Antiphospholipid syndrome is an autoimmune thrombophilic disorder that is uncommon in adults and remarkably rare in children. Thrombotic etiological factors are variable in antiphospholipid syndrome, including antibody-antigen complex-mediated platelet activation, inhibition of anticoagulants, or attenuation of fibrinolysis. We present the case of a child with antiphospholipid syndrome presenting with syncope, constrictive pericarditis and hepatic enlargement that was found to have platelet-mediated hypercoagulability and marked clot lysis via thrombelastography in the preoperative period. Restoration of circulation following pericardectomy and inotropic support was associated with attenuation of hypercoagulability and fibrinolysis. It is concluded that the etiological factors responsible for antiphospholipid syndrome-mediated hemostatic abnormalities and the probable effects of hepatic hypoperfusion on clot lysis in this patient were detected with thrombelastography, and similar thrombelastographic analyses are recommended to compliment standard coagulation assessments of patients with antiphospholipid syndrome.

To study the time-course of infectious asthma, we retrospectively examined FEV1 from 5 days before to 10 days after the onset of illness in 31 asthmatic children (20 boys and 11 girls), aged 8 to 12 years. Infections were confirmed by a rise of at least fourfold in serum compliment fixation titers (respiratory syncytial virus, adenovirus, and Mycoplasma pneumoniae) and hemoagglutination inhibition titers (parainfluenza virus types 1, 2, and 3). All the patients had 20 percent or more fall in FEV1 from baseline value during acute phase, but were clinically tolerable and required minimum or no bronchodilators. Regardless of infectious agent, FEV1 began to fall on the first disease day or the previous day, and deteriorate for the first few days. Mean(SD) maximum fall in FEV1 ranged from 39(12) percent to 45(20) percent. Thereafter, FEV1 began to improve and returned to the preillness level by the seventh to tenth day. These results suggest that progressive bronchial obstruction may be inevitable during the acute stage of any infectious asthma.

Our aim was to determine whether post-treatment laboratory values could help to predict the clinical response in patients with advanced diabetic foot infections. One hundred and three consecutive patients hospitalized for moderate or severe diabetic foot infections at a large, university-affiliated hospital were identified and their records retrospectively reviewed. Definitive therapy during each patient's hospital course was defined as any foot surgery when additional major surgery was not anticipated or when a course of deep soft tissue and/or bone culture-specific antibiotics had been initiated. The clinical response was assessed at 90 days after the start of definitive therapy. A poor response was recognized as persistent infection at the initial or a contiguous site or when unplanned revision surgery or amputation was subsequently required. The peripheral white blood cell count, neutrophil count, erythrocyte sedimentation rate, and C-reactive protein levels measured shortly after initiating definitive therapy (i.e., post-treatment) were examined for their association with the clinical response using logistic regression models. A total of 38 patients with the complete compliment of laboratory and clinical follow-up aged 59.7 ± 12.3 years with a diabetes duration of 13.3 ± 9.1 years were included. Leukocytosis, defined as a white blood cell count >11,000 cells/μL, observed an average of 3 ± 1.4 days after treatment, was the single most important marker for predicting a poor clinical response, and the only significant study variable in both univariate and multivariate analyses (multivariate odds ratio 9.7, 95% confidence interval 1.0 to 92, p = .048). We conclude that leukocytosis observed shortly after initiating definitive therapy is predictive of an unfavorable clinical response by 90 days.

OBJECTIVE

The application of an automated immunomagnetic separation-enzyme immunoassay (AIMS-EIA) during the investigation of a suspected outbreak of Salmonella food poisoning at a retail premises.

RESULTS

Six food samples and 24 environmental swabs were taken from the retail premises and six food handlers' submitted faecal samples during the investigation of the outbreak. Isolation and identification of Salmonella from these samples was performed according to established standard operating procedures and by AIMS-EIA. Twelve of the 18 (67%) Salmonella culture positive samples were AIMS-EIA positive on testing pre-enrichment samples after 24 h, whilst 17 (94%) samples were AIMS-EIA positive following selective enrichment for a further 48 h. One food handler was found to be positive for Salmonella by both culture and AIMS-EIA. All Salmonella isolates were confirmed as Salmonella Enteritidis phagetype 21c.

CONCLUSIONS

The AIMS-EIA protocol compliments the conventional culture approach to produce more timely results for the management of the risk to public health without significantly increasing the workload of the laboratory.

