The SOAR stroke score predicts hospital length of stay in acute stroke: an external validation study.

AIMS: The objective of this study is to externally validate the SOAR stroke score (Stroke subtype, Oxfordshire Community Stroke Project Classification, Age and prestroke modified Rankin score) in predicting hospital length of stay (LOS) following an admission for acute stroke. METHODS: We conducted a multi-centre observational study in eight National Health Service hospital trusts in the Anglia Stroke & Heart Clinical Network between September 2008 and April 2011. The usefulness of the SOAR stroke score in predicting hospital LOS in the acute settings was examined for all stroke and then stratified by discharge status (discharged alive or died during the admission). RESULTS: A total of 3596 patients (mean age 77 years) with first-ever or recurrent stroke (92% ischaemic) were included. Increasing LOS was observed with increasing SOAR stroke score (p < 0.001 for both mean and median) and the SOAR stroke score of 0 had the shortest mean LOS (12 ± 20 days) while the SOAR stroke score of 6 had the longest mean LOS (26 ± 28 days). Among patients who were discharged alive, increasing SOAR stroke score had a significantly higher mean and median LOS (p < 0.001 for both mean and median) and the LOS peaked among patients with score value of 6 [mean (SD) 35 ± 31 days, median (IQR) 23 (14-48) days]. For patients who died as in-patient, there was no significant difference in mean or median LOS with increasing SOAR stroke score (p = 0.68 and p = 0.79, respectively). CONCLUSION: This external validation study confirms the usefulness of the SOAR stroke score in predicting LOS in patients with acute stroke especially in those who are likely to survive to discharge. This provides a simple prognostic score useful for clinicians, patients and service providers.

Stability of vision during space flight in an astronaut with bilateral intraocular lenses.

PURPOSE: To report excellent and stable vision in an astronaut during space flight after bilateral cataract surgery with intraocular lenses. METHODS: A 60-year-old physician mission specialist astronaut developed cataracts and underwent phacoemulsification with insertion of one-piece polymethylmethacrylate intraocular lenses that had 6-mm optics bilaterally. Several months later, he flew on a space shuttle mission. Ocular examinations were performed before and after the mission, and the patient was questioned about visual changes during flight. RESULTS: Ocular examinations demonstrated stable bilateral posterior chamber intraocular lenses. Our subject reported excellent vision during liftoff, 18 days of microgravity, changes in cabin pressure, and reentry. CONCLUSION: Results suggest that intraocular lenses are safe, effective, and well tolerated during space flight.

Demographic impact of HIV infection in rural Rakai district, Uganda: results of a population-based cohort study.

OBJECTIVES: To examine HIV-1-related mortality and demographic impact in a high HIV prevalence rural district of Uganda. DESIGN: One-year follow-up (1990-1991) in a population-based rural cohort. SETTING AND PARTICIPANTS: Annual enumeration of all consenting residents of 1945 households in 31 randomly selected community clusters in Rakai District. Subjects provided yearly HIV serological samples, behavioral and health information. MAIN OUTCOME MEASURE: Mortality in HIV-infected and uninfected persons. RESULTS: Mortality among HIV-seropositive adults aged > or = 15 years of 118.4 per 1000 person-years (PY) was substantially higher than in HIV-seronegative adults [12.4 per 1000 PY; relative risk (RR), 9.5; 95% confidence interval (CI), 6.0-14.9]. Infant mortality among offspring of HIV-infected mothers was almost double that for uninfected women (210 compared with 111 per 1000 live births; RR, 1.9; 95% CI, 1.0-3.5). Adult HIV-related mortality was associated with HIV prevalence and, in this cohort, with higher education, non-agricultural occupation and residence in roadside trading centers. We estimate that adult HIV prevalence in the district is 13% and adult HIV attributable mortality 52%. For all ages combined, district HIV attributable mortality is 28%. CONCLUSION: HIV is the leading cause of adult death in Rakai. Its effects on mortality are particularly marked in the most economically active sectors. However, the overall crude birth rate in the district (45.7 per 1000 population) remains higher than the crude death rate (28.1 per 1000 population), resulting in continued rapid population growth.

Incidence of HIV-1 infection in a rural region of Uganda.

