Trends in Malaria in Odisha,India—An Analysis of the 2003–2013 Time-Series Data from the National Vector Borne Disease Control Program

Background

Although Odisha is the largest contributor to the malaria burden in India, no systematic study has examined its malaria trends. Hence, the spatio-temporal trends in malaria in Odisha were assessed against the backdrop of the various anti-malaria strategies implemented in the state.

Methods

Using the district-wise malaria incidence and blood examination data (2003–2013) from the National Vector Borne Disease Control Program, blood examination-adjusted time-trends in malaria incidence were estimated and predicted for 2003–2013 and 2014–2016, respectively. An interrupted time series analysis using segmented regression was conducted to compare the disease trends between the pre (2003–2007) and post-intensification (2009–2013) periods. Key-informant interviews of state stakeholders were used to collect the information on the various anti-malaria strategies adopted in the state.

Results

The state annual malaria incidence declined from 10.82/1000 to 5.28/1000 during 2003–2013 (adjusted annual decline: -0.54/1000, 95% CI: -0.78 to -0.30). However, the annual blood examination rate remained almost unchanged from 11.25% to 11.77%. The keyinformants revealed that intensification of anti-malaria activities in 2008 led to a more rapid decline in malaria incidence during 2009–2013 as compared to that in 2003–2007 [adjusted decline: -0.83 (-1.30 to -0.37) and -0.27 (-0.41 to -0.13), respectively]. There was a significant difference in the two temporal slopes, i.e., -0.054 (-0.10 to -0.002, p = 0.04) per 1000 population per month, between these two periods, indicating almost a 200% greater decline in the post-intensification period. Although, the seven southern high-burden districts registered the highest decline, they continued to remain in that zone, thereby, making the achievement of malaria elimination (incidence <1/1000) unlikely by 2017.

Conclusion

The anti-malaria strategies in Odisha, especially their intensification since 2008, have helped improve its malaria situation in recent years. These successful measures need to be sustained and perhaps intensified further for eliminating malaria from Odisha.     

Patient-Safety-Related Hospital Deaths in England: Thematic Analysis of Incidents Reported to a National Database, 2010–2012

Background

Hospital mortality is increasingly being regarded as a key indicator of patient safety, yet methodologies for assessing mortality are frequently contested and seldom point directly to areas of risk and solutions. The aim of our study was to classify reports of deaths due to unsafe care into broad areas of systemic failure capable of being addressed by stronger policies, procedures, and practices. The deaths were reported to a patient safety incident reporting system after mandatory reporting of such incidents was introduced.

Methods and Findings

The UK National Health Service database was searched for incidents resulting in a reported death of an adult over the period of the study. The study population comprised 2,010 incidents involving patients aged 16 y and over in acute hospital settings. Each incident report was reviewed by two of the authors, and, by scrutinising the structured information together with the free text, a main reason for the harm was identified and recorded as one of 18 incident types. These incident types were then aggregated into six areas of apparent systemic failure: mismanagement of deterioration (35%), failure of prevention (26%), deficient checking and oversight (11%), dysfunctional patient flow (10%), equipment-related errors (6%), and other (12%). The most common incident types were failure to act on or recognise deterioration (23%), inpatient falls (10%), healthcare-associated infections (10%), unexpected per-operative death (6%), and poor or inadequate handover (5%). Analysis of these 2,010 fatal incidents reveals patterns of issues that point to actionable areas for improvement.

Conclusions

Our approach demonstrates the potential utility of patient safety incident reports in identifying areas of service failure and highlights opportunities for corrective action to save lives. Please see later in the article for the Editors'' Summary     

Validity of U.S. Nutritional Surveillance: National Health and Nutrition Examination Survey Caloric Energy Intake Data, 1971–2010

Importance

Methodological limitations compromise the validity of U.S. nutritional surveillance data and the empirical foundation for formulating dietary guidelines and public health policies.

