Defining barriers in caring for seriously-ill children in a resource-limited setting: An observational study of 2 children's hospitals in Haiti

Background. According to the WHO 2007 country report, Haiti lags behind the Millennium Development Goal of reducing child mortality and maintains the highest under-5 mortality rate in the Western hemisphere. 3 Overall, few studies exist that seek to better grasp barriers in caring for a seriously ill child in a resource-limited setting and only a handful propose sustainable, effective interventions. ^ Objectives. The objectives of this study are to describe the prevalence of serious illnesses among children hospitalized at 2 children's hospitals in Port au Prince, to determine the barriers faced when caring for seriously ill children, and to report hospital outcomes of children admitted with serious illnesses. ^ Methods. Data were gathered from 2 major children's hospitals in Port au Prince, Haiti (Grace Children's Hospital [GCH] and Hopital d l'Universite d'Etat d'Haiti [HUEH]) using a triangulated approach of focus group discussions, physician questionnaires, and retrospective chart review. 23 pediatric physicians participated in focus group discussions and completed a self-administered questionnaire evaluating healthcare provider knowledge, self-efficacy, and perceived barriers relating to the care of seriously ill children in a resource-limited setting. A sample of 240 patient charts meeting eligibility criteria was abstracted for pertinent elements including sociodemographics, documentation, treatment strategies, and outcomes. Factors associated with mortality were analyzed using χ2 test and Fisher exact test [Minitab v.15]. ^ Results. The most common primary diagnoses at admission were gastroenteritis with moderate dehydration (35.5%), severe malnutrition (25.8%), and pneumonia (19.3%) for GCH, and severe malnutrition (32.6%), sepsis (24.7%), and severe respiratory distress (18%) for HUEH. Overall, 12.9% and 27% of seriously ill patients presented with shock to GCH and HUEH, respectively. ^ Shortage of necessary materials and equipment represented the most commonly reported limitation (18/23 respondents). According to chart data, 9.4% of children presenting with shock did not receive a fluid bolus, and only 8% of patients presenting with altered mental status or seizures received a glucose check. 65% of patients with meningitis did not receive a lumbar puncture due to lack of materials. ^ Hospital mortality rates did not differ by gender or by institution. Children who died were more likely to have a history of prematurity (OR 4.97 [95% CI 1.32-18.80]), an incomplete vaccination record (OR 4.05 [95% CI 1.68-9.74]), or a weight for age ≤3rd percentile (OR 6.1 [95% CI 2.49-14.93]. Case-fatality rates were significantly higher among those who presented with signs of shock compared with those who did not (23.1% vs. 10.7%, RR=2.16, p=0.03). Caregivers did not achieve shock reversal in 21% of patients and did not document shock reversal in 50% of patients. ^ Conclusions. Many challenges face those who seek to optimize care for seriously ill children in resource-limited settings. Specifically, in Haiti, qualitative and quantitative data suggest major issues with lack of supplies, pre-hospital factors, including malnutrition as a comorbidity, and early recognition and management of shock. A tailored intervention designed to address these issues is needed in order to prospectively evaluate improvements in child mortality in a high-risk population.^

Glacial-interglacial bioproductivity of the Mexican Margin

Sedimentary accumulation of biogenic components (organic carbon, opal, and biogenic barium) on the northwestern Mexican margin declined during every glacial interval of the past 140 kyr, indicating decreases in upwelling-induced productivity during cold periods. The glacial-interglacial contrasts in upwelling on this margin are attributed to reversals in land-ocean thermal contrast, the waxing and waning of the Laurentide Ice Sheet, and consequent responses of the western hemisphere wind fields. This scenario is consistent with three independent lines of evidence: terrestrial paleoclimatic data, general circulation model results, and our marine records. This pattern of glacial-interglacial variability in upwelling off NW Mexico is opposite to that observed in other low-latitude and midlatitude upwelling areas, such as the eastern equatorial Pacific. These results add to a growing pool of observations that the response of oceanic upwelling to glacial climatic forcing has been regionally variable.

Fulminant hepatic and multiple organ failure following acute viral tonsillitis: a case report.

