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The withdrawal of water with a free surface through a line sink from a two-dimensional, vertical sand column is considered using the hodograph method and a novel spectral method. Hodograph solutions are presented for slow flow and for critical, limiting steady flows, and these are compared with spectral solutions to the steady problem. The spectral method is then extended to obtain unsteady solutions and hence the evolution of the phreatic surface to the steady solutions when they exist. It is found that for each height of the interface there is a unique critical coning value of flow rate, but also that the value obtained is dependent on the flow history.
To validate a novel photographic portion guide as a tool to estimate consumption of fish and shrimp. Application of such a validated tool can facilitate accurate individual and community seafood intake assessments and provide meaningful data relative to health benefits and hazard assessment, particularly in response to environmental contamination and disasters.
A photographic fish and shrimp portion guide presenting a stepped range of cooked portion sizes was used by participants to estimate their typical portion sizes. Participants selected their typical portion size from the photographic guide and also from a selection of freshly cooked reference meals. Photographic portions selections were compared with plated reference portions for each participant.
Academic sensory testing laboratory in the USA.
Separate groups of adults (25–64 years) contributed to fish (n 54) and shrimp (n 53) portion size comparison studies.
In the fish study, there was no difference between photographic portion selections (6·59 (sd 2·65) oz (186·8 (sd 75·1) g)) and reference plate selections (7·04 (sd 2·63) oz (199·6 (sd 74·6) g); P=0·384). Similarly in the shrimp study, there was no difference between photographic portion selections (6·88 (sd 3·40) oz (195·0 (sd 96·4) g)) and reference plate selections (6·06 (sd 2·65) oz (171·8 (sd 75·1) g); P=0·159). Photographic portions predicted plated reference portions for both fish and shrimp based on linear regression (P<0·001). Bland–Altman plot analyses showed good agreement between the two methods, <1 oz (<28·3 g) bias, in both fish and shrimp studies.
This validated photographic seafood portion guide provides a utilitarian tool for accurately assessing fish and shrimp intake in a community setting.
Makkah (Mecca) is a holy city located in the western region of the Kingdom of Saudi Arabia. Each year, millions of pilgrims visit Makkah. These numbers impact both routine health care delivery and disaster response. This study aimed to evaluate hospitals’ disaster plans in the city of Makkah.
Study investigators administered a questionnaire survey to 17 hospitals in the city of Makkah. Data on hospital characteristics and three key domains of disaster plans (general evaluation of disaster planning, structural feasibility of the hospitals, and health care worker knowledge and training) were collated and analyzed.
A response rate of 82% (n=14) was attained. Ten (71%) of the hospitals were government hospitals, whereas four were private hospitals. Eleven (79%) hospitals had a capacity of less than 300 beds.
Only nine (64%) hospitals reviewed their disaster plan within the preceding two years. Nine (64%) respondents were drilling for disasters at least twice per year. The majority of hospitals did not rely on a hazard vulnerability analysis (HVA) to develop their Emergency Operations Plan. Eleven (79%) hospitals had the Hospital Incident Command Systems (HICS) present in their plans.
All hospitals described availability of some supplies required for the first 24 hours of a disaster response, such as: N95 masks, antidotes for nerve agents, and antiviral medications. Only five (36%) hospitals had a designated decontamination area. Nine (64%) hospitals reported ability to re-designate inpatient wards into an intensive care unit (ICU) format. Only seven (50%) respondents had a protocol for increasing availability of isolation rooms to prevent the spread of airborne infection. Ten (71%) hospitals had a designated disaster-training program for health care workers.
Makkah has experienced multiple disaster incidents over the last decade. The present research suggests that Makkah hospitals are insufficiently prepared for potential future disasters. This may represent a considerable threat to the health of both residents and visitors to Makkah. This study demonstrated that there is significant room for improvement in most aspects of hospital Emergency Operations Plans, in particular: reviewing the plan and increasing the frequency of multi-agency and multi-hospital drills. Preparedness for terrorism utilizing chemical, biologic, radiation, nuclear, explosion (CBRNE) and infectious diseases was found to be sub-optimal and should be assessed further.
Al-ShareefAS, AlsulimaniLK, BojanHM, MasriTM, GrimesJO, MolloyMS, CiottoneGR. Evaluation of Hospitals’ Disaster Preparedness Plans in the Holy City of Makkah (Mecca): A Cross-Sectional Observation Study. Prehosp Disaster Med. 2017;32
To determine whether implementation of a multifaceted intervention would significantly reduce the incidence of central line–associated bloodstream infections.
Prospective cohort collaborative.
