Atmospheric dispersion modeling for an accidental release from a SLOWPOKE-2 research reactor: a case study.

Atmospheric dispersion modeling was performed for a postulated design basis accident at a SLOWPOKE research reactor. The MCNP-5 computer code was used to estimate the neutron flux spectrum which was then used in the ORIGEN-S code to perform core depletion calculations and determine the radiological source term. The HotSpot health physics code was then used to model the atmospheric transport of the radioactive material released to estimate the resulting doses to the population downwind of the reactor. The highest total effective dose (TED) for a release from the reactor's exhaust stack in predominant meteorological conditions, stability class C, was 0.37 mSv, while a maximum TED of 4.29 mSv was estimated for a release at ground level. Ground deposition was estimated to be 3900 kBq/m2. It was shown that any hypothetical release of radioactive material resulting from such an accident would have no significant adverse effect on the municipal water reservoir close to the reactor.

Universal health coverage and intersectoral action for health: key messages from Disease Control Priorities, 3rd edition.

The World Bank is publishing nine volumes of Disease Control Priorities, 3rd edition (DCP3) between 2015 and 2018. Volume 9, Improving Health and Reducing Poverty, summarises the main messages from all the volumes and contains cross-cutting analyses. This Review draws on all nine volumes to convey conclusions. The analysis in DCP3 is built around 21 essential packages that were developed in the nine volumes. Each essential package addresses the concerns of a major professional community (eg, child health or surgery) and contains a mix of intersectoral policies and health-sector interventions. 71 intersectoral prevention policies were identified in total, 29 of which are priorities for early introduction. Interventions within the health sector were grouped onto five platforms (population based, community level, health centre, first-level hospital, and referral hospital). DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance. DCP3 is intended to be a model starting point for analyses at the country level, but country-specific cost structures, epidemiological needs, and national priorities will generally lead to definitions of EUHC that differ from country to country and from the model in this Review. DCP3 is particularly relevant as achievement of EUHC relies increasingly on greater domestic finance, with global developmental assistance in health focusing more on global public goods. In addition to assessing effects on mortality, DCP3 looked at outcomes of EUHC not encompassed by the disability-adjusted life-year metric and related cost-effectiveness analyses. The other objectives included financial protection (potentially better provided upstream by keeping people out of the hospital rather than downstream by paying their hospital bills for them), stillbirths averted, palliative care, contraception, and child physical and intellectual growth. The first 1000 days after conception are highly important for child development, but the next 7000 days are likewise important and often neglected.

Essential surgery: key messages from Disease Control Priorities, 3rd edition.

The World Bank will publish the nine volumes of Disease Control Priorities, 3rd edition, in 2015-16. Volume 1--Essential Surgery--identifies 44 surgical procedures as essential on the basis that they address substantial needs, are cost effective, and are feasible to implement. This report summarises and critically assesses the volume's five key findings. First, provision of essential surgical procedures would avert about 1·5 million deaths a year, or 6-7% of all avertable deaths in low-income and middle-income countries. Second, essential surgical procedures rank among the most cost effective of all health interventions. The surgical platform of the first-level hospital delivers 28 of the 44 essential procedures, making investment in this platform also highly cost effective. Third, measures to expand access to surgery, such as task sharing, have been shown to be safe and effective while countries make long-term investments in building surgical and anaesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at first-level hospitals, expansion of access requires that such facilities be widely geographically diffused. Fourth, substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates including anaesthesia-related deaths in low-income and middle-income countries. Feasible measures, such as WHO's Surgical Safety Checklist, have led to improvements in safety and quality. Fifth, the large burden of surgical disorders, cost-effectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be financed early on the path to universal health coverage. We point to estimates that full coverage of the component of universal coverage of essential surgery applicable to first-level hospitals would require just over US$3 billion annually of additional spending and yield a benefit-cost ratio of more than 10:1. It would efficiently and equitably provide health benefits, financial protection, and contributions to stronger health systems.

Systematic Review of Surgical Literature from Resource-Limited Countries: Developing Strategies for Success.

