Pediatric Surgery Collaboration in Uganda, the Benefits of Long Term Partnerships at Regional Referral Hospitals.

Background: In 2022 there were only seven pediatric surgeons in Uganda, but approximately 170 are needed. Consequently, Ugandan general surgeons treat most pediatric surgical problems at regional hospitals. Accordingly, stakeholders created the Pediatric Emergency Surgery Course, which teaches rural providers identification, resuscitation, treatment and referral of pediatric surgical conditions. In order to improve course offerings and better understand pediatric surgery needs we collected admission and operative logbook data from four participating sites. One participating site, Lacor Hospital, rarely referred patients and had a much higher operative volume. Therefore, we sought to understand the causes of this difference and the resulting economic impact. Methods: Over a four-year period, data was collected from logbooks at four different regional referral hospitals in Uganda. Patients ≤ 18 years old with a surgical diagnosis were included. Patient LOS, referral volume, age, and case type were compared between sites and DALYs were calculated and converted into monetary benefit. Results: Over four sites, 8,615 admissions, and 5,457 cases were included. Lacor patients were younger, had a longer length of stay, and were referred less. Additionally, Lacor's long-term partnerships with a high-income country institution, a missionary organization, and visiting Ugandan and international pediatric surgeons were unique. In 2018, the pediatric surgery case volume was: Lacor (967); Fort Portal (477); Kiwoko (393); and Kabale (153), resulting in a substantial difference in long-term monetary health benefit. Conclusion: Long-term international partnerships may advance investments in surgical infrastructure, workforce, and education in low- and middle-income countries. This collaborative model allows stakeholders to make a greater impact than any single institution could make alone.

The Safety and Efficacy of Early Enteral Nutrition After Paediatric Enterostomy Closure - The EPOC Study.

INTRODUCTION: Keeping children nil by mouth until return of bowel function after intestinal anastomosis surgery is said to reduce complications. Fasting may extend up to five days, risking malnourishment and usage of parenteral nutrition. This study aims to establish the efficacy and safety of early enteral nutrition in children undergoing intestinal stoma closure. METHODOLOGY: A retrospective cohort study of children aged three months to 16 years who underwent an intestinal stoma closure between 1/1/2019 and 31/12/2021 at two tertiary paediatric hospitals was undertaken. Children fed clear fluids within 24 h (EEN) were compared to those commencing feeds later (LEN). The primary outcome was length of post-operative stay (LOS) and secondary outcomes included: time to feeds; time to stool; and complications. RESULTS: Of the 129 children that underwent a stoma closure, 69 met inclusion criteria: 35 (51 %) in the LEN group and 34 (49 %) in the EEN group. Children in the EEN group had a significantly shorter LOS (92.6 h vs 121.7 h, p = 0.0045). Early feeding was also associated with a significantly decreased time to free fluids (p < 0.001) and full enteral intake (p = 0.007). There was no significant intergroup difference in complications. CONCLUSION: Commencing feeding within 24 h of stoma closure is efficacious and safe, with clear reductions in LOS, time to full feeds and time to stool, and no increase in complications. Further research is required to extrapolate these findings to other populations. LEVEL OF EVIDENCE: III.

A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome.

BACKGROUND: The prevalence of neonatal abstinence syndrome is increasing, but the number and quality of clinical practice guidelines available are unknown. This systematic review aimed to identify, appraise and evaluate clinical practice guidelines for neonatal abstinence syndrome. METHODS: A systematic search of databases and the grey literature was conducted between 1 June and 1 July 2022. Full-text guidelines published by national or state-wide institutions were included. The recommendations from each guideline were extracted. The AGREE-II instrument was used to assess guideline quality. Sufficient-quality scores were defined as >60 and good-quality scores were >80 for each domain of AGREE-II. RESULTS: A total of 1703 records were identified, and 22 guidelines from the United States, Australia, Canada and the United Kingdom, published between 2012 to 2021, were included. The quality scores were low, with median scores of 37/100 for stakeholder involvement, 33/100 for methodology, 34/100 for applicability and 0 for editorial independence. Scope and purpose scored 72/100, and presentation scored 85/100. Sixteen (73%) guidelines did not meet the cut-offs for clinical use. CONCLUSION: Many guidelines were of insufficient quality to guide clinical practice for neonatal abstinence syndrome. This emphasises the need for high-quality studies to inform clinical practice guidelines, improve care and reduce the risk of poor outcomes in these high-risk infants.