Objectives

Evaluate the validity of the National Health and Nutrition Examination Survey (NHANES) caloric intake data throughout its history, and examine trends in the validity of caloric intake estimates as the NHANES dietary measurement protocols evolved.

Design

Validity of data from 28,993 men and 34,369 women, aged 20 to 74 years from NHANES I (1971–1974) through NHANES 2009–2010 was assessed by: calculating physiologically credible energy intake values as the ratio of reported energy intake (rEI) to estimated basal metabolic rate (BMR), and subtracting estimated total energy expenditure (TEE) from NHANES rEI to create ‘disparity values’.

Main Outcome Measures

1) Physiologically credible values expressed as the ratio rEI/BMR and 2) disparity values (rEI–TEE).

Results

The historical rEI/BMR values for men and women were 1.31 and 1.19, (95% CI: 1.30–1.32 and 1.18–1.20), respectively. The historical disparity values for men and women were −281 and −365 kilocalorie-per-day, (95% CI: −299, −264 and −378, −351), respectively. These results are indicative of significant under-reporting. The greatest mean disparity values were −716 kcal/day and −856 kcal/day for obese (i.e., ≥30 kg/m2) men and women, respectively.

Conclusions

Across the 39-year history of the NHANES, EI data on the majority of respondents (67.3% of women and 58.7% of men) were not physiologically plausible. Improvements in measurement protocols after NHANES II led to small decreases in underreporting, artifactual increases in rEI, but only trivial increases in validity in subsequent surveys. The confluence of these results and other methodological limitations suggest that the ability to estimate population trends in caloric intake and generate empirically supported public policy relevant to diet-health relationships from U.S. nutritional surveillance is extremely limited.     

U.S. National Institutes of Health Core Consolidation–Investing in Greater Efficiency

The U.S. National Institutes of Health (NIH) invests substantial resources in core research facilities (cores) that support research by providing advanced technologies and scientific and technical expertise as a shared resource. In 2010, the NIH issued an initiative to consolidate multiple core facilities into a single, more efficient core. Twenty-six institutions were awarded supplements to consolidate a number of similar core facilities. Although this approach may not work for all core settings, this effort resulted in consolidated cores that were more efficient and of greater benefit to investigators. The improvements in core operations resulted in both increased services and more core users through installation of advanced instrumentation, access to higher levels of management expertise; integration of information management and data systems; and consolidation of billing; purchasing, scheduling, and tracking services. Cost recovery to support core operations also benefitted from the consolidation effort, in some cases severalfold. In conclusion, this program of core consolidation resulted in improvements in the effective operation of core facilities, benefiting both investigators and their supporting institutions.     

Acute Thiopurine Overdose: Analysis of Reports to a National Poison Centre 1995–2013

Literature regarding acute human toxicity of thiopurines is limited to a handful of case reports. Our objectives were to describe all cases of overdose with thiopurines reported to the Swiss Toxicological Information Centre between 1995–2013. A retrospective analysis was performed to determine circumstances, magnitude, management and outcome of overdose with these substances. A total of 40 cases (14 paediatric) were reported (azathioprine, n = 35; 6-mercaptopurine, n = 5). Of these, 25 were with suicidal intent, 12 were accidental and 3 were iatrogenic errors. The magnitude of overdose ranged from 1.5 to 43 (median 8) times the usual dose in adults. Twelve cases (30%) had attributable symptoms. The majority of these were minor and included gastrointestinal complaints and liver function test and blood count abnormalities. Symptoms were experienced by patients who took at least 1.5-times their usual daily thiopurine dose. Overdoses over two or more consecutive days, even if of modest size, were less well tolerated. One case of azathioprine and allopurinol co-ingestion over consecutive days led to agranulocytosis. Decontamination measures were undertaken in 11 cases (10 activated charcoal, 1 gastric lavage) and these developed fewer symptoms than untreated patients. This study shows that acute overdoses with thiopurines have a favourable outcome in the majority of cases and provides preliminary evidence that gastrointestinal decontamination with activated charcoal may reduce symptom development after overdose of these substances if patients present to medical services soon after ingestion.     

