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Little is known about the existence, distribution, and characteristics of Emergency Medical Services (EMS) systems in Africa, or the corresponding epidemiology of prehospital illness and injury.
A survey was conducted between 2013 and 2014 by distributing a detailed EMS system questionnaire to experts in paper and electronic versions. The questionnaire ascertained EMS systems’ jurisdiction, operations, finance, clinical care, resources, and regulatory environment. The discovery of respondents with requisite expertise occurred in multiple phases, including snowball sampling, a review of published scientific literature, and a rigorous search of the Internet.
The survey response rate was 46%, and data represented 49 of 54 (91%) African countries. Twenty-five EMS systems were identified and distributed among 16 countries (30% of African countries). There was no evidence of EMS systems in 33 (61%) countries. A total of 98,574,731 (8.7%) of the African population were serviced by at least one EMS system in 2012. The leading causes of EMS transport were (in order of decreasing frequency): injury, obstetric, respiratory, cardiovascular, and gastrointestinal complaints. Nineteen percent of African countries had government-financed EMS systems and 26% had a toll-free public access telephone number. Basic emergency medical technicians (EMTs) and Basic Life Support (BLS)-equipped ambulances were the most common cadre of provider and ambulance level, respectively (84% each).
Emergency Medical Services systems exist in one-third of African countries. Injury and obstetric complaints are the leading African prehospital conditions. Only a minority (<9.0%) of Africans have coverage by an EMS system. Most systems were predominantly BLS, government operated, and fee-for-service.
Mould-MillmanNK, DixonJM, SefaN, YanceyA, HollongBG, HagahmedM, GindeAA, WallisLA. The State of Emergency Medical Services (EMS) Systems in Africa. Prehosp Disaster Med. 2017;32(3):273–283.
Silicified beyrichiocopid and podocopid ostracods from limestone nodules derived from the middle part of the Ichinotani Formation within the Hida Gaien Terrane of central Honshu Island, Japan, are associated with fusulinid foraminifera that indicate strata of the middle Moscovian (Pennsylvanian, Carboniferous). This is a rare record of ostracods from the Palaeozoic of Japan and the first systematic description of ostracods from the Carboniferous of the Hida Gaien Terrane. The fauna comprises six ostracod species (two new) assigned to the genera Amphissites, Kirkbya, Bairdia, Aechmina and Healdia, and additional material of possible cavellinids. The numerical dominance of ornamented beyrichiocopids such as Kirkbya and Amphissites, along with smaller numbers of smooth podocopids such as Bairdia, indicates an ‘Eifelian mega-assemblage’ ecotype (sensu G. Becker), that is typical of mid Palaeozoic shallow marine, high-energy environments in a fore-reef ecosystem.
It has long been recognized that collisional cooling and recombination processes are likely to be important in the inner cometary coma, in a 104 km radius region for the larger comets (Biermann & Trefftz 1964) Cherednichenko (1970) laid stress on dissociative recombination processes, as possibly playing a role in the production of observed ions and radicals. Oppenheimer, in his spirited contribution to this conference, emphasized that a variety of ion-molecule interactions occur relatively rapidly and probably take part in the production of known cometary radicals.
The Rosetta Radio Science Investigations (RSI) experiment was selected by the European Space Agency to be included in the International Rosetta Mission to comet P/Wirtanen (launch in 2003, arrival and operational phase at the comet 2011–2013). The RSI science objectives address fundamental aspects of cometary physics such as the mass and bulk density of the nucleus, the gravity field, non-gravitational forces, the size and shape, the internal structure, the composition and roughness of the nucleus surface, the abundance of large dust grains and the plasma content in the coma and the combined dust and gas mass flux on the orbiter. RSI will make use of the radio subsystem of the Rosetta spacecraft.
Sometime between 1070 and 1077, Anselm, then prior of the monastery of Bec in Normandy, wrote to his friend Maurice, a former Bec monk residing at Christ Church, Canterbury, and asked him to seek out copies of various texts, including Bede's De temporibus and the Regula of St. Dunstan — presumably the Regularis concordia, the platform-document of the English Benedictine reform of the tenth century. Shortly thereafter, Anselm wrote again to Maurice, indicating that another text had been added to his desiderata:
Should it come to pass that, with [Archbishop Lanfranc's] favor always embracing us, you return to us (as is expedient for you, and as you and I desire), bring with you what you will have copied of the Aphorisms. In the meantime, however, do as much of the text as you can without inconvenience to yourself, and then, if you are free, of the commentary, giving heed above all that whatever you will have brought with you has been corrected with the utmost diligence. If after your return any of it still remains to be done, and if Dom Gundulf is able to finish it through someone else, leave it to the person whom he designates. But it would be much better if Dom Gundulf were able to obtain by request the exemplar itself, so that it could be lent to me.
