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BACKGROUND: In the United Kingdom, tuberculosis (TB) predominantly affects the most deprived populations, yet the extent to which deprivation affects TB care outcomes is unknown. METHODS: Since 2011, the North West TB Cohort Audit collaboration has undertaken quarterly reviews of outcomes against consensus-defined care standard indicators for all individuals notified with TB. We investigated associations between adverse TB care outcomes and Index of Multiple Deprivation (IMD) 2010 scores measured at lower super output area of residence using logistic regression models. RESULTS: Of 1831 individuals notified with TB between 2011 and 2014, 62% (1131/1831) came from the most deprived national quintile areas. In single variable analysis, greater deprivation was significantly associated with increased likelihood of the completion of a standardised risk assessment (OR 2.99, 95%CI 5.27–19.65) and offer of a human immunodeficiency virus test (OR 1.72, 95%CI 1.10–2.62). In multivariable analysis, there were no significant associations. CONCLUSIONS: TB patients in the most deprived areas had similar care indicators across a range of standards to those of individuals living in the more affluent areas, suggesting that the delivery of TB care in the North West of England is equitable. The extent to which the cohort review process contributes to, and sustains, this standard of care deserves further study. Publisher PDF

Objective To decrease the incidence of bloodstream infection (BSI) for neonates 48 h, for a total of 33 933 bed days and 14 447 central line days. There was a significant decrease from 2012 to 2014 in BSI/1000 bed days (7.8±3.0 vs 3.8±1.1, p=0.000), CLABSI/1000 bed days (4.6±2.1 vs 2.1±0.8, p=0.003), CLABSI/1000 central line days (9.9±4.3 vs 5.4±1.7, p=0.012) and antibiotic days/100 bed days (31.1±4.3 vs 25.5±4.2, p=0.046). Conclusions This study demonstrates a >50% reduction in BSI in extremely premature neonates from D3 to 35 following a collaborative quality improvement project to reduce neonatal infection across an NICU network, supported by timely provision of data.

A myriad of downstream communities and industries rely on streams fed by both groundwater discharge and glacier meltwater draining the Cordillera Blanca, Northern Peruvian Andes, which contains the highest density of glaciers in the tropics. During the dry season, approximately half the discharge in the region's proglacial streams comes from groundwater. However, because of the remote and difficult access to the region, there are few field methods that are effective at the reach scale to identify the spatial distribution of groundwater discharge. An energy balance model, Rhodamine WT dye tracing, and high-definition kite-borne imagery were used to determine gross and net groundwater inputs to a 4-km reach of the Quilcay River in Huascaran National Park, Peru. The HFLUX computer programme () was used to simulate the Quilcay River's energy balance using stream temperature observations, meteorological measurements, and kite-borne areal photography. Inference from the model indicates 29% of stream discharge at the reach outlet was contributed by groundwater discharge over the study section. Rhodamine WT dye tracing results, coupled with the energy balance, show that approximately 49% of stream water is exchanged (no net gain) with the subsurface as gross gains and losses. The results suggest that gross gains from groundwater are largest in a moraine subreach but because of large gross losses, net gains are larger in the meadow subreaches. These insights into pathways of groundwater-surface water interaction can be applied to improve hydrological modelling in proglacial catchments throughout South America.

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