Impact of a malaria-control project in Benin that included the integrated management of childhood illness strategy

Objectives. To estimate the impact of the Integrated Management of Childhood Illness (IMCI) strategy on early-childhood mortality, we evaluated a malaria-control project in Benin that implemented IMCI and promoted insecticide-treated nets (ITNs).Methods. We conducted a before-and-after intervention study that included a nonrandomized comparison group. We used the preceding birth technique to measure early-childhood mortality (risk of dying before age 30 months), and we used health facility surveys and household surveys to measure process indicators.Results. Most process indicators improved in the area covered by the intervention. Notably, because ITNs were also promoted in the comparison area children''s ITN use increased by about 20 percentage points in both areas. Regarding early-childhood mortality, the trend from baseline (1999–2001) to follow-up (2002–2004) for the intervention area (13.0% decrease; P < .001) was 14.1% (P < .001) lower than was the trend for the comparison area (1.3% increase; P = .46).Conclusions. Mortality decreased in the intervention area after IMCI and ITN promotion. ITN use increased similarly in both study areas, so the mortality impact of ITNs in the 2 areas might have canceled each other out. Thus, the mortality reduction could have been primarily attributable to IMCI''s effect on health care quality and care-seeking.In sub-Saharan Africa, malaria is a leading cause of child mortality.^1,2 These deaths can be prevented with insecticide-treated nets (ITNs), indoor insecticide spraying, prompt and effective treatment of malaria cases, and intermittent preventive treatment of malaria in pregnant women.²To improve children''s malaria treatment, the Roll Back Malaria partnership and the World Health Organization (WHO) recommend the Integrated Management of Childhood Illness (IMCI) strategy.^3–5 IMCI, which was developed by WHO and other partners, aims to prevent mortality from all leading causes of child deaths (e.g., pneumonia, diarrhea, and malaria). IMCI has 3 components: (1) improving case-management quality (especially in health facilities) by training health workers to use evidence-based clinical guidelines, (2) strengthening health systems, and (3) promoting community and family health practices.IMCI has been introduced in more than 100 developing countries,⁶ and studies have demonstrated that it can improve health care quality at health facilities.^7–10 With regard to its effect on mortality, however, the evidence is mixed. IMCI seems to have lowered child mortality in Tanzania,¹¹ but studies in Brazil¹² and Bangladesh⁸ did not find a statistically significant reduction. Thus, despite IMCI being one of the world''s most widely implemented child health strategies, its impact on mortality remains unclear.In 1998, before today''s billion-dollar malaria initiatives, the US Agency for International Development launched a subnational malaria demonstration project in Benin that included IMCI. Benin is a low-income country in West Africa with extreme poverty,¹³ endemic malaria, and high mortality for children younger than 5 years (160 deaths per 1000 live births when the project began¹⁴). We conducted this study to evaluate the project''s impact on early-childhood mortality, with an emphasis on IMCI''s impact.     

Eurobloodpack: a common European design for blood bag systems with integral leucodepletion filters

Three EBA specified blood bag configurations ('Eurobloodpack') are described which are capable of meeting >80% of its member's requirements. These include a 'top-and-top' and two 'bottom-and-top' packs enabling aseptic, pre-donation collection of up to 40 ml of samples, 427.5-522.5 ml of whole blood and the preparation of an extensive range of blood components. Features currently beyond the scope of ISO standardisation have been controlled including: anticoagulant and additive volumes; collection needle and sampling system; transfer tubing; cross-match line; base label; leucodepletion filter performance; compatibility of access ports and transfusion sets. Eurobloodpack has significant advantages for blood services and blood bag manufacturers.     

SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state

Following an outbreak of carbapenem resistant Klebsiella pneumoniae (CRKP) bacteremia among inpatients in the Hemato-oncology and BMT unit, we studied the course of this infection in patients undergoing intensive chemotherapy and SCT. In addition, we conducted a pilot study aimed to eradicate CRKP colonization in the gastrointestinal tract, using oral gentamicin. Adult patients admitted to the BMT unit, identified as CRKP carriers on surveillance rectal cultures, were included in the study. Oral gentamicin at a dose of 80 mg q.i.d. was administered to all identified carriers until eradication. Among 15 colonized patients included in the study, the eradication rate achieved was 66% (10/15); discontinuation of persistent bacteremia occurred in 62.5% (5/8) and nosocomial spread of CRKP carrier state ceased. Administration of intensive chemotherapy and SCT is feasible, although associated with increased risk. Hematological patients in need of intensive chemotherapy/SCT should not be denied the required treatment on the basis of being CRKP carriers. Oral gentamicin treatment for eradication of CRKP from the gastrointestinal reservoir could serve as additional tool in the combat against the nosocomial spread and severe infections caused by this difficult-to-treat organism.     

Enhancing the utility of complex-valued functional magnetic resonance imaging detection of neurobiological processes through postacquisition estimation and correction of dynamic B(0) errors and motion

Functional magnetic resonance imaging (fMRI) time series analysis is typically performed using only the magnitude portion of the data. The phase information remains unused largely due to its sensitivity to temporal variations in the magnetic field unrelated to the functional response of interest. These phase changes are commonly the result of physiologic processes such as breathing or motion either inside or outside the imaging field of view. As a result, although the functional phase response carries pertinent physiological information concerning the vasculature, one aspect of which is the location of large draining veins, the full hemodynamic phase response is understudied and is poorly understood, especially in comparison with the magnitude response. It is likely that the magnitude and phase contain disjoint information, which could be used in tandem to better characterize functional hemodynamics. In this work, simulated and human fMRI experimental data are used to demonstrate how statistical analysis of complex-valued fMRI time series can be problematic, and how robust analysis using these powerful and flexible complex-valued statistics is possible through postprocessing with correction for dynamic magnetic field fluctuations in conjunction with estimated motion parameters. These techniques require no special pulse sequence modifications and can be applied to any complex-valued echo planar imaging data set. This analysis shows that the phase component appears to contain information complementary to that in the magnitude and that processing and analysis techniques are available to investigate it in a robust and flexible manner.