An unlinked anonymous study was conducted to estimate the prevalence of hepatitis C virus (HCV) infection in emergency department (ED) attendees at a London Hospital. Nine hundred and ninety-seven samples collected over a 12-day period were tested for HCV antibody (Ab) and reactive samples were further tested for HCV RNA. The HCV seroprevalence was 2·6% (26/997) with 1·2% (12/997) HCV RNA positive. A peak HCV RNA-positive prevalence of 4·8% (3/63) was found in males aged 35–44 years, this was compared to 0% (0/136) in males aged <35 years (P = 0·0614) and 1·4% (4/278) in males aged ⩾45 years (P = 0·2415). Assuming the cost for HCV Ab is £6 and HCV RNA is £40 per test, screening ED attendees aged 25–54 years would cost £360 per viraemic infection and identify 82% of those who were HCV RNA positive, yielding the most favourable cost/benefit ratio. HCV screening of ED attendees aged 25–54 years in this population could be an effective way of identifying patients and limit onward transmission.
Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN.
We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12–18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT).
The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group.
Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.
Tourette syndrome and chronic tic disorder are heritable but aetiologically complex. Although environment plays a role in their development, existing studies of non-genetic risk factors are inconsistent.
To examine the association between pre- and perinatal exposures and Tourette syndrome/chronic tic disorder in the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective longitudinal pre-birth cohort.
Relationships between exposures and Tourette syndrome/chronic tic disorder were examined in 6090 children using logistic regression.
Maternal alcohol and cannabis use, inadequate maternal weight gain and parity were associated with Tourette syndrome or Tourette syndrome/chronic tic disorder. Other previously reported exposures, including birth weight and prenatal maternal smoking, were not associated with Tourette syndrome/chronic tic disorder.
This study supports previously reported relationships between Tourette syndrome/chronic tic disorder and prenatal alcohol exposure, and identifies additional previously unexplored potential prenatal risk factors.
To assess the relative importance of independent risk factors for peripheral intravenous catheter (PIVC) failure.
Secondary data analysis from a randomized controlled trial of PIVC dwell time. The Prentice, Williams, and Peterson statistical model was used to identify and compare risk factors for phlebitis, occlusion, and accidental removal.
Three acute care hospitals in Queensland, Australia.
The trial included 3,283 adult medical and surgical patients (5,907 catheters) with a PIVC with greater than 4 days of expected use.
Modifiable risk factors for occlusion included hand, antecubital fossa, or upper arm insertion compared with forearm (hazard ratio [HR], 1.47 [95% confidence interval (CI), 1.28–1.68], 1.27 [95% CI, 1.08–1.49], and 1.25 [95% CI, 1.04–1.50], respectively); and for phlebitis, larger diameter PIVC (HR, 1.48 [95% CI, 1.08–2.03]). PIVCs inserted by the operating and radiology suite staff had lower occlusion risk than ward insertions (HR, 0.80 [95% CI, 0.67–0.94]). Modifiable risks for accidental removal included hand or antecubital fossa insertion compared with forearm (HR, 2.45 [95% CI, 1.93–3.10] and 1.65 [95% CI, 1.23–2.22], respectively), clinical staff insertion compared with intravenous service (HR, 1.69 [95% CI, 1.30–2.20]); and smaller PIVC diameter (HR, 1.29 [95% CI, 1.02–1.61]). Female sex was a nonmodifiable factor associated with an increased risk of both phlebitis (HR, 1.64 [95% CI, 1.28–2.09]) and occlusion (HR, 1.44 [95% CI, 1.30–1.61]).
PIVC survival is improved by preferential forearm insertion, selection of appropriate PIVC diameter, and insertion by intravenous teams and other specialists.
Background: The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-NAB) offers information on the clinical diagnosis of Alzheimer's disease (AD) and gives a profile of cognitive functioning. This study explores the effects of age, education and gender on participants' performance on eight subtests in the Chinese-Cantonese version of the CERAD-NAB.
Methods: The original English version of the CERAD-NAB was translated and content-validated into a Chinese-Cantonese version to suit the Hong Kong Chinese population. The battery was administered to 187 healthy volunteers aged 60 to 94 years. Participants were excluded if they had neurological, medical or psychiatric disorders (including dementia). Stepwise multiple linear regression analyses were performed to assess the relative contribution of the demographic variables to the scores on each subtest.
Results: The Cantonese version of CERAD-NAB was shown to have good content validity and excellent inter-rater reliability. Stepwise multiple regression analyses revealed that performances on seven and four out of eight subtests in the CERAD-NAB were significantly influenced by education level and age, respectively. Age and education had significant effects on participants' performance on many tests. Gender also showed a significant effect on one subtest.
Conclusions: The preliminary data will serve as an initial phase for clinical interpretation of the CERAD-NAB for Cantonese-speaking Chinese elders.
