Cochrane Review summary: Preoperative fasting for preventing perioperative complications in children

During general anaesthetic, in adults and children alike, the protective reflexes that prevent lung aspiration of stomach contents are inhibited. Preoperative fasting is thought to reduce the risk of regurgitation and gastric aspiration during surgery. Several professional body guidelines have recommended a more relaxed fasting period than the traditional ‘nil by mouth from the midnight before surgery’ policy. However, practices vary widely due to a lack of confidence in the evidence. The aim of this Cochrane Review was to determine the effects of different fasting regimens (duration, type and volume of permitted intake) and the impact on perioperative complications and patient well being (aspiration, regurgitation, related morbidity, thirst, hunger, pain, comfort, behaviour, nausea and vomiting) in children. The search for this review was updated in 2009

Positioning for acute respiratory distress in hospitalised infants and children

An association has been established between prone positioning and sudden infant death syndrome (SIDS) which has lead to the recommendation that young infants be positioned supine. Yet, the prone position has been shown to improve the arterial oxygenation in older infants and children with respiratory distress. Due to structural and physiological immaturity, the respiratory mechanics differ between adults and children, which means that the risks and benefits of positioning in the younger age group may have more clinical significance. Given the SIDS recommendations for supine positioning in young infants and the benefits associated with prone positioning with respiratory distress, a systematic review of the literature was necessary to guide clinical practice in hospitalised infants and children. The aim of this Cochrane Review was to compare the effects of different body positions (prone, supine, lateral, elevated and flat) on infants and children hospitalised with acute respiratory distress. The search for this review was updated in August 2008

Proton and cadmium adsorption by the archaeon Thermococcus zilligii: Generalising the contrast between thermophiles and mesophiles as sorbents

Adsorption by microorganisms can play a significant role in the fate and transport of metals in natural systems. Surface complexation models (SCMs) have been applied extensively to describe metal adsorption by mesophilic bacteria, and several recent studies have extended this framework to thermophilic bacteria. We conduct acid-base titrations and batch experiments to characterise proton and Cd adsorption onto the thermophilic archaeon Thermococcus zilligii. The experimental data and the derived SCMs indicate that the archaeon displays significantly lower overall sorption site density compared to previously studied thermophilic bacteria such Anoxybacillus flavithermus, Geobacillus stearothermophilus, G. thermocatenulatus, and Thermus thermophilus. The thermophilic bacteria and archaea display lower sorption site densities than the mesophilic microorganisms that have been studied to date, which points to a general pattern of total concentration of cell wall adsorption sites per unit biomass being inversely correlated to growth temperature

Aménagements hydro-agricoles et santé (vallée du fleuve Sénégal)

Près de 1 500 personnes résidant dans les villages rattachés au périmètre irrigué MO 6bis (périmètre de Diomandou, département de Podor) ont fait l'objet de prélèvements d'urine et/ou de selle afin de déterminer la prévalence de la bilharziose urinaire, de la bilharziose intestinale ainsi que des autres parasitoses entériques. Chez les riverains du périmètre, 1 295 urines ont été examinées, parmi lesquelles sept contenaient des oeufs viables de #Schistosoma haematobium$, ce qui représente un taux de prévalence de 0,5$, ce qui correspond à un indice d'infestation de 0,1%. Il s'agissait là aussi d'un individu dont la contamination avait eu lieu en dehors de la zone d'étude. #Eschirichia coli$est la parasite entérique le plus répandu avec 17,2$, #Strongyloïdes stercoralis, #Ascaris lumbricoïdes et #Trichiuris trichiura$ sont rares et ne concernent qu'un peu moins de 2% des sujets examinés. Ces résultats démontrent l'absence, pour l'instant tout au moins, de foyers de transmission des bilharzioses dans les villages du périmètre de Diomandou. Le risque d'apparition de ces maladies est cependant important et dépend à la fois de l'évolution des infrastructures et de l'éventuelle apparition d'hôtes intermédiaires encore absent du réseau hydrographique de ce périmètre mis en place récemment. (Résumé d'auteur

Qualitative study to develop processes and tools for the assessment and tracking of African institutions’ capacity for operational health research

Objectives Research is key to achieving global development goals. Our objectives were to develop and test an evidence-informed process for assessing health research management and support systems (RMSS) in four African universities and for tracking interventions to address capacity gaps. Setting Four African universities. Participants 83 university staff and students from 11 cadres. Intervention/methods A literature-informed ‘benchmark’ was developed and used to itemise all components of a university’s health RMSS. Data on all components were collected during site visits to four African universities using interview guides, document reviews and facilities observation guides. Gaps in RMSS capacity were identified against the benchmark and institutional action plans developed to remedy gaps. Progress against indicators was tracked over 15 months and common challenges and successes identified. Results Common gaps in operational health research capacity included no accessible research strategy, a lack of research e-tracking capability and inadequate quality checks for proposal submissions and contracts. Feedback indicated that the capacity assessment was comprehensive and generated practical actions, several of which were no-cost. Regular follow-up helped to maintain focus on activities to strengthen health research capacity in the face of challenges. Conclusions Identification of each institutions’ strengths and weaknesses against an evidence-informed benchmark enabled them to identify gaps in in their operational health research systems, to develop prioritised action plans, to justify resource requests to fulfil the plans and to track progress in strengthening RMSS. Use of a standard benchmark, approach and tools enabled comparisons across institutions which has accelerated production of evidence about the science of research capacity strengthening. The tools could be used by institutions seeking to understand their strengths and to address gaps in research capacity. Research capacity gaps that were common to several institutions could be a ‘smart’ investment for governments and health research funders