SETTING AND PARTICIPANTS
Intensive care units of the Abu Dhabi Health Services Company hospitals in the Emirate of Abu Dhabi.
A bundled intervention consisting of 3 components was implemented as part of the program. It consisted of a multifaceted approach that targeted clinician use of evidence-based infection prevention recommendations, tools that supported the identification of local barriers to these practices, and implementation ideas to help ensure patients received the practices. Comprehensive unit-based safety teams were created to improve safety culture and teamwork. Finally, the measurement and feedback of monthly infection rate data to safety teams, senior leaders, and staff in participating intensive care units was encouraged. The main outcome measure was the quarterly rate of central line–associated bloodstream infections.
Eighteen intensive care units from 7 hospitals in Abu Dhabi implemented the program and achieved an overall 38% reduction in their central line–associated bloodstream infection rate, adjusted at the hospital and unit level. The number of units with a quarterly central line–associated bloodstream infection rate of less than 1 infection per 1,000 catheter-days increased by almost 40% between the baseline and postintervention periods.
A significant reduction in the global morbidity and mortality associated with central line–associated bloodstream infections is possible across intensive care units in disparate settings using a multifaceted intervention.
Infect. Control Hosp. Epidemiol. 2015;36(7):816–822
In the Kingdom of Saudi Arabia (KSA), Old World cutaneous leishmaniasis (CL) is mainly caused by Leishmania major and Leishmania tropica parasites. Diagnosis of CL is predominately made by clinicians, who at times fail to detect the disease and are unable to identify parasite species. Here, we report the development of a chemiluminescent enzyme-linked immunosorbent assay (CL-ELISA) to measure the levels of anti-α-galactosyl antibodies in human sera. Using this assay, we have found that individuals infected with either Leishmania spp. had significantly elevated levels (up to 9-fold higher) of anti-α-Gal IgG compared to healthy control individuals. The assay sensitivity was 96% for L. major (95% CI; 94–98%) and 91% for L. tropica (95% CI; 86–98%) infections and therefore equivalent to restriction fragment length polymorphism-polymerase chain reaction analysis of parasite ITS1 gene. In addition, the assay had higher sensitivity than microscopy analysis, which only detected 68 and 45% of the L. major and L. tropica infections, respectively. Interestingly, up to 2 years following confirmed CL cure individuals had 28-fold higher levels of anti-α-Gal IgG compared to healthy volunteers. Monitoring levels of anti-α-Gal antibodies can be exploited as both a diagnostic tool and as a biomarker of cure of Old World CL in disease elimination settings.
We review clinical, neuroimaging, and genetic information on six individuals with isolated sulfite oxidase deficiency (ISOD).
All patients were examined, and clinical records, biochemistry, neuroimaging, and sulfite oxidase gene (SUOX) sequencing were reviewed.
Data was available on six individuals from four nuclear families affected by ISOD. Each individual began to seize within the first week of life. neurologic development was arrested at brainstem reflexes, and severe microcephaly developed rapidly. neuroimaging within days of birth revealed hypoplasia of the cerebellum and corpus callosum and damage to the supratentorial brain looking like severe hypoxic-ischemic injury that evolved into cystic hemispheric white matter changes. Affected individuals all had elevated urinary S-sulfocysteine and normal urinary xanthine and hypoxanthine levels diagnostic of ISOD. Genetic studies confirmed SUOX mutations in four patients.
ISOD impairs systemic sulfite metabolism, and yet this genetic disease affects only the brain with damage that is commonly confused with the clinical and radiologic features of severe hypoxic-ischemic encephalopathy.
Previous community surveys of the drop out from mental health treatment have been carried out only in the USA and Canada.
To explore mental health treatment drop out in the World Health Organization World Mental Health Surveys.
Representative face-to-face household surveys were conducted among adults in 24 countries. People who reported mental health treatment in the 12 months before interview (n = 8482) were asked about drop out, defined as stopping treatment before the provider wanted.
Overall, drop out was 31.7%: 26.3% in high-income countries, 45.1% in upper-middle-income countries, and 37.6% in low/ lower/middle-income countries. Drop out from psychiatrists was 21.3% overall and similar across country income groups (high 20.3%, upper-middle 23.6%, low/lower-middle 23.8%) but the pattern of drop out across other sectors differed by country income group. Drop out was more likely early in treatment, particularly after the second visit.
Drop out needs to be reduced to ensure effective treatment.