BACKGROUND Pyogenic tonsillitis may often be observed in the general Western population. In severe cases, it may require antibiotic treatment or even hospitalization and often a prompt clinical response will be noted. Here we present an unusual case of progressive multiple organ failure including fulminant liver failure following acute tonsillitis initially mistaken for "classic" pyogenic (that is bacterial) tonsillitis. CASE PRESENTATION A 68-year-old previously healthy white man was referred with suspicion of pyogenic angina. After tonsillectomy, he developed acute liver failure and consecutive multiple organ failure including acute hemodynamic, pulmonary and dialysis-dependent renal failure. Immunohistopathological analysis of his tonsils and liver as well as serum polymerase chain reaction analyses revealed herpes simplex virus-2 to be the causative pathogen. Treatment included high-dose acyclovir and multiorgan supportive intensive care therapy. His final outcome was favorable. CONCLUSIONS Fulminant herpes simplex virus-2-induced multiple organ failure is rarely observed in the Western hemisphere and should be considered a potential diagnosis in patients with tonsillitis and multiple organ failure including acute liver failure. From a clinical perspective, it seems important to note that fulminant herpes simplex virus-2 infection may masquerade as "routine" bacterial severe sepsis/septic shock. This persevering condition should be diagnosed early and treated goal-oriented in order to gain control of this life-threatening condition.

A pre-Columbian Y chromosome-specific transition and its implications for human evolutionary history.

A polymorphic C-->T transition located on the human Y chromosome was found by the systematic comparative sequencing of Y-specific sequence-tagged sites by denaturing high-performance liquid chromatography. The results of genotyping representative global indigenous populations indicate that the locus is polymorphic exclusively within the Western Hemisphere. The pre-Columbian T allele occurs at > 90% frequency within the native South and Central American populations examined, while its occurrence in North America is approximately 50%. Concomitant genotyping at the polymorphic tetranucleotide microsatellite DYS19 locus revealed that the C-->T mutation displayed significant linkage disequilibrium with the 186-bp allele. The data suggest a single origin of linguistically diverse native Americans with subsequent haplotype differentiation within radiating indigenous populations as well as post-Columbian European and African gene flow. The mutation may have originated either in North America at a very early time during the expansion or before it, in the ancestral population(s) from which all Americans may have originated. The analysis of linkage of the DYS199 and the DYS19 tetranucleotide loci suggests that the C-->T mutation may have occurred around 30,000 years ago. We estimate the nucleotide diversity over 4.2 kb of the nonrecombining portion of the Y chromosome to be 0.00014. compared to autosomes, the majority of variation is due to the smaller effective population size of the Y chromosome rather than selective sweeps. There begins to emerge a pattern of pronounced geographical localization of Y-specific nucleotide substitution polymorphisms.