Ecogeochemistry of the subsurface food web at pH 0–2.5 in Iron Mountain,California, U.S.A.

Pyrite oxidation in the underground mining environment of Iron Mountain, California, has created the most acidic pH values ever reported in aquatic systems. Sulfate values as high as 120000 mg l^–1 and iron as high as 27600 mg l^–1 have been measured in the mine water, which also carries abundant other dissolved metals including Al, Zn, Cu, Cd, Mn, Sb and Pb. Extreme acidity and high metal concentrations apparently do not preclude the presence of an underground acidophilic food web, which has developed with bacterial biomass at the base and heliozoans as top predators. Slimes, oil-like films, flexible and inflexible stalactites, sediments, water and precipitates were found to have distinctive communities. A variety of filamentous and non-filamentous bacteria grew in slimes in water having pH values <1.0. Fungal hyphae colonize stalactites dripping pH 1.0 water; they may help to form these drip structures. Motile hypotrichous ciliates and bdelloid rotifers are particularly abundant in slimes having a pH of 1.5. Holdfasts of the iron bacterium Leptothrix discophora attach to biofilms covering pools of standing water having a pH of 2.5 in the mine. The mine is not a closed environment – people, forced air flow and massive flushing during high intensity rainfall provide intermittent contact between the surface and underground habitats, so the mine ecosystem probably is not a restricted one.     

Do Female Cancer Patients Display Better Survival Rates Compared with Males? Analysis of the Korean National Registry Data, 2005–2009

Background

Sex differences have been reported in the prognosis of certain cancers. In this study, we investigated whether Korean females display better survival rates compared with male patients for solid tumor sites.

Methods

We analyzed data from the Korean National Cancer Incidence Database from 599,288 adult patients diagnosed with solid cancers between 2005 and 2009. Patients were followed until December 2010. We applied a relative excess risk (RER) model adjusting for year of follow-up, age at diagnosis, and stage at diagnosis.

Results

For all solid cancer sites combined, women displayed an 11% lower risk of death compared to men (RER 0.89; 95% CI 0.88–0.90) after adjusting for year of follow-up, age, stage, and case mix. Women showed significantly lower RERs for the following sites: head/neck, esophagus, small intestine, liver, nasal cavities, lung, bone/cartilages, melanoma of skin, soft tissue, brain and CNS, and thyroid. In contrast, women displayed a poorer prognosis than did men for colorectal, laryngeal, kidney and bladder cancer. However, the survival gaps between men and women narrowed by increase in age; female patients over 75 years of age displayed a 3% higher RER of death compared with males in this age group.

Conclusions

Female cancer patients display an improved survival for the majority of solid tumor sites, even after adjustment for age and stage. Age at diagnosis was the major contributor to the women’s survival advantage.     

Using Local Ecological Knowledge to Assess Morel Decline in the U.S. Mid–Atlantic Region

Using Local Ecological Knowledge to Assess Morel Decline in the U.S. Mid–Atlantic Region. Morels (Morchella spp.) are prized wild edible mushrooms. In the United States, morels are the focus of family traditions, local festivals, mycological society forays, and social media, as well as substantial commercial trade. A majority of the anglophone research on morels has been conducted in Europe and in the U.S. Pacific Northwest and Midwest. This literature provides insights into a diverse and plastic genus, but much of its biology and ecology remains a mystery. In 2004, we initiated a study of morel mushroom harvesting in the U.S. Mid–Atlantic region in response to concerns that morels might be in decline in the national parks in that area. This paper presents results from that research with an emphasis on morel hunters’ local ecological knowledge of morel types, phenology, habitat, vegetative associations, and responses to disturbance. We conclude that experienced morel harvesters possess local ecological knowledge that complements scientific knowledge and can increase our understanding of the complex and regionally variable ecology of Morchella and inform conservation efforts.     

