Neonatal deaths comprise a growing proportion of global under-five mortality. However, data from the highest-burden areas is sparse. This descriptive retrospective study analyses the outcomes of all infants exiting the Médecins sans Frontières-managed neonatal unit in Aweil Hospital, rural South Sudan from 2011 to 2014. A total of 4268 patients were treated over 4 years, with annual admissions increasing from 687 to 1494. Overall mortality was 13.5% (n = 576), declining from 18.7% to 11.1% (p for trend <0.001). Newborns weighing <2500 g were at significantly increased mortality risk compared with babies ≥2500 g (odds ratio = 2.27, 95% confidence interval = 1.9–2.71, p < 0.001). Leading causes of death included sepsis (49.7%), tetanus (15.8%), respiratory distress (12.8%) and asphyxia (9.2%). Tetanus had the highest case fatality rate (49.7%), followed by perinatal asphyxia (26.5%), respiratory distress (20.4%) and neonatal sepsis (10.5%). Despite increasing admissions, overall mortality declined, indicating that survival of these especially vulnerable infants can be improved even in a basic-level district hospital programme.

A pilot economic evaluation of a projected pressure ulcer prevention policy was carried out in a 252-bed geriatric unit in Glasgow. The aim was to set up a framework for evaluating and comparing the costs and benefits of current care and a potential prevention programme. Data were collated from prevalence and incidence studies. Prevalence results showed that 41% of the patient population suffered pressure damage to some extent and incidence data showed that 45% of these were potentially preventable. Evaluation of the costs and benefits shows that the prevention programme would be cost-effective. The cost would be between 17,606 Pounds and 28,669 Pounds but the benefits would range from 305,506 Pounds to 342,510 Pounds. The authors conclude that economic appraisal is feasible.

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patients (81.5%) and adenocarcinoma in 5 (18.5%). The rates of metastasis-directed therapy after recurrence were 23.1% and 71.4% in Groups A and B, respectively. In Group A, radical hysterectomy was performed in 1 patient; lymphadenectomy for para-aortic region in 4; neck dissection in 1; and radiotherapy for the para-aortic region in 4, supraclavicular region in 3, axillary region in 1, and mediastinum region in 3. In Group B, radical hysterectomy was performed in 1 patient, pulmonary resection in 1, and radiotherapy for the para-aortic region in 1. The total dose of radiotherapy was determined by the site of recurrence (39.6e60 Gy). The 2-year overall survival rates after the first recurrence (OSr) were 82.5% and 31.2% for Groups A and B, respectively (p Z 0.001). The 2-year OSr for patients who underwent salvage local therapy was 74.1%, whereas that for patients who did not was 41.6% (p Z 0.03). Grade 3 toxicity related to salvage local therapy was observed in 1 patient. Conclusion: Patients with extrapelvic lymph node recurrence alone had favorable prognoses. Metastasis-directed therapy may contribute to such long-term survival with acceptable toxicities.

Purpose/Objective(s): Various adjuvant approaches are utilized in the management of endometrial cancer based on surgical pathology and institutional preference. The radiosensitivity index (RSI) is a previously validated multi-gene expression index that estimates tumor radiosensitivity. In this study, we evaluate RSI as a genomic predictor for pelvic failure (PF) in patients treated with adjuvant radiotherapy. Materials/Methods: A total of 204 consecutively treated patients with endometrial cancer were identified from our IRB-approved institutional tissue biorepository. All patients underwent hysterectomy with bilateral salpingo-oophorectomy with the majority undergoing lymph node dissection (nZ181; 88%) between 01/99 and 04/11 and followed until 01/ 19. Gene expression was from Affymetrix Hu-RSTA-2a520709 (Affymetrix; Santa Clara, CA). The RSI 10-gene signature was calculated for each sample using the previously published algorithm. Radiophenotype was determined by dichotomization of RSI at the previously identified cutpoint of 0.375; 0.375 Z radioresistant (RR) and <0.375 Z radiosensitive (RS). Time to event analysis was performed with Kaplan-Meier estimates and the log-rank test. Associations between radiophenotype and outcomes were explored with univariable (UVA) and multivariable (MVA) Cox regression. The threshold for statistical significance in all tests was set at p<0.05. Results: Median follow-up was 38.5 months (range: 0.2-216). The median RSI was 0.42 (range: 0.11-0.70). There were no significant differences in RS and RR patients in age (pZ0.99), serosa and/or adnexa involvement (pZ0.37), vaginal and/or parametrial involvement (pZ0.48), cervical stromal invasion (pZ0.59), receipt of adjuvant chemotherapy (pZ0.12), and node involvement (pZ0.78). A total of 83 (41%) patients were treated with adjuvant radiotherapy with vaginal brachytherapy (nZ19; 23%), pelvic radiotherapy (nZ26; 31%), or both (nZ38; 46%). In patients treated with radiation, RR patients were more likely to undergo PF (3 year pelvic control 84% vs 100%; pZ0.02) with worse PF free survival (PFFS) (3 year PFFS 65% vs. 89%; pZ0.04). However, since RSI is a radiation specific signature it did not predict PF (pZ0.86) or PFFS (pZ0.57) in patients not treated with radiation. Factors found to predict PF on UVA included grade 3/1-2 (HR 3.8; 95% CI 1.2-14.8, pZ0.03), serosa and/or adnexa involvement (5.9; 95% CI 1.6-20.2, pZ0.008), lymph node involvement (4.9; 95% CI 1.5-18.8, 0.009), and RR/RS (7.7; 95% CI 1.5-140.9, 0.01). On MVA, factors that continued to predict for PF included RR/RS (10.7; 95% CI 1.9-202.4, pZ0.004), lymph node involvement (4.1; 95% CI 1.2-16.3, pZ0.03), and serosa and/or adnexa involvement (4.3; 95% CI 1.2-16.4, pZ0.03). Conclusion: RSI was found to be a significant predictor of PF in patients treated with adjuvant radiotherapy on MVA. We propose RSI may be a method to predict which patients are most likely to fail in the pelvis and candidates for treatment escalation in the adjuvant setting.