CONCLUSIONS

The food production premise investigated in this study was heavily contaminated with Salmonella Enteritidis. Application of the AIMS-EIA was significant in the effective intervention of control measures for the protection of public health.

In Streptomycetes, tetracycline repressor family of transcription regulators (TetR-FTRs) controls various biological processes including antibiotic biosynthesis, cellular morphology and innate resistance. Here, we focus on understanding the structural basis of transcription regulation by CprB, a member of TetR-FTRs from S. coelicolor. CprB is implicated as a receptor of γ-butyrolactones, a class of quorum sensing molecules, responsible for initiating secondary metabolic pathways. In order to understand the molecular mechanism of DNA recognition, the X-ray structure of CprB in complex with its biological relevant operator sequence was solved to a resolution of 3.95Å. Furthermore, to refine and compliment the results, atomistic molecular dynamics simulations were carried out using the X-ray structure as the template. The studies reveal that CprB binds to DNA as dimer of dimers with this mode of interaction results in minimal distortion in the DNA, enabling these proteins to recognize multiple sequences with varying affinity. Another crucial finding from our simulation results was that the positively charged N-terminal arm of CprB brings extra stability to the protein-DNA complex by interacting with the minor-groove of the DNA and anchoring itself to the phosphate backbone. Corroborating electrophoretic mobility shift assay and fluorescence anisotropy experiments showed that the mutant ΔN6-CprB exhibited about 7-8 fold reduced DNA binding. Comparison with other TetR-FTRs reveals that this strategy is also employed by over 25% of TetR-FTRs, where N-terminal anchoring mechanism is used to enhance selectivity for a particular DNA sequence.

The study of canine cognition can be useful in understanding the selective pressures affecting cognitive abilities. Dogs have undergone intensive artificial selection yielding distinctive breeds, which differ both phenotypically and behaviorally and no other species has a wider range in brain size. As brain size has long been hypothesized to relate to cognitive capacity, this species offers a useful model to further explore this relationship. The influence of physical size on canine cognition has not been thoroughly addressed, despite the fact that large dogs are often perceived to be 'smarter' than small dogs. To date, this preconception has only recently been addressed and supported in one study comparing large and small dogs in a social cognition task, where large dogs outperformed small dogs in a pointing choice task. We assessed large and small dogs using a series of spatial cognition tasks and detected no differences between the two groups. Further research is needed to clarify why our results failed to compliment previous findings. It is possible that differences found in social cognition tasks may not be due to differences in size, rather they may be based on other factors such as methodology, prior training experience, or past experience with humans in general.

OBJECTIVE

To determine, for people seeking a date online, what activities and behaviours have an effect on the chances of converting electronic communication into a face-to-face meeting.

METHODS

Literature in psychology, sociology, and computer, behavioural and neurocognitive sciences that informed effective online dating was captured through electronic searching of Psychinfo, Medline and Embase in November 2013. Study selection and meta-narrative synthesis were carried out in duplicate.

RESULTS

There were 3938 initial citations and 86 studies were synthesised. Initial interest was best captured through: a desirable screen name starting with a letter in the top half of the alphabet; an attractive still picture; and a fluent headline message. For those attracted to browse into the profile, a description of personal traits increased likeability when it: showed who the dater was and what they were looking for in a 70:30 ratio; stayed close to reality; and employed simple language with humour added. Invitations were most successful in obtaining a response from the potential date when they: were short personalised messages addressing a trait in their profile; rhymed with their screen name or headline message; and extended genuine compliments. Online communication was most effective in leading to an in-person meeting if there were: a genuine interest; a rapid turnaround; reciprocity in self-disclosure; mimicry of body movements on the webcam; avoidance of criticism; humour; uncertainty about whether there was likeability; and an early move from electronic chat to a date.

CONCLUSIONS

Attraction and persuasion research provides an evidence-based approach to online dating.