Transfer of seabed mining technology: A stumbling block to U.S. ratification of the law of the sea convention?

Abstract

The Law of the Sea Convention's provisionson the transfer of seabed technology are designed to translate into specific terms the general notions (adopted in the U. N.’s Declaration of Principles of 1970) that the resources of the seabed are the “common heritage”; of humankind and that the developing nations are to gain special benefits from the exploitation of these resources. Some developed nations—in particular, the United States—have argued that these provisions are unfair, because they deprive the multinational enterprises of the developed world of the competitive advantage they have gained from their substantial investment in research and development and their innovative capabilities.

The transfer of technology is not a new concept. It is a mechanism that has been used systematically by many developing countries to ensure that foreign investments will produce a lasting infrastructure for continued national development. Multinational enterprises have learned to accommodate national needs in this area, and technology‐transfer requirements for land‐based investments have not deterred investments in the developing world.

The technology‐transfer provisions in the Law of the Sea Convention are ambiguous in certain respects, but the Preparatory Conference should provide ample opportunity to clarify these ambiguities and thus to accommodate the needs of both the investors and the developing nations. If this issue is examined from a common‐sense perspective, it should not continue to be a stumbling block that would prevent the United States from ratifying this important Convention.     

Estimating the Development Assistance for Health Provided to Faith-Based Organizations, 1990–2013

Background

Faith-based organizations (FBOs) have been active in the health sector for decades. Recently, the role of FBOs in global health has been of increased interest. However, little is known about the magnitude and trends in development assistance for health (DAH) channeled through these organizations.

Material and Methods

Data were collected from the 21 most recent editions of the Report of Voluntary Agencies. These reports provide information on the revenue and expenditure of organizations. Project-level data were also collected and reviewed from the Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. More than 1,900 non-governmental organizations received funds from at least one of these three organizations. Background information on these organizations was examined by two independent reviewers to identify the amount of funding channeled through FBOs.

Results

In 2013, total spending by the FBOs identified in the VolAg amounted to US$1.53 billion. In 1990, FB0s spent 34.1% of total DAH provided by private voluntary organizations reported in the VolAg. In 2013, FBOs expended 31.0%. Funds provided by the Global Fund to FBOs have grown since 2002, amounting to $80.9 million in 2011, or 16.7% of the Global Fund’s contributions to NGOs. In 2011, the Gates Foundation’s contributions to FBOs amounted to $7.1 million, or 1.1% of the total provided to NGOs.

Conclusion

Development assistance partners exhibit a range of preferences with respect to the amount of funds provided to FBOs. Overall, estimates show that FBOS have maintained a substantial and consistent share over time, in line with overall spending in global health on NGOs. These estimates provide the foundation for further research on the spending trends and effectiveness of FBOs in global health.     

Effects of temperature variation on suicide in five U.S. counties, 1991–2001

Effects of weather variables on suicide are well-documented, but there is still little consistency among the results of most studies. Nevertheless, most studies show a peak in suicides during the spring season, and this is often attributed to increased temperatures. The purpose of this study is to test the relationship between monthly temperature and monthly suicide, independent of months or seasons, for five counties located across the United States. Harmonic analysis shows that four of the five counties display some seasonal components in the suicide data. However, simple linear regression shows no correlation between suicide and temperature, and discriminant analysis shows that monthly departure from mean annual suicide rates is not a useful tool for identifying months with temperatures that are colder or warmer than the annual average. Therefore, it appears that the seasonality of suicides is due to factors other than temperature.     

The search for Fort Armstrong: Dendroarchaeology of the Williamson “Snow Hill” Plantation,Cherokee County,Alabama, U.S.A.

