EBOLA Ag K-SeT rapid test: field evaluation in Sierra Leone.

OBJECTIVES: Efficient interruption of Ebola virus disease (EVD) transmission chains critically depends on reliable and fast laboratory diagnosis. We evaluated the performance of the EBOLA Virus Antigen Detection K-SeT (EBOLA Ag K-SeT), a new rapid diagnostic antigen test in field settings. METHODS: The study was conducted in a field laboratory located in Freetown (Sierra Leone) by the Italian National Institute for Infectious Diseases 'L. Spallanzani' and the EMERGENCY Onlus NGO. The EBOLA Ag K-SeT was tested on 210 residual plasma samples (EVD prevalence 50%) from patients hospitalized at the EMERGENCY Ebola treatment center in Goderich (Freetown), comparing the results with quantitative real-time PCR. RESULTS: Overall, the sensitivity of EBOLA Ag K-SeT was 88.6% (95% confidence interval (CI), 82.5-94.7), and the corresponding specificity was 98.1% (95% CI, 95.5-100.7). The positive and negative predictive values were 97.9% (95% CI, 95.0-100.8) and 89.6% (95% CI, 84-95.2), respectively. The sensitivity strongly increased up to 98.7% (95% CI, 96.1-101.2) for those samples with high virus load (≥6.2 log RNA copies/mL). CONCLUSIONS: Our results suggest that EBOLA Ag K-SeT could represent a new effective diagnostic tool for EVD, meeting a need for resource-poor settings and rapid diagnosis for individuals with suspected EVD.

Geospatial analysis of household spread of Ebola virus in a quarantined village - Sierra Leone, 2014.

We performed a spatial-temporal analysis to assess household risk factors for Ebola virus disease (Ebola) in a remote, severely-affected village. We defined a household as a family's shared living space and a case-household as a household with at least one resident who became a suspect, probable, or confirmed Ebola case from 1 August 2014 to 10 October 2014. We used Geographic Information System (GIS) software to calculate inter-household distances, performed space-time cluster analyses, and developed Generalized Estimating Equations (GEE). Village X consisted of 64 households; 42% of households became case-households over the observation period. Two significant space-time clusters occurred among households in the village; temporal effects outweighed spatial effects. GEE demonstrated that the odds of becoming a case-household increased by 4·0% for each additional person per household (P < 0·02) and 2·6% per day (P < 0·07). An increasing number of persons per household, and to a lesser extent, the passage of time after onset of the outbreak were risk factors for household Ebola acquisition, emphasizing the importance of prompt public health interventions that prioritize the most populated households. Using GIS with GEE can reveal complex spatial-temporal risk factors, which can inform prioritization of response activities in future outbreaks.

Field Verification of the Prediction Model on Desert Locust Adult Phase Status From Density and Vegetation.

Previous studies investigated the effect of vegetation on density thresholds of adult Desert Locust gregarization from historical data in Mauritania. We examine here the prediction of locust phase based on adult density and vegetation conditions using the statistical model from Cisse et al. compared with actual behavior of Desert Locust adults observed in the field in Mauritania. From the 130 sites where adult locusts were found, the model predicted the phase of Desert Locust adults with a relatively small error of prediction of 6.1%. Preventive locust control should be rational, based on a risk assessment. The staff involved in implementation of the preventive control strategy needs specific indicators for when or where chemical treatment should be done. In this respect, we show here that the statistical model of Cisse et al. may be appropriate.

Restoring ADL function after wrist surgery in children with cerebral palsy: a novel Bilateral robot system design.

Cerebral palsy is a leading cause of disability in children and reducing its effects on arm function will improve quality of life. Our goal is to train children with CP after wrist tendon transfer surgery using a robotic therapy system consisting of two robot arms and wrist robots. The therapeutic goal is to determine if the robot training combined with surgery intervention improved functional outcomes significantly more than surgery alone. To accomplish this long-term goal we have developed a Bilateral ADL Exercise Robot, BiADLER aimed at training children with CP in reach to grasp coordination on ADLs. Specifically, the robot will provide active training using an assist-as-needed. This paper presents the design concepts.

In-plane magnetic anisotropy and temperature dependence of switching field in (Ga, Mn) as ferromagnetic semiconductors.

