Ten Years of Experience Training Non-Physician Anesthesia Providers in Haiti.

Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings

Outcomes of a remote, decentralized health center-based HIV/AIDS antiretroviral program in Zambia, 2003 to 2007

A cross-sectional study of patients living with HIV/ AIDS treated during 2003 to 2007 in decentralized, rural health centers in Zambia was performed to measure virological outcomes after 12 months of antiretroviral therapy and identify factors associated with virological failure. Data from 228 patients who started antiretroviral therapy >12 months prior were analyzed. In all, 93% received stavudine + lamivudine + nevirapine regimens, and median antiretroviral therapy duration was 23.5 months (interquartile range 20-28). Of the 205 patients tested for viral load, 177 (86%) had viral load <1000 copies/mL. Probability of developing virological failure (viral load >1000 copies/mL) was 8.9% at 24 months and 19.6% at 32 months. Predictors for virological failure were <100% adherence, body mass index <18.5 kg/m(2), and women <40 years old. Of those with virological failure who underwent 3 to 6 months of intensive adherence counseling, 45% obtained virological success. In a remote, resource-limited setting in decentralized health centers, virological and immunological assessments of patients on antiretroviral therapy >12 months showed that positive health outcomes are achievable

The Attainment of Nirvana by Arya Shariputra and Maha Maudgalyayana

Tenzing , Thupten (trans

Ellalou Dimmock Honors Voice Recital, November 8, 2005

This is the concert program of the Ellalou Dimmock Honors Voice Recital performance on Tuesday, November 8, 2005 at 8:00 p.m., at the Concert Hall, 855 Commonwealth Avenue. Works performed were "La ci darem la mano" from "Don Giovanni" by Wolfgang Amadeus Mozart, "Amore traditore, Cupido, du verräter" BWV 203 by Johann Sebastian Bach, "Ariettes Oubliées" by Claude Debussy, "In der Fremde," "Intermezzo," "Waldesgespräch," "Mondnacht," "Auf einer Burg," and "Frühlingsnacht" from "Liederkreis," Op. 39 by Robert Schumann, "The Lilacs," Op. 21 No. 5 by Sergey Rachmaninov, "Oh, nver sing to me again," Op. 4 No. 4 by S. Rachmaninov, "Spring Waters," Op. 14 No. 11 by S. Rachmaninov, "Don Quichotte à Dulcinée by Maurice Ravel, and "Caro! Bella!" from "Giulio Cesare" by George Frideric Handel. Digitization for Boston University Concert Programs was supported by the Boston University Center for the Humanities Library Endowed Fund

Research needs for Chagas disease prevention.

We present an overview of the two main strategies for the primary (vector control) and secondary (patient care) prevention of Chagas disease (CD). We identify major advances, knowledge gaps, and key research needs in both areas. Improved specific chemotherapy, including more practical formulations (e.g., paediatric) or combinations of existing drugs, and a better understanding of pathogenesis, including the relative weights of parasite and host genetic makeup, are clearly needed. Regarding CD vectors, we find that only about 10-20% of published papers on triatomines deal directly with disease control. We pinpoint the pitfalls of the current consensus on triatomine systematics, particularly within the Triatomini, and suggest how some straightforward sampling and analytical strategies would improve research on vector ecology, naturally leading to sounder control-surveillance schemes. We conclude that sustained research on CD prevention is still crucial. In the past, it provided not only the know-how, but also the critical mass of scientists needed to foster and consolidate CD prevention programmes; in the future, both patient care and long-term vector control would nonetheless benefit from more sharply focused, problem-oriented research