BACKGROUND: Injuries and surgical diseases are leading causes of global mortality. We sought to identify successful strategies to augment surgical capacity and research endeavors in low-income countries (LIC's) based on existing peer-reviewed literature. METHODS: A systematic review of literature from or pertaining to LIC's from January 2002 to December 2011 was performed. Variables analyzed included type of intervention performed, research methodology, and publication demographics such as surgical specialty, partnerships involved, authorship contribution, place and journal of publication. FINDINGS: A total of 2049 articles met the inclusion criteria between 2002 and 2011. The two most common study methodologies performed were case series (44%) and case reports (18%). A total of 43% of publications were without outcome measures. Only 21% of all publications were authored by a collaboration of authors from low-income countries and developed country nationals. The five most common countries represented were Nepal (429), United States (408), England (170), Bangladesh (158), and Kenya (134). Furthermore, of countries evaluated, Nepal and Bangladesh were the only two with a specific national journal. INTERPRETATION: Based on the results of this research, the following recommendations were made: (1) Describe, develop, and stimulate surgical research through national peer-reviewed journals, (2) Foster centers of excellence to promote robust research competencies, (3) Endorse partnerships across regions and institutions in the promotion of global surgery, and (4) Build on outcome-directed research.

Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study.

BACKGROUND: The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent population-based studies reporting substantial levels of obstructive and restrictive lung function.OBJECTIVE: To characterise the common chronic respiratory diseases encountered in hospital outpatient clinics in three African countries.METHODS This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8 weeks) attending hospital outpatient departments in Ethiopia, Kenya and Sudan. Patients were assessed using a respiratory questionnaire, spirometry and chest radiography. The diagnoses of the reviewing clinicians were ascertained.RESULT: A total of 519 patients (209 Kenya, 170 Ethiopia, 140 Sudan) participated; the mean age was 45.2 years (SD 16.2); 53% were women, 83% had never smoked. Reviewing clinicians considered that 36% (95% CI 32-40) of patients had asthma, 25% (95% CI 21-29) had chronic bronchitis, 8% (95% CI 6-11) chronic obstructive pulmonary disease (COPD), 5% (95% CI 4-8) bronchiectasis and 4% (95% CI 3-6) post-TB lung disease. Spirometry consistent with COPD was present in 35% (95% CI 30-39). Restriction was evident in 38% (95% CI 33-43). There was evidence of sub-optimal diagnosis of asthma and COPD.CONCLUSION: In Ethiopia, Kenya and Sudan, asthma, COPD and chronic bronchitis account for the majority of diagnoses in non-TB patients with chronic respiratory symptoms. The suboptimal diagnosis of these conditions will require the widespread use of spirometry.

The burden and outcomes of COVID-19 among patients with co-morbid disease in Africa: protocol for a systematic review and meta-analysis.

The coronavirus disease 2019 (COVID-19) outbreak is now a global public health concern and has had an enormous adverse impact in both developed and developing countries. In Africa, in August 2020, the total number of confirmed cases was 1 022 401 cases, with 704 704 recovered and 22 501 deaths. People with co-morbidities are at increased risk of complications and COVID-19-related death. Evidence on the burden and outcome among patients with co-morbid diseases has not been published in Africa, so this systematic review and meta-analysis aims to quantify these. Observational studies reporting on the burden and outcome of COVD-19 among patients with co-morbid diseases in Africa will be included and a search of online databases PubMed/MEDLINE, EMBASE, HINARI, Cochrane Library, World Health Organization COVID-19 database, Africa Wide Knowledge and Web of Science will be applied. Two independent authors will carry out data extraction and assess the risk of bias using a predetermined and structured method of data collection. Disagreements will be resolved by discussion after mutual consensus with a third reviewer who is an experienced researcher (AH) in meta-analysis studies. We will use random-effects to estimate the overall burden and outcome of COVID-19 among patients with co-morbid diseases in Africa. To assess possible publication bias, funnel plot test and Egger's test methods will be used. This systematic review and meta-analysis protocol will be reported based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis protocol guidelines. Results will be stratified by the African geographic region, diagnostic methods and co-morbidity. COVID-19 distribution data will be shown by interest variables such as residence/geographic region, diagnostic methods, type of co-morbidity and outcomes of co-morbidity. The findings of this review will notify health-care professionals about the burden and outcome of COVID-19 among patients with co-morbid diseases while providing evidence to bring about the requisite improvements in clinical practice for these patients.

Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey.

BACKGROUND: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. METHODS AND FINDINGS: We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. CONCLUSION: African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.

Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries.

BACKGROUND: Surgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub-Saharan African countries. METHODS AND FINDINGS: In a retrospective descriptive study, field data were collected from eight district hospitals in Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population. CONCLUSION: The findings of this study clearly indicate low levels of surgical care provision at the district level for the hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable morbidity and mortality. Please see later in the article for the Editors' Summary.