We explore the magnetic anisotropy of GaMnAs ferromagnetic semiconductor by Planar Hall Effect (PHE) measurements. Using low magnitude of applied magnetic field (i.e., when the magnitude H is smaller than both cubic Hc and uniaxial Hu anisotropy field), we have observed various shapes of applied magnetic field direction dependence of Planar Hall Resistance (PHR). In particular, in two regions of temperature. At T < Tc/2, the "square-shape" signal and at T > Tc/2 the "zigzag-shape" signal of PHR. They reflect different magnetic anisotropy and provide information about magnetization reversal process in GaMnAs ferromagnetic semiconductor. The theoretical model calculation of PHR based on the free energy density reproduces well the experimental data. We report also the temperature dependence of anisotropy constants and magnetization orientations. The transition of easy axis from biaxial to uniaxiale axes has been observed and confirmed by SQUID measurements.

[The mammals of Guinea as reservoirs and carriers of arboviruses].

A great body of data on the fauna and ecology of wild mammals and their participation in the circulation of arboviruses were collected when the ecology of the latter of the Republic of Guinea was studied in 1978 to 1989. A hundred and eighteen species belonging to 10 orders were identified. Over 2,000 biological specimens were virologically and serologically examined. Six arboviruses were isolated. These included Dugbe virus (from the hussar monkey Cercopithecus (Erythrocebus patas) and 5 viruses from chiropters: Rift valley fever, from Micropteropus pusillus, Miniopterus schreibersi, and Hipposideros caffer, Saboya, Fomede, and Ank 6909 from Nycteris gambiensis and Kolenter from Hipposideros sp. Fomede, Kolente, and Ank 6909 viruses turned out to be new species for science. Rodents were found to have viral antigens of Lass fever (Mastomys natalensis, Tatera valida kempi and Rattus rattus), Dugbe and Chikungunya fevers (M. natalensis) and West Nile fever (Mus sp.). A serological survey of mammals revealed that the latter had antibodies to 12 arboviruses. Thus, the mammals of Guinea participate in the circulation of 18 arboviruses, 13 of them are pathogenic for man.

[The problem of intoxication in the population of the Republic of Guinea due to venomous snake bites].

Intoxication of the population of Guinea due to venomous snake bites (100-150 intoxications per 100,000 with an 18% mortality rate) is a serious public health problem in the Republic of Guinea. Guinea's fauna of venomous snakes is diverse and numbers 20 species that are dangerous to human beings. The representatives of the family Elapidae (cobras and mambas) whose venom is highly toxic (LD50 5-12 mg) are responsible for the bulk (59.6%) of their bites. There has been recently an increase in the number of deaths from venomous snake bites, as high as 60% of the patients consulting a doctor being notified in one of the prefectures. At the same time the situation associated with the availability of antisnake serum is critical in the country due to its minute amount and to the inaccessibility of its high prices. By taking into account the great demand for the serum in Guinea, as everywhere over West Africa (thousands of doses every year), its manufacture may be profitable for potential investors and partners of the Pasteur Institute of Guinea.

State mental hospitals in Washington State in an era of policy change.

This paper examines changes in use of state mental hospitals in Washington State from July 1, 1990, to July 1, 1997. It focuses on the phenomenon of ongoing use of state mental hospital by patients over a period of years. Two panels of state mental hospital users were identified: one preceded and one followed implementation of state mental hospital downsizing policies. Though the number of adults per year using the state mental hospital decreased following policy implementation, there was a significant increase in the overall rate of ongoing use. A logistic regression for ongoing use with multiple individual and regional predictor variables is described.

Outcomes of regular versus extended outpatient alcohol/drug treatment. Part II. Medical, psychiatric, legal and social problems.

UNLABELLED: Alcohol and drug patients were placed into two groups in order to study differences in outcome based on treatment duration. One group received regular outpatient treatment of 90 days (n = 103), and the other received extended outpatient treatment of 180 days (n = 127). Most patients received 30 days of inpatient stabilization treatment before placement into outpatient. METHODS: Patients were randomized into the two groups, and interviewed at discharge, and three and six months post-discharge. Data were analyzed using chi-square, t-test, and multivariate logistic regression techniques. RESULTS: There were no major differences between the two groups in the numbers reporting subsequent drug use, or medical, psychiatric, legal, and social problems. However, in terms of ancillary effects, the extended treatment group had slightly more desirable outcomes with respect to doctor's visits, arrests, or being a homemaker at three and six months post-discharge. Post-discharge medical problems, in terms of doctor's office visits, were predictable by longer treatment duration, pre-treatment cocaine use as primary drug, and pre-treatment heroin use as secondary drug. Patients were most likely to live with parents, roommates, or alone. Whereas abstinence was related to stability in living arrangements, aftercare attendance and heroin use were related to unstable living situations.