Hostile people tend to view the world as a hostile place. Although there are individual differences in hostile world-views, situational factors can also play a role. For example, scenes of violence in the mass media might influence people to view the world as a hostile place. This meta-analysis aggregates, for the first time, all studies that have investigated the link between exposure to violent media and hostile appraisals (e.g., perceiving the ambiguous actions by others as aggressive actions). This meta-analysis included 37 independent studies involving 10,410 participants. The results showed a "small" to "moderate" sized average correlation between exposure to violent media and hostile appraisals (r+ = .20, 95%CI = .14, .26). Significant correlations were found in experimental, cross-sectional, and longitudinal studies, indicating a triangulation of evidence. Effects were not correlated with participant gender. Effects were also stable over time. However, the link between exposure to violent media and hostile appraisals was positively related to age, perhaps because violent media can have cumulative effects over time. There was no evidence of publication bias. The findings from this meta-analysis are consistent with the General Aggression Model (e.g., Anderson, & Bushman, 2002; Annual Review of Psychology 53:27-51). These results compliment those from previous meta-analyses showing that violent media can increase aggressive thoughts, angry feelings, physiological arousal, and aggressive behavior. These findings also have practical significance, because people who view the world in a hostile manner are more likely to behave aggressively themselves. Aggr. Behav. 42:605-613, 2016. © 2016 Wiley Periodicals, Inc.

We describe an investigation into how Massey University's Pollen Classifynder can accelerate the understanding of pollen and its role in nature. The Classifynder is an imaging microscopy system that can locate, image and classify slide based pollen samples. Given the laboriousness of purely manual image acquisition and identification it is vital to exploit assistive technologies like the Classifynder to enable acquisition and analysis of pollen samples. It is also vital that we understand the strengths and limitations of automated systems so that they can be used (and improved) to compliment the strengths and weaknesses of human analysts to the greatest extent possible. This article reviews some of our experiences with the Classifynder system and our exploration of alternative classifier models to enhance both accuracy and interpretability. Our experiments in the pollen analysis problem domain have been based on samples from the Australian National University's pollen reference collection (2,890 grains, 15 species) and images bundled with the Classifynder system (400 grains, 4 species). These samples have been represented using the Classifynder image feature set. We additionally work through a real world case study where we assess the ability of the system to determine the pollen make-up of samples of New Zealand honey. In addition to the Classifynder's native neural network classifier, we have evaluated linear discriminant, support vector machine, decision tree and random forest classifiers on these data with encouraging results. Our hope is that our findings will help enhance the performance of future releases of the Classifynder and other systems for accelerating the acquisition and analysis of pollen samples.

Whilst the complex ethical and benefit/risk questions that need to be considered when determining whether an investigational treatment should be given to a patient remain constant throughout the world, the practical and logistical realities of running an Early Access Program (EAP) differ widely globally presenting a whole range of challenges if the objective is to find solutions that are in the patients best interest and are as fair and equitable as possible. Some of the complexities can create extreme challenges for Pharma Companies looking to set up global programs, but with the right planning and strategy it is possible to overcome hurdles allowing patients to access critical treatments they desperately need. The exact design and scope of any global EAP will depend on country scope, expected demand, regulatory feasibility, the license status of the product, necessary drug pricing structure, as well as company strategy, costs, and product supply. Having worked in this space for many years, I am constantly reminded of the dramatic positive impact early access to critical treatments can have on the lives of patients and their families. I am also well aware of the potential risks that need to be well thought through and managed in order to provide access in a timely and compliant manner to the right patients and to compliment and support, rather than disrupt, traditional development pathways.

BACKGROUND

Biological monitors are increasingly important in 'Biological Early Warning Systems' (BEWS) for monitoring water quality. This study examines the freshwater amphipod Crangonyx pseudogracilis as a potential new indicator species when used in the Multispecies Freshwater Biomonitor (MFB). The MFB is an online continuous biomonitor which uses impedance conversion to record behavioural responses of vertebrates and invertebrates.

METHODS

Four experiments were undertaken to establish: (1) if the electrical field generated by the MFB affected the organisms' behaviour, (2) if defined behaviours and their response to a gradient of ammonium chloride could be detected by the MFB, (3) if there was variation in the behaviour of C. pseudogracilis over a diel cycle, and (4) if behaviour changed significantly in response to a pulse of ammonium chloride.

CONCLUSIONS

Results showed no significant effect of the MFB's current on behaviour of C. pseudogracilis. Four behaviours; swimming, walking, grooming and inactivity, were observed and identified in the MFB. In the MFB, each behaviour changed significantly in response to an increasing gradient of ammonium chloride exposure. The MFB also detected increases in nocturnal activity by C. pseudogracilis. The MFB also detected a significant increase in activity after a pulse of ammonium chloride.

