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.^

The effects of IL -10 producing monocytes on T-cell activation in patients with epithelial ovarian cancer

A newly described subset of monocytes has been identified in peritoneal exudate cells (PEC) from the malignant ascites of patients with ovarian cancer. These cells were characterized by the production of IL-10 and TGF-β2, but not IL-12, IL-1α, or TNF-α, and expressed CD14, CD16, and CD54, but not HLA-DR, CD80, CD86, CD11a, CD11b, or CD25 cell surface antigens. Since this subset of monocytes could affect the modulation of tumor immune responses in vivo, studies were undertaken to determine their effect on the activation and proliferation of autologous T-cells from the peritoneal cavity of patients with ovarian carcinoma. Cytokine transcripts, including IL-2, GM-CSF, and IFN-γ were detected in T-cells isolated from patient specimens that also contained the IL-10 producing monocytes, although the IFN-γ and IL-2 proteins could not be detected in T-cells co-incubated with the IL-10 producing monocytes in vitro. Additionally, IL-10 producing monocytes co-cultured with autologous T-cells inhibited the proliferation of the T-cells in response to PHA. T-cell proliferation and cytokine protein production could be restored by the addition of neutralizing antibodies to IL-10R and TGF-β to the co-culture system. These results suggested that this subset of monocytes may modulate antitumor immune responses by inhibiting T-cell proliferation and cytokine protein production. Further studies determined that the precursors to the inhibitory monocytes were tumor-associated and only present in the peripheral blood of patients with ovarian cancer and not present in the peripheral blood of healthy donors. These precursors could be induced to the suppressor phenotype by the addition of IL-2 and GM-CSF, two cytokines detected in the peritoneal cavity of ovarian cancer patients. Lastly, it was shown that the suppressor monocytes from the peritoneal cavity of ovarian cancer patients could be differentiated to a non-inhibitory phenotype by the addition of TNF-α and IFN-γ to the culture system. The differentiated monocytes did not produce IL-10, expressed the activation antigens HLA-DR, CD80, and CD86, and were able to stimulate autologous T-cells in vitro. Since a concomitant reduction in immune function is associated with tumor growth and progression, the effects of these monocytes are of considerable importance in the context of tumor immunotherapy. ^

Abb. 2 Pollen stratigraphy of the Miocene in Middle Europe

Anknüpfend an die von V. D. RRELIE (1961) erläuterte pollenanalytische Gliederung für das Miozän der Niederrheinischen Bucht soll untersucht werden, inwieweit diese auch für die angrenzenden Gebiete allgemeingültig ist oder noch vervollkommnet werden kann. Damit werden die Möglichkeiten einer weitergehenden Gliederung des Miocäns für den gesamten mitteleuropäischen Raum einschließlich der Nordsee-Umrandung zur Darstellung gebracht.

Physical oceanography and ADCP measurements during Maria S. Merian cruise MSM13/2

Up to the end of the eighties the main source of deep water masses in the Ionian Basin was the southern Adriatic Sea. However, during the nineties a dramatic climatic change took place in the eastern Mediterranean Sea: the Eastern Mediterranean Transient (EMT). Since then, deep water has been formed by waters originating in the Aegean Sea. Expeditions carried out in this region in recent years indicate that the process of deep water formation might reverse again. To what extent this assumption applies and what characteristics the deep water in the Ionian Sea exhibit nowadays, should be determined on the cruise. The process of a re-reversal of abyssal water production in the Ionian Sea is a long-term process and must therfore be monitored for several years. Hence, this cruise is part of a series of cruises investigating this question (POS98, M71/3, MSM13/1-2, MSM15/4). The investigations were carried out by means of CTD/lADCP measurements.

Micropaleontological and geochemical proxy studies of sediment core GeoB7926-2

[1] The low-latitude upwelling regime off the Mauritanian coast in the subtropical NE Atlantic accounts for a significant part of global export production. Although productivity variations in coastal upwelling areas are usually attributed to changes in wind stress and upwelling intensity, productivity dynamics off Mauritania are less straightforward because of the complex atmospheric and hydrographic setting. Here we integrate micropaleontological (diatoms) and geochemical (bulk biogenic sediment components, X-ray fluorescence, and alkenones) proxies to examine on submillennial-to-millennial changes in diatom production that occurred off Mauritania, NW Africa, for the last 25 ka. During the Last Glacial Maximum (LGM, 19.0-23.0 ka B.P.), moderate silicate content of upwelled waters coupled with weakened NE trade winds determined moderate diatom productivity. No significant cooling is observed during the LGM, suggesting that our alkenone-based SST reconstruction represents a local, upwelling-related signal rather than a global insolation related one. Extraordinary increases in diatom and opal concentrations during Heinrich event 1 (H1, 15.5-18.0 ka B.P.) and the Younger Dryas (YD, 13.5-11.5 ka B.P.) are attributed to enhanced upwelling of silica-rich waters and an enlarged upwelling filament, due to more intense NE trade winds. The synchronous increase of CaCO3 and K intensity and the decreased opal and diatoms values mark the occurrence of the Bølling/Allerød (BA, 13.5-15.5 ka B.P.) due to weakened eolian input and more humid conditions on land. Although the high export of diatoms is inextricably linked to upwelling intensity off Mauritania, variability in the nutrient content of the thermocline also plays a decisive role.

