Introduction

This chapter: ■ explains what is meant by a complex emergency and the different phases of an emergency ■ discusses the impact of complex emergencies, explaining who is affected ■ provides basic information about malaria parasites, malaria transmission and populations at risk, and why malaria is signifi cant in emergency situations ■ sets out the key steps of an effective emergency response

Improving the Quality of Elder Care: The Continuing Care Retirement Community

Includes bibliographical references.By 2020, the segment of the population 65 and older will have increased by 42% to reach over one million persons and those 85 and older will number roughly 129,000. These trends indicate an increase in the demands for social services, such as housing and formal health care, including long-term nursing care. One option that provides for the needs of the elderly is the Continuing Care Retirement Community (CCRC)

Benthic macroinvertebrates and degradation of phytomass as indicators of ecosystem functions in flooded rice cropping.

The objective of this work was to evaluate the ecosystem functions of a natural wetland and of artificially flooded rice areas, managed under organic and conventional systems, by phytomass degradation and by the colonization of this material by benthic macroinvertebrates. The experiment was carried out in a natural wetland area, and in two flooded rice areas managed under organic and conventional systems. Twenty-five decomposition bags filled with 10 g of dry vegetation were installed in each site. At 14, 28, 42, 56, and 70 days after the beginning of the experiment, five bags from each site were collected. Macroinvertebrates were identified and classified by functional trophic group. The number of species of benthic macroinvertebrates increased: natural wetland > organic system > conventional system. The Chironomidae group was present in all areas, confirming its food plasticity and adaptability to different substrates and environmental stress situations. The Amphipoda group was present only in the artificially flooded rice area, and the Acari, only in the natural wetland. The diversity of species in the natural wetland area was higher than in the artificially flooded rice area. Nutrient cycling, provided by phytomass decomposition, is affected by the management system, and the delay in this process causes a reduction of the ecosystem functions in the conventional system.Título em português: Macroinvertebrados betônicos e degradação da fitomassa como indicadores de funções ecossistêmicas em arroz irrigado por inundação

Combined Endoscopic and Laparoscopic Approach to a Gastroesophageal Tumor

Minimally invasive techniques may be used in combination to manage difficult problems in general surgery leading to shorter hospital stays and improved patient satisfaction

The burden of acute respiratory infections in crisis-affected populations: a systematic review

Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case management and vaccine strategies will help to reduce disease burden

Observational case-control study of non-invasive ventilation in patients with ARDS

Background. The application of non-invasive pressure support ventilation (NIPSV) in patients with acute lung injury or ARDS remains controversial despite recent promising results. Data in rather homogeneous ARDS groups is lacking. Objective. To compare the outcome of NIPSV-treated patients satisfying the diagnostic criteria for primary (pulmonary) ARDS (ARDSp) and presenting without distant organ failures at admission, with those of a matched control group treated in the same ICU with endotracheal mechanical ventilation (ETMV). Methods. We applied NIPSV in 12 immunocompetent and collaborative patients who met the above cited criteria. NIPSV failure rate, short-term oxygenation, length of stay, mortality rate and complications were analyzed and compared with a control group of 12 intubated ARDSp-patients matched for age, SAPS II, PaO2/FiO2 and pH at admission. Results. NIPSV failed in 4 patients developing distant organ failures. Compared to the ETMV control group, NIPSV success patients had reduced cumulative time on ventilation (p = 0.001) and length of ICU stay (p = 0.004). After the first 60’ of ventilation, oxygenation improved more in the NIPSV than in the ETMV group (146 ± 52 mmHg vs 109 ± 34 mmHg; p = 0.05). The overall ICU mortality rate did not differ significantly between the groups but tended to be higher in the NIPSV group. Conclusions. In ARDSp patients without distant organ failures at admission and during the disease course, NIPSV might be a suitable alternative to invasive ventilation; however, the real effects on outcome of NIPSV applied to stable homogeneous subgroups of ARDS patients merit further investigations in randomised studies