CONCLUSIONS

The range of behaviours exhibited by Crangonyx pseudogracilis, together with its ease of culture, suggest future potential of this species as an indicator species for the Multispecies Freshwater Biomonitor.

CONCLUSIONS

Further testing is required over a range of toxicants and concentration gradients to establish threshold responses and the full compliment of behaviours that could be useful in online biomonitoring.

The complement system is an ancient cascade system that has a major role in innate and adaptive immunity. Component C3 is central to the three complement pathways. Hereditary compliment 3 (C3) deficiency characterized by severe recurrent infections and immune complex disorders is extremely rare disease. Since 1972, inherited C3 deficiency has been described in many families representing a variety of national origins; however, only 8 families of these cases have been identified their genetic defects. Interestingly, all except one (incomplete analysis) were shown to harbor homozygous C3 gene mutations. Previously we proposed a hypothesis, based on the unique process of C3 synthesis; C3 deficiency is not inherited as a simple autosomal recessive trait. Here, we report the first confirmed case with C3 deficiency caused by compound heterozygous mutations. They were a novel one base insertion (3176insT) in exon 24 which is predicted to result in a frameshift and a premature downstream stop codon (K1105X) in exon 26, and a nonsense mutation of C3303G (Y1081X) in exon 26 which was previously reported as homozygous mutations. This confirmed case suggests that our proposed hypothesis has prospects of a new aspect of pathogenesis for C3 deficiency.

The writings of Charcot and Féré on migraine and its permanent complications are translated. They emphasize how the art of observation was considered of paramount importance in clinical neurology, as stated by Charcot on 28 February 1888: "Let someone say of a doctor that he really knows his physiology and anatomy, that he is dynamic--these are not the real compliments; but if you say he is an observer, a man who knows how to see, this is perhaps the greatest compliment one can make." These writings also reveal that arteriolar vasoconstriction in migrainous infarction and the vascular theory of migraine are hypotheses generated over 100 years ago and still being tested by contemporary neurologists.

OBJECTIVE

To know the proportion of people older than 74, who are not institutionalized and not immobilized with cognitive alteration and to analyze if there is any association with social demographic characteristics and health factors.

METHODS

Cross-sectional descriptive study, made by interview.

METHODS

In an urban environment: Getafe, Parla, Pinto and rural environment: Griñón.

METHODS

The study population included all the people older than 74, that was registered in data base of individual health card, INSALUD. The sample, consisted by 704 elderly, who compliment including criterion, accuracy +/- 3.4%, p < 0.05 It's evaluated 615 persons.

RESULTS

It's made by questionnaire that included social demographic variables, information about the necessity of help for basic activities in daily life (ADLs), perceived health status, illness, sensorial alterations, falls, stay in hospital, social support, rotation, architectonics obstacles. For evaluating the likely cognitive deterioration, it was used the Short Potable Mental Questionnaire (SPSMQ) with 2 cutting points: 2-4 errors and>> 4 errors. The proportion of elderly people with cognitive deterioration (SPSMQ>> 2) was 19% (95% CI, 16.2-22.4). This proportion grew with age, the same as men as in women (p < 0.0001), 11% (95% CI, 8-15) in < 80 years, 29% (95% CI, 23.8-34.8) in>> 79 years. It's proved a significant statistically association between cognitive deficit (SPSMQ>> 4), in age>> 84 years OR = 4.1 (95% CI, 1.7-9.7), dependence degree for ADLs OR = 4.4 (95% CI, 2.2-8.8), and low cultural level, OR = 6.2 (95% CI, 2-18).

CONCLUSIONS

The prevalence of cognitive deficit in elderly population who lives in community environment, it's associated with the degree of functional damage, advanced age and the absence of studies, without any difference between urban and rural environment.

Despite numerous morphological studies on the avian tongue, very little meaningful information is currently available on the surface features of this organ using scanning electron microscopy (SEM). The only SEM description of a ratite tongue is that of the ostrich, although the descriptions are brief and superficial. This SEM study of the emu tongue confirms and compliments the comprehensive macroscopic and histological data available for this commercially important species. The tongues of five emus were fixed, cut into blocks representing the dorsum, ventrum and root and routinely processed for SEM. Three morphologically distinguishable surface types (desquamating, non-desquamating and lymphoepithelium) related to peculiarities in surface cell shape and status (desquamating or non-desquamating), cell surface modifications and distribution of gland openings, and which showed a regional distribution, could be identified. Three basic types of cell surface modifications (microplicae, microvilli and cilia) were observed, with microvilli and cilia being described for the first time in an avian tongue by SEM. The desquamating surface cells fulfil a mechanical protective function, whereas the microplicae, microvilli and cilia appear to be adaptations for the trapping and spreading of mucus which also fulfils a protective function.

