Phonon downconversion to suppress correlated errors in superconducting qubits.

Quantum error correction can preserve quantum information in the presence of local errors, but correlated errors are fatal. For superconducting qubits, high-energy particle impacts from background radioactivity produce energetic phonons that travel throughout the substrate and create excitations above the superconducting ground state, known as quasiparticles, which can poison all qubits on the chip. We use normal metal reservoirs on the chip back side to downconvert phonons to low energies where they can no longer poison qubits. We introduce a pump-probe scheme involving controlled injection of pair-breaking phonons into the qubit chips. We examine quasiparticle poisoning on chips with and without back-side metallization and demonstrate a reduction in the flux of pair-breaking phonons by over a factor of 20. We use a Ramsey interferometer scheme to simultaneously monitor quasiparticle parity on three qubits for each chip and observe a two-order of magnitude reduction in correlated poisoning due to background radiation.

Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models.

OBJECTIVES: To derive a model of paediatric postdischarge mortality following acute infectious illness. DESIGN: Prospective cohort study. SETTING: 2 hospitals in South-western Uganda. PARTICIPANTS: 1307 children of 6 months to 5 years of age were admitted with a proven or suspected infection. 1242 children were discharged alive and followed up 6 months following discharge. The 6-month follow-up rate was 98.3%. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was postdischarge mortality within 6 months following the initial hospital discharge. RESULTS: 64 children died during admission (5.0%) and 61 died within 6 months of discharge (4.9%). Of those who died following discharge, 31 (51%) occurred within the first 30 days. The final adjusted model for the prediction of postdischarge mortality included the variables mid-upper arm circumference (OR 0.95, 95% CI 0.94 to 0.97, per 1 mm increase), time since last hospitalisation (OR 0.76, 95% CI 0.61 to 0.93, for each increased period of no hospitalisation), oxygen saturation (OR 0.96, 95% CI 0.93 to 0·99, per 1% increase), abnormal Blantyre Coma Scale score (OR 2.39, 95% CI 1·18 to 4.83), and HIV-positive status (OR 2.98, 95% CI 1.36 to 6.53). This model produced a receiver operating characteristic curve with an area under the curve of 0.82. With sensitivity of 80%, our model had a specificity of 66%. Approximately 35% of children would be identified as high risk (11.1% mortality risk) and the remaining would be classified as low risk (1.4% mortality risk), in a similar cohort. CONCLUSIONS: Mortality following discharge is a poorly recognised contributor to child mortality. Identification of at-risk children is critical in developing postdischarge interventions. A simple prediction tool that uses 5 easily collected variables can be used to identify children at high risk of death after discharge. Improved discharge planning and care could be provided for high-risk children.

Adults with chronic cough in urban Bangladesh: healthcare utilization and management of cases by private practitioners.

Tuberculosis (TB) case detection under the Directly Observed Treatment - Short-course (DOTS) strategy largely relies upon care seeking of chronic coughers and the actions taken by their healthcare providers. This study aimed to describe the healthcare utilization of people 15 years of age with a chronic cough in urban areas of Bangladesh and to understand their management by private practitioners. A community-based, household survey included 60,382 persons ≥ 15 years of age from two administrative areas of Dhaka City. A total of 1138 (2%) were identified to have had a cough for 3 weeks or more. This survey was linked to interviews of licensed and unlicensed practitioners in Dhaka and the Chittagong City Corporation of Bangladesh. Among identified coughers, 1046 (92%) were interviewed, of whom 648 (62%) reported having sought care from any provider. Among care seekers, 16% directly attended a DOTS facility. The remaining 84% sought care from the private sector, where less than 1% reported referral to a DOTS facility. Bivariate and multivariate assessments showed that care seeking from a licensed private practitioner or a DOTS centre was significantly associated with severity of the disease and previous diagnosis of TB.

Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh.

