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Extended material for SAINTS protocol

BackgroundDiphtheria is a serious and life-threatening infection, Since 2015, two unvaccinated children have died of diphtheria in Europe . Due to the rarity of this infection in the UK, delay in diagnosis and recognising complications, can lead to delay in effective patient care. Severe disease can also occur in partially immunised children.Case Presentation SummaryA 4 year old Slovak boy, presented with a croup-like illness; adenovirus Moraxella and Haemophilus were isolated from respiratory secretions. He developed upper airway obstruction requiring intubation and ventilation; on extubation a grey pharyngeal membrane was discovered. Toxigenic C. diptheriae was later confirmed microbiologically. He had received vaccine at 2 and 12 months. A clinical decision was made to treat. As he was afebrile and clinically improving, he received 40,000 units of antitoxin. Five days later he developed further respiratory compromise with a pulmonary haemorrhage, myocarditis and prolonged QT. A further 60,000 units were administered with no adverse reaction. He required a tracheostomy and was discharged to the ward. He developed persistent fever; imaging and CSF did not identify other causes. A repeat echocardiogram showed evidence of coronary artery dilation. After discussion with experts nationally IVIG was not given due to concern about exacerbation of an immune complex process. His fever settled spontaneously. He developed diphtheritic polyneuropathy which was biphasic and required readmission to PICU with bulbar and diaphragmatic palsies. He was discharged after 3 months in hosptial with significant but improving polyneuropathy.Learning pointsSevere diphtheria may occur in partially immunised children in low incidence countries. Neurological involvement may be insidious and diagnosis may be delayed in countries with little experience. Diptheria associated coronary artery dilatation is not well documented.

The influence of treatment programs of specialized psychiatric units of the need for nurse staffing was the problem area explored in this study. The major research question asked whether the treatment program of an inpatient psychiatric unit accounted for more variance in the need for nurse staffing than was attributable to a nursing patient classification system which measures patients' need for nursing care. The study was an extension of a larger research project completed for the Veterans Administration (VA). Six test hospitals in the VA system were used as the sample. The six test hospitals contained 30 impatient units with a variety of treatment programs. A nursing patient classification instrument developed as an outcome of the VA study was used to reclassify all 898 original study patients according to their need for nursing care. The direct care hours given to each category of patient were obtained by worksampling in the original study. The direct care hours were used to analyze the effect of treatment program in hierarchical regression analysis. The treatment program accounted for approximately 1% of the variance in direct care give to patients. The nursing patient classification instrument together with shift accounted for 17% of the variance in direct care. This finding was consistent with the original VA study in that other variable thought to influence the need for nurse staffing, such as amount of socialization groups or chronicity of patients, contributed 1% less to the variance in direct care. The nursing patient classification instrument is a valid indicator of the amount of nursing care required by patients in a wide variety of VA hospitals. A valid nursing patient classification instrument is particularly useful in determining staffing patterns and budget. Other applications of the data produced by a nursing patient classification instrument are in the areas of quality assurance and costing of nursing care services. With the advent of prospective payment systems for hospitals, it is crucial to the nursings' professional and economic survival to unbundle the costs of patients for nursing care from the daily hospital room rate. The outcomes of the VA study and this study will add to the knowledge base of the profession in the area of nursing patient classification and support the use of new nursing patient classification system, the MESA Psychiatric Patient Classification System (MEPP).

BACKGROUND: The period of complementary feeding, starting around 6 months of age, is a time of high risk for growth faltering and morbidity. Low micronutrient density of locally available foods is a common problem in low income countries. Children of HIV-infected women are especially vulnerable. Although antiretroviral prophylaxis can reduce breast milk HIV transmission in early infancy, there are no clear feeding guidelines for after 6 months. There is a need for acceptable, feasible, affordable, sustainable and safe (AFASS by WHO terminology) foods for both HIV-exposed and unexposed children after 6 months of age. METHODS AND FINDINGS: We conducted in Lusaka, Zambia, a randomised double-blind trial of two locally made infant foods: porridges made of flour composed of maize, beans, bambaranuts and groundnuts. One flour contained a basal and the other a rich level of micronutrient fortification. Infants (n = 743) aged 6 months were randomised to receive either regime for 12 months. The primary outcome was stunting (length-for-age Z

In this paper we estimate the price and income elasticities for five sweet spreads using a two-stage budgeting procedure. The first stage modeled the consumer's budget decision as a Tobit model, where total sweet spread expenditures are based on income and demographic variables. The second stage, including only those households with nonzero first stage expenditures, was treated as a standard consumer allocation problem using the AIDS model. To incorporate population demographics, the AIDS model was expanded by specifying the constant term as a linear function of demographic variables. The coefficients for the prices and expenditures are highly significant and demand is elastic for all five goods. The most significant demographic effects are due to household size, and female food shopper. The theoretical restrictions of homogeneity and symmetry were tested and rejected for the complete system.