Tree-ring dating has been applied to three historical log buildings in northeastern Alabama to determine if any of the structures could have been associated with historic Fort Armstrong. Fort Armstrong was constructed near Cedar Bluff, Alabama by militia members under the ultimate command of Andrew Jackson to support actions against the “Red Stick” faction of Creeks during the First Creek War in 1813. Comparison of tree-ring samples from the structures with reference chronologies from nearby living trees strongly indicates that none of the three buildings was constructed prior to about 1849 and therefore could not have been contemporaneous with Fort Armstrong. However, the dating does indicate that the buildings are Antebellum in age and were very likely constructed as part of the early development of Snow Hill Plantation. As such these structures provide insight into the physical and cultural patterns of an early Alabama plantation. We believe that this project represents the first dendroarchaeological research reported from Alabama.     

Where did all the nitrogen go? Fate of nitrogen inputs to large watersheds in the northeastern U.S.A.

To assess the fate of the large amounts of nitrogen (N) brought into the environment by human activities, we constructed N budgets for sixteen large watersheds (475 to 70,189 km²) in the northeastern U.S.A. These watersheds are mainly forested (48–87%), but vary widely with respect to land use and population density. We combined published data and empirical and process models to set up a complete N budget for these sixteen watersheds. Atmospheric deposition, fertilizer application, net feed and food inputs, biological fixation, river discharge, wood accumulation and export, changes in soil N, and denitrification losses in the landscape and in rivers were considered for the period 1988 to 1992. For the whole area, on average 3420 kg of N is imported annually per km² of land. Atmospheric N deposition, N₂ fixation by plants, and N imported in commercial products (fertilizers, food and feed) contributed to the input in roughly equal contributions. We quantified the fate of these inputs by independent estimates of storage and loss terms, except for denitrification from land, which was estimated from the difference between all inputs and all other storage and loss terms. Of the total storage and losses in the watersheds, about half of the N is lost in gaseous form (51%, largely by denitrification). Additional N is lost in riverine export (20%), in food exports (6%), and in wood exports (5%). Change in storage of N in the watersheds in soil organic matter (9%) and wood (9%) accounts for the remainder of the sinks. The presence of appreciable changes in total N storage on land, which we probably under-rather than overestimated, shows that the N budget is not in steady state, so that drainage and denitrification exports of N may well increase further in the future.     

Quality of Life and Work Productivity Impairment among Psoriasis Patients: Findings from the National Psoriasis Foundation Survey Data 2003–2011

Objective

To ascertain impairment in quality of life and work productivity among patients with psoriasis and psoriatic arthritis.

Design

From 2003 through 2011, the National Psoriasis Foundation collected survey data from patients with psoriasis and psoriatic arthritis via email and telephone correspondences.

Setting

Survey data were collected from psoriasis and psoriatic arthritis patients in the general community in the U.S.

Main Outcome Measures

Quality of life focusing on emotional impact (anger, frustration, helplessness, etc.) and physical impact (pain, pruritus, physical irritation, etc.); employment status.

Patients

The surveys were performed through random sampling of participants from a database of over 75,000 patients.

Results

From 2003 to 2011, 5,604 patients completed the surveys. Psoriasis and psoriatic arthritis affected overall emotional wellbeing in 88% of patients, and they interfered with enjoyment of life in 82%. Most patients reported experiencing anger (89%), frustration (89%), helplessness (87%), embarrassment (87%), and self-consciousness (89%). Many patients also actively concealed physical manifestations of their diseases (83%), and experienced pain (83%) and pruritus (93%) regularly. Of note, 12% of patients were unemployed, and 11% worked part-time. Among unemployed patients, 92% cited psoriasis and/or psoriatic arthritis as the sole reasons for not working. Among working patients, 49% missed work days regularly due to psoriasis. Compared to patients with mild psoriasis, patients with severe psoriasis have 1.8 times greater odds to be unemployed after adjusting for age and gender (Adjusted OR = 1.7, 95% CI 1.4–2.3).

Conclusion

Patients with psoriasis and psoriatic arthritis continue to experience significant impairment of quality of life and work productivity.