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Humanitarian relief operations (HUMRO) represent a nexus between military diplomacy and global health engagement, and may play an increasing role in military operations in the near future. Language barriers between providers and the individuals being assisted are a significant constraint on HUMRO. A literature review was conducted to identify recommendations to address patient-provider language discordance in the international HUMRO context. This was supplemented by a North Atlantic Treaty Organization and US Department of Defense doctrinal review to identify existing best practices for addressing language barriers. Four general themes were identified: (1) print-based aids, (2) information technology, (3) bilingual responders, and (4) the effective use of medical interpreters in the HUMRO setting. Each strategy is reviewed. Informed by expert opinion, we provide concrete leadership and training recommendations for how HUMRO providers might more effectively communicate with patients in a deployed language-discordant context.
Our clinical experience at a specialized brain injury clinic suggests that numerous patients with traumatic brain injury (TBI) are using cannabis to alleviate their symptoms. While this patient population often inquires about the evidence of using cannabis post-head injury for the neurosensory, neurocognitive, and neuropsychiatric sequelae, most health professionals have little to no knowledge of this evidence. Given the recent legalization of recreational cannabis in Canada, questions and guidance related to cannabis use following a TBI are likely to become more common. This article reviews the evidence for cannabis use in psychiatric disorders with or without TBI. Overall, we found that the evidence for the use of cannabis among TBI patients is sparse and that patients tend to have little knowledge of the proven benefits and diverse effects of cannabis use. We feel this paper can serve as a stepping stone for future studies that explore the impact of cannabis use in a TBI population and can guide clinicians in advising their patients.
The increased use and mastery of ceasarian section for deliveries and the refinement of technologies for assisted delivery in the setting of dfficult second stage of labour have made intrapartum deaths more rare and modern obstetrical pracices are rarely accompanied by the classic forceps related intracranial injuries. We document a novel pattern of intracranial injury in three cases of neonatal death following prolonged labor, of which two out of three required vacuum and forceps.
All three showed similar bilateral parasagittal intraparenchymal haemorrhages and cerebral edema, in a pattern reminiscent of “gliding contusion, as well as subgaleal haemorrhage of varying amout. Two out of the three cases showed parietal bone fractures and one demonstrated extensive craniolcuniae. We briefly discuss the significance of these findings and implications for future cases.
This presentation will enable the learner to:
1.Explore the current theories leading to neonatal death in prolonged labor
2.Summarize the known pathological findings associated with vacuum and forceps
3.Discuss the significance of intraparenchymal hematoma in the setting of prolonged delivery
Over the last 15 years, frailty has become a dominant discourse on late life. Taken-for-granted knowledge and practice can be seen in initiatives such as the International Association of Gerontology and Geriatrics’ White Book on Frailty. This paper begins with an overview of key themes on frailty from the biomedical literature, followed by critical literature in the social sciences and humanities. It discusses the tensions within the biomedical field, frailty as a social construction and ‘social imaginary’, practices of frailty as historically linked to political systems of care, and frailty as an emotional and relational experience. It then draws on a critical discourse analysis to assess the 2016 White Book on Frailty. Drawing on the idea of ‘significant absences’, the paper highlights the gaps that exist where the social and emotional understandings and political readings of frailty are concerned. The paper concludes by outlining the need to recognise the ‘politics of frailty’ including the power relations that are deeply embedded in the knowledge and practices surrounding frailty, and to incorporate older people's experience and ideas of vulnerability into research, policy and care practice.
We revisit the linear stability of a falling liquid film flowing through an inclined narrow channel in interaction with a gas phase. We focus on a particular region of parameter space, small inclination and very strong confinement, where we have found the gas to strongly stabilize the film, up to the point of fully suppressing the long-wave interfacial instability attributed to Kapitza (Zh. Eksp. Teor. Fiz., vol. 18 (1), 1948, pp. 3–28). The stabilization occurs both when the gas is merely subject to an aerostatic pressure difference, i.e. when the pressure difference balances the weight of the gas column, and when it flows counter-currently. In the latter case, the degree of stabilization increases with the gas velocity. Our investigation is based on a numerical solution of the Orr–Sommerfeld temporal linear stability problem as well as stability experiments that clearly confirm the observed effect. We quantify the degree of stabilization by comparing the linear stability threshold with its passive-gas limit, and perform a parametric study, varying the relative confinement, the Reynolds number, the inclination angle and the Kapitza number. For example, we find a 30 % reduction of the cutoff wavenumber of the instability for a water film in contact with air, flowing through a channel inclined at
and of height 2.8 times the film thickness. We also identify the critical conditions for the full suppression of the instability in terms of the governing parameters. The stabilization is caused by the strong confinement of the gas, which produces perturbations of the adverse interfacial tangential shear stress that are shifted by half a wavelength with respect to the wavy film surface. This tends to reduce flow-rate variations within the film, thus attenuating the inertia-based driving mechanism of the Kapitza instability.
Provider working conditions are important in mental health service delivery.
To identify variables associated with perceived recovery-oriented care among mental health professionals.
A total of 315 mental health professionals and 41 managers across four Quebec service networks completed questionnaires. Univariate and multilevel mixed-effects linear regressions for bivariate and multivariate analyses were performed using independent variables from the input–mediator–output–input model and recovery-oriented care.
Recovery-oriented care related to: working in primary care or out-patient mental health services, team support, team interdependence, prevalence of individuals with suicide ideation, knowledge-sharing, team reflexivity, trust, vision (a subset of team climate), belief in multidisciplinary collaboration and frequency of interaction with other organisations.