Paroxysmal nocturnal hemoglobinurea (PNH) is a rare disorder of complement regulation due to somatic mutation of PIGA (phosphatidylinositol glycan anchor) gene. We herewith report a case who developed a symptomatic PNH long after an allogenic marrow transplant. Some reasonable arguments concerning the origin of PNH clone have been discussed. The molecular studies revealed presence of JAK2 and TET2 mutations without a BCOR mutation. The literature review has been performed to probe into the complex interplay of autoimmunity and clonal selection and expansion of PNH cells, which occurs early in hematopoietic differentiation. The consequent events such as hypoplastic and/or hemato-oncologic features could further be explained on the basis of next-generation sequencing (NGS) studies. Paroxysmal nocturnal hemoglobinuria (PNH) is a rare clonal disorder of hematopoietic stem cells, characterized by a somatic mutation of the phosphatidylinositol glycan-class A (PIGA). The PIGA gene products are crucial for biosynthesis of glycosylphosphatidylinositol (GPI) anchors, which attaches a number of proteins to the plasma membrane of the cell. Amongst these proteins, the CD55 and CD59 are complement regulatory proteins. The CD55 inhibits C3 convertase whereas the CD59 blocks the membrane attack complex (MAC) by inhibiting the incorporation of C9 to MAC. The loss of complement regulatory protein renders the red cell susceptible to complement-mediated lysis leading to intravascular and extravascular hemolysis. The intravascular hemolysis explains most of the morbid clinical manifestations of the disease. The clinical features of syndrome of PNH are recurrent hemolytic episodes, thrombosis, smooth muscle dystonia, and bone marrow failure; other important complications include renal failure, myelodysplastic syndrome (MDS), and acute myeloid leukemia (AML). The most used therapies were blood transfusions, immunosuppressive, and steroid. Allogeneic stem cell transplantation was also practiced. At present, the therapy of choice is eculizumab (Soliris, Alexion Pharmaceuticals), a humanized monoclonal antibody that blocks activation of the terminal complement at C5. The limiting factor for this therapy is breakthrough hemolysis and the frequent dosing schedule. Ravulizumab (ALXN1210) is the second generation terminal compliment inhibitor which seems to provide a sustained control of hemolysis without breakthrough hemolysis and with a longer dosing interval.

The aim of this study was to generate a local confidence limit (CL) for intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques used at Waikato Regional Cancer Centre. This work was carried out based on the American Association of Physicists in Medicine (AAPM) Task Group (TG) 119 report. The AAPM TG 119 report recommends CLs as a bench mark for IMRT commissioning and delivery based on its multiple institutions planning and dosimetry comparisons. In this study the locally obtained CLs were compared to TG119 benchmarks. Furthermore, the same bench mark was used to test the capabilities and quality of the VMAT technique in our clinic. The TG 119 test suite consists of two primary and four clinical tests for evaluating the accuracy of IMRT planning and dose delivery systems. Pre defined structure sets contoured on computed tomography images were downloaded from AAPM website and were transferred to a locally designed phantom. For each test case two plans were generated using IMRT and VMAT optimisation. Dose prescriptions and planning objectives recommended by TG119 report were followed to generate the test plans in Eclipse Treatment Planning System. For each plan the point dose measurements were done using an ion chamber at high dose and low dose regions. The planar dose distribution was analysed for percentage of points passing the gamma criteria of 3%/3 mm, for both the composite plan and individual fields of each plan. The CLs were generated based on the results from the gamma analysis and point dose measurements. For IMRT plans, the CLs obtained were (1) from point dose measurements: 2.49% at high dose region and 2.95% for the low dose region (2) from gamma analysis: 2.12% for individual fields and 5.9% for the composite plan. For VMAT plans, the CLs obtained were (1) from point dose measurements: 2.56% at high dose region and 2.6% for the low dose region (2) from gamma analysis: 1.46% for individual fields and 0.8% for the composite plan. All these CLs were well within the TG119 recommended bench marks. Based on these analysis which were performed in line with the TG119 recommendations, it is evident that the local clinic has commissioned IMRT and VMAT techniques with adequate accuracy. These results compliment our clinical confidence of using IMRT and VMAT routinely and expanding to different clinical sites.