Second-Order Kinetic Rate Coefficients for the Aqueous-Phase Sulfate Radical (SO4•-) Oxidation of Some Atmospherically Relevant Organic Compounds.

The sulfate anion radical (SO4•-) is a reactive oxidant formed in the autoxidation chain of sulfur dioxide, among other sources. Recently, new formation pathways toward SO4•- and other reactive sulfur species have been reported. This work investigated the second-order rate coefficients for the aqueous SO4•- oxidation of the following important organic aerosol compounds (kSO4): 2-methyltetrol, 2-methyl-1,2,3-trihydroxy-4-sulfate, 2-methyl-1,2-dihydroxy-3-sulfate, 1,2-dihydroxyisoprene, 2-methyl-2,3-dihydroxy-1,4-dinitrate, 2-methyl-1,2,4-trihydroxy-3-nitrate, 2-methylglyceric acid, 2-methylglycerate, lactic acid, lactate, pyruvic acid, pyruvate. The rate coefficients of the unknowns were determined against that of a reference in pure water in a temperature range of 298-322 K. The decays of each reagent were measured with nuclear magnetic resonance (NMR) and high-performance liquid chromatography-high-resolution mass spectrometry (HPLC-HRMS). Incorporating additional SO4•- reactions into models may aid in the understanding of organosulfate formation, radical propagation, and aerosol mass sinks.

Sulfur radical formation from the tropospheric irradiation of aqueous sulfate aerosols.

The sulfate anion radical (SO4•-) is known to be formed in the autoxidation chain of sulfur dioxide and from minor reactions when sulfate or bisulfate ions are activated by OH radicals, NO3 radicals, or iron. Here, we report a source of SO4•-, from the irradiation of the liquid water of sulfate-containing organic aerosol particles under natural sunlight and laboratory UV radiation. Irradiation of aqueous sulfate mixed with a variety of atmospherically relevant organic compounds degrades the organics well within the typical lifetime of aerosols in the atmosphere. Products of the SO4•- + organic reaction include surface-active organosulfates and small organic acids, alongside other products. Scavenging and deoxygenated experiments indicate that SO4•- radicals, instead of OH, drive the reaction. Ion substitution experiments confirm that sulfate ions are necessary for organic reactivity, while the cation identity is of low importance. The reaction proceeds at pH 1-6, implicating both bisulfate and sulfate in the formation of photoinduced SO4•-. Certain aromatic species may further accelerate the reaction through synergy. This reaction may impact our understanding of atmospheric sulfur reactions, aerosol properties, and organic aerosol lifetimes when inserted into aqueous chemistry model mechanisms.

Gas-Phase Oxidation Rates and Products of 1,2-Dihydroxy Isoprene.

