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BackgroundThe Gambia has high rates of under-5 mortality from diarrhoea and pneumonia, peaking during complementary-feeding age. Community-based interventions may reduce complementary-food contamination and disease rates.Methods and findingsA public health intervention using critical control points and motivational drivers, delivered February-April 2015 in The Gambia, was evaluated in a cluster randomised controlled trial at 6- and 32-month follow-up in September-October 2015 and October-December 2017, respectively. After consent for trial participation and baseline data were collected, 30 villages (clusters) were randomly assigned to intervention or control, stratified by population size and geography. The intervention included a community-wide campaign on days 1, 2, 17, and 25, a reminder visit at 5 months, plus informal community-volunteer home visits. It promoted 5 key complementary-food and 1 key drinking-water safety and hygiene behaviours through performing arts, public meetings, and certifications delivered by a team from local health and village structures to all villagers who attended the activities, to which mothers of 6- to 24-month-old children were specifically invited. Control villages received a 1-day campaign on domestic-garden water use. The background characteristics of mother and clusters (villages) were balanced between the trial arms. Outcomes were measured at 6 and 32 months in a random sample of 21-26 mothers per cluster. There were no intervention or research team visits to villages between 6 and 32 months. The primary outcome was a composite outcome of the number of times key complementary-food behaviours were observed as a proportion of the number of opportunities to perform the behaviours during the observation period at 6 months. Secondary outcomes included the rate of each recommended behaviour; microbiological growth from complementary food and drinking water (6 months only); and reported acute respiratory infections, diarrhoea, and diarrhoea hospitalisation. Analysis was by intention-to-treat analysis adjusted by clustering. (Registration: PACTR201410000859336). We found that 394/571 (69%) of mothers with complementary-feeding children in the intervention villages were actively involved in the campaign. No villages withdrew, and there were no changes in the implementation of the intervention. The intervention improved behaviour adoption significantly. For the primary outcome, the rate was 662/4,351(incidence rate [IR] = 0.15) in control villages versus 2,861/4,378 (IR = 0.65) in intervention villages (adjusted incidence rate ratio [aIRR] = 4.44, 95% CI 3.62-5.44, p < 0.001), and at 32 months the aIRR was 1.17 (95% CI 1.07-1.29, p = 0.001). Secondary health outcomes also improved with the intervention: (1) mother-reported diarrhoea at 6 months, with adjusted relative risk (aRR) = 0.39 (95% CI 0.32-0.48, p < 0.001), and at 32 months, with aRR = 0.68 (95% CI 0.48-0.96, p = 0.027); (2) mother-reported diarrhoea hospitalisation at 6 months, with aRR = 0.35 (95% CI 0.19-0.66, p = 0.001), and at 32 months, with aRR = 0.38 (95% CI 0.18-0.80, p = 0.011); and (3) mother-reported acute respiratory tract infections at 6 months, with aRR = 0.67 (95% CI 0.53-0.86, p = 0.001), though at 32 months improvement was not significant (p = 0.200). No adverse events were reported. The main limitations were that only medium to small rural villages were involved. Obtaining laboratory cultures from food at 32 months was not possible, and no stool microorganisms were investigated.ConclusionsWe found that low-cost and culturally embedded behaviour change interventions were acceptable to communities and led to short- and long-term improvements in complementary-food safety and hygiene practices, and reported diarrhoea and acute respiratory tract infections.Trial registrationThe trial was registered on the 17th October 2014 with the Pan African Clinical Trial Registry in South Africa with number (PACTR201410000859336) and 32-month follow-up as an amendment to the trial.