SUMMARY OBJECTIVE: To determine the effectiveness of green banana in the home management of acute (<7 days) or prolonged (≥ 7 days) diarrhoea at the community level. METHODS: A cluster randomized field trial was conducted among 2968 Bangladeshi rural children 6-36 months old. Wards (villages) were randomly assigned to either a standard care group or a standard care plus green banana group where mothers were instructed to add cooked green banana to the diets of diarrhoeal children. Through a village-based surveillance system, diarrhoeal morbidity data (severity, duration, compliance) were collected for 14 days. Treatment effects were determined by analysing cumulative probability of cure by testing Cox proportional hazards models and relative risk (RR). RESULTS: The cumulative probability of cure was significantly (P < 0.001) different in children receiving GB for both acute [hazard ratio (HR) = 0.63 (95% CI: 0.56-0.67)] and prolonged diarrhoea [HR = 0.38 (95% CI: 0.26-0.59)]. The recovery rates of children with acute diarrhoea receiving GB (vs. control) were significantly more by day 3: 79.9%vs. 53.3% [(RR) = 0.47, 95% CI: 0.41-0.55], (P < 0.001) and day 7: 96.6%vs. 89.1% (RR = 0.32; 0.22-0.46), (P < 0.001). Children with prolonged diarrhoea receiving green banana had significantly higher recovery rates by day 10: 79.8%vs. 51.9% (RR = 0.42; 0.23-0.73), (P < 0.001) and day 14: 93.6%vs. 67.2% (RR = 0.22; 0.08-0.54), (P < 0.001). CONCLUSION: A green banana-supplemented diet hastened recovery of acute and prolonged childhood diarrhoea managed at home in rural Bangladesh.

Effects of local climate variability on transmission dynamics of cholera in Matlab, Bangladesh.

Cholera is considered as a model for climate-related infectious diseases. In Bangladesh, cholera epidemics occur during summer and winter seasons, but it is not known how climate variability influences the seasonality of cholera. Therefore, the variability pattern of cholera events was studied in relation to the variation in local climate variables in Matlab, Bangladesh. Classification and regression tree (CART) and principal component analysis (PCA) were used to study the dependency and variability pattern of monthly total cholera cases. An average temperature <23.25 degrees C corresponded to the lowest average cholera occurrence (23 cases/month). At a temperature of >or=23.25 degrees C and sunshine <4.13h/day, the cholera occurrence was 39 cases/month. With increased sunshine (>or=4.13h/day) and temperature (23.25-28.66 degrees C), the second highest cholera occurrence (44 cases/month) was observed. When the sunshine was >or=4.13h/day and the temperature was >28.66 degrees C, the highest cholera occurrence (54 cases/month) was observed. These results demonstrate that in summer and winter seasons in Bangladesh, temperature and sunshine hours compensate each other for higher cholera incidence. The synergistic effect of temperature and sunshine hours provided the highest number of cholera cases.

Introduction of routine zinc therapy for children with diarrhoea: evaluation of safety.

On 8 May 2004, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommended routine administration of zinc in the management of children, aged less than five years, with acute diarrhoea. In making the recommendation, WHO and UNICEF also suggested careful monitoring for adverse events associated with routine administration of zinc, particularly unusual or excess vomiting. The study assessed, in a phase IV trial, i.e. post-marketing surveillance of zinc, the occurrence of adverse events during the first hour after the administration of the first dose of zinc in children with acute or persistent diarrhoea. The study was conducted at the Dhaka Hospital of ICDDR,B and at an outpatient clinic operated by a local health NGO-Progoti Samaj Kallyan Protisthan (PSKP), Dhaka, Bangladesh. Eligible children, aged 3-59 months, were treated with 20 mg of zinc sulphate provided in a dispersible tablet formulation. The children were observed for 60 minutes following the initial treatment with zinc for adverse events, with particular attention given to vomiting or regurgitation. During the one-year observation period, 42,440 children (male 57% and female 43%) received zinc, and 20,246 (47.8%) of them were observed. Regurgitation and/or vomiting occurred in 4,392 (21.8%) of the children; 90.8% of these children had vomiting only once, 8.7% twice, and 0.5% more than twice. No children revisited the hospital for recurrent vomiting following their discharge. A significant proportion of infants and children may experience vomiting or regurgitation, usually once, following the administration of the first dose of zinc. This is a transient phenomenon that did not impact on continuation of treatment with zinc.

Urban to rural routes of HIV infection spread in Ethiopia.

A descriptive survey to identify routes of spread of HIV infection from urban to rural populations was carried out in a rural south-central Ethiopian district. High risk practices for HIV infection and transmission were first documented among rural residing former soldiers, merchants and students. Extramarital intercourse during the previous 3 months was reported by 45-50% of these subgroups. In 25-37%, intercourse with an urban commercial sex worker (CSW) was reported and condom use varied from 10 to 30% among subgroups. The perceived risk for AIDS was low and changes in risk behaviours were minimal. Next, 502 rural males farmers were surveyed. An extramarital sexual contact in the past 3 months was reported by 13.5%, with 7% reporting their most recent contact with an urban CSW. Only 6% of farmers reported using condoms. Awareness of AIDS was reported by 59% and, of these, only 28% perceived they were vulnerable. In this study increased knowledge was associated with more frequent high risk sexual practices. It is concluded that the spread of AIDS into rural communities is occurring as a result of the high frequency of high risk sexual behaviours in specific rural residing subgroups which frequently travel into urban communities in combination with a low background prevalence of high risk practices among the general male farmer population.