1,2-Dihydroxy isoprene (1,2-DHI), a product of isoprene oxidation from multiple chemical pathways, is produced in the atmosphere in large quantities; however, its chemical fate has not been comprehensively studied. Here, we perform chamber experiments to investigate its gas-phase reactions. We find that the reactions of 1,2-DHI with OH radicals and ozone are rapid (kOH = 8.0 (±1.3) × 10-11 cm3 molecule-1 s-1; kO3 = 7.2 (±1.1) × 10-18 cm3 molecule-1 s-1). Reaction with OH, which dominates 1,2-DHI loss, leads primarily to fragmentation and radical recycling; major products under both high- and low-NO conditions include hydroxyacetone, glycolaldehyde, and 2,3-dihydroxy-2-methyl-propanal (DHMP). Radical-terminating hydroperoxide formation from the peroxy radical (RO2) reaction with HO2 and organonitrate formation from RO2 + NO are not observed in the gas phase, possibly due to low volatility; constraints for their branching ratios are instead derived by mass balance. We also measure secondary organic aerosol mass yields from 1,2-DHI (0-23%) and show that oxidation in the presence of aqueous particles leads to formic and acetic acid production. Finally, we incorporate results into GEOS-Chem, a global chemical transport model, to compute the global production (25.3 Tg a-1) and gas-phase loss (20.2 Tg a-1) of 1,2-DHI and show that its oxidation provides non-negligible contributions to the atmospheric budgets of hydroxyacetone, glycolaldehyde, hydroxymethyl hydroperoxide, formic acid, and DHMP.

Second-Order Kinetic Rate Coefficients for the Aqueous-Phase Hydroxyl Radical (OH) Oxidation of Isoprene-Derived Secondary Organic Aerosol Compounds at 298 K.

The hydroxyl radical (OH) oxidation of the most abundant nonmethane volatile organic compound emitted to the atmosphere, isoprene (C5H8), produces a number of chemical species that partition to the condensed phase via gas-particle partitioning or form condensed-phase compounds via multiphase/heterogeneous chemistry to generate secondary organic aerosols (SOA). The SOA species in aerosol water or cloud/fog droplets may oxidize further via aqueous reaction with OH radicals, among other fates. Rate coefficients for compounds in isoprene's photochemical cascade are well constrained in the gas phase; however, a gap of information exists for the aqueous OH rate coefficients of the condensed-phased products, precluding the atmospheric modeling of the oxidative fate of isoprene-derived SOA. This work investigated the OH-initiated oxidation kinetic rate coefficients (kOH) for six major SOA compounds formed from the high-NO and low-NO channels of isoprene's atmospheric oxidation and one analog, most of which were synthesized and purified for study: (k1) 2-methyltetrol [MT: 1.14 (±0.17) × 109 M-1 s-1], (k2) 2-methyl-1,2,3-trihydroxy-4-sulfate [MT-4-S: 1.52 (±0.25) × 109 M-1 s-1], (k3) 2-methyl-1,2-dihydroxy-3-sulfate [MD-3-S: 0.56 (±0.15) × 109 M-1 s-1], (k4) 2-methyl-1,2-dihydroxy-but-3-ene [MDE: 4.35 (±1.16) × 109 M-1 s-1], (k5) 2-methyl-2,3-dihydroxy-1,4-dinitrate [MD-1,4-DN: 0.24 (±0.04) × 109 M-1 s-1], (k6) 2-methyl-1,2,4-trihydroxy-3-nitrate [MT-3-N: 1.12 (±0.15) × 109 M-1 s-1], and (k7) 2-methylglyceric acid [MGA: pH 2:1.41 (±0.49) × 109 M-1 s-1; pH 5:0.97 (±0.42) × 109 M-1 s-1]. The second-order rate coefficients are determined against the known kOH of erythritol in pure water. The decays of each reagent were measured with nuclear magnetic resonance (NMR) and high-performance liquid chromatography-high resolution mass spectrometry (HPLC-HRMS). The aqueous photooxidation fates of isoprene-derived SOA compounds are substantial and may impact the SOA budget when implemented into global models.

Tuning the copper(II)/copper(I) redox potential for more robust copper-catalyzed C-N bond forming reactions.