OBJECTIVE: To determine the incidence of infection with HIV-1 and the risk factors associated with seroconversion in three geographical strata of a rural Ugandan district. DESIGN: Serological, sociodemographic, and behavioural surveys of everyone aged 13 or more in 21 randomly selected communities at baseline and one year later. SETTING: Rural population of Rakai district, southwestern Uganda, residing in main road trading centres, secondary trading villages, and agricultural villages. SUBJECTS: In 1989, 1292 adults provided a blood sample and interview data; one year later, 778 survivors (77%) who had been seronegative at baseline provided follow up data. MAIN OUTCOME MEASURES: Incidence of HIV infection in relation to individual characteristics and risk factors, including place of residence. RESULTS: Incidence of HIV infection in all adults was 2.1/100 person years of observation (SE 0.5 (95% confidence interval 1.1 to 3.1)); in people aged 15-39 the incidence was 3.2/100 person years. Incidence was highest in men and women aged 20-24 (9.2/100 person years (3.9) and 6.8/100 person years (2.9) respectively). Risk factors significantly associated with seroconversion were age 24 and under and two or more sexual partners. Between the surveys the proportion of all respondents reporting high risk behaviour (two or more partners) significantly increased from 8.9% to 12.3%. CONCLUSIONS: Despite preventive programmes and substantial knowledge about AIDS the incidence of HIV infection remains high in this rural population. Prevention aimed at vulnerable rural communities is urgently needed to contain the HIV epidemic.

PIP: In 1990, researchers followed up on as many of the 1292 adults they surveyed in 1989 as they who lived in rural Rakai district in southwestern Uganda to determine HIV-1 incidence and the risk factors associated with seroconversion. They were only able to follow up on 774 of the 1037 adults who were HIV-1 seronegative in 1989. In 1989, knowledge about AIDS and about sexual intercourse as a mode of HIV transmission was high (94% and 86%, respectively). The 1989 HIV-1 seroprevalence rate ranged from 38.5% in trading centers to 8.6% in agricultural villages off main and secondary roads. 21 (2.7%) had seroconverted (incidence = 2.1/100 person years). Since the researchers oversampled in trading centers, they estimated the weighted seroincidence to be 1.9%. HIV-1 seroconversion peaked in the 20-24 year old age group with it being greater in men than in women (9.2% vs. 6.8%). The most significant risk factor for seroconversion was number of sexual partners (8.3% for 2 or more partners vs. 2.5% for 0-1 partners; rate ratio = 3.4; p .01 for trend). The risk of seroconversion for someone with just 1 sexual partner was high (2.8%), reflecting the high HIV-1 seroprevalence in Rakai district. The percentage of subjects with at least 2 sexual partners rose from 8.9% in 1989 to 12.3% in 1990. Seroconversion was not associated with injections. No one had had a blood transfusion. Attendance at a 1989 AIDS education rally did not affect HIV seroconversion. In fact, it was greater among people attending the rally (3.5% vs. 2.1%). Logistic regression revealed that age and numbers of partners were the only significant factors affecting seroconversion (odds ration [OR] for 15-24 years compared to 25-39 years was 3.9 and OR for 2 or more sexual partners was 6.5). These findings indicated that existing HIV/AIDS education programs do not reduce HIV transmission and that better strategies are needed.

Expression of P.69/pertactin from Bordetella pertussis in a baculovirus/insect cell expression system: protective properties of the recombinant protein.

The surface antigen P.69/pertactin of Bordetella pertussis has been expressed using the polyhedron promoter of baculovirus in cultured insect cells. Either full-length or truncated prn DNA was used to express P.69 pertactin. The full-length gene gave rise to low levels of P.93 precursor protein, some of which was processed to P.69. The shortened prn expressed P.69 pertactin directly at levels up to 3.5 mg per litre. P.69 vaccinated animals were protected against aerosol challenge with virulent B. pertussis bacteria.

Focus group interviews about AIDS in Rakai District of Uganda.

Focus group interviews about AIDS were held in Rakai district, Uganda during early 1990 with groups from various sections of the community. It was found that the knowledge of AIDS symptoms and its transmission were widespread. Attitudes regarding many aspects of sexual behavior, AIDS patients, condoms, injections, hospital treatment, sexually transmitted diseases and an AIDS cure were investigated. We found that most people no longer fear casual contact with AIDS patients but they blame spouses of people with AIDS for spreading the infection. Condoms are generally not trusted. Many people feel that condoms cannot prevent transmission of the AIDS virus and some fear that they may get torn and cause complications in women. Most people now do not like injections for treatment and when necessary, prefer disposable needles and syringes. Hospital treatment for AIDS patients is not trusted very much, and many people believe that AIDS patients are intentionally killed off by doctors. Sexual behavior was extensively discussed and it was found that there is generally a reduced level of multiple sexual partners. The reduction is more marked in rural areas but the urban areas are still having higher levels of multiple sexual partners.

HIV risk factors in three geographic strata of rural Rakai District, Uganda.

