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Introduction: Although acute gastroenteritis is an extremely common childhood illness, there is a paucity of literature characterizing the associated pain and its management. Our primary objective was to quantify the pain experienced by children with acute gastroenteritis in the 24-hours prior to emergency department (ED) presentation. Secondary objectives included describing maximum pain, analgesic use, discharge recommendations, and factors that influenced analgesic use in the ED. Methods: Study participants were recruited into this prospective cohort study by the Alberta Provincial Pediatric EnTeric Infection TEam between January 2014 and September 2017. This study was conducted at two Canadian pediatric EDs; the Alberta Children's Hospital (Calgary) and the Stollery Children's Hospital (Edmonton). Eligibility criteria included < 18 years of age, acute gastroenteritis (□ 3 episodes of diarrhea or vomiting in the previous 24 hours), and symptom duration □ 7 days. The primary study outcome, caregiver-reported maximum pain in the 24-hours prior to presentation, was assessed using the 11-point Verbal Numerical Rating Scale. Results: We recruited 2136 patients, median age 20.8 months (IQR 10.4, 47.4); 45.8% (979/2136) female. In the 24-hours prior to enrolment, 28.6% (610/2136) of caregivers reported that their child experienced moderate (4-6) and 46.2% (986/2136) severe (7-10) pain in the preceding 24-hours. During the emergency visit, 31.1% (664/2136) described pain as moderate and 26.7% (571/2136) as severe. In the ED, analgesia was provided to 21.2% (452/2131) of children. The most commonly administered analgesics in the ED were ibuprofen (68.1%, 308/452) and acetaminophen (43.4%, 196/452); at home, acetaminophen was most commonly administered (77.7%, 700/901), followed by ibuprofen (37.5%, 338/901). Factors associated with analgesia use in the ED were greater pain scores during the visit, having a primary-care physician, shorter illness duration, fewer diarrheal episodes, presence of fever and hospitalization. Conclusion: Although children presenting to the ED with acute gastroenteritis experience moderate to severe pain, both prior to and during their emergency visit, analgesic use is limited. Future research should focus on appropriate pain management through the development of effective and safe pain treatment plans.
Surgery for CHD has been slow to develop in parts of the former Soviet Union. The impact of an 8-year surgical assistance programme between an emerging centre and a multi-disciplinary international team that comprised healthcare professionals from developed cardiac programmes is analysed and presented.
Material and methods
The international paediatric assistance programme included five main components – intermittent clinical visits to the site annually, medical education, biomedical engineering support, nurse empowerment, and team-based practice development. Data were analysed from visiting teams and local databases before and since commencement of assistance in 2007 (era A: 2000–2007; era B: 2008–2015). The following variables were compared between periods: annual case volume, operative mortality, case complexity based on Risk Adjustment for Congenital Heart Surgery (RACHS-1), and RACHS-adjusted standardised mortality ratio.
A total of 154 RACHS-classifiable operations were performed during era A, with a mean annual case volume by local surgeons of 19.3 at 95% confidence interval 14.3–24.2, with an operative mortality of 4.6% and a standardised mortality ratio of 2.1. In era B, surgical volume increased to a mean of 103.1 annual cases (95% confidence interval 69.1–137.2, p<0.0001). There was a non-significant (p=0.84) increase in operative mortality (5.7%), but a decrease in standardised mortality ratio (1.2) owing to an increase in case complexity. In era B, the proportion of local surgeon-led surgeries during visits from the international team increased from 0% (0/27) in 2008 to 98% (58/59) in the final year of analysis.
The model of assistance described in this report led to improved adjusted mortality, increased case volume, complexity, and independent operating skills.
In this study, the cross-section of electron-selective titanium oxide (TiO2) contacts for n-type crystalline silicon solar cells were investigated by transmission electron microscopy. It was revealed that the excellent cell efficiency of 21.6% obtained on n-type cells, featuring SiO2/TiO2/Al rear contacts and after forming gas annealing (FGA) at 350°C, is due to strong surface passivation of SiO2/TiO2 stack as well as low contact resistivity at the Si/SiO2/TiO2 heterojunction. This can be attributed to the transformation of amorphous TiO2 to a conducting TiO2−x phase. Conversely, the low efficiency (9.8%) obtained on cells featuring an a-Si:H/TiO2/Al rear contact is due to severe degradation of passivation of the a-Si:H upon FGA.