As far as the exam is concerned, it is very similar to a chess match. It ought to be treated with respect, but played in a clever fashion. As soon as you try to think of the exam as a wrestling match pitfalls for failing are plentiful. In the orals, just like chess, you have to preempt the move of your opponent, which in this situation is the examiner. It is a time-dependent chess match where every move must be undertaken in a specified time. Keep this analogy as you attempt different clinical scenarios. It is not only knowledge of the subject that is important, but to impart it in an appropriate fashion, which is inherently more important in the orals.
Treat each subject as a chess game that is going to last 5 minutes.
Structured oral examination question 1
A 35-year-old motorcyclist came off his bike yesterday; he has been resuscitated and has an isolated closed injury of the knee.
EXAMINER: What are your views?
Here the next 1 minute belongs to the candidate and you can take it whichever way you want to. However, there are essentials to be covered. In the first 30 seconds you are expected to comment on the following:
Name of the patient.
Site of radiograph.
Fracture through the tibia with depression of the lateral tibial plateau and always ask for a lateral radiograph.
Associations between specific parent and offspring mental disorders are likely to have been overestimated in studies that have failed to control for parent comorbidity.
To examine the associations of parent with respondent disorders.
Data come from the World Health Organization (WHO) World Mental Health Surveys (n = 51 507). Respondent disorders were assessed with the Composite International Diagnostic Interview and parent disorders with informant-based Family History Research Diagnostic Criteria interviews.
Although virtually all parent disorders examined (major depressive, generalised anxiety, panic, substance and antisocial behaviour disorders and suicidality) were significantly associated with offspring disorders in multivariate analyses, little specificity was found. Comorbid parent disorders had significant sub-additive associations with offspring disorders. Population-attributable risk proportions for parent disorders were 12.4% across all offspring disorders, generally higher in high- and upper-middle- than low-/lower-middle-income countries, and consistently higher for behaviour (11.0–19.9%) than other (7.1–14.0%) disorders.
Parent psychopathology is a robust non-specific predictor associated with a substantial proportion of offspring disorders.
In late 2002, health professionals from the ministries of health and academia of Jordan, the Palestinian Authority and Israel formed the Middle East Consortium on Infectious Disease Surveillance (MECIDS) to facilitate trans-border cooperation in response to infectious disease outbreaks. The first mission of MECIDS was to establish a regional, laboratory-based surveillance network on foodborne diseases. The development of harmonized methodologies and laboratory capacities, the establishment of a common platform of communication, data sharing and analysis and coordination of intervention steps when needed were agreed upon. Each of the three parties selected the microbiological laboratories that would form the network of sentinel laboratories and cover the different districts of each country and also designated one laboratory as the National Reference Laboratory (NRL). Data analysis units have been established to manage the data and serve as a central point of contact in each country. The MECIDS also selected a regional data analysis unit, the Cooperative Monitoring Centre (CMC) located in Amman, Jordan, and established a mechanism for sharing data from the national systems. Joint training courses were held on interventional epidemiology and laboratory technologies. Data collection started in July 2005 with surveillance of salmonellosis as the first target. This network of collaboration and communication established in an area of continuous dispute represents an important step towards assessing the burden of foodborne diseases in the region and is expected to be fundamental for coordination of public health interventions and prevention strategies.
A band of fascial thickening, termed the iliopubic tract, lies
on the posterior aspect of the inguinal region
and has been described in the surgical literature as playing an important
role during herniorraphy. This
study was undertaken to examine the gross and microscopic anatomy of the
iliopubic tract in 12 cadavers.
The results confirmed that the iliopubic tract can be readily identified
as a thickening of the transversalis
fascia running deep and parallel to the inguinal ligament. It attaches
to the superomedial part of the pubic
bone medially, but laterally its fibres fan out within the fascia transversalis
and fascia iliaca without bony
attachment to the iliac spines. In contrast to the inguinal ligament, the
histological analysis of the iliopubic
tract shows a high elastin to collagen ratio. The functional signficance
of this structure merits further study,
but there is no doubt that it is important in many approaches to inguinal
herniorraphy. For this reason it is
considered that the iliopubic tract deserves greater emphasis in the anatomy
teaching of the inguinal region.
Starting with eggs from a natural habitat the authors were able to raise and breed Bulinus truncatus, the snail vector of schistosomiasis haematobia, under conditions of total and continuous darkness and to complete the life-cycle from egg to egg in 70 days. The rearing of a second generation was interrupted by circumstances beyond the authors’ control. Darkness is shown nevertheless to have a restrictive effect on population growth and the use of covered channels and pipes for irrigation water, although not a complete control measure, should therefore be adopted wherever possible in endemic foci of schistosomiasis haematobia where snail control is necessary.
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