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Objective

To compare oxygen supply options for health facilities in the Gambia and develop a decision-making algorithm for choosing oxygen delivery systems in Africa and the rest of the developing world.

Methods

Oxygen cylinders and concentrators were compared in terms of functionality and cost. Interviews with key informants using locally developed and adapted WHO instruments, operational assessments, cost-modelling and cost measurements were undertaken to determine whether oxygen cylinders or concentrators were the better choice. An algorithm and a software tool to guide the choice of oxygen delivery system were constructed.

Findings

In the Gambia, oxygen concentrators have significant advantages compared to cylinders where power is reliable; in other settings, cylinders are preferable as long as transporting them is feasible. Cylinder costs are greatly influenced by leakage, which is common, whereas concentrator costs are affected by the cost of power far more than by capital costs. Only two of 12 facilities in the Gambia were found suitable for concentrators; at the remaining 10 facilities, cylinders were the better option.

Conclusion

Neither concentrators nor cylinders are well suited to every situation, but a simple options assessment can determine which is better in each setting. Nationally this would result in improved supply and lower costs by comparison with conventional cylinders alone, although ensuring a reliable supply would remain a challenge. The decision algorithm and software tool designed for the Gambia could be applied in other developing countries.  相似文献   
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Radiation therapy (RT) is used for local tumor control through direct killing of tumor cells. Radiation-induced cell death can trigger tumor antigen-specific immune responses, but these are often noncurative. Radiation has been demonstrated to induce immunogenic modulation (IM) in various tumor types by altering the biology of surviving cells to render them more susceptible to T cell-mediated killing. Little is known about the mechanism(s) underlying IM elicited by sub-lethal radiation dosing. We have examined the molecular and immunogenic consequences of radiation exposure in breast, lung, and prostate human carcinoma cells. Radiation induced secretion of ATP and HMGB1 in both dying and surviving tumor cells. In vitro and in vivo tumor irradiation induced significant upregulation of multiple components of the antigen-processing machinery and calreticulin cell-surface expression. Augmented CTL lysis specific for several tumor-associated antigens was largely dictated by the presence of calreticulin on the surface of tumor cells and constituted an adaptive response to endoplasmic reticulum stress, mediated by activation of the unfolded protein response.This study provides evidence that radiation induces a continuum of immunogenic alterations in tumor biology, from immunogenic modulation to immunogenic cell death. We also expand the concept of immunogenic modulation, where surviving tumor cells recovering from radiation-induced endoplasmic reticulum stress become more sensitive to CTL killing. These observations offer a rationale for the combined use of radiation with immunotherapy, including for patients failing RT alone.  相似文献   
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Objective To describe how, through a DSS in a rural area of The Gambia, it has been possible to measure substantial reductions in child mortality rates and how we investigated whether the decline paralleled the registered fall in malaria incidence in the country. Methods Demographic surveillance data spanning 19.5 years (1 April 1989–30 September 2008) from 42 villages around the town of Farafenni, The Gambia, were used to estimate childhood mortality rates for neonatal, infant, child (1–4 years) and under‐5 age groups. Data were presented in five a priori defined time periods, and annual rates per 1000 live births were derived from Kaplan–Meier survival probabilities. Results From 1989–1992 to 2004–2008, under‐5 mortality declined by 56% (95% CI: 48–63%), from 165 (95% CI: 151–181) per 1000 live births to 74 (95% CI: 65–84) per 1000 live births. In 1‐ to 4‐year‐olds, mortality during the period 2004–2008 was 69% (95% CI: 60–76%) less than in 1989–1992. The corresponding mortality decline in infants was 39% (95% CI: 23–52%); in neonates, it was 38% (95% CI: 13–66%). The derived annual under‐5 mortality rates declined from 159 per 1000 live births in 1990 to 45 per 1000 live births in 2008, thus implying an attainment of MDG4 seven years in advance of the target year of 2015. Conclusion Achieving MDG4 is possible in poor, rural areas of Africa through widespread deployment of relatively simple measures that improve child survival, such as immunisation and effective malaria control.  相似文献   
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PURPOSE.e To test the validity and repeatability of a newly designed Trachoma Rapid Assessment (TRA) methodology. METHOD. Results from an initial TRA in 20 villages (TRA1) are compared with those of a second validation TRA (TRA2) after 6 weeks in 13 villages, randomly selected out of the original 20, conducted by different field staff. Findings of TRA1 and TRA2 are compared with those of a door-to-door survey of the entire population of all 13 villages. RESULTS. There is a considerable amount of variation between the results of TRA1 and TRA2 and between the results of both TRA¹s and the door-to-door survey. Even indicators that should have remained the same, like distance to Primary Health Centre or distance to trichiasis surgery facility, scored differently. CONCLUSIONS. The TRA methodology is easy to use and the results are quickly available. The scoring system indicates which intervention(s) of the SAFE strategy are needed and facilitates priority setting. The definition of some indicators, like availability and use of latrines, may need modification. In some cases, the scoring system seems to exaggerate differences between the actual findings. The consistency between two TRA¹s in the same village is low and the accuracy in measuring the actual situation is doubtful.  相似文献   
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Background  

Streptococcus pneumoniae is an important cause of community acquired pneumonia, sepsis, meningitis and otitis media globally and has been incriminated as a major cause of serious childhood bacterial infections in The Gambia. Better understanding of the dynamics of transmission and carriage will inform control strategies.  相似文献   
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