PIP: During December 1991-February 1992, in Ethiopia, interviews were conducted with 19 merchants, 20 high school students, 20 recently returned soldiers, and 502 rural farmers to examine movement patterns and the incidence of high risk behaviors for HIV infection and transmission from urban into rural communities. 45-50% of soldiers, students, and merchants had extramarital intercourse in the last three months, mainly with a commercial sex worker (CSW) (45-78%). (HIV prevalence among CSWs exceeds 60% in some instances.) Condom use was highest in students (55%), followed by soldiers (22%). None of the merchants used a condom. Among the men who had had extramarital sex, the mean number of penetrations/contact ranged from 3.7 to 4.9 per subgroup. 90% of soldiers, 40% of students, and 32% of merchants hoped to have sexual intercourse while in town. 13% of farmers had had extramarital sex, usually with a CSW (50%), in town (54%), and without using a condom (94%). All the students knew about AIDS and condoms, yet only 40% considered themselves vulnerable to AIDS and only 10% changed their sex behavior. Most soldiers, merchants, and farmers knew about AIDS (70%, 68%, and 59%, respectively). Knowledge of condoms was lowest among farmers (11% vs. 80% for soldiers and 47% for merchants). Less than 50% of soldiers considered themselves to be vulnerable to AIDS and only 14% had adopted safer sex practices. Only 28% of farmers who knew about AIDS considered themselves at risk of AIDS. Among farmers, high risk sexual practices were related to younger age (p 0.03), literacy (p 0.05), Gurage ethnicity (p 0.008), and Moslem religion (p 0.001). When the researchers controlled for age, literacy, and religion, knowledge about AIDS had a strong positive association with high risk sexual practices (beta = 0.19; 95% confidence interval, 0.01-0.3). These findings indicate that high risk sexual behaviors for HIV infection are common among highly mobile, rural male populations. They suggest that farmers may be the main carrier of HIV into rural Ethiopian communities.

Parental smoking and risk of otitis media in pre-school children.

This study was designed to estimate the role of passive smoking in the occurrence of repeated acute otitis media among pre-school children. The parents of 918 children, who were part of a birth cohort, were interviewed when the children were four years old. The frequency of episodes of otitis media was determined, as well as the age at which the first such episode occurred. Information about smoking in the home had been obtained when the child was two weeks old and again at 6, 12, 18 and 40 months of age. In all, 119 mothers (13%) smoked at least 20 cigarettes a day on average, 205 (22%) smoked less than 20, and 593 (65%) stated that they did not smoke at all. Children of mothers who smoked 20 or more cigarettes per day were at significantly increased risk of having four or more episodes of acute otitis media: relative risk (RR) = 1.8, 95% confidence interval (CI) = 1.1-3.0 and of having their first episode earlier in life RR = 1.3 (CI = 1.0-1.8), after adjustment. Moreover, the risk of recurrent (> or = four episodes) otitis media increases with the amount of cigarettes smoked. These findings clearly strengthen the case for persuading parents not to smoke in the presence of young children.

Multisite evaluation of a continuous intraarterial blood gas monitoring system.