Complexes of copper and 1,10-phenanthroline have been utilized for organic transformations over the last 50 years. In many cases these systems are impacted by reaction conditions and perform best under an inert atmosphere. Here we explore the role the 1,10-phenanthroline ligand plays on the electronic structure and redox properties of copper coordination complexes, and what benefit related ligands may provide to enhance copper-based coupling reactions. Copper(II) triflate complexes bearing 1,10-phenanthroline (phen), ([Cu(phen)2(OTf)]OTf, 1) and oxidized derivatives of phen including [Cu(edhp)2](OTf)2 (2), [Cu(pdo)2](OTf)2 (3), [Cu(dafo)2](OTf)2 (4) were prepared and characterized. X-ray crystallographic data show these related ligands subtly impacted the coordination geometry of the copper(II) ion. Complexes 1-3 had only incremental changes to the redox properties of the copper ions, complex 4 showed a drastically different redox potential affording a remarkably air stable copper(I) complex. These complexes 1-4 were then used to catalyze the C-N bond forming cross coupling between imidazole and various boronic acid substrates, where the increased stability of the copper(I) species in complex 4 appears to better support these CEL cross couplings.

Electrocatalytic reduction of CO2 with CCC-NHC pincer nickel complexes.

A CCC-NHC pincer Ni(ii)Cl complex was prepared according to the metallation/transmetallation methodology. It was fully characterized by electrochemical, NMR spectroscopic, theoretical, and X-ray crystallographic methods. The complex and its cation were evaluated for electrocatalytic reduction of CO2 under a variety of conditions and found to provide some of the fastest catalytic rates and highest substrate selectivities (CO2vs. H+) reported. Rates improved in the presence of water and, significantly, catalysis occurred at the first reduction potential, presumably at the Ni(i) state. Controlled potential electrolysis (CPE) was found to yield CO at 34% and formate at 47% Faradaic efficiency (FE).

Immediate Closures and Violations Identified During Routine Inspections of Public Aquatic Facilities - Network for Aquatic Facility Inspection Surveillance, Five States, 2013.

PROBLEM/CONDITION: Aquatic facility-associated illness and injury in the United States include disease outbreaks of infectious or chemical etiology, drowning, and pool chemical-associated health events (e.g., respiratory distress or burns). These conditions affect persons of all ages, particularly young children, and can lead to disability or even death. A total of 650 aquatic facility-associated outbreaks have been reported to CDC for 1978-2012. During 1999-2010, drownings resulted in approximately 4,000 deaths each year in the United States. Drowning is the leading cause of injury deaths in children aged 1-4 years, and approximately half of fatal drownings in this age group occur in swimming pools. During 2003-2012, pool chemical-associated health events resulted in an estimated 3,000-5,000 visits to U.S. emergency departments each year, and approximately half of the patients were aged <18 years. In August 2014, CDC released the Model Aquatic Health Code (MAHC), national guidance that can be adopted voluntarily by state and local jurisdictions to minimize the risk for illness and injury at public aquatic facilities. REPORTING PERIOD COVERED: 2013. DESCRIPTION OF SYSTEM: The Network for Aquatic Facility Inspection Surveillance (NAFIS) was established by CDC in 2013. NAFIS receives aquatic facility inspection data collected by environmental health practitioners when assessing the operation and maintenance of public aquatic facilities. This report presents inspection data that were reported by 16 public health agencies in five states (Arizona, California, Florida, New York, and Texas) and focuses on 15 MAHC elements deemed critical to minimizing the risk for illness and injury associated with aquatic facilities (e.g., disinfection to prevent transmission of infectious pathogens, safety equipment to rescue distressed bathers, and pool chemical safety). Although these data (the first and most recent that are available) are not nationally representative, 15.7% of the estimated 309,000 U.S. public aquatic venues are located in the 16 reporting jurisdictions. RESULTS: During 2013, environmental health practitioners in the 16 reporting NAFIS jurisdictions conducted 84,187 routine inspections of 48,632 public aquatic venues. Of the 84,187 routine inspection records for individual aquatic venues, 78.5% (66,098) included data on immediate closure; 12.3% (8,118) of routine inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health. Disinfectant concentration violations were identified during 11.9% (7,662/64,580) of routine inspections, representing risk for aquatic facility-associated outbreaks of infectious etiology. Safety equipment violations were identified during 12.7% (7,845/61,648) of routine inspections, representing risk for drowning. Pool chemical safety violations were identified during 4.6% (471/10,264) of routine inspections, representing risk for pool chemical-associated health events. INTERPRETATION: Routine inspections frequently resulted in immediate closure and identified violations of inspection items corresponding to 15 MAHC elements critical to protecting public health, highlighting the need to improve operation and maintenance of U.S. public aquatic facilities. These findings also underscore the public health function that code enforcement, conducted by environmental health practitioners, has in preventing illness and injury at public aquatic facilities. PUBLIC HEALTH ACTION: Findings from the routine analyses of aquatic facility inspection data can inform program planning, implementation, and evaluation. At the state and local level, these inspection data can be used to identify aquatic facilities and venues in need of more frequent inspections and to select topics to cover in training for aquatic facility operators. At the national level, these data can be used to evaluate whether the adoption of MAHC elements minimizes the risk for aquatic facility-associated illness and injury. These findings also can be used to prioritize revisions or updates to the MAHC. To optimize the collection and analysis of aquatic facility inspection data and thus application of findings, environmental health practitioners and epidemiologists need to collaborate extensively to identify public aquatic facility code elements deemed critical to protecting public health and determine the best way to assess and document compliance during inspections.