The Eastern Gangetic Plain is among the world's most intensively farmed regions, where rainfed and irrigated agriculture coexist. While the region and especially Bangladesh is a major producer of rice (Oryza sativa L. ssp. indica), there is potential to further develop sustainable rice production systems. Specifically, there is scope to include a replacement crop for the short fallow between rice crops in the dominant cropping pattern of rainfed monsoon rice harvest followed by irrigated spring rice. The aim of the current research was to identify a suitable cool-season legume crop – pea (Pisum sativum L.) or lentil (Lens culinaris Medik. ssp. culinaris) – that could be grown in the brief period between rice crops. The study comprised four crop sequence experiments comparing legume cultivars differing in maturity grown in between both long and short duration rice cultivars. These experiments were done at the Bangladesh Rice Research Institute regional station at Rajshahi over three cropping cycles. This was followed by an evaluation of pea vs. fallow between rice crops on three farmers’ fields in one cropping cycle. Here it is demonstrated that green pod vegetable pea is one of the best options to intensify the rainfed monsoon rice–fallow–spring irrigated rice cropping system, notwithstanding other remunerative rabi cropping options that could displace boro rice. The inclusion of an extra crop, pea as green pod vegetable, increased farm productivity by 1·4-fold over the dominant cropping sequence (rice–fallow–rice) and farm net income by fourfold. The study highlighted the advantages in total system productivity and monetary return of crop intensification with the inclusion of a pea crop between successive rice crops instead of a fallow period.
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
Africa is experiencing a rapid increase in adult obesity and associated cardiometabolic diseases (CMDs). The H3Africa AWI-Gen Collaborative Centre was established to examine genomic and environmental factors that influence body composition, body fat distribution and CMD risk, with the aim to provide insights towards effective treatment and intervention strategies. It provides a research platform of over 10 500 participants, 40–60 years old, from Burkina Faso, Ghana, Kenya and South Africa. Following a process that involved community engagement, training of project staff and participant informed consent, participants were administered detailed questionnaires, anthropometric measurements were taken and biospecimens collected. This generated a wealth of demographic, health history, environmental, behavioural and biomarker data. The H3Africa SNP array will be used for genome-wide association studies. AWI-Gen is building capacity to perform large epidemiological, genomic and epigenomic studies across several African counties and strives to become a valuable resource for research collaborations in Africa.
Coronary artery anomalies are a heterogeneous group of congenital disorders presenting with a wide spectrum of symptoms, ranging from vague chest pain to sudden cardiac death. Despite available data, there is no consensus about the classification, nomenclature, and outcomes of coronary anomalies in the normally connected heart. In this study, we aimed to investigate clinical and angiographic characteristics of coronary arterial anomalies, as well as the frequency of atherosclerotic involvement in anomalous coronaries, diagnosed at a tertiary referral centre.
We retrospectively reviewed coronary angiograms performed between 2011 and 2015 for the presence of a coronary anomaly. A total of 111 patients with a final diagnosis of coronary anomaly were included in the study group. We also recruited 110 age- and sex-matched patients who underwent coronary angiography because of symptomatic coronary artery disease as controls.
Among 36,893 coronary angiograms, 111 (0.30%) major coronary anomalies were found. Compared with controls, the prevalence of significant atherosclerotic coronary disease was lower in patients with coronary anomalies and stable symptoms (p=0.02); however, the prevalence of significant coronary atherosclerosis was similar among patients admitted with unstable angina or myocardial infarction (p>0.05). Compared with controls, patients with an anomalous left anterior descending coronary artery had significantly less atherosclerotic involvement than those in whom the left anterior descending artery was not anomalous (p=0.005).
Although coronary artery anomalies are cited as a cause for myocardial ischaemia, atherosclerotic coronary artery disease is also frequent and may offer an alternative explanation to ischaemic symptoms. No predisposition to accelerated atherosclerosis was found, however, and atherosclerotic involvement was less frequent in some anomalous vessels.
A theoretical study of an unsteady two-layered blood flow through a stenosed artery is presented in this article. The geometry of a rigid stenosed artery is assumed to be
-shaped. The flow regime is assumed to be laminar, unsteady and uni-directional. The characteristics of blood are modelled by the generalized Oldroyd-B non-Newtonian fluid model in the core region and a Newtonian fluid model in the periphery region. The governing partial differential equations are derived for each region by using mass and momentum conservation equations. In order to facilitate numerical solutions, the derived differential equations are nondimensionalized. A well-tested explicit finite-difference method (FDM) which is forward in time and central in space is employed for the solution of a nonlinear initial boundary value problem corresponding to each region. Validation of the FDM computations is achieved with a variational finite element method algorithm. The influences of the emerging geometric and rheological parameters on axial velocity, resistance impedance and wall shear stress are displayed graphically. The instantaneous patterns of streamlines are also presented to illustrate the global behaviour of the blood flow. The simulations are relevant to haemodynamics of small blood vessels and capillary transport, wherein rheological effects are dominant.