Background: Despite the introduction of immunisation for hepatitis B virus (HBV) in the 1990s, HBV-related morbidity and mortality remain high in sub-Saharan Africa. Identification and treatment of asymptomatic people with chronic HBV infection should reduce the disease burden. We therefore assessed the feasibility of a screen-and-treat programme for HBV infection in The Gambia, west Africa, and estimated the proportion of HBV-infected people who had significant liver disease in need of treatment. Methods: Between Dec 7, 2011, and Jan 24, 2014, individuals living in randomly selected communities in western Gambia were offered hepatitis B surface antigen (HBsAg) screening via a point-of-care test. The test was also offered to potential blood donors attending the central hospital in the capital, Banjul. HBsAg-positive individuals were invited for a comprehensive liver assessment and were offered treatment according to international guidelines. We defined linkage to care as visiting the liver clinic at least once. Eligibility for treatment was judged in accordance with the 2012 European Association for the Study of the Liver guidelines. Findings: HBsAg screening was accepted by 5980 (weighted estimate 68·9%, 95% CI 65·0–72·4) of 8170 adults from 27 rural and 27 urban communities and 5559 (81·4%, 80·4–82·3) of 6832 blood donors. HBsAg was detected in 495 (8·8%, 7·9–9·7) individuals in communities and 721 (13·0%, 12·1–13·9) blood donors. Prevalence was higher in men (239 [10·5%, 8·9–12·1] of 2328 men vs 256 [7·6%, 6·5–8·7] of 3652 women; p=0·004) and middle-aged participants. Linkage to care was high in the communities, with 402 (81·3%) of 495 HBsAg-positive individuals attending the clinic. However, only 300 (41·6%) of 721 HBsAg-positive people screened at the blood bank linked into care. Of those who attended the clinic, 18 (4·4%, 2·5–7·7) patients from the communities and 29 (9·7%, 6·8–13·6) from the blood bank were eligible for treatment. Male sex was strongly associated with treatment eligibility (odds ratio 4·35, 1·50–12·58; p=0·007). Interpretation: HBV infection remains highly prevalent in The Gambia. The high coverage of community-based screening, good linkage into care, and the small proportion of HBsAg carriers who need treatment suggest that large-scale screening and treatment programmes are feasible in sub-Saharan Africa. Funding: European Commission (FP7).

In this work, a respiratory sensor is studied, measuring the capacitance constructed by attached electrodes on the abdomen. Based on previous findings, that skin thickness changes caused by respiration provides the signal, the fitting condition of the electrode on the skin is stabilized using a 7-μm-thick dressing film. This film can be comfortably worn for a long time, while maintaining the electrode’s position on the skin. This stabilized setup enables the detection of, not only respiration, as the cyclic capacitance change, but also of minute body volume changes over the daytime, as a change in the base line indicates the quality of the sensor signal. For this demonstration, the respiration signal is measured during the daily activity of exercise and 6-min walks.

BackgroundThe Gambia Hepatitis Intervention Study (GHIS) was designed as a randomised control trial of infant hepatitis B vaccination applied to public health policy, with the main goal of preventing primary liver cancer later in adult life in The Gambia. To that effect, the National Cancer Registry of The Gambia (NCR), a population-based cancer registry (PBCR), was established in 1986 to actively collect data on all cancer diagnosis nation-wide. We extracted 20-years (1990-2009) of data to assess for the first time, the evolution of the most common cancers, also describe and demonstrate the role of the PBCR in a hepatitis B and liver cancer prevention programme in this population.Methods and findingsWe estimated Age-Standardised Incidence Rates (ASR (W)) of the most common cancers registered during the period by gender. The registration period was divided into four 5-year intervals and incidence rates were estimated for each interval. The most common cancers in males were liver, prostate, lung plus bronchus, non-Hodgkin lymphoma (NHL) and stomach, accounting for 60%, 5%, 4%, 5% and 3%, respectively. Similarly, cancers of the cervix uteri, liver, breast and NHL, were the most common in females, accounting for 33%, 24%, 11% and 4% of the female cancers, respectively.ConclusionsCancer incidence has remained relatively stable over time, but as shown elsewhere in sub-Saharan Africa the disease is a threat in The Gambia. The infection related cancers which are mostly preventable (HBV in men and HPV/HIV in women) were the most common. At the moment the data is not enough to detect an effect of hepatitis B vaccination on liver cancer incidence in The Gambia. However, we observed that monitoring case occurrence through PBCR is a key public health pre-requisite for rational planning and implementation of targeted interventions for improving the health of the population.

BACKGROUND:In areas of declining malaria transmission such as in The Gambia, the identification of malaria infected individuals becomes increasingly harder. School surveys may be used to identify foci of malaria transmission in the community. METHODS:The survey was carried out in May-June 2011, before the beginning of the malaria transmission season. Thirty two schools in the Upper River Region of The Gambia were selected with probability proportional to size; in each school approximately 100 children were randomly chosen for inclusion in the study. Each child had a finger prick blood sample collected for the determination of antimalarial antibodies by ELISA, malaria infection by microscopy and PCR, and for haemoglobin measurement. In addition, a simple questionnaire on socio-demographic variables and the use of insecticide-treated bed nets was completed. The cut-off for positivity for antimalarial antibodies was obtained using finite mixture models. The clustered nature of the data was taken into account in the analyses. RESULTS:A total of 3,277 children were included in the survey. The mean age was 10 years (SD = 2.7) [range 4-21], with males and females evenly distributed. The prevalence of malaria infection as determined by PCR was 13.6% (426/3124) [95% CI = 12.2-16.3] with marked variation between schools (range 3-25%, p

