Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India

Background: Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective: The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design: We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results: In total, 1,532 incident cases were recorded that mainly included hypertension (n622, 41%) and diabetes (n460, 30%). Dropout rate was 10% (n13). The monthly reporting consistency was quite constant, with the majority (n63, 50%) submitting 110 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions: The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation of the private sector, cross-practices among different systems of medicine, limited clinic infrastructure, and knowledge gaps about disease surveillance. We suggest a voluntary augmented sentinel NCD surveillance system including public and private healthcare facilities at all levels of care

Family outbreak of an infection with a recombinant Coxsackie A virus in eastern Switzerland

Purpose: We report on an unusual familial outbreak of a coxsackie virus infection in Switzerland in which five family members were affected. Most of the patients presented with signs of meningitis, and four were hospitalized. Methods: In three individuals, the virus was detected in the cerebrospinal fluid, pharynx, and stool, respectively. The genome was sequenced in specimens of two patients. Results: The nucleotide sequences of both virus strains were identical. Blast search revealed that the first half of the sequence was 88% homologous to Enterovirus 75 (EV-75), 87% with Echovirus 11 (E-11), and 84% homologous to Coxsackie virus A9 (CV-A9). The second half of the sequence was 77% homologous to EV-75, 75% to E-11, and 91% to CV-A9. Conclusion: We propose that the isolated virus strain is a recombinant strain with a 5′ untranslated region and with the start of the VP4 sequence originating from E-11/EV-75 and the rest of the genome originating from CV-A9. Interestingly, this novel virus strain showed an exceptional virulence and rapid spread. Twoweeks after the initial outbreak in this family, a similar outbreak was observed in a second geographic area roughly 100km distant to the primary identification site, and another 2months later this virus strain was found to circulate in the western part of Switzerland some 250km distant to the primary locus. These findings suggest that genetic recombination has resulted in a novel enterovirus with features of high virulence, contagiosity, and spreadin

Quasi-fission reactions as a probe of nuclear viscosity

Fission fragment mass and angular distributions were measured from the ^{64}Ni+^{197}Au reaction at 418 MeV and 383 MeV incident energy. A detailed data analysis was performed, using the one-body dissipation theory implemented in the code HICOL. The effect of the window and the wall friction on the experimental observables was investigated. Friction stronger than one-body was also considered. The mass and angular distributions were consistent with one-body dissipation. An evaporation code DIFHEAT coupled to HICOL was developed in order to predict reaction time scales required to describe available data on pre-scission neutron multiplicities. The multiplicity data were again consistent with one-body dissipation. The cross-sections for touch, capture and quasi-fission were also obtained.Comment: 25 pages REVTeX, 3 tables, 13 figures, submitted to Phys. Rev

Fission Hindrance in hot 216Th: Evaporation Residue Measurements

The fusion evaporation-residue cross section for 32S+184W has been measured at beam energies of E_beam = 165, 174, 185, 196, 205, 215, 225, 236, 246,and 257 MeV using the ATLAS Fragment Mass Analyzer. The data are compared with Statistical Model calculations and it is found that a nuclear dissipation strength, which increases with excitation energy, is required to reproduce the excitation function. A comparison with previously published data show that the dissipation strength depends strongly on the shell structure of the nuclear system.Comment: 15 pages 9 figure

Oral human papillomavirus is common in individuals with Fanconi anemia

Fanconi anemia is a rare genetic disorder resulting in a loss of function of the Fanconi anemia-related DNA repair pathway. Individuals with Fanconi anemia are predisposed to some cancers, including oropharyngeal and gynecologic cancers, with known associations with human papillomavirus (HPV) in the general population. As individuals with Fanconi anemia respond poorly to chemotherapy and radiation, prevention of cancer is critical. METHODS: To determine whether individuals with Fanconi anemia are particularly susceptible to oral HPV infection, we analyzed survey-based risk factor data and tested DNA isolated from oral rinses from 126 individuals with Fanconi anemia and 162 unaffected first-degree family members for 37 HPV types. RESULTS: Fourteen individuals (11.1%) with Fanconi anemia tested positive, significantly more (P = 0.003) than family members (2.5%). While HPV prevalence was even higher for sexually active individuals with Fanconi anemia (17.7% vs. 2.4% in family; P = 0.003), HPV positivity also tended to be higher in the sexually inactive (8.7% in Fanconi anemia vs. 2.9% in siblings). Indeed, having Fanconi anemia increased HPV positivity 4.9-fold (95% CI, 1.6-15.4) considering age and sexual experience, but did not differ by other potential risk factors. CONCLUSION: Our studies suggest that oral HPV is more common in individuals with Fanconi anemia. It will be essential to continue to explore associations between risk factors and immune dysfunction on HPV incidence and persistence over time. IMPACT: HPV vaccination should be emphasized in those with Fanconi anemia as a first step to prevent oropharyngeal cancers, although additional studies are needed to determine whether the level of protection it offers in this population is adequate