OBJECTIVES: To examine risk factors for HIV-1 infection in three geographic strata (main road trading centers that service local and international traffic, small trading villages on secondary dirt roads that serve as foci for local communications, and agricultural villages off main and secondary roads) in Rakai District, Uganda. DESIGN AND METHODS: Serological, sociodemographic, knowledge/behaviors and health survey conducted in 21 randomly selected community clusters; complete data were collected for 1292 consenting adults. RESULTS: Fifteen per cent of the men and 24% of the women were HIV-1-positive. On univariate analysis, several sociodemographic and behavioral factors were significantly associated with risk of HIV infection, including age, place of residence, travel, occupation, marital status, number of sex partners, sex for money or gifts, history of sexually transmitted disease (STD), and history of injections. On multivariate analysis, age, residence and number of sex partners remained significantly associated with HIV infection in both sexes; a history of STD and not having been circumcised were significant in men. There was a significant interaction between place of residence and reported number of sex partners: for any given level of sexual activity, the risk of HIV infection was markedly increased if the background community prevalence was high. CONCLUSION: Sexual transmission appears to be the primary behavioral risk factor for infection, but the risks associated with this factor vary substantially between the three geographic strata. These data can be used to design targeted interventions.

HIV risk factors in three geographic strata of rural Rakai District; Uganda

OBJECTIVES: To examine risk factors for HIV-1 infection in three geographic strata (main road trading centers that service local and international traffic; small trading villages on secondary dirt roads that serve as foci for local communications; and agricultural villages off main and secondary roads) in Rakai District; Uganda. DESIGN AND METHODS: Serological; sociodemographic; knowledge/behaviors and health survey conducted in 21 randomly selected community clusters; complete data were collected for 1292 consenting adults. RESULTS: Fifteen per cent of the men and 24pc of the women were HIV-1-positive. On univariate analysis; several sociodemographic and behavioral factors were significantly associated with risk of HIV infection; including age; place of residence; travel; occupation; marital status; number of sex partners; sex for money or gifts; history of sexually transmitted disease (STD); and history of injections. On multivariate analysis; age; residence and number of sex partners remained significantly associated with HIV infection in both sexes; a history of STD and not having been circumcised were significant in men. There was a significant interaction between place of residence and reported number of sex partners: for any given level of sexual activity; the risk of HIV infection was markedly increased if the background community prevalence was high. CONCLUSION: Sexual transmission appears to be the primary behavioral risk factor for infection; but the risks associated with this factor vary substantially between the three geographic strata. These data can be used to design targeted interventions

Dynamics of spread of HIV-I infection in a rural district of Uganda.

OBJECTIVE: To define the geographical distribution of HIV infection and the community characteristics associated with HIV prevalence in a rural population of Uganda. DESIGN: Seroprevalence survey and interviews of the population aged 13 years and older in 21 randomly selected clusters. SETTING: Rural population of Rakai district, south west Uganda. SUBJECTS: 1292 adults, of whom 594 men and 698 women gave a blood sample and answered the questionnaire. MAIN OUTCOME MEASURES: HIV status determined by ELISA and western blotting in relation to community characteristics. RESULTS: The weighted seroprevalence of HIV for the district was 12.6% with prevalence by cluster varying from 1.2% to 52.8%. Seroprevalence was highest in main road trading centres (men 26%, women 47%), intermediate in rural trading villages on secondary roads (men 22%, women 29%), and lowest in rural agricultural villages (men 8%, women 9%). For both men and women, multiple regression showed a strong negative association between cluster seroprevalence and the proportion of the population employed in agriculture (beta = -0.677 for men, -0.807 for women). Among women, cluster seroprevalence increased with a higher proportion of the population reporting multiple sex partners (beta = 0.814), external travel (beta = 0.579), and injections (beta = 0.483). CONCLUSIONS: Community characteristics, particularly the proportion of the population in agriculture, are associated with HIV prevalence and can be used for targeting interventions. The seroprevalences of HIV suggest spread of infection from main road trading centres, through intermediate trading villages, to rural agricultural villages.

AIDS and HIV infection in Uganda--are more women infected than men?

In countries in sub-Saharan Africa, HIV is transmitted primarily heterosexually. HIV infection and AIDS in women not only affects women's health but also has implications for the other members of society. Maternal infection is the source of most childhood HIV infection in Africa and maternal health is a strong predictor of child survival. In Uganda, a review of passive AIDS surveillance has shown almost equal numbers of clinical cases reported in men and women. However, in three population-based HIV serosurveys, women were consistently found to have a higher infection rate (approximately 1.4 times) than men. In addition, both AIDS case surveillance and seroprevalence studies demonstrate an earlier age of presentation and mean age of infection in women. The higher rate of HIV infection in women suggests either differential rates of transmission between women and men, higher rates of female sexual exposure to infected men, or longer survival among HIV-infected women compared with men. Although further studies are required to illuminate both the biology and the epidemiology of heterosexual HIV transmission in Africa, these findings of earlier and higher infection rates in women have important implications for women's health and child survival in Uganda and indicate the need for specially targeted interventions to reduce transmission in this group.