Optimising team processes (for example knowledge-sharing) and emergent states (for example trust) may enhance recovery-oriented care. Adequate financial and other resources, stable team composition, training on recovery best practices and use of standardised assessment tools should be promoted, while strengthening primary care and interactions with other organisations.
As Canada’s population continues to age, social isolation among older people is a growing concern and national-level priority. Although much is known about individual-level risks and negative health outcomes associated with social isolation in later life, the impact of life course trajectories and the more collective experiences are seldom considered. Current definitions and program responses tend to rely on individualized approaches to social isolation. Here, we argue that the conversation be extended to consider the social and cultural aspects of social isolation among older people. Specifically, we suggest that definitions and approaches consider three particular dimensions: temporal factors, spatial factors, and the relationship between social isolation and exclusion. Doing so, we argue, would result in a more inclusive approach to social isolation in late life, and the development of capacity to address social isolation among a wide range of older people, particularly the needs of vulnerable or marginalized groups.
This chapter will give a status on the current possibilities of analysis at the molecular and cellular levels enabled by the convergence of microwave dielectric spectroscopy and the use of microtechnologies. Highlights of the technique will be addressed, such as its noninvasivity, its specificity in terms of high-frequency signature, its compatibility with high ionic and nutrient contents classically encountered with cell culture media, and its suitability and sufficient sensitivity for cell probing, even down to single-cell investigations. These particularities notably will be performed in the context of cancer studies in order to offer complementary noninvasive analyzing tools to the biologists and physicians for living cells in their typical liquid microenvironment.
There are plenty of physical ways to identify and characterize (bio-)matter physically and/or chemically. Whereas humans exploit their traditional senses (sight, hearing, taste, smell, and touch) to probe the environment, (artificial) sensors – especially biosensors, which are the topic of this chapter – also rely on such sensing mechanisms, for example, mechanical (touch) and optical (sight), but also on other types of interactions, for example, electromagnetic. Such techniques feature a key characteristic: the frequency of the electromagnetic waves can be varied over a range (narrow or broad) to get a rich set of data from spectra, and consequently, the technique is called spectroscopy. Combined with the massive progress in micro- and nanotechnology, miniature biosensors based on dielectric spectroscopy have been in use for several decades, first initiated in direct current (dc) and low frequencies (kilohertz and megahertz) and now reaching microwave and millimeter-wave ranges.
This chapter aims at showing the status of the current possibilities of analysis at the molecular and cellular levels enabled by the convergence of microwave dielectric spectroscopy and the use of microtechnologies. To understand the interests of developing microwave-based and miniature biosensors for molecular and cellular investigations, examples of the main and current cellular analyzing techniques that are available in biolabs will be given, followed by an introduction to microwave dielectric spectroscopy. Highlights of such a technique will then be addressed in terms of noninvasivity, specificity, compatibility with the high ionic and nutrient contents classically encountered in cell culture media, and suitability and sufficient sensitivity for cell probing, even down to single-cell investigations.
A detailed knowledge of the atomic structure of magnetic semiconductors is crucial to understanding their electronic and magnetic properties, which could enable spintronic applications. Energy-dispersive X-ray spectrometry (EDX) in the scanning transmission electron microscope and atom probe tomography (APT) experiments reveal the formation of Cr-rich regions in Cd1−xCrxTe layers grown by molecular beam epitaxy. These Cr-rich regions occur on a length scale of 6–10 nm at a nominal Cr composition of x=0.034 and evolve toward an ellipsoidal shape oriented along <111> directions at a composition of x=0.083. Statistical analysis of the APT reconstructed volume reveals that the Cr aggregation increases with the average Cr composition. The correlation with the magnetic properties of such (Cd,Cr)Te layers is discussed within the framework of strongly inhomogeneous materials. Finally, difficulties in accurately quantifying the Cr distribution in the CdTe matrix on an atomic scale by EDX and APT are discussed.
Ongoing provision of pharmaceuticals and medical supplies is of key importance during and following a disaster or other emergency event. An effectively coordinated response involving locally available pharmacy personnel—drawing upon the efforts of licensed pharmacists and unlicensed support staff—can help to mitigate harms and alleviate hardship in a community after emergency events. However, pharmacists and their counterparts generally receive limited training in disaster medicine and emergency preparedness as part of their initial qualifications, even in countries with well-developed professional education programs. Pharmacy efforts have also traditionally focused on medical supply activities, more so than on general emergency preparedness. To facilitate future work between pharmacy personnel on an international level, our team undertook an extensive review of the published literature describing pharmacists’ experiences in responding to or preparing for both natural and manmade disasters. In addition to identifying key activities that must be performed, we have developed a classification scheme for pharmacy personnel. We believe that this framework will enable pharmacy personnel working in diverse practice settings to identify and undertake essential actions that are necessary to ensure an effective emergency response and will promote better collaboration between pharmacy team members during actual disaster situations. (Disaster Med Public Health Preparedness. 2017;11:496–504)
EGRET, the high-energy γ-ray telescope on the Compton Gamma-Ray Observatory, has the sensitivity, angular resolution, and background rejection necessary to study diffuse γ-ray emission from the interstellar medium (ISM). High-energy γ rays produced in cosmic-ray (CR) interactions in the ISM can be used to determine the CR density and calibrate the CO line as a tracer of molecular mass. Dominant production mechanisms for γ rays of energies ∼30 MeV–30 GeV are the decay of pions produced in collisions of CR protons with ambient matter and Bremsstrahlung scattering of CR electrons.