A molecular dynamics simulation has been performed on the crystal lithium iodide, LiI. A rigid ion potential was used with parameters fit to thermal expansion, isothermal compressibility, lattice energy and the frequency of the transverse optical mode at the zone center. The current-current correlation function has been calculated at T = 200K and 400K, and from this the absorption and dispersion have been obtained. Anharmonic broadening is observed at the higher temperature.
The central force nearest neighbor model for glasses is used to discuss the Raman and infrared vibrational data for the family of lithium doped borate glasses B2O3 - xLi2O. The addition of the dopant is shown to cause local structural changes, including the transformation of three-coordinated borons to four-coordinated ones. An extremely simple structural model for the glass gives good qualitative agreement with experiment. The results of lattice dynamics calculations fall within the allowed frequency band limits predicted by network dynamics. The success of this model illustrates the importance of short range order on the vibrational spectra of covalently bonded solids.
The effect of intercalated lithium on the electronic band structure of the γ-polytype of InSe has been investigated using a tight-binding method. The energy bands of the pure polytype were calculated and the results compared with previous work. The modifications of the energy bands produced by the introduction of one lithium atom per unit cell were calculated for the lowest potential energy position of the lithium atom in the Van der Waals gap between layers. The results for the changes in the smallest and next-to-smallest direct band gaps are compared with experimental data. An interpretation of a photoluminescence peak produced by lithium intercalation is given.
Ion diffusion across material interfaces is considered in a sequence of approximations with increasing complexity. First, the one-dimensional lattice gas model of particle diffusion is generalized to include a finite width interface region, and the possible existence of an energy barrier at the interface. Overvoltage measurements on InSe, and dielectric loss measurements on B2O3 - 0.5Li20 - 0.15Li2SO4 are used to determine the field-free hopping rates in the two materials. It is shown that the energy barrier is a dominant parameter. This model is then modified by considering the disorder of the glass structure and the blocking effect resulting from the ion interaction. Next, a more rigorous treatment is presented by solving the Poisson equation with appropriate boundatry conditions, and a self-consistent theory of the ionic diffusion is proposed. To clarify this problem, an intermediate step and two additional models with increasing sophistication are considered: first, the potential φ(x) of the moving charge density n(x) is calculated and it is shown that φ(x) is not negligible. Then, a feed-back is provided by including this potential in the diffusion equation. This treatment is already self-consistent and more realistic but leads to long computations even for the simple one dimensional lattice-gas model. A remedy of this difficulty is proposed whereby the theory is reformulated in order to guarantee from the beginning the self-consistency of the solution of the non-linear diffusion problem. Straightforward extensions to the two-dimensional case are then possible. The results of the computations are illustrated with numerical examples for different values of the physical parameters.
Composite materials have found a number of structural applications, but their use in the electronics industry has been relatively limited. As the function of electroceramic composites are better understood, we can expect this picture to change. In this paper some of the piezoelectric composite sensor and actuator studies carried out in our laboratory during the past decade will be reviewed. The ideas that provide a basic understanding of functional composites have previously been discussed . This paper describes recent advances in the processing and properties of composites possessing 0-3, 1-3, and 2-2 connectivity made of polymers, metals and ferroelectric ceramics. The introduction of open spaces in the previous connectivity patterns allows the development of new designs of several piezoelectric composites with connectivity patterns of 0(0)-3, 1(0)-3, 2(0)-2-2, and 2-0-2. As in most electronic systems that are developed with improved properties a push toward lower cost and smaller sizes of the piezoelectric ceramics, together with improved reliability and performance occurs. The piezocomposites with open spaces in their structures clearly demonstrate the growth of the functional ceramics into the field of the smart ceramics as the materials for the beginning of the next century.
ProNectin®F is a recombinant engineered protein polymer of de novo design which incorporates the RGD epitope recognized by mammalian cell integrins. It is biologically active as a cell attachment protein, manifests properties of a planar polymeric surfactant, and is extremely resistant to thermal degradation. ProNectin®F was dispersed onto polystyrene powder, fabricated into plastic ware through injection molding, and the plastic ware was shown to have cell attachment activity. This technology represents a new paradigm for the production of plastic ware useful for mammalian cell culture under serum free conditions; and more generally, for the production of molded devices for use in contact with cells in vitro or in vivo.
The response of a range of porous Si and poly Si films to storage in acellular simulated body fluids is summarised and its implications discussed. It is suggested that the combination of VLSI technology, micromachining and surface microstructuring achievable with silicon, could establish this prominent semiconductor as a very useful biomaterial by the next century. The ‘biocompatibility’ of a variety of silicon microstructures, and even bulk silicon has received surprisingly little study, but now warrants detailed in-vitro and in-vivo assessment.