Evaluation of the accuracy of common weight estimation formulae in a Zambian paediatric surgical population.

Limited resources and access to healthcare in sub-Saharan Africa are associated with high rates of malnourished children, although many countries globally are demonstrating increasing childhood obesity. This study evaluated how well current age- or height-based formulae estimate the weight of children undergoing surgery in Zambia. All children under 14 years of age presenting for elective surgery at the University Teaching Hospital, Lusaka, had both height and weight measured. Their actual weight was compared against estimated weight from various formulae. The Broselow tape outperformed all the age-based formulae, demonstrating the lowest median percentage error of -5.8%, with 46.0% of estimates falling within 10% of the actual measured weight (p < 0.001). Of the 1111 children who were eligible for World Health Organization growth standard appraisal, 88 (8%) met the weight criteria for severe acute malnutrition. Our results are consistent with other studies in finding that the Broselow tape is the best estimator of weight in a lower middle-income country, followed by the original Advanced Paediatric Life Support formula if the Broselow tape is unavailable.

An evaluation of inpatient morbidity and critical care provision in Zambia.

The aim of this study was to objectively measure demand for critical care services in a southern African tertiary referral centre. We carried out a point prevalence study of medical and surgical admissions over a 48-h period at the University Teaching Hospital, Lusaka, recording the following: age; sex; diagnosis; Human Immunodeficiency Virus (HIV) status and National Early Warning Score. One-hundred and twenty medical and surgical admissions were studied. Fifty-four patients (45%) had objective evidence of a requirement for critical care review and potential or probable admission to an intensive care unit, according to the Royal College of Physicians (UK) guidelines. A greater than expected HIV rate was also noted; 53 of 75 tested patients (71%). When applied to the estimated 17,496 annual acute admissions, this would equate to 7873 patients requiring critical care input annually at this hospital alone. In contrast to this demand, we identified 109 critical care beds nationally, and only eight at this institution.

Elasticity of demand for water in Khartoum, Sudan.

A survey of the quantities of water purchased from vendors in the squatter areas of Khartoum, Sudan, was used to assess the effect of the price charged for water and of household income on domestic water consumption. Households in two squatter communities--Meiyo and Karton Kassala--were studied by observation and by interview. In spite of the substantially higher charges, water consumption in Karton Kassala was as high as that in Meiyo. Households within these communities showed no tendency to use less water when paying a higher price for it, or when their income was below average. In other words, no price elasticity or income elasticity was detectable. This was all the more striking in view of the high proportion of income that was spent on water; 17% in Meiyo, and 56% in Karton Kassala. One consequence of this lack of elasticity is that the poorest households devote the greatest percentage of their income to the purchase of water, although the only major item in their household budget which can be sacrificed to make this possible is food. The high price of water in urban Sudan is probably a major cause of the malnutrition prevalent in the squatter areas. Another consequence is that a low-income household's consumer surplus for domestic water is very high, amounting to a substantial proportion of its total income. This has important consequences for the economic appraisal of urban water supply schemes. It also follows that wealthier households with private connections would be willing to pay at least as much for water as that currently paid by the poor.

90Sr and 137Cs in soil and biota of fallout areas in southern Nevada and Utah.

Measurements of 90Sr and 137Cs in soil, vegetation and small mammals were made periodically at sites in southern Nevada and Utah that were contaminated by radioactive fallout from nuclear detonations at the Nevada Test Site (NTS) as well as from global sources. Results from a survey in 1980 indicate that both of these fallout-derived radionuclides have remained primarily within the top 5-cm layer of undisturbed soil in these arid land areas. Trace amounts of 90Sr and 137Cs were measured in soil and biota samples. The 90Sr concentrations in jackrabbit and rodent bone samples in 1980 varied within the range of 2-8 pCi/g ash (equivalent to 0.4-1.6 pCi/g wet bone or 5-20 pCi/g Ca). The 137Cs concentrations in muscle-tissue samples were generally less than 1.5 pCi/g ash (less than 0.045 pCi/g wet muscle). Comparisons of data obtained periodically since the early 1950s show that measured concentrations of 90Sr in bone tissues have been highly variable in trace amounts, and that the concentration attenuation appears to be following radioactive decay of this radionuclide.

