A scorecard of progress towards measles elimination in 15 west African countries, 2001-19: a retrospective, multicountry analysis of national immunisation coverage and surveillance data.

BACKGROUND: The WHO Regional Office for the Africa Regional Immunization Technical Advisory Group, in 2011, adopted the measles control and elimination goals for all countries of the African region to achieve in 2015 and 2020 respectively. Our aim was to track the current status of progress towards measles control and elimination milestones across 15 west African countries between 2001 and 2019. METHODS: We did a retrospective multicountry series analysis of national immunisation coverage and case surveillance data from Jan 1, 2001, to Dec 31, 2019. Our analysis focused on the 15 west African countries that constitute the Economic Community of West African States. We tracked progress in the coverage of measles-containing vaccines (MCVs), measles supplementary immunisation activities, and measles incidence rates. We developed a country-level measles summary scorecard using eight indicators to track progress towards measles elimination as of the end of 2019. The summary indicators were tracked against measles control and elimination milestones. FINDINGS: The weighted average regional first-dose MCV coverage in 2019 was 66% compared with 45% in 2001. 73% (11 of 15) of the west African countries had introduced second-dose MCV as of December, 2019. An estimated 4 588 040 children (aged 12-23 months) did not receive first-dose MCV in 2019, the majority (71%) of whom lived in Nigeria. Based on the scorecard, 12 (80%) countries are off-track to achieving measles elimination milestones; however, Cape Verde, The Gambia, and Ghana have made substantial progress. INTERPRETATION: Measles will continue to be endemic in west Africa after 2020. The regional measles incidence rate in 2019 was 33 times the 2020 elimination target of less than 1 case per million population. However, some hope exists as countries can look at the efforts made by Cape Verde, The Gambia, and Ghana and learn from them. FUNDING: None.

Effects of mechanical ventilation and portable air cleaner on aerosol removal from dental treatment rooms.

OBJECTIVES: To evaluate the mechanical ventilation rates of dental treatment rooms and assess the effectiveness of aerosol removal by mechanical ventilation and a portable air cleaner (PAC) with a high-efficiency particulate air (HEPA) filter. METHODS: Volumetric airflow were measured to assess air change rate per hour by ventilation (ACHvent). Equivalent ventilation provided by the PAC (ACHpac) was calculated based on its clean air delivery rate. Concentrations of 0.3, 0.5 and 1.0 µm aerosol particles were measured in 10 dental treatment rooms with various ventilation rates at baseline, after 5-min of incense burn, and after 30-min of observation with and without the PAC or ventilation system in operation. Velocities of aerosol removal were assessed by concentration decay constants for the 0.3 µm particles with ventilation alone (Kn) and with ventilation and PAC (Kn+pac), and by times needed to reach 95 % and 100 % removal of accumulated aerosol particles. RESULTS: ACHvent varied from 3 to 45. Kn and Kn+pac were correlated with ACHvent (r = 0.90) and combined ACHtotal (r = 0.81), respectively. Accumulated aerosol particles could not be removed by ventilation alone within 30-min in rooms with ACHvent<15. PAC reduced aerosol accumulation and accelerated aerosol removal, and accumulated aerosols could be completely removed in 4 to 12-min by ventilation combined with PAC. Effectiveness of the PAC was especially prominent in rooms with poor ventilation. Added benefit of PAC in aerosol removal was inversely correlated with ACHvent. CONCLUSIONS: Aerosol accumulation may occur in dental treatment rooms with poor ventilation. Addition of PAC with a HEPA filter significantly reduced aerosol accumulation and accelerated aerosol removal. CLINICAL SIGNIFICANCE: Addition of PAC with a HEPA filter improves aerosol removal in rooms with low ventilation rates.

Determination of ambient noise levels in the medical and surgical intensive care units and adult ward of the Makati Medical Center

Objective@#To measure the levels of environmental noise in the medical intensive care unit, surgical intensive care unit, and adult ward of the Makati Medical Center for the morning, afternoon, and evening shifts, on weekdays and weekends, and to compare noise levels across shifts, and between weekdays and weekends. @*Methods@#Design: Environmental Noise Survey. Setting: Tertiary Private Training Hospital. Participants: None. @*Results@#The overall mean environment noise levels in all the areas surveyed (medical intensive care unit, surgical intensive care unit and adult ward) exceeded World Health Organization recommendations by more than 20 dB across different working shifts on both weekdays and weekends. There was no significant difference in noise levels between weekdays and weekends across shifts in all areas, except for the afternoon shift in the Medical ICU. Using Repeated Measures ANOVA, results showed that there is no sufficient evidence to conclude that at least one shift has significantly different mean noise level in any of the 3 areas (MICU: F(2)=4.73, p-value=.1124; SICU: F(2)=7.91, p-value=.0540; WARD: F(2)=2.73, p-value=.1948) @*Conclusion@#The overall environmental noise levels in the different areas of MICU, SICU and Adult ward exceeded the WHO recommendation. It is recommended that a change in strategy is needed for prevention of environmental noise, setting guidelines and policies to assure quality health care and noise control. Further investigations to ascertain exact sources may give rise to feasible solutions.

Comparison of ICRP 67 and Other Plutonium Systemic Model Predictions with the Biokinetic Data from Nonhuman Primates.

Despite the presence of a relatively large amount of human data available on the metabolism of plutonium, the experimental animal data is still important in constructing and parameterizing the biokinetic models. Recognizing this importance, the biokinetic data obtained from studies done by P.W. Durbin in nonhuman primates (NHP) were evaluated against the ICRP 67 systemic model and the two human models developed thereafter. The default transfer rates recommended for adult humans in these models predict the urinary excretion in NHP to a certain extent. However, they were unable to describe the fecal excretion rates several days post intake and the activities in skeleton and liver at the time of the death. These inconsistencies between the human reference models and the NHP biokinetic data are the result of metabolic and physiological differences between the species, as demonstrated by early biokinetic studies.