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Background Safely reducing red blood cell transfusions can prevent transfusion-related adverse effects, conserve the blood supply, and reduce health care costs. Both anemia and red blood cell transfusion are independently associated with AKI, but observational data are insufficient to determine whether a restrictive approach to transfusion can be used without increasing AKI risk. Methods In a prespecified kidney substudy of a randomized noninferiority trial, we compared a restrictive threshold for red blood cell transfusion (transfuse if hemoglobin= 0.3 mg/dl within 48 hours of surgery, or >= 50% within 7 days of surgery. Results Patients in the restrictive-threshold group received significantly fewer transfusions than patients in the liberal-threshold group (1.8 versus 2.9 on average, or 38% fewer transfusions in the restricted threshold group compared with the liberal-threshold group; P

BACKGROUND: Existing bowel preparation scales (BPS) are limited in their ability to predict interval to next colonoscopy. The US Multi-Society Task Force (MSTF) recommends screening or surveillance colonoscopies be repeated within the year if the preparation does not allow for detection of polyps greater than 5 mm in size. AIMS: To assess reliability and validity of an auditable application of the MSTF in comparison with the Boston BPS (BBPS). METHODS: We developed an auditable application of the MSTF guidelines which we termed the Montreal Bowel Preparation Scale (MBPS). We compared this with the BBPS using a total cut-off score of 6 with each segment score ≥2 (BBPS 2–6). In sensitivity analyses, we applied the MBPS using a cut-off of 3mm rather than 5mm, and also assessed the BBPS using an adequacy threshold of total score ≥5 (BBPS 5). Video recordings of 83 colonoscopies (8 for intra-rater agreements) were independently evaluated by nine physicians trained to use the different scales. Weighted kappas quantified intra- and inter-rater agreements. Intra class correlations were used to assess agreement of the BBPS as a continuous scale. Associations between scores and clinical outcomes were assessed. RESULTS: The BBPS 2–6 and 5mm MBPS showed moderate to substantial intra-rater agreements (κ=0.44–0.63 and κ=0.50–0.53, respectively), while inter-rater agreements were only fair to moderate and slight to moderate (κ=0.25–0.48 and κ=0.19–0.50, respectively). Similar results were noted using alternate thresholds of BBPS 5 and 3mm MBPS. No significant associations were found between scores and clinical outcomes. CONCLUSIONS: For all scales, intra-rater kappas were superior to inter-rater values with the latter reflecting at best moderate agreement. This modest performance may reflect the dichotomized interpretation of the scales (adequate vs inadequate) contrary to previous studies which compared scores assessed as continuous variables. Further validation studies of existing ordinal bowel preparation scales should aim to assess reliability in a categorical manner based on proposed adequacy thresholds in order to determine optimal interpretation with regards to interval to next colonoscopy. FUNDING AGENCIES: None

SETTING: Free antiretroviral therapy (ART) services in Zambia were introduced in hospitals beginning in 2005 and in selected rural health centres (RHCs) beginning in 2007 through the mobile ART programme. OBJECTIVE: To analyse the impact of scaling up ART services on tuberculosis (TB) treatment outcomes in Mumbwa District Zambia. DESIGN: TB patients registered at all RHCs in the district between July 2006 and September 2009 were reviewed. RHCs were divided into two groups: ART sites which provided ART services after 2007 and non-ART sites which did not provide such services even after 2007. A before-after comparison analysis of TB patients was conducted between the groups. RESULTS: A total of 732 patients were enrolled (median age 34.5 years; female 44.4%). The overall human immunodeficiency virus (HIV) testing rate was 72.3% and 66.7% of these patients were HIV-positive. The TB treatment success rate at the ART sites increased significantly compared to non-ART sites after the mobile ART programme was started (P < 0.01). The HIV testing acceptance rate also increased dramatically at ART sites which facilitated intensified case finding (P = 0.02). CONCLUSION: Scaling up ART services in rural health facilities through the mobile ART programme was found to be associated with greatly improved anti-tuberculosis treatment outcomes.

AN EXACT SOLUTION OF THE TRANSIENT FORCED CONVECTION ENERGY EQUATION FOR TIMEWISE LINEAR VARIATION OF INLET TEMPERATURE IN A CIRCULAR PIPE

EXACT SOLUTION OF THE TRANSIENT FORCED CONVECTION ENERGY EQUATION FOR TIMEWISE VARIATION OF INLET TEMPERATURE IN A CIRCULAR PIPE

As the United Nations Decade of Education for Sustainable Development (DESD) (2005 to 2014) ends, a lot of progress has been made at policy level in re-orienting geography education at Further Education and Training (FET) (Gr 10–12) level in South Africa, towards the teaching of environmental education (EE) and education for sustainable development (ESD). However, there is limited research on conceptual issues facing geography teachers, regarding the meaning of EE and ESD. This paper, based on my PhD research, seeks to address this gap. The PhD project focused on how geography teachers from diverse contexts in Western Cape secondary schools are implementing EE and ESD through the geography curriculum at FET level. In this paper, I use the qualitative data generated from my PhD study to show how three of the geography teachers grapple with the meaning of environmental education, sustainable development and education for sustainable development. The data reveals that the three teachers have conceptual difficulties regarding these terms. I argue that unless these conceptual difficulties are addressed through pre-service teacher training and in-service professional development programmes, the implementation of EE and ESD through the geography curriculum is not likely to be effective.