Methods for the estimation of the number and quality of animal cells immobilized in carbohydrate gels.

Rapid and reliable methods for the determination of survival, proliferation, and metabolic activity of immobilized cells in gels are described. The first method is based on an MTT assay that measures qualitatively and quantitatively the metabolic activity of the cells. The second method determines cell number by measuring the amount of DNA available for Feulgen staining. In the third method, two fluorescent dyes are used to differentially stain viable and dead cells. The fourth method involves the use of glutaraldehyde to protect the cells when melting the gel to facilitate hemocytometric count. The presented techniques should help to test the efficiency of the immobilization procedures and to monitor the growth and survival of immobilized cells.

Evaluation of a simplified method for estimation of early childhood mortality in small populations.

The provision of simple health technologies in less developed countries has far outpaced the capabilities to evaluate their impact on health in general, and early childhood survival in particular. In rural Haiti, attempts to monitor the impact of health care delivery programmes have been frustrated by some of the same problems encountered elsewhere; ie lack of practicable yet scientifically sound methodologies that interface well with ongoing service delivery programmes. The 'preceding birth' technique, originally advanced by Brass and Macrae, holds promise as just such a method. Its practical appeal derives largely from simple data requirements. In its simplest form, the method requires only responses to a single question put to mothers at delivery regarding the survival status of her previous child. They have shown that the proportion of immediately preceding births dying before the 'index' birth date provides a good approximation of the standard life table probability of death before the second birthday. Given that in rural Haiti, as in much of the less developed world, few women deliver in clinic or hospital where such data could be systematically obtained, exploitation of the preceding birth method would require identification of a convenient and unobtrusive point of contact between questioner and mothers who have recently delivered. In Haiti, two options arose: (1) interview women at home after childbirth, and (2) interview women when they bring the 'index' child seeking vaccination or some other child survival intervention. Both of these deviate from the original technique of Brass and Macrae with respect to the timing and method of data collection, and could therefore introduce serious complications to the interpretation of trends in child mortality. To study this, we examined the effects of adapting the preceding birth method to a rural less developed country setting in Mirebalais, where since 1983 primary health care activities have been administered by MARCH (Management and Resources for Community Health), a private voluntary health organization. The Mirebalais study used a pregnancy register, originally developed for targeting of services, to identify women who were expected to have given birth during the 12-month period before each of two survey rounds. Brief interviews with these women would provide direct life table estimates of child mortality level and trend with which to compare estimates produced from use of the preceding birth method in modified form. Direct estimates of the probability of dying before the second birthday were 138/1000 from first round data and 134/1000 from second round data, indicating a 3% decline.(ABSTRACT TRUNCATED AT 400 WORDS)

Second or subsequent remission with a disease-free survival of 5 years or longer in acute lymphocytic leukemia of childhood: results of a national survey.

A national survey was conducted to determine the number of children with acute lymphocytic leukemia who have survived 5 years or longer in their second or subsequent remission. Seventy-two such patients were identified. The clinical and laboratory characteristics of these patients as well as their therapy are described. It is concluded that long-term second or subsequent remission may occur more frequently than previously appreciated.

Oxygen consumption in heifers three months of age related to lactation milk energy.

Calibration techniques were developed for a modified commercial oxygen consumption computer. Oxygen consumption over 5 min by 130 3-mo-old dairy calves was measured 3 h after feeding. Subsequently, Estimated Transmitting Abilities were used to calculate the production potential for lactation milk energy (kcal/305-day lactation) for 88 of the animals. Correlations between lactation milk energy and oxygen consumption or oxygen consumption corrected for weight of calf were calculated by breed. Breed correlations were tested for homogeneity and pooled. The correlation coefficient between oxygen consumption and lactation milk energy was .20 with a 95% confidence interval of -.02 to .40.

Characteristics of the absorptive surface of the small intestine of the chicken from 1 day to 14 weeks of age.

The epithelial surface of the intertine of chicks 1 day to 14 weeks of age was examined with both scanning and transmission electron microscopes. Most of the intestinal villi were seen to be plate-like structures. During the first week post-hatch, goblet cell orifices were easily seen. Goblet cell pores were not readily apparent in the older birds. During this stage of early development discontinuity was seen among some epithelial cells. The villi of birds one week or older showed a more convoluted mucosal surface than the younger birds. Areas of cell extrusion were observed at the tips of some villi. The three dimensional cylindrical structure of the microvilli was shown with the scanning electron microscope.