Measuring biomaterials is usually subject to error. Measurement errors are classified into either random errors or biases. Random errors can be well controlled using appropriate statistical methods. But, biases due to unknown, unobserved, or temporary causes, may lead to biased conclusions. This study describes a verification method to examine whether measurement errors are random or not and to determine efficient statistical methods. A number of studies have dealt with associations between hair minerals and exposures such as health, dietary or environmental conditions. Most review papers, however, emphasize the necessity for validation of hair mineral measurements, since large variations can cause highly variable results. To address these issues, we answer the following questions: How can we ascertain the reliability of measurements?How can we assess and control the variability of measurements?How do we efficiently determine associations between hair minerals and exposures?How can we concisely present the reference values? Since hair minerals all have distinctive natures, it would be unproductive to examine each mineral individually to find significant and consistent answers that apply to all minerals. To surmount this difficulty, we used one simple model for all minerals to explore quantitative answers. Hair mineral measurements of six-year-old children were analyzed based on the statistical model. The analysis verified that most of the measurements were reliable, and their inter-individual variations followed two-parameter distributions. These results allow for sophisticated study designs and efficient statistical methods to examine the effects of various kinds of exposures on hair minerals., Competing Interests: The authors have declared that no competing interests exist.

Fourteen patients were laboratory-confirmed cases of imported infectious diseases at the Narita Airport Quarantine Station in 2013. Blood tests were performed on 283 subjects suspected of having imported infectious diseases. Of these, 11 were diagnosed as having dengue fever (dengue) and 3 as having chikungunya fever (chikungunya) using real-time RT-PCR. The possible countries from which dengue virus infections were contracted were Thailand, Laos, Sri Lanka, and some other countries in Southeast Asia and South Asia. The 3 chikungunya cases were also diagnosed in individuals that returned from Southeast Asia. Most of the patients with dengue had a fever of over 38℃. The other symptoms were generalized fatigue, dull headache, pain behind the eyes, arthralgia, and digestive symptoms. Four of the patients were unaware of any mosquito bites. The information obtained from the confirmed cases showed that it is important to consider both the destination to which individuals travelled and the clinical symptoms, regardless of whether the subjects were aware of mosquito bites. The detection rate of chikungunya at the Quarantine Station was higher than that of dengue in all reported cases in Japan.

We examined the efficacy of liposomal amphotericin B (L-AMB) for intractable cryptococcal meningoencephalitis in a patient with acquired immunodeficiency syndrome (AIDS) and the presence of immune reconstitution syndrome (IRS) caused by the treatment. A 34-year-old patient presented with meningitis. Cryptococcal organisms were detected microscopically in the cerebrospinal fluid (CSF) with Indian ink staining, and were then cultured from the CSF. Initial treatment with amphotericin B and flucytosine (5-FC) or voriconazole and/or fluconazole failed to eradicate cryptococcal organisms from the CSF. Secondary treatment with L-AMB and 5-FC following seven months of antiretroviral therapy was successful. Simultaneously, treatment with L-AMB caused severe brain edema likely due to IRS. There were large differences in immune function improvement and liposomalization of the fungicide between the initial and secondary treatments. In conclusion, differences in immune status should be considered when administering L-AMB, in order to prevent IRS-related complications.

Numbers of individuals infected with Human Immunodeficiency Virus (HIV) are increasing in Japan. The majority of them are Men who have sex with men and a part of them take drugs as 'Sex drug' at their sexual intercourse. Especially, Amyl nitrite, Methamphetamine, 5-methoxy-N, N-diisopropyltryptamine (5-MeO-DIPT; Foxy), and 3, 4-methylenedioxy- methamphetamine (MDMA; Ecstasy) are used, and they sometimes cause the physical and mental disorders. However, the actual drug inducing troubles among Japanese HIV-infected drug users had not yet been discussed enough. In this report, we describe three cases with HIV infection; a case developed severe neuroleptic malignant syndrome (NMS) after taking 5-MeO-DIPT, a case with persistent convulsion due to multiple drug intake and a case with rhabdomyolysis due to the non-subjective methamphetamine intake. Through these cases, we raise and discuss several underlying problems associated with drug use among HIV-infected individuals.