Qualitative study to develop processes and tools for the assessment and tracking of African institutions’ capacity for operational health research

Objectives Research is key to achieving global development goals. Our objectives were to develop and test an evidence-informed process for assessing health research management and support systems (RMSS) in four African universities and for tracking interventions to address capacity gaps. Setting Four African universities. Participants 83 university staff and students from 11 cadres. Intervention/methods A literature-informed ‘benchmark’ was developed and used to itemise all components of a university’s health RMSS. Data on all components were collected during site visits to four African universities using interview guides, document reviews and facilities observation guides. Gaps in RMSS capacity were identified against the benchmark and institutional action plans developed to remedy gaps. Progress against indicators was tracked over 15 months and common challenges and successes identified. Results Common gaps in operational health research capacity included no accessible research strategy, a lack of research e-tracking capability and inadequate quality checks for proposal submissions and contracts. Feedback indicated that the capacity assessment was comprehensive and generated practical actions, several of which were no-cost. Regular follow-up helped to maintain focus on activities to strengthen health research capacity in the face of challenges. Conclusions Identification of each institutions’ strengths and weaknesses against an evidence-informed benchmark enabled them to identify gaps in in their operational health research systems, to develop prioritised action plans, to justify resource requests to fulfil the plans and to track progress in strengthening RMSS. Use of a standard benchmark, approach and tools enabled comparisons across institutions which has accelerated production of evidence about the science of research capacity strengthening. The tools could be used by institutions seeking to understand their strengths and to address gaps in research capacity. Research capacity gaps that were common to several institutions could be a ‘smart’ investment for governments and health research funders

Safety and Efficacy of Adding a Single Low Dose of Primaquine to the Treatment of Adult Patients With Plasmodium falciparum Malaria in Senegal, to Reduce Gametocyte Carriage: A Randomized Controlled Trial.

Introduction: More information is needed about the safety of low-dose primaquine in populations where G6PD deficiency is common. Methods: Adults with Plasmodium falciparum malaria were randomized to receive 1 of 3 artemisinin combination therapies (ACTs) with or without primaquine (0.25 mg/kg). Glucose-6-phosphate dehydrogenase (G6PD) status was determined using a rapid test. Patients were followed for 28 days to record hemoglobin concentration, adverse events, and gametocyte carriage. The primary end point was the change in Hb at day 7. Results: In sum, 274 patients were randomized, 139 received an ACT alone, and 135 received an ACT + primaquine. The mean reduction in Hb at day 7 was similar in each group, a difference in the ACT + PQ versus the ACT alone group of -0.04 g/dL (95% confidence interval [CI] -0.23, 0.31), but the effect of primaquine differed according to G6PD status. In G6PD-deficient patients the drop in Hb was 0.63 g/dL (95% CI 0.03, 1.24) greater in those who received primaquine than in those who received an ACT alone. In G6PD-normal patients, the reduction in Hb was 0.22 g/dL (95% CI -0.08, 0.52) less in those who received primaquine (interaction P = .01). One G6PD normal patient who received primaquine developed moderately severe anaemia (Hb < 8 g/dL). Dark urine was more frequent in patients who received primaquine. Primaquine was associated with a 73% (95% CI 24-90) reduction in gametocyte carriage (P = .013). Conclusion: Primaquine substantially reduced gametocyte carriage. However, the fall in Hb concentration at day 7 was greater in G6PD-deficient patients who received primaquine than in those who did not and one patient who received primaquine developed moderately severe anemia. Clinical Trial registration: PACTR201411000937373 (www.pactr.org)

Event attribution science in adaptation decision-making: the context of extreme rainfall in urban Senegal

Event attribution assesses the effect of climate change on individual extreme events. While scientists have suggested that results could be relevant for climate adaptation policy, this has had little empirical investigation, particularly in developing regions. Taking the case of Senegal, the national adaptation policy context regarding extreme precipitation and flooding in urban areas, and the scientific information needed to support this policy, is investigated using key informant interviews, a workshop and document analysis. Flooding in Senegal was found to be viewed primarily as an urban planning concern rather than a climate change issue, with actions to address the impacts focussing on current vulnerabilities of urban communities without considering changing climate risks. While stakeholders thought event attribution might be useful to inform about climate change impacts and future risks of extreme events, it is unclear whether there would be opportunity for this at present, due to the limited role climate information has in adaptation decision-making. While addressing vulnerability to extremes is necessary whether or not the risk is climate change-related, if long-term planning is to be resilient then knowledge about future changes in risks of extremes will need to be considered, even if individual events are not attributed to climate change

of Education or Offices within it. NCEO Core Staff

assessment: Results of a comparative study (Technical Report 64). Minneapolis, MN: University of Minnesota, National Center on Educationa