BACKGROUND: We compared the performance of a new, continuous intraarterial blood gas (CIABG) monitor with arterial values obtained periodically and analyzed by conventional equipment. METHODS: A CIABG monitoring system consisting of a sterile, disposable, fiberoptic sensor and a microprocessor-controlled monitor with a self-contained calibration unit and detachable display panel was used. The sensor was inserted through a 20-G radial artery cannula. Light was transmitted from the monitor to the sensor tip where it reacted with fluorescent dyes sensitive to oxygen or hydrogen ions (analytes). The change in the intensity of the photoluminescent radiation caused by the analytes was measured every 20 s and derived blood gas values were displayed. Twenty-nine sensors were evaluated in 29 surgical or intensive care unit patients at one of three institutions (Stanford University Hospital, Evanston Memorial Hospital, and the Palo Alto Veterans Administration Hospital). The duration of study averaged 6 h (5-8 h) in the operating room, and 46 h (7-121 h) in the intensive care unit. A total of 552 values were compared with those obtained at regular intervals and analyzed in the hospital blood gas laboratory. Average bias (mean difference between lab value and CIABG), precision (SD of difference), and drift (change in the bias with time were determined. RESULTS: At arterial oxygen tension (PO2) values of 32-528 mmHg, the average bias was -1% meaning that the average CIABG monitor values were 1% lower than those obtained by conventional equipment. The precision was 15%. At arterial PO2 values of 32-99 mmHg, average bias and precision were -0.3 +/- 8.9 mmHg. At arterial carbon dioxide tension (PCO2) values of 24-54 mmHg, average bias and precision were 1.3 +/- 3.3 mmHg, and at pHa values of 7.23-7.57, average bias and precision were 0.01 +/- 0.04. Observed drift per day was -1.2% for arterial PO2, 0.3 mmHg for arterial PCO2, and 0.01 for pH. Bias and precision for samples compared in two pairs of like-model in vitro blood gas analyzers were 0.4 +/- 4.6% for arterial PO2 over the full range, and 0.4 +/- 3.7 mmHg for values less than 100 mmHg, -0.5 +/- 1.8 mmHg for arterial PCO2, and 0.01 +/- 0.01 for pHa. Although the occasional marked discrepancies between one or more CIABG and in vitro values could sometimes be corrected by flushing the arterial catheter or repositioning the sensor, usually we could not determine the cause of the discrepancy or which values were the more accurate. CONCLUSIONS: Over the range of values and under the clinical conditions studied, CIABG monitoring provides immediate blood gas results and trend information with sufficient agreement with in vitro results to be reliable for decision making in most clinical circumstances. Generally, the differences in the values between the two methods of analysis were the result of the combination of the inherent errors of each method. Additional studies need to be undertaken to evaluate the performance of the CIABG monitor across wider ranges of blood gas values, especially for arterial PO2 values less than 60 mmHg and arterial PCO2 values greater than 50 mmHg.

Health in Ethiopia: a summary of 52 district health profiles

This paper integrates the data contained in 52 district health profiles completed during the years 1988 to 1991. These profiles encompass approximately 40 percent of the Ethiopian population and thus provide a summary assessment of health services and health status. Thirty percent of children were found to be attending school; 33 percent of children under five years of age were malnourished; and 35 percent of the population had access to safe water. The analysis was stratified by districts; urban versus rural populations; and hospital versus non hospital health institutions. Large disparities between districts were found in measures of health and human development. On a per capita basis; urban districts benefit from three times the number of physicians; four times more nurses; and double the number of health assistants. Nearly; 70 percent of physicians and nurses were hospital based. Of the 1.88 birr per capita yearly health expenditure; hospital budget accounted for 60 percent. This summary review of health profiles provides baseline data on the health of Ethiopians early in the establishment of district health services from which future trends can be monitored

Modern contraception use in Ethiopia: does involving husbands make a difference?

OBJECTIVES: This study was undertaken to determine the relative efficacy of home visitation with and without husband participation on the use of modern contraception in Ethiopia. METHODS: A randomized field trial of a family planning education intervention using home visitation with and without husband participation was conducted in Addis Ababa, Ethiopia, from August 1990 to December 1991 and included a 12-month postintervention follow-up. A total of 266 experimental and 261 control subjects were entered, of whom 91.7% and 88.9%, respectively, were followed through 12 months. RESULTS: A greater proportion of couples in the experimental group were practicing modern contraception at 2 months (25% vs 15%) and 12 months (33% vs 17%) following the home visit intervention. By 12 months following the home visits, experimental subjects were less likely to have defaulted and more likely to have started using modern contraception following an initial delay. CONCLUSIONS: The inclusion of husbands in family planning programs will result in relevant increases in the use of modern contraception. However, there exists an important "sleeper" effect to the education intervention, reflected by a delay of greater than 2 months in the initiation of modern contraception for most couples.

A community-based randomized trial of home-made oral rehydration therapies.