Impact of the COVID-19 Pandemic on Surgical Training and Learner Well-Being: Report of a Survey of General Surgery and Other Surgical Specialty Educators.

BACKGROUND: The COVID-19 pandemic disrupted the delivery of surgical services. The purpose of this communication was to report the impact of the pandemic on surgical training and learner well-being and to document adaptations made by surgery departments. STUDY DESIGN: A 37-item survey was distributed to educational leaders in general surgery and other surgical specialty training programs. It included both closed- and open-ended questions and the self-reported stages of GME during the COVID-19 pandemic, as defined by the ACGME. Statistical associations for items with stage were assessed using categorical analysis. RESULTS: The response rate was 21% (472 of 2,196). US stage distribution (n = 447) was as follows: stage 1, 22%; stage 2, 48%; and stage 3, 30%. Impact on clinical education significantly increased by stage, with severe reductions in nonemergency operations (73% and 86% vs 98%) and emergency operations (8% and 16% vs 34%). Variable effects were reported on minimal expected case numbers across all stages. Reductions were reported in outpatient experience (83%), in-hospital experience (70%), and outside rotations (57%). Increases in ICU rotations were reported with advancing stage (7% and 13% vs 37%). Severity of impact on didactic education increased with stage (14% and 30% vs 46%). Virtual conferences were adopted by 97% across all stages. Severity of impact on learner well-being increased by stage-physical safety (6% and 9% vs 31%), physical health (0% and 7% vs 17%), and emotional health (11% and 24% vs 42%). Regardless of stage, most but not all made adaptations to support trainees' well-being. CONCLUSIONS: The pandemic adversely impacted surgical training and the well-being of learners across all surgical specialties proportional to increasing ACGME stage. There is a need to develop education disaster plans to support technical competency and learner well-being. Careful assessment for program advancement will also be necessary. The experience during this pandemic shows that virtual learning and telemedicine will have a considerable impact on the future of surgical education.

Effects of location and extraction solvent on physico chemical properties of Moringa stenopetala seed oil.

This research was initiated to evaluate the physicochemical property of crude oil from Moringa stenopetala (M. Stenopetala) seed collected from three locations (Damba Gofa, Shelle and Konso) which wasextracted with two solvents (hexane and petroleum ether). Physical properties of crude oil varied from 34.8- 44.3%, 0.8-0.9, 0.8-0.9gcm3and 1.4-1.5 at 40 °C for yield, specific gravity, relative density and refractive index, respectively. The chemical properties of the crude oil varied from 0.1 - 0.3mg KOHg-1, 76.5-91.6g I2 100g-1, 17.6-20.6 mEqKg-1, 154.0-199.3mg KOHg-1 oil and 0.2-0.4mgg-1for Free fatty acid(FFA), iodine value, peroxide value, saponification value and acid value respectively. Two-way interaction effect of all physical and chemical properties showed a significant difference (p < 0.05) except the refractive index. The finding indicates that oil extracted with Hexane from Konso had a better quality. The extraction of oil using hexane from M. stenopetala seed could be of great importance in edible crude oil production. Further investigation should be done on oxidative stability of crude oilof M. Stenopetala.

Think globally, act locally, and collaborate internationally: global health sciences at the University of California, San Francisco.

The University of California, San Francisco (UCSF) established Global Health Sciences (GHS) as a campus-wide initiative in 2003. The mission of GHS is to facilitate UCSF's engagement in global health across its four schools by (1) creating a supportive environment that promotes UCSF's leadership role in global health, (2) providing education and training in global health, (3) convening and coordinating global health research activities, (4) establishing global health outreach programs locally in San Francisco and California, (5) partnering with academic centers, especially less-well-resourced institutions in low- and middle-income countries, and (6) developing and collaborating in international initiatives that address neglected global health issues.GHS education programs include a master of science (MS) program expected to start in September 2008, an introduction to global health for UCSF residents, and a year of training at UCSF for MS and PhD students from low- and middle-income countries that is "sandwiched" between years in their own education program and results in a UCSF Sandwich Certificate. GHS's work with partner institutions in California has a preliminary focus on migration and health, and its work with academic centers in low- and middle-income countries focuses primarily on academic partnerships to train human resources for health. Recognizing that the existing academic structure at UCSF may be inadequate to address the complexity of global health threats in the 21st century, GHS is working with the nine other campuses of the University of California to develop a university-wide transdisciplinary initiative in global health.