Poultry production has experienced tremendous change in Egypt in the last three decades. Small-scale family poultry production, otherwise termed household poultry, was part of this transformation but to date no concise description has been made of Egyptian household poultry. In this report, this is described using surveys and reviews. Inputs and outputs of this production system were evaluated and the profitability of the household poultry was estimated. Household poultry contribute immensely to food security in Egypt; providing income for individual families. A mean flock size of 73 (mixed breeds) was determined and this yielded a net annual profit of 2287.67LE (US$397.34) per annum. The important household poultry diseases are principally viral and bacterial. While Egyptian household poultry are similar to others in Africa in terms of multi-species flocks, women-driven projects, labour and marketing structures, it differs in input systems, hatchery method, disease management, and other indices. Suggestions for improvement of this sector of the poultry industry are offered.
Synthesis, structural, magnetic properties and heating efficiency of γ-Fe2O3 nanoparticles have been investigated. X-ray diffraction (XRD) and Mössbauer spectroscopy show that the obtained nanoparticles are mainly composed of maghemite phase (γ-Fe2O3). Williamson-Hall method shows that the crystallite is around 14nm.The specific absorption rate (SAR) under an alternating magnetic field is investigated as a function of frequency. A highest SAR value of 12W/g for frequency 523 kHz was obtained.
To assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities.
Retrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008–12).
Reported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012.
Of the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.
Infect. Control Hosp. Epidemiol. 2015;36(8):963–968
To determine the effect of a State of Emergency (SOE) on penetrating injuries at the main trauma center in Trinidad and Tobago.
Emergency room registers were accessed in order to identify all patients treated for penetrating injuries from July 1, 2010 through December 30, 2012. This study period was chosen to include injuries one year before and one year after the SOE that spanned from August 21, 2011 to December 5, 2011. Data were analyzed using SPSS version 19 and a P value <.05 was considered statistically significant.
There were 1,067 patients treated for penetrating injuries. There were significantly more injuries from gunshots compared to stab wounds (64.7% vs 35.3%; P<.001), and this pattern was maintained during the SOE (54.7% vs 45.3%; P=.37). There was a significant fall in mean monthly admissions for penetrating trauma during the SOE when compared to the 12-month period before its imposition (17.7, SD=4.0 vs 38.9, SD=12.3; CI, 5.6-36.8; P=.0108). One year later, mean monthly admissions for penetrating trauma were similar to those during the SOE (22.7, SD=2.1 vs 17.6, SD=4.0; CI, -2.3-12.3; P=.1295). The incidence of gunshot wounds remained low and stab wounds increased.
This study has demonstrated that there was a reduction in the incidence of penetrating trauma at the national trauma center after the SOE, with a shift from gunshot to stab wounds.
RamdassMJ, CawichSO, PooranS, MilneD, AliE, NaraynsinghV.Declaration of a State of Emergency in Trinidad and Tobago: Effect on the Trauma Admissions at the National Referral Trauma Centre. Prehosp Disaster Med. 2015;30(3):14.
The cropping systems of the Eastern Gangetic Plains of Bangladesh, India and Nepal are based on rice. There is a scope to intensify such systems through diversification with lentil, the most popular food legume. Two strategies were evaluated to fit lentil into the short fallow between successive monsoonal (i.e., T. aman) and pre-monsoonal (aus) or irrigated rice (boro) crop. These were early-flowering sole-cropped lentil and relay-sown lentil into rice. Firstly, 18 early-flowering lentil lines at three contrasting sowing dates were tested over two seasons on a research station at Ishurdi in Bangladesh. Secondly, relay sowing was evaluated at the same location with six early-flowering lines and two control cultivars in two seasons. It was also assessed on ten farms in Western Bangladesh, comparing relay with sole cropping over 3 years. Flowering in the early-flowering lentil lines was consistently 9–17 days earlier, than the control cultivars, but they did not achieve an economic yield (<1·0 t/ha). Relay sowing with an existing cultivar produced an economic yield of lentil, which was comparable or higher than sole-cropped lentil in all situations. The relay-sown lentil matured in sufficient time to allow the land to be prepared for the succeeding rain-fed rice crop. It was concluded that the substitution of relay-sown lentil for fallow in the monsoonal rice–fallow–rain-fed rice cropping pattern is a useful option to intensify and diversify cropping in the Eastern Gangetic Plain.