A field trial of the relative efficacy of three oral rehydration therapies (ORT) in the treatment of acute childhood diarrhoea in children < 5 years old was carried out in a rural Ethiopian district. The three ORT were 1) pre-packaged glucose and salt solution (GORS; n = 153), 2) home-made cereal added to pre-packaged salt solution (CBORS; n = 154), and 3) entirely home-made cereal-based and salt therapy (CBORT; n = 156). Out of 127 eligible peasant associations, 18 were randomly selected, and groups of six were then randomly assigned to receive one of the three treatment options. In infants aged 0-12 months, after adjusting for baseline weight and diarrhoea frequency, CBORT was found to be superior (P < 0.01) to GORS and CBORS in terms of weight gain at 24, 48, and 96 hours. There were no significant between-group differences in weight gain in children > 12 months old. Over the 96-hour duration of follow-up, mothers' compliance was significantly better among those giving CBORT when compared to CBORS (P < 0.001) or GORS (P < 0.013). The results of this field trial indicate that CBORT is an efficacious alternative to GORS or CBORS in the treatment of acute childhood diarrhoea in rural community settings. Larger scale, effectiveness studies are recommended.

PIP: Public health specialists conducted a randomized, field trial in the East Shewa Administrative Region of Adamaboset District in Ethiopia to discover the relative efficacy of 3 different oral rehydration therapies (ORTs) in treating acute childhood diarrhea. These ORTs were prepackaged glucose and salt solution (GORS), homemade cereal added to a prepackaged salt solution (CBORS), and completely homemade cereal plus salt therapy (CBORT). The study population consisted of 463 children less than 5 years old with active diarrhea living in 18 of 127 rural peasant associations in the district. When the researchers adjusted for child's weight and diarrhea frequency at outset, 0-12 month old CBORT infants gained more weight than did GORS and CBORS infants at 24, 48 and 96 hours following treatment (p .01). No significant difference in weight gain occurred, however, among children older than 1 year. CBORT children experienced fewer mean total stools per day than did the other groups (2.77 vs. 3.67 for CBORS and 3.79 for GORS; p .01). Dehydration scores were essentially the same for all groups. Mothers using CBORT were more likely to comply with rehydration therapy instructions that were those using CBORS (p .001) or GORS (p .013). The children were more likely to favor the prepackaged solutions than CBORT (p .015). The researchers suggested that the improved compliance among CBORT mothers accounted for the increased weight gain in 0-12 month old CBORT infants. These findings indicated that entirely homemade ORT has the potential of reaching the greatest number of children, but further longitudinal studies of compliance and safety in preparation are needed.

The occurrence and driver characteristics associated with motor vehicle injuries in Addis Ababa, Ethiopia.

Ethiopian documentation of the occurrence and determinants of motor vehicle related morbidity and mortality is sparse. The purpose of this investigation was to determine the incidence of hospital treated motor vehicle injuries (MVI) in Addis Ababa and driver characteristics associated with involvement in a MVI. The study was conducted over a 12-week period in the autumn of 1988. Over 91% of MVI involved pedestrians. The overall MVI incidence density rate was 279.4 per 100,000 person years and the mortality rate was 17.6 per 100,000 population per year. Road accident injury and fatality rates were 946 and 59.5 respectively per 10,000 registered vehicles. Overall years of person life lost was 595 per 100,000 person-years exposure. Significantly increased odds of exposure among drivers inflicting a MVI were found for younger age, fewer years driving experience, male gender, and those driving newer, government owned, and mass transit vehicles.

Determinants of mental illness in a rural Ethiopian adult population.

A cross-sectional survey was conducted on 2000 adult Ethiopians living in rural communities to determine firstly the prevalence of mental illness and secondly its association with stress and demographic variables. The Self-Reporting Questionnaire developed by WHO experts was used as the measure of mental illness. A modified version of the Holmes-Rahe Social Readjustment Scale was the measure of stress. Respondents were interviewed in their homes. Those experiencing 11 or more of the 20 neurotic symptoms and 3 or more of the 4 psychotic symptoms were considered mentally ill. Despite the use of high cut-off points for identifying potential cases, the prevalence of mental illness was 17.2%--neurotic 11.2% and psychotic 6.0%. This is higher than earlier reports for Ethiopia, but comparable to rates found in other African countries. Mental illness scores were most strongly associated with stress in that the odds of experiencing 6 or more stressful life events in the past year were 2.7 times greater for neurotics and 2.1 times greater for psychotics. In addition, neuroses and psychoses were significantly associated with a family history of mental illness and with being divorced, separated or widowed. Neurosis alone was also associated with chronic illness, females, those between the ages of 35 and 44, and illiteracy. These findings were discussed in terms of their relevance for identifying high stress groups and thus for preventing mental illness through community activities.