Prevalence of physical illness among psychiatric inpatients who die of natural causes.

OBJECTIVE: The state psychiatric hospital is experiencing an increase in medically sick and aging patients who die of natural causes while hospitalized. This study explored the "medicalization" of the state hospital by examining the prevalence of medical illness and its relationship with psychiatric illness and age among state hospital psychiatric inpatients who died of natural causes--deaths that were not accidents, homicides, or suicides. METHODS: A total of 179 inpatients who died of natural causes at Western State Hospital in Washington State between 1989 and 1994 were studied retrospectively through case file review. Their demographic and institutional characteristics and psychiatric diagnoses were compared with those of others treated at the hospital (N=9,258). The medical diagnoses of patients who died were analyzed by age and psychiatric condition. RESULTS: The patients who died were much older than the other patients treated during the study period. Two-thirds of those who died had organic mental disorders, mostly dementia, whereas only a fifth of the other patients had these disorders. The patients who died had a mean of eight physical illnesses, with a range from none to 21. Circulatory and respiratory conditions were most prevalent, affecting half to two-thirds of patients; these conditions had high rates of comorbidity with organic mental disorders. CONCLUSIONS: The characteristics of the state hospital population and the services provided are shifting in response to mental health reform and new policies on patient self-determination. Increased emphasis on medical care added to traditional psychiatric services will require increased financial and personnel resources.

Homicide or suicide: the killing of suicidal persons by law enforcement officers.

This paper presents 15 deaths of suicidal persons in Oregon and Florida who, by their behavior, sufficiently provoked law enforcement officers into killing them. Four deaths were certified as suicide, one as undetermined and ten as homicide. All of the deaths are individually described in detail and their case characteristics are presented in a table. The method of study is a descriptive analysis of the case characteristics, including 21 variables which are determined to be relevant to the classification of death. The variables were grouped into six categories: (a) personal information; (b) criminal behavior during the fatal incident; (c) dangerous behavior during the fatal incident; (d) toxicological data; (e) mental illness information; and (f) certification data. From the analysis, reasons for the opinions on manner of death classification are presented. All incidents were perceived as life-threatening to law officers, family members, or hostages. All victims were male except one, and all were Caucasian except two. All victims resisted arrest and verbally threatened homicide during the fatal incident. Two-thirds of the victims took hostages. All victims possessed an apparent handgun or other weapon (knife, iron bar). All victims posed their weapon and threatened others during the incident, 60% of victims actually used the weapon with apparent intent to inflict damage to others. 40% of victims were intoxicated with alcohol but other drug-involvement was uncommon. Seven of 15 had previous suicide attempts, 40% had medically documented psychiatric diagnoses and 60% had reasonable historical evidence of psychiatric diagnoses, most commonly depression or substance abuse. One of the co-authors presents the case for some of the deaths to be certified as suicides, whereas two present the case for all to be certified as homicide. A brief discussion of psychiatric issues is also presented concerning individuals who use others to commit suicide and who may engage in dangerous and/or criminal behavior to do so. A major conclusion is that there is lack of a unified opinion on death certification procedures for individuals who have provoked law enforcement officers to kill them. For such cases, it is recommended that professional organizations of medical examiners/coroners develop guidelines to promote consistency in death certification practices including manner of death classification and selection of death certificate wording so that "police-assisted suicide" may be appropriately reported and studied.

Employment outcomes of regular versus extended outpatient alcohol and drug treatment.

In a study on treatment duration, alcohol and drug patients were placed in two groups, one receiving regular (3 months) and the other extended (6 months) outpatient treatment. The objective was to determine differences in outcomes at 3 and 6 months post-treatment. Most patients received 30 days of inpatient treatment before outpatient treatment.

Outcomes of regular vs. extended alcohol/drug outpatient treatment: I. Relapse, aftercare, and treatment re-entry.