Scaling Properties of the Giant Dipole Resonance Width in Hot Rotating nuclei

We study the systematics of the giant dipole resonance width $\Gamma$ in hot rotating nuclei as a function of temperature $T$, spin $J$ and mass $A$. We compare available experimental results with theoretical calculations that include thermal shape fluctuations in nuclei ranging from A=45 to A=208. Using the appropriate scaled variables, we find a simple phenomenological function $\Gamma(A,T,J)$ which approximates the global behavior of the giant dipole resonance width in the liquid drop model. We reanalyze recent experimental and theoretical results for the resonance width in Sn isotopes and $^{208}$Pb.Comment: LaTeX, 4 pages with 4 figures (to appear in Phys. Rev. Lett.

Der Umzug der Menschheit: Die transformative Kraft der Städte

Die Wucht der derzeitigen Urbanisierungsdynamik und ihre Auswirkungen sind so groß, dass sich weltweit Städte, Stadtgesellschaften, Regierungen und Internationale Organisationen diesem Trend stellen müssen. Ein „Weiter so wie bisher“, würde ohne gestaltende Urbanisierungspolitik zu einer nicht-nachhaltigen Welt-Städte-Gesellschaft führen. Nur wenn Städte und Stadtgesellschaften ausreichend handlungsfähig werden, können sie ihre Kraft für eine nachhaltige Entwicklung entfalten: In den Städten wird sich entscheiden, ob die Große Transformation zur Nachhaltigkeit gelingt. In diesem Buch werden die Erfolgsbedingungen dafür diskutiert

Does rapid urbanization aggravate health disparities? Reflections on the epidemiological transition in Pune, India

Background: Rapid urbanization in low- and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups. Objective: The study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups. Design: A mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers. Results: The mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected. Conclusions: The rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holistic understanding of urban health. In order to derive evidence-based solutions and interventions, routine surveillance data become indispensable

Humanity on the move: Unlocking the transformative power of cities

The momentum of urbanization and its impacts are so massive that we must face up to this trend. In view of the existing cognitive, technical, economic and institutional path dependencies, a policy of business as usual – i.e. an unstructured, quasi-automatic urbanization – would lead to a non-sustainable ‘world cities society’. Only if cities and urban societies are sufficiently empowered can they make use of the opportunities for sustainability and successfully follow the urban transformation pathways. The success or failure of the Great Transformation will be decided in the cities. The WBGU discusses the relevant conditions for the success of this transformation in this report

Resolving the mystery of milliwatt-threshold opto-mechanical self-oscillation in dual-nanoweb fiber

It is interesting to pose the question: How best to design an optomechanical device, with no electronics, optical cavity, or laser gain, that will self-oscillate when pumped in a single pass with only a few mW of single-frequency laser power? One might begin with a mechanically resonant and highly compliant system offering very high optomechanical gain. Such a system, when pumped by single-frequency light, might self-oscillate at its resonant frequency. It is well-known, however, that this will occur only if the group velocity dispersion of the light is high enough so that phonons causing pump-to-Stokes conversion are sufficiently dissimilar to those causing pump-to-anti-Stokes conversion. Recently it was reported that two light-guiding membranes 20 μm wide, ∼500 nm thick and spaced by ∼500 nm, suspended inside a glass fiber capillary, oscillated spontaneously at its mechanical resonant frequency (∼6 MHz) when pumped with only a few mW of single-frequency light. This was surprising, since perfect Raman gain suppression would be expected. In detailed measurements, using an interferometric side-probing technique capable of resolving nanoweb movements as small as 10 pm, we map out the vibrations along the fiber and show that stimulated intermodal scattering to a higher-order optical mode frustrates gain suppression, permitting the structure to self-oscillate. A detailed theoretical analysis confirms this picture. This novel mechanism makes possible the design of single-pass optomechanical oscillators that require only a few mW of optical power, no electronics nor any optical resonator. The design could also be implemented in silicon or any other suitable material