World Bathymetric Chart of the Oceans, 1899 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Bathymetrical chart of the oceans, showing the "deeps" according to Sir John Murray. It was published by the Royal Geographical Society in 1899. Scale [ca. 1:100,000,000]. The image inside the map neatline is georeferenced to the surface of the earth and fit to the 'World Gall Stereographic' projection with the central meridian at 20.00000 degrees west. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, shoreline features, and more. Relief shown by hypsometric tints. Depths shown by gradient tints. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Atmospheric Temperature Isotherms (January), 1884 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Karte der Januar-Isotherme. It is part of a two map set: [Karten der Isothermen, von Alexander Supan]. It was published by Ed. Holzel in 1884. Scale [ca. 1:110,000,000]. Map in German. The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'Mercator' projection with the central meridian at 17.666 degrees west. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, selected cities, shoreline features, and more. Isotherms are shown at 2 degree intervals for January. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Atmospheric Temperature Isotherms (July), 1884 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Karte der Juli-Isothermen. It is part of a two map set: [Karten der Isothermen, von Alexander Supan]. It was published by Ed. Holzel in 1884. Scale [ca. 1:110,000,000]. Map in German. The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'Mercator' projection with the central meridian at 17.666 degrees west. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, selected cities, shoreline features, and more. Isotherms are shown at 2 degree intervals for July. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Map Showing Geomagnetic Meridians and Parallels, 1849 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Wachsende Karte der Magnetischen Meridiane und Parallelen : Gegründet auf die Beobachtungen der Declination welche sämmtlich auf das Jahr 1825 reducirt worden sind, von dem Schiffs Kapitain L. I. Duperrey. It was published by Stablstich (diretion v. Kleinecht) aus der Schweinfurter Geographischen Graviranstalt de Bibliographischen Instituts in [1849]. Scale [ca. 1:190,000,000]. Map in German. The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'Mercator' projection with the central meridian at 180 degrees west. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as geomagnetic meridians, parallels, and magnetic declination, selected cities and other human settlements, shoreline features, and more. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Map, 1725 (Image 1 of 2) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Carte generale de toutes les costes du Monde : et les pays nouvellement decouvert, dressé sur les relations les plus nouvelles et principalement sur le carte que Monsieur N. Witsen à donnée au public. It was published by Iean Cóvens et Corneille Mortier Libraires in [1725]. Scale [ca. 1:450,000]. This layer is image 1 of 2 total images of the two sheet source map representing the western portion of the map. Text in French. The image inside the map neatline is georeferenced to the surface of the earth and fit to the 'World Mercator' projection. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, territorial boundaries, shoreline features, and more. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Map Showing Isodynamic Lines, 1849 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Darstellung der isodynamischen Linien : nach den Beobachtungen der magnetischen Intensität, die in den Jahren 1790 bis 1830 gemacht worden sind, Namen der Beobachter: De Rossel, A. v. Humboldt, Sabine, Hansteen, Duperrey, Keilhau u. Boeck, Keilhau, Litke, King, Due, Erman, Kupffer. Die vorlieg. Darstellung ist von Duperry, Kapitain der französ. Marine, entworfen. It was published by [Stablstich (diretion v. Kleinecht) aus der Schweinfurter Geographischen Graviranstalt de Bibliographischen Instituts] in [1849]. Scale [ca. 1:190,000,000]. The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'Mercator' projection with the central meridian at 180 degrees west. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as geomagnetic isodynamic lines, selected cities and other human settlements, shoreline features, and more. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Map, ca. 1774 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: An accurate chart of the world with the new discoveries : also a view of the general &c coasting trade winds, monsoons or shifting trade winds & the variations of the compass ; from the latest and best authorities by T. Kitchin, Geographer for the Lond. Mag. It was published ca. 1774. Scale [ca. 1:90,000,000]. The image inside the map neatline is georeferenced to the surface of the earth and fit to the 'World Mercator' projection. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, trade winds, magnetic variations, shoreline features, and more. Relief shown pictorially. Includes text and notes. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Map Showing Routes of Exploration and Discovery, 1853 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Planisphere : elémentaire et illustré indiquant la description géographique des parties connues de la terre, l'époque des grandes découvertes des navigateurs les colonies Européennes, les principaux parcours des paquebots, l'époque des départs, la durée du trajet, &c[a]., dreseé par Vuillemin, géographie ; gravé par Langevin. It was published by Fatout in 1853. Scale [ca. 1:50,000,000]. Map in French. The image inside the map neatline is georeferenced to the surface of the earth and fit to the the 'World Mercator' projection. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, territorial boundaries, shoreline features, and more. Shows voyage routes of exploration and discovery. Relief shown pictorially and by spot heights. Includes historical notes, explanations, and ill. of sea vessels and scenes of exploration. Includes insets at lower margin: Costumes des différentes races qui peuplent la terre -- [Chart of Mt. heights in Europe] -- Hauteur des principales montagnes du monde -- [Chart of Mt. heights in Asia] -- Tableau faisant voir que le Planisphère n'est que le développement figure du globe sur une surface plane -- Longueurs sources et embouchures des principaux fleuves du monde -- Costumes des différentes races qui peuplent la terre. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Map Showing Routes of Exploration and Discovery, 1850 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: The world, on Mercator's projection, by David H. Burr. It was published by J. Haven, 86 State St. in 1850. Scale [ca. 1:74,000,000]. The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'Mercator' projection with the central meridian at 90 degrees west. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. "Showing the different routes to California, and distance by each, routes of different navigators, route of the contemplated Pacific R. Road, distances to China, Europe, & c." This map shows features such as drainage, cities and other human settlements, shoreline features, and more. Relief shown by abbreviated form lines. Includes historical notes, ship ill., tables of distances, "Nicaragua route" distances, and text on "Pacific Railroad." Insets: Map of the Nicaragua route -- Map of the proposed rail road from St. Louis to the bay of St. Francisco. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

World Map Showing the Voyages of the Vettor Pisani, 1882-1885 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Viaggio della R[a] Corvetta 'Vettor Pisani', negli anni 1882-1883-1884-1885 (comandante G. Palumbo). It was published by Stab. Lit. Bruno e Salomone in 1885. Scale [ca. 1:250,500]. World map showing the voyages of the Vettor Pisani. The image inside the map neatline is georeferenced to the surface of the earth and fit to a non-standard 'Mercator' projection with the central meridian at 160 degrees east. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, ship route with dates, territorial boundaries, shoreline features, and more. This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection and the Harvard University Library as part of the Open Collections Program at Harvard University project: Organizing Our World: Sponsored Exploration and Scientific Discovery in the Modern Age. Maps selected for the project correspond to various expeditions and represent a range of regions, originators, ground condition dates, scales, and purposes.

Impact of commuter aliens along the Mexican and Canadian borders : hearings.

Hearings held in various cities Jan. 26-Mar. 8, 1968.