(Table 1) Average aluminium accumulation rate at 40 DSDP Sites for the time interval 0-10 Ma and relative rates for other time intervals

A six-fold increase in the rate of accumulation of Al in north and central Atlantic and Pacific Ocean sediments indicates vastly increased denudation of the continents during the past 15 Ma. The increase is more apparent in hemipelagic than pelagic sites, demonstrating widely distributed local controls. Similarities in the rate of increase in the Atlantic and Pacific show that tectonic elevation is not responsible for the difference in sedimentation rate. Also, similarities in the difference at sites of low and high latitude suggest that glaciation is not the most significant source. A lack of correspondence between sedimentation rates and Vail's sea-level curve similarly rule out that effect. The conclusion drawn here is that worldwide climatic deterioration during the late Tertiary is the explanation for the striking increase in detrital sedimentation in the World ocean.

Estudio de calidad de codificación utilizando los perfiles 10 Bits del estándar H.264

Desde los inicios de la codificación de vídeo digital hasta hoy, tanto la señal de video sin comprimir de entrada al codificador como la señal de salida descomprimida del decodificador, independientemente de su resolución, uso de submuestreo en los planos de diferencia de color, etc. han tenido siempre la característica común de utilizar 8 bits para representar cada una de las muestras. De la misma manera, los estándares de codificación de vídeo imponen trabajar internamente con estos 8 bits de precisión interna al realizar operaciones con las muestras cuando aún no se han transformado al dominio de la frecuencia. Sin embargo, el estándar H.264, en gran auge hoy en día, permite en algunos de sus perfiles orientados al mundo profesional codificar vídeo con más de 8 bits por muestra. Cuando se utilizan estos perfiles, las operaciones efectuadas sobre las muestras todavía sin transformar se realizan con la misma precisión que el número de bits del vídeo de entrada al codificador. Este aumento de precisión interna tiene el potencial de permitir unas predicciones más precisas, reduciendo el residuo a codificar y aumentando la eficiencia de codificación para una tasa binaria dada. El objetivo de este Proyecto Fin de Carrera es estudiar, utilizando las medidas de calidad visual objetiva PSNR (Peak Signal to Noise Ratio, relación señal ruido de pico) y SSIM (Structural Similarity, similaridad estructural), el efecto sobre la eficiencia de codificación y el rendimiento al trabajar con una cadena de codificación/descodificación H.264 de 10 bits en comparación con una cadena tradicional de 8 bits. Para ello se utiliza el codificador de código abierto x264, capaz de codificar video de 8 y 10 bits por muestra utilizando los perfiles High, High 10, High 4:2:2 y High 4:4:4 Predictive del estándar H.264. Debido a la ausencia de herramientas adecuadas para calcular las medidas PSNR y SSIM de vídeo con más de 8 bits por muestra y un tipo de submuestreo de planos de diferencia de color distinto al 4:2:0, como parte de este proyecto se desarrolla también una aplicación de análisis en lenguaje de programación C capaz de calcular dichas medidas a partir de dos archivos de vídeo sin comprimir en formato YUV o Y4M. ABSTRACT Since the beginning of digital video compression, the uncompressed video source used as input stream to the encoder and the uncompressed decoded output stream have both used 8 bits for representing each sample, independent of resolution, chroma subsampling scheme used, etc. In the same way, video coding standards force encoders to work internally with 8 bits of internal precision when working with samples before being transformed to the frequency domain. However, the H.264 standard allows coding video with more than 8 bits per sample in some of its professionally oriented profiles. When using these profiles, all work on samples still in the spatial domain is done with the same precision the input video has. This increase in internal precision has the potential of allowing more precise predictions, reducing the residual to be encoded, and thus increasing coding efficiency for a given bitrate. The goal of this Project is to study, using PSNR (Peak Signal to Noise Ratio) and SSIM (Structural Similarity) objective video quality metrics, the effects on coding efficiency and performance caused by using an H.264 10 bit coding/decoding chain compared to a traditional 8 bit chain. In order to achieve this goal the open source x264 encoder is used, which allows encoding video with 8 and 10 bits per sample using the H.264 High, High 10, High 4:2:2 and High 4:4:4 Predictive profiles. Given that no proper tools exist for computing PSNR and SSIM values of video with more than 8 bits per sample and chroma subsampling schemes other than 4:2:0, an analysis application written in the C programming language is developed as part of this Project. This application is able to compute both metrics from two uncompressed video files in the YUV or Y4M format.