Progress in Global Surgery Comment on "Global Surgery - Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa".

Impressive progress has been made in global surgery in the past 10 years, and now serious and evidence-based national strategies are being developed for scaling-up surgical services in sub-Saharan Africa. Key to achieving this goal requires developing a realistic country-based estimate of burden of surgical disease, developing an accurate estimate of existing need, developing methods, rigorously planning and implementing the plan, and scaling-up essential surgical services at the national level.

Visceral leishmaniasis in northern Ethiopia.

BACKGROUND: Visceral leishmaniasis (VL) has been well documented by the Medecins sans Frontieres (MSF) VL treatment programmeme in the Tigray region of Ethiopia, but reports are limited from other facilities in this region where this disease continues to cause substantial morbidity and mortality. OBJECTIVE: To describe the clinical manifestations and treatment outcomes of VL in a government hospital in Axum, Ethiopia. DESIGN: Retrospective analysis of 111 patients treated for visceral leishmaniasis. SETTING: Saint Mary's Hospital, Axum, Ethiopia. SUBJECTS: One hundred and Eleven patients treated for visceral leishmaniasis in a government hospital in Axum, Ethiopia. RESULTS: All patients were male and most reported travel history to Humera, a known endemic area. Patients presented with classic signs and symptoms, including fever, weight loss, splenomegaly and anaemia. Almost one third (15/53) of patients who underwent HIV testing had a positive result. Crude death rate at six months was 13.5 per 100 patients (95% CI: 6.7 - 20.3 per 100 patients). Presence of HIV and other co-infections were associated with increased risk of death. CONCLUSIONS: Clinical manifestations and treatment outcomes in this setting were comparable to that of the MSF programmeme in Tigray, Ethiopia and highlight the importance of HIV testing for patients presenting with visceral leishmaniasis.

Global Surgery 2030: a roadmap for high income country actors.

The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.

A New Master's Degree in Global Health: Reflections on a 5-year Experience.

BACKGROUND: The University of California-San Francisco's (UCSF) Master of Science (MS) degree in global health sciences, a 1-year degree program started in 2008, is the first accredited master's degree in global health in the country. OBJECTIVE: The aim of this study was to review the genesis and structure of the MS degree program, and describe its progress over its first 5 years. METHODS: We reviewed the program's teaching methods, academic curriculum, course evaluations, and backgrounds and outcomes of the first 127 graduates. Student opinions were gathered from anonymous course evaluations. Student outcome data and graduates' perspectives were gathered through a voluntary, anonymous, online survey. We reflect on student demand, program strengths and weaknesses, and future academic directions. FINDINGS: The program's structure arose from three learning objectives identified by the Curriculum Committee: a multidisciplinary approach to the foundations of global health, an emphasis on research design and methods, and an application of theory to international fieldwork. The resulting broad curriculum has attracted students of diverse backgrounds, which has enriched classroom discussions. Over the first 5 years, the program revised its fieldwork project criteria to allow more flexibility in design, leading to a higher rate of publication and enabling students to graduate with an academic portfolio. Students have reported that the high faculty-to-student ratio has fostered strong mentorship relationships; this is vital as 66% of graduates work in academics. Graduates have reflected that group work in the program appropriately prepared them for their work environment. The program's experience has guided its response to: pressure to focus on medical aspects of global health; students' needs for career skill-building; financial challenges; and trends toward online didactics. CONCLUSIONS: The recent surge in interest in global health careers has created demand for academic programs. UCSF has designed the MS degree program to balance breadth and depth of learning in a multidisciplinary curriculum, and combine career preparation and theoretical learning in a one-year academic degree. The challenges of balancing breadth and depth of learning in a multidisciplinary program, and combining career preparation and theoretical learning in a one-year academic degree, have informed UCSF's MS program design.

Schistosomiasis in Omo National Park of southwest Ethiopia.

Schistosomiasis mansoni infection was found in more than 50 tourists who had visited Omo National Park, Ethiopia, and bathed and swum in the Mui River. A survey revealed Schistosoma mansoni infection in 41% of Park residents and in 33% of the neighboring Suri people. Eggs were found in stools and adult worms at autopsy of wild Papio anubis and Cercopithecus aethiops. Trematode larvae were found in 27% of Biomphalaria pfeifferi snails found in the Mui River. The source of the disease and the implications of its spread with the future development of the Omo Valley are discussed.