The U.S. Department of Defense (DoD) conducts humanitarian assistance missions under the Overseas Humanitarian Disaster and Civic Aid program for the statutory purposes of training military personnel, serving the political interests of the host nation and United States, and providing humanitarian relief to foreign civilians. These purposes are undertaken via the humanitarian assistance (HA), humanitarian and civic assistance, and excess property donation programs. DoD conducts over 200 such projects annually at a direct cost of approximately 27 million dollars in fiscal year 2001. Although varying by year and command, as many as one-half of these projects involve aspects of health care. These range from short-term patient care to donation of medical supplies and equipment excess to the needs of the DoD. Despite the considerable resources invested and importance of international actions, there is presently no formal evaluation system for these HA projects. Current administrative staffing of these programs by military personnel is often by individuals with many other duties and responsibilities. As a result, humanitarian projects are often inadequately coordinated with nongovernmental organizations, private volunteer organizations, or host-nation officials. Nonmedical military personnel sometimes plan health-related projects with little or no coordination with medical experts, military or civilian. After action reports (AARs) on these humanitarian projects are often subjective, lack quantitative details, and are devoid of measures of effectiveness. AARs are sometimes inconsistently completed, and there is no central repository of information for analysis of lessons learned. (The approximate 100 AARs used in the conduct of these studies are available for official use in the Learning Resources Center, Uniformed Services University of Health Sciences.) Feedback from past humanitarian projects is rare and with few exceptions; DoD-centric projects of a similar design are often repeated. Critical reviews to determine whether other kinds of projects might be more effective are rarely conducted. Recommendations for improving the effectiveness of DoD HA under Overseas Humanitarian Disaster and Civic Aid programs include: ensuring adequate staffing to meet the complex, dynamic nature of humanitarian missions and measuring the effectiveness of each project in mandatory, standardized AARs. For medical HA projects, application of public health strategies would compliment the patient care approach of the majority of medical projects to date. This offers possibilities for enhancing host nation infrastructure, allowing improvements beyond the short period of most military humanitarian projects.

A 34-year-old man with manic-depressive disorder was found dead sitting in a vehicle with a hose running from the exhaust pipe to the cabin. Numerous suicide notes were found inside his house. At autopsy, the decedent was wearing jeans and a long-sleeved windcheater. Upon removal of his clothes, a series of messages were also found written on the legs and forearm. Death was due to carbon monoxide toxicity with a blood level of carboxyhemoglobin of 84%. Skin messages represent a rare form of suicide note that may suggest that a suicide has not been planned, as the decedent may have used the nearest surface to write on. This case demonstrates, however, that skin messages may be more organized, being written prior to dressing and setting up the fatal episode. They also may compliment other notes and messages.

BACKGROUND

Under-five mortality, which is the probability of a child dying before their fifth birthday, is of concern in Zambia as infant and child mortality rates are important social indicators. Displaced population in camps provide a basis for under-five mortality surveillance because detailed registration databases have been developed. Additionally, health data routinely collected on mortality allowed for a review of mortality trends and identification of correlating factors to under-five mortality. Literature suggests a number of factors that influence child mortality including biological, socio-econimic and environmental factors. However, while progress in reducing mortality is evident disparities in under-five mortality trends have been observed.

METHODS

The study examined differential levels and trends of under-five mortality with correlating factors in Meheba refugee camp in Zambia which is presently in its post emergency phase. The retrospective cross-sectional study reviewed the ProGres and Health Information System (HIS) databases under-five mortality data for a seven (7) year period (2008-2014) and included all children aged less than five years in each year of review. STATA 12 (including Ordinary Least Squares Regression) and Microsoft Excel 2010 where used for data analysis and computation of findings.

RESULTS

Malaria and respiratory infections accounted for 81 % of under-five deaths while cases of Diarrhoea were responsible for 10 % of reported mortalities. Seventy five percent (75 %) of all mortalities were reported in children aged less than 1 year (<1 year). While no significant variations in mortality were noted as a result of time, increased frequency of visits to health centre significantly (P < 0.05) reduced mortalities in children by 3/1000 in each year.

