Escherichia coli (61.5%), Staphylococcus aureus (14%), Pseudomonasspecies (6.5%), Enterococcus faecalis (5.5%) and Streptococcus agalactiae (5%). The isolated uropathogens showed low sensitivity to cotrimoxazole (32.5% – 75.0%) and amoxicillin (33.2% – 87.5%) and high sensitivity to ciprofloxacin (84.0% – 95.1%) and nitrofurantoin (76.9% – 100%). Conclusion: In the Maluti setting, cotrimoxazole and amoxicillin should be avoided as first-line drugs for the empirical treatment of community-acquired UTI. We recommend the use of nitrofurantoin as first choice

A large-scale trial to evaluate the efficacy of a 1% pour-on formulation of Cyfluthrin (Cylence, Bayer) in controlling bovine trypanosomosis in Eastern Zambia

A trial to evaluate the efficacy of a 1% cyfluthrin pour-on formulation (Cylence, Bayer) in reducing the incidence of bovine trypanosomosis was conducted in an area of ca. 2000 km2 of the Eastern Province of Zambia. The trial area was cultivated and carried a cattle population of approximately 11 animals/km2. Cattle were the main host of tsetse. Following the free of charge treatment of the adult cattle at intervals of 7 weeks and at a dosage of 15 ml/100 kg body weight, there was an increase in the average packed cell volume in the herd although the decline in the incidence of trypanosomal infections was more prolonged. The monthly incidence of trypanosomal infections started to decline substantially 8 months after the treatments were initiated. No trypanosomal infections were detected from 10 months after the start of the trial