Although it has not caused overt renal damage in clinical trials, tenofovir disoproxil fumarate (TDF) has been associated with renal dysfunction in isolated cases. The objective of this study was to assess the TDF concentration with use of the glomerular filtration rate (GFR) and blood urea nitrogen (BUN) level. Serum creatinine (used to calculate GFR), BUN, and plasma TDF trough values were measured in 51 patient volunteers at pretreatment and post-treatment time points. The post-treatment GFR (post&#95;GFR) and the difference between the pretreatment and post-treatment BUN levels (dif&#95;BUN) were strongly related to TDF concentration. A piecewise multiple regression technique was applied to the nonlinear TDF distribution, revealing a significant association of the post&#95;GFR and dif&#95;BUN values with TDF concentration (P=0.002 and P= 0.003, respectively). Post&#95;GFR values below 125 mL/min/1.73 m(2) and/or dif&#95;BUN values below -3 mg/dL are predicted to cause a marked increase in the TDF concentration. The relationship between TDF and BUN is a new finding. Knowledge of the pretreatment and post-treatment serum creatinine and BUN levels is important for the safe clinical administration of TDF.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS) is an uncommon neurological disorder which shows the diffuse edema in white matter of occipital lobe of brain. In this report, we describe a RPLS case with Human Immunodeficiency Virus (HIV) infection, whose lesion was improved with Highly Active Antiretroviral Therapy (HAART). A HIV-infected man, who was diagnosed as a mental deterioration with Central Pontine Myelinolysis (CPM) appearing high intensity pontine lesion in brain Magnetic Resonance Imaging (MRI), improved with HAART. No episode of hyponatremia or hypertension was observed in his clinical course. Evaluation of apparent diffusion coefficient (ADC) mapping in diffusion weight imaging (DWI) was performed in brain MRI at the onset and four months after commencement of HAART. ADC mapping enabled to interpret the pontine lesion as RPLS. HAART improved the mental deterioration within two weeks and the elevated ADC value at the onset was normalized at four-month clinical course.

This report examines simultaneous tuberculous and syphilitic meningitis in a patient with human immunodeficiency virus (HIV). The 41-year-old homosexual patient presented with meningitis and hydrocephalus. His CD4+ and CD8+ T-lymphocyte counts per microliter were 60 and 71, respectively. His clinical presentation was of a rapid-onset cerebral attack incompatible with tuberculous meningitis. Imaging indicated fatal bilateral cerebral infarction at the basal nuclei, and basal meningitis. We believe that syphilitic meningitis in HIV exacerbated the central nervous system (CNS) damage caused by tuberculosis and syphilis. The combination of three pathogens, Mycobacterium tuberculosis, Treponema pallidum, and HIV, has a great potential to cause serious CNS damage.

Background: A program of medical evaluation for former Savannah River Site (SRS) workers at health effects due to exposures to hazardous or radioactive agents was conducted., Methods: This study includes data from 1,368 participants aged 45 years or older who were assessed regarding work-history and exposures to industrial agents. According to the standard industrial classification (SIC), participants were employed in five of the SIC divisions. Based on the International Labour Office Classification of Radiographs, two categories of pleural and parenchymal abnormalities were evaluated by a single radiologist. The SRS results were compared with the second national health and nutrition examination survey (NHANES II) results., Results: The odds ratio of the SRS male aged 45-75 compared to NHANES was 2.4 for pleura abnormalities and 0.8 for parenchymal abnormalities. Using logistic regression, the highest-risk worker division was construction (OR = 2.76); asbestos exposure was clearly associated with pleural abnormality (OR = 2.15)., Conclusions: Pulmonary abnormalities were higher in former SRS workers than that in general population. Asbestos and possibly other exposures were related to pulmonary disease in this population.

The malicious code "W32/Sircam" is spread via e-mail and potentially through the file space shared by local area networks. Such Trojan-horse-type computer worms easily penetrate Internet firewalls and propagate via the "backdoor" to other computers. Once a malicious code, such as "W32/Sircam," has been executed on a system, it may reveal or delete confidential data, such as clinical records. In order to protect against the leakage of clinical records, we devised a mail filter that successfully prevents the spread of mail containing this malicious code. It is significant that neither access control nor packet filtering is guaranteed to prevent the spread of this mail-attachment-type Trojan horse computer worm.