Assessing knowledge and application of emergency risk communication principles among public health workers in China.

OBJECTIVE: Since 2003, the Chinese National Health and Family Planning Commission (formerly the Ministry of Health) has implemented changes to more effectively communicate risk during public health emergencies. In spite of ongoing improvements, provincial and sub-provincial leaders face barriers, such as established modes of operation, lack of training, shortage of trained risk communicators, and limited understanding and willingness of recipients to mitigate risks. METHODS: We assessed the current status of and barriers to risk communication knowledge and practice among public health practitioners in China. We designed the survey questionnaire to capture information related to the risk communication core capacities required by international health regulations and common risk communication principles. RESULTS: Our findings showed that risk communication training has successfully developed an awareness of risk communication principles and the ability to implement those principles in practice in China. CONCLUSIONS: Future efforts should focus on areas such as a dedicated risk communication workforce, requirements that public health agencies develop a risk communication plan, and additional training for public health practitioners and their partners. It is critical that the infectious diseases prevention and control law be amended to grant provincial and local public health agencies more autonomy to release information.

Household expenditures as a measure of socioeconomic status among Iraqis displaced in Jordan and Syria.

BACKGROUND: Various measures are used to represent socioeconomic status (SES) in health research, including income. However, reliability of income data can be low. Household expenditures are an accepted proxy for income as a more reliable measure but have been studied little in refugee populations. METHODS: Health and SES measures from cross-sectional surveys of Iraqi refugees in Jordan and Syria were analyzed using logistic regression to assess the interchangeability of household income and expenditures. RESULTS: In Jordan, odds ratios in the regression models including income quartiles were frequently similar to odds ratios found in the models including expenditure quartiles, indicating interchangeability. In Syria, fewer similarities were observed. CONCLUSIONS: This study provides some evidence that household expenditures may be used interchangeably with household income for some populations, allowing for the potential collection and use of data related to expenditures as a measure of SES, similar in importance to that of income.

Outbreak of Burkholderia cepacia bloodstream infection at an outpatient hematology and oncology practice.

We investigated an outbreak of infection in 10 patients with blood cultures positive for B. cepacia. All patients had indwelling intravenous catheters. Though we did not identify the source of the organism, our findings support the hypothesis that cross-contamination of multidose medications through the use of the same needle and syringe was a contributing factor.

Local and state collaboration for effective preparedness planning.

State and local collaboration is critical to effective preparedness and response planning. Through various assessments, the National Association of County and City Health Officials (NACCHO) is tracking the way in which local and state public health agencies are coordinating their planning efforts to ensure adequate bioterrorism and emergency response capacities. NACCHO's analysis of planning provides a case study of effective and ineffective collaboration. NACCHO intends to share these lessons to provide local and state public health agencies with strategies for enhancing collaboration in the future.