Alcohol and drug patients were randomized into two groups, one receiving three months and the other six months of outpatient treatment to determine differences in treatment outcomes. Most clients had received prior 30 days of inpatient treatment. Patients were contacted after the first 70 days of outpatient treatment and 12 refused participation. Consenters were randomized and assigned into control (n = 103) and experimental (n = 127) groups, and interviewed at discharge, and three and six months later. A gratuity of $10.00 was offered after a completed phone interview. Data were analyzed using chi-square, t-test, and multivariate logistic regression techniques. Controls had lower treatment drop-out and higher follow-up attrition rates than experimentals. There were no major differences in reported subsequent alcohol/drug use, or attendance to aftercare, Alcohol Anonymous (AA) and support groups during the 3 and 6 months follow-up surveys. More controls re-entered treatment than experimentals at 3 months post-treatment, but there was no such difference at 6 months post-treatment. In terms of ancillary effects, experimentals had slightly more desirable outcomes with respect to abstinence at time of discharge, and use of cocaine at 3 months follow-up. Controls were more likely to use cocaine and less likely to re-enter inpatient treatment or attend aftercare than experimentals. At six months the few who reported using painkillers were controls. Relapse was predictably influenced both at 3 and 6 months by pretreatment use of cocaine as primary drug, and by duration of abstinence from all chemicals. The predictive influence of cocaine was greater at 3 than at 6 months post-discharge.

The descriptive epidemiology of unnatural deaths in Oregon's state institutions: a 25-year (1963-1987) study. IV. The reduction of unnatural death rates during 1988-1992 in three facilities as a result of planned changes.

This paper documents the most recent five-year (1988-1992) analysis of unnatural deaths in Oregon's state mental and correctional institutions. The current findings are compared with those of the preceding five years (1983-1987) within the context of the long term trend in unnatural death rates for the previous 25 years. The unnatural death rates for the institutional clients are also compared with those for the noninstitutionalized citizens of Marion County, Oregon. There are two major findings in these 1988-1992 data: (a) There have been highly significant reductions in unnatural death rates in Oregon State Hospital and in the Forensic Psychiatric Program, which the authors believe are largely due to the implementation of planned changes to reduce the previously very high suicide rates in these two facilities; and (b) There was a dramatic reduction (to zero) of unnatural deaths at the Fairview Training Center. The authors also believe that this was attainable mostly because of large-scale improvements made at that facility, by the Department of Human Resources and the Oregon Legislature, just before and during the present study time frame. Changes in these three facilities which led to the improvement in unnatural death rates of clients are discussed.

[Subcapsular liver hematoma, a HELLP syndrome complication]. / Hématome sous-capsulaire du foie, complication du HELLP syndrome.

The authors report a case of unruptured subcapsular haematoma of the liver in a 31-year-old woman, para 2, in the 34th week of pregnancy, complicated by preeclampsia. Clinical signs of preeclampsia were associated with pain in the right hypocondrium and laboratory findings consistent with a true HELLP syndrome. The diagnosis of subcapsular haematoma was confirmed by tomodensimetry. A cesarean section was carried out but a conservative treatment of the hepatic haematoma was decided. Regular X-ray follow-ups showed the regression of the hepatic lesion. This case confirms recent reports that patients with unruptured capsular haematoma should be treated conservatively but should receive careful monitoring.

The descriptive epidemiology of unnatural deaths in Oregon's state institutions: a 25-year (1963-1987) study. II. Analysis of the incidence rate and its many variations.

We have analyzed suicide data of the Forensic Psychiatric Program of the Oregon State Hospital in terms of the various ways of expressing occurrence rates that are found in the literature. All of these rates are ultimately based upon either (a) the average daily population, computed from occupancy rates of institutional beds, or (b) a measure of the total number of individuals at risk (that is, all who were in the study population during the time frame of the study). We discuss reasons for the use of these different rates. We have also calculated the risk of suicide for each of two factors: (a) the primary psychiatric diagnosis and (b) the type of legal commitment under which these patients were admitted to the Forensic Psychiatric Program. We discovered that virtually the entire risk of suicide in this program was borne by patients whose primary diagnosis was that of chronic schizophrenia and who were committed there because of diminished criminal responsibility for a crime of which they were found guilty in a court of law.

[The role of te transposition of Tn1000 from Flac+-plasmid into chromosome of Erwinia chrysanthemi in the formation of Hfr-type donors]. / Rol' transpozitsii Tn1000 iz Flac+-plazmidy v khromosomu Erwinia chrysanthemi v formirovanii donorov Hfr-tipa.

Based on the data of stability of the donor state of Hfr-like strain Erwinia chrysanthemi VY1-10 in RecA+ and RecA- cells, it can be suggested that the donor properties of the strain are mediated by the presence of the genetic homology region which occurred as a result of transposition of the Tn1000 from the Flac+ plasmid into the chromosome of E. chrysanthemi. Tn1000 may be transposed into several sites on the chromosome of E. chrysanthemi ENA49. This leads to the appearance of donors transferring their chromosome from several fixed points oriT and in opposite directions. The location of these points and the direction of transfer are determined by Tn1000 insertion sites and their orientation.