'Therapy as well as the tablets': an exploratory study of service users' views of community mental health nurses' (CMHNs) responses to hearing voices.

Mental health nurses have traditionally been discouraged from engaging with service users' experiences of hearing voices and to reinforce reality. However, this may not be a helpful way of intervening in what can be a very distressing symptom. There is little evidence of service users' experiences of community mental health nurses' (CMHNs) responses to their voices. This paper presents the findings of an exploratory interview study of a sample (n = 20) of service users to ascertain their perception of CMHN responses to their experience of hearing voices. Data are both quantitative and qualitative in nature. Content analysis of the qualitative elements of the study suggests responses can be conceptualized as facilitators, barriers and attributions. CMHNs are considered to be allies and the quality of the relationship is deemed important. The therapeutic repertoire of CMHNs, however, is seen as limited and rarely extends beyond facilitating access to the psychiatrist for review of medication.

The professionalization of Canadian nursing, 1924-32: views in the CN and the CMAJ.

This article provides an assessment of the attitudes of the nursing and medical elites to the professionalization of nursing in the 1920s, as expressed, respectively, in the Canadian Nurse and the Canadian Medical Association Journal. The material printed in the CN between 1924 and 1932 indicates that the nursing elite perceived three factors inhibiting professional development: the tension between the somewhat incompatible values of professionalism and sacrificing service upon which nursing was based; indifference within the nursing rank-and-file; and opposition from the medical profession. Material printed in the CMAJ in the 1920s indicates that there was opposition within the medical profession to nurses' attempts to achieve higher standards of education, self-regulation, and more recompense. The medical profession was not, however, unamimous in its opposition to the professional development of nursing. Much of the material printed in the journal on nursing, particularly toward the end of the 1920s, indicates that there existed among doctors a substantial amount of support for nurses' efforts. This study illustrates that over the course of the 1920s, a number of shifts in political alignments occurred between and among doctors and nurses. As the decade progressed, the medical profession became more supportive of nurses' efforts to professionalize; simultaneously, the nursing leadership drew further away from the rank-and-file nurses and placed itself in closer alliance with the supportive segment of the medical profession.

Source population of dispersing rock-wallabies (Petrogale lateralis) identified by assignment tests on multilocus genotypic data.

The ability to confidently identify or exclude a population as the source of an individual has numerous powerful applications in molecular ecology. Several alternative assignment methods have recently been developed and are yet to be fully evaluated with empirical data. In this study we tested the efficacy of different assignment methods by using a translocated rock-wallaby (Petrogale lateralis) population, of known provenance. Specimens from the translocated population (n = 43), its known source population (n = 30) and four other nearby populations (n = 19-32) were genotyped for 11 polymorphic microsatellite loci. The results identified Bayesian clustering, frequency and Bayesian methods as the most consistent and accurate, correctly assigning 93-100% of individuals up to a significance threshold of P = 0.01. Performance was variable among the distance-based methods, with the Cavalli-Sforza and Edwards chord distance performing best, whereas Goldstein et al.'s (deltamu)2 consistently performed poorly. Using Bayesian clustering, frequency and Bayesian methods we then attempted to determine the source of rock-wallabies which have recently recolonized an outcrop (Gardners) 8 km from the nearest rock-wallaby population. Results indicate that the population at Gardners originated via a recent dispersal event from the eastern end of Mt. Caroline. This is only the second published record of dispersal by rock-wallabies between habitat patches and is the longest movement recorded to date. Molecular techniques and methods of analysis are now available to allow detailed studies of dispersal in rock-wallabies and should also be possible for many other taxa.

A comparative cost analysis of insecticide-treated nets and indoor residual spraying in highland Kenya.