CONCLUSIONS

In addition to improving health infrastructure and reducing distances to health facilities, the study also recommends sensitization programmes targeted at ensuring accessibility to health care services for children under-5 years. The study found that increased health centre visitations were associated with reduction in under-five mortality and encourages initiatives targeted at sensitizing communities to seek health care. Furthermore, collaboration between the health systems, community and Non Governmental Organisations (NGOs) is key in addressing higher infant mortality observed. It is envisaged that this will contribute to the reduction in mortality cases and will compliment already existing strategies.

Caring for critically ill patients with a subarachnoid haemorrhage and preventing its most prevalent and devastating complication, vasospasm, requires an in-depth understanding of the mechanisms which underpin the physiology of SAH. This is essential to provide appropriate nursing practice derived from theory. All too often practitioners are asked to follow unsubstantiated regimes without question of the origins of practices. This paper approaches the physiological theory underpinning the mechanisms surrounding subarachnoid haemorrhage and the altered cerebral and extracerebral dysfunction which can occur. Physiological theory is analysed to generate nursing interventions which may be individually tailored to provide comprehensive nursing care with a sound underpinning to its practice. The foundations of effective management of SAH lies within prevention, early diagnosis, and correction of complications [Neurosurg. Clin. North Am. 9 (3) (1998) 595]. In order for such identification to take place, it is essential to have an understanding of the physiological theory that underpins the basis of care interventions. These interventions should compliment all other theoretical input that influences patient care and nursing practice, contributing to a holistic, dynamically formulated plan of care.

Functional areas in fMRI studies are often detected by brain-behavior correlation, calculating across-subject correlation between the behavioral index and the brain activity related to a function of interest. Within-subject correlation analysis is also employed in a single subject level, which utilizes cognitive fluctuations in a shorter time period by correlating the behavioral index with the brain activity across trials. In the present study, the within-subject analysis was applied to the stop-signal task, a standard task to probe response inhibition, where efficiency of response inhibition can be evaluated by the stop-signal reaction time (SSRT). Since the SSRT is estimated, by definition, not in a trial basis but from pooled trials, the correlation across runs was calculated between the SSRT and the brain activity related to response inhibition. The within-subject correlation revealed negative correlations in the anterior cingulate cortex and the cerebellum. Moreover, the dissociation pattern was observed in the within-subject analysis when earlier vs. later parts of the runs were analyzed: negative correlation was dominant in earlier runs, whereas positive correlation was dominant in later runs. Regions of interest analyses revealed that the negative correlation in the anterior cingulate cortex, but not in the cerebellum, was dominant in earlier runs, suggesting multiple mechanisms associated with inhibitory processes that fluctuate on a run-by-run basis. These results indicate that the within-subject analysis compliments the across-subject analysis by highlighting different aspects of cognitive/affective processes related to response inhibition.

El Niño southern oscillation (ENSO) dynamics has been shown to drive seasonal influenza dynamics. Severe seasonal influenza epidemics and the 2009-2010 pandemic were coincident with chaotic regime of ENSO dynamics. ENSO dynamics from 1876 to 2016 were characterized to determine if influenza pandemics are coupled to chaotic regimes. Time-varying spectra of southern oscillation index (SOI) and sea surface temperature (SST) were compared. SOI and SST were decomposed to components using the algorithm of noise-assisted multivariate empirical mode decomposition. The components were Hilbert transformed to generate instantaneous amplitudes and phases. The trajectories and attractors of components were characterized in polar coordinates and state space. Influenza pandemics were mapped to dynamic regimes of SOI and SST joint recurrence of annual components. State space geometry of El Niños lagged by influenza pandemics were characterized and compared with other El Niños. Timescales of SOI and SST components ranged from sub-annual to multidecadal. The trajectories of SOI and SST components and the joint recurrence of annual components were dissipative toward chaotic attractors. Periodic, quasi-periodic, and chaotic regimes were present in the recurrence of trajectories, but chaos-chaos transitions dominated. Influenza pandemics occurred during chaotic regimes of significantly low transitivity dimension (p < 0.0001). El Niños lagged by influenza pandemics had distinct state space geometry (p < 0.0001). Chaotic dynamics explains the aperiodic timing, and varying duration and strength of El Niños. Coupling of all influenza pandemics of the past 140 years to chaotic regimes of low transitivity indicate that ENSO dynamics drives influenza pandemic dynamics. Forecasts models from ENSO dynamics should compliment surveillance for novel influenza viruses.