It is necessary to estimate financial status to determine hospital management policy. The costs and revenues (financial balance) of each hospital division are one good index. However, it is difficult to calculate the financial balance for each division, since clinics and central services are intricately involved with each other There are no reports on a pragmatic method for calculating the financial balance. We devised a simple method based on proportional dividing. Consequently, one individual was able to complete the calculation for our hospital, which consists of 1300 beds and 23 clinics, without using the central hospital computer system.

We carried out a statistical study of the influence of meteorological and day-of-the-week factors on the intrinsic emergency patients transported to hospitals by ambulance. Multiple piecewise linear regression analysis was performed on data from 6,081 emergency admissions for 1 year between April 1997 and March 1998 in Fukuoka, Japan. The response variable was the daily number of emergency patients admitted with three types of disease: cerebrovascular, respiratory and digestive diseases. The results showed that the number of emergency patients admitted daily with cerebrovascular disease was significantly associated with temperature on the day of admission and whether the day was Sunday. As it became colder than 12 degrees C, emergency admissions of patients with cerebrovascular disease increased drastically, reaching a plateau at 4 degrees C. On the 3rd and 7th days after the temperature fell below 10 degrees C, the daily admission of patients with respiratory disease significantly increased. We also observed a weak association between emergency admissions of patients suffering from digestive disease and rising barometric pressure on the day of admission.

Our hospital wired three LAN cables separately to improve the data distribution range. One LAN is between the various sections of the hospital (hospital LAN), another is within each section (section LAN), and the other is connected to the Internet (open LAN). The section LAN was connected to the hospital LAN to enable data exchange. Data from the section LAN for common use is collected through the hospital LAN and stored in the central server The duplicate cabling and separate LANs increased the independence of each LAN and the system within each section. The section systems can be changed at anytime without the necessity of reconstructing the whole hospital information system. The data transfer speed of each cable increased. Hospital information processing systems often use a distributed-processing centralized management system. Because of advances in technology, each section can now take responsibility for developing their own system, making the responsibility of the information processing section responsible for hospital information systems more limited than previously. Herein, we show the merits of separate cable installation.

A solid water/cylindrical phantom is machined to create a spiral cavity for placing radiographic or radiochromatic film in a spiral configuration. This spiral phantom is used to sample, predict, and measure data in three-dimension subspace. The predicted data are obtained by projecting the patient plan data on the spiral phantom in the treatment planning software. The measured data are obtained by irradiating the spiral phantom (with film in the spiral cavity) as per the treatment plan. The predicted and measured data are converted to a two-dimensional matrix and plotted as a spiralogram. Comparison of these predicted and measured spiralograms provides a quantitative comparison and thus validation of treatment delivered as planned. The spiral phantom is a simple, cost-effective approach to sample 3D data from complexly shaped, intensity modulated or compensated multiple beams. A software script is being written to automate the entire process of projection, data sampling, and comparison. Design aspects and some examples of dose verification are presented. The usefulness of the spiral phantom for intensity modulated radiation therapy and dynamic field shaping are discussed.

Clinical efficacy and safety of pareteral sulbactam/ampicillin (SBT/ABPC) was compared with cefotiam (CTM) in a randomized clinical trial of pneumonia in the elderly at 13 National Hospitals of Kyushu island. 37 patients received SBT/ABPC 3 g i.v., b.i.d., and 31 patients received CTM 1 g i.v., b.i.d. for 7 to 14 days. 1. 68 patients (37 for SBT/ABPC and 31 for CTM) were evaluated for safety. No statistical differences were noted in the patients' backgrounds of either group. 2. The clinical efficacy of SBT/ABPC was 96.3% (26/27 cases) while CTM was 75.2% (17/23 cases). This was found to be statistically significant (Fisher's exact test: p < 0.05). 3. 100% of evaluated cases (10 for SBT/ABPC and 4 for CTM) showed bacterial elimination. 4. No side effects were observed in the study. 5. Abnormal laboratory findings were noted in 10.8% (4/37 cases) for SBT/ABPC and 3.2% (1/31 cases) for CTM. The major adverse events were mild elevation of GOT, GPT and A1-P for SBT/ABPC, and mild platelets overproduction for CTM. No statistical differences were noted in both groups. These results are consistent with SBT/ABPC as a highly effective antibiotic in the treatment of elderly patients with pneumonia.