The relative cost of indoor residual house-spraying (IRS) versus insecticide-treated bednets (ITNs) forms part of decisions regarding selective malaria prevention. This paper presents a cost comparison of these two approaches as recently implemented by Merlin, a UK emergency relief organization funded through international donor support and working in the highland districts of Gucha and Kisii in Kenya. The financial costs (cash expenditures) and the economic costs (including the opportunity costs of using existing staff and volunteers, and an annualized cost for capital items) were assessed. The financial cost for IRS was US dollars 0.86 per person protected, compared with 4.21 dollars for ITNs (reducing to 3.42 dollars to the provider assuming cost recovery). The economic cost per person protected for IRS was 0.88 dollars, compared with 2.34 dollars for ITNs. The costs for ITNs were sensitive to the number of nets sold per community group ('efficiency'), as the delivery costs constituted upwards of 40% of the total cost. However, even marked increases in efficiency of these groups could not reduce the costs of ITNs to that comparable with IRS, except if more than one cycle of IRS was needed. The implications of predicted reductions in the cost of insecticide for both IRS and ITNs are also explored. The provision of itemized cost data allows predictions to be made on changes in the design of these programmes. Under almost all design scenarios, IRS would appear to be a more cost-efficient means of vector control in the Kenyan highlands.

Characteristics of R931 and other Pseudomonas aeruginosa R factors.

R factors were detected in 3.3% of 233 hospital isolates of Pseudomonas aeruginosa using P. aeruginosa recipients in conjugations. Transferred markers included streptomycin, tetracycline, and sulfonamide resistance. Gentamicin resistance was transferred from two strains previously shown to acetylate gentamicin. A group of R factors exemplified by R931 were characterized by failure to transfer to Escherichia coli recipients. Such R factors formed a single compatibility group when examined in a P. aeruginosa recipient. Other P. aeruginosa R factors, including RP4, showed stable coexistence with the R931 group. It is proposed that RP4 and similar R factors be members of the P-1 compatibility group and that R931, R3108, R209, and R130 be members of a group termed P-2. The buoyant densities of all R factors examined were similar, about 1.716 to 1.719 g/cm(3). The content of R-factor deoxyribonucleic acid (DNA) relative to the total DNA varied among the different R factors, ranging from about 18 +/- 2% in log-phase cells of 931 (R931) to undetectable for 679 (R679). However, R679, which transferred from strain 679 at extremely low and irregular frequencies to an E. coli host, was shown to represent about 4% R-factor DNA in that host. The relative DNA content of R931 appeared to decline in the stationary growth phase of 931 (R931) or 280 (R931). R931 covalently closed circular DNA was isolated by ethidium bromide-CsCl gradient centrifugation and examined by electron microscopy. Two major molecular distributions existed, having contour lengths of 0.5 and 12.4 mum. The molecular weights were estimated to be 10(6) and 25 x 10(6). Both molecules were under relaxed replication control. R factor R931 exists as a naturally occurring high-frequency transfer system in P. aeruginosa strains 931 and 1310. However, in strain 280 it acts as if subject to fertility repression. Other members of the P-2 compatibility group also are high-frequency transfer systems in the natural host and in strain 1310. RP4 is restricted from recipient strain 1310. Some additional recipient effects were noted in that strains 1310 or 280 sometimes differed in recipient effectiveness with a given donor. Agglutination reactions with absorbed antiserum were able to distinguish between two members of the same R-factor compatibility group, R931 and R3108.

A comparison of the serologic responses to oral and injectable trivalent poliovirus vaccines.

United States children two months of age were randomly assigned to two groups that received either the commercially available oral trivalent poliovirus vaccine ( OPV ) or an injectable (inactivated) trivalent poliovirus vaccine (IPV) with a confirmed minimum D-antigen content of 27, 3.5, and 29 units for poliovirus types 1, 2, and 3, respectively. Vaccine was given at two, four, and 18 months of age. Sera obtained from 439 children at two, four, and six months of age and from 85 children at 18 and 20 months of age were examined for neutralizing antibodies. The percentage of children with detectable antibodies and the reciprocal geometric mean titers were similar for both groups at two months of age for antibodies to all three poliovirus types. At 20 months of age, all children but one had detectable antibodies to all three poliovirus types. Significantly higher geometric mean titers against types 2 and 3 were noted at 20 months of age for the IPV group.