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

Generalized Uncertainty Principle, Modified Dispersion Relation and Barrier penetration by a Dirac particle

We have studied the energy band structure of a Dirac particle in presence of a generalised uncertainty principle (GUP). We start from defining a modified momentum operator and derive corresponding modified dispersion relation (MDR) and GUP. Apart from the forbidden band within the range $\pm m$, $m$ being the mass of the particle, we find the existence of additional forbidden bands at the both ends of the spectrum. Such band structure forbids a Dirac particle to penetrate a potential step of sufficient height ($\sim E_P$, $E_P$ being Planck energy). This is also true for massless particle. Unlike the relativistic case, a massless particle also can reflect from a barrier of sufficient height. Finally we discuss about the Klein's paradox in presence of the GUP.Comment: 10 pages, 7 figures, LaTe

A comprehensive evaluation of colonic mucosal isolates of Sutterella wadsworthensis from inflammatory bowel disease

Peer reviewedPublisher PD

Observations of Buried Lake Drainage on the Antarctic Ice Sheet.

Between 1992 and 2017, the Antarctic Ice Sheet (AIS) lost ice equivalent to 7.6 ± 3.9 mm of sea level rise. AIS mass loss is mitigated by ice shelves that provide a buttress by regulating ice flow from tributary glaciers. However, ice-shelf stability is threatened by meltwater ponding, which may initiate, or reactivate preexisting, fractures, currently poorly understood processes. Here, through ground penetrating radar (GPR) analysis over a buried lake in the grounding zone of an East Antarctic ice shelf, we present the first field observations of a lake drainage event in Antarctica via vertical fractures. Concurrent with the lake drainage event, we observe a decrease in surface elevation and an increase in Sentinel-1 backscatter. Finally, we suggest that fractures that are initiated or reactivated by lake drainage events in a grounding zone will propagate with ice flow onto the ice shelf itself, where they may have implications for its stability

A Land System representation for global assessments and land-use modeling

Current global scale land-change models used for integrated assessments and climate modeling are based on classifications of land cover. However, land-use management intensity and livestock keeping are also important aspects of land use, and are an integrated part of land systems. This article aims to classify, map, and to characterize Land Systems (LS) at a global scale and analyze the spatial determinants of these systems. Besides proposing such a classification, the article tests if global assessments can be based on globally uniform allocation rules. Land cover, livestock, and agricultural intensity data are used to map LS using a hierarchical classification method. Logistic regressions are used to analyze variation in spatial determinants of LS. The analysis of the spatial determinants of LS indicates strong associations between LS and a range of socioeconomic and biophysical indicators of human-environment interactions. The set of identified spatial determinants of a LS differs among regions and scales, especially for (mosaic) cropland systems, grassland systems with livestock, and settlements. (Semi-)Natural LS have more similar spatial determinants across regions and scales. Using LS in global models is expected to result in a more accurate representation of land use capturing important aspects of land systems and land architecture: the variation in land cover and the link between land-use intensity and landscape composition. Because the set of most important spatial determinants of LS varies among regions and scales, land-change models that include the human drivers of land change are best parameterized at sub-global level, where similar biophysical, socioeconomic and cultural conditions prevail in the specific regions. © 2012 Blackwell Publishing Ltd

Dose painting based on tumor uptake of Cu-ATSM and FDG:a comparative study

BACKGROUND: Hypoxia and increased glycolytic activity of tumors are associated with poor prognosis. The purpose of this study was to investigate differences in radiotherapy (RT) dose painting based on the uptake of 2-deoxy-2-[(18) F]-fluorodeoxyglucose (FDG) and the proposed hypoxia tracer, copper(II)diacetyl-bis(N(4))-methylsemithiocarbazone (Cu-ATSM) using spontaneous clinical canine tumor models. METHODS: Positron emission tomography/computed tomography scans of five spontaneous canine sarcomas and carcinomas were obtained; FDG on day 1 and (64)Cu-ATSM on day 2 and 3 (approx. 3 and 24 hours pi.). Sub-volumes for dose escalation were defined by a threshold-based method for both tracers and five dose escalation levels were formed in each sub-volume. Volumetric modulated arc therapy plans were optimized based on the dose escalation regions for each scan for a total of three dose plans for each dog. The prescription dose for the GTV was 45 Gy (100%) and it was linearly escalated to a maximum of 150%. The correlations between dose painting plans were analyzed with construction of dose distribution density maps and quality volume histograms (QVH). Correlation between high-dose regions was investigated with Dice correlation coefficients. RESULTS: Comparison of dose plans revealed varying degree of correlation between cases. Some cases displayed a separation of high-dose regions in the comparison of FDG vs. (64)Cu-ATSM dose plans at both time points. Among the Dice correlation coefficients, the high dose regions showed the lowest degree of agreement, indicating potential benefit of using multiple tracers for dose painting. QVH analysis revealed that FDG-based dose painting plans adequately covered approximately 50% of the hypoxic regions. CONCLUSION: Radiotherapy plans optimized with the current approach for cut-off values and dose region definitions based on FDG, (64)Cu-ATSM 3 h and 24 h uptake in canine tumors had different localization of the regional dose escalation levels. This indicates that (64)Cu-ATSM at two different time-points and FDG provide different biological information that has to be taken into account when using the dose painting strategy in radiotherapy treatment planning

PainDroid: An android-based virtual reality application for pain assessment

Earlier studies in the field of pain research suggest that little efficient intervention currently exists in response to the exponential increase in the prevalence of pain. In this paper, we present an Android application (PainDroid) with multimodal functionality that could be enhanced with Virtual Reality (VR) technology, which has been designed for the purpose of improving the assessment of this notoriously difficult medical concern. Pain- Droid has been evaluated for its usability and acceptability with a pilot group of potential users and clinicians, with initial results suggesting that it can be an effective and usable tool for improving the assessment of pain. Participant experiences indicated that the application was easy to use and the potential of the application was similarly appreciated by the clinicians involved in the evaluation. Our findings may be of considerable interest to healthcare providers, policy makers, and other parties that might be actively involved in the area of pain and VR research

Choosing the most suitable classifier For supporting assistive technology adoption In people with Parkinson’s disease: a fuzzy Multi-criteria approach

Parkinson’s disease (PD) is the second most common neurodegenerative disorder which requires a long-term, interdisciplinary disease management. While there remains no cure for Parkinson’s disease, treatments are available to help reduce the main symptoms and maintain quality of life for as long as possible. Owing to the global burden faced by chronic conditions such as PD, Assistive technologies (AT’s) are becoming an increasingly common prescribed form of treatment. Low adoption is hampering the potential of digital technologies within health and social care. It is then necessary to employ classification algorithms have been developed for differentiating adopters and non-adopters of these technologies; thereby, potential negative effects on people with PD and cost overruns can be further minimized. This paper bridges this gap by extending the Multi-criteria decision-making approach adopted in technology adoption modeling for people with dementia. First, the fuzzy Analytic Hierarchy Process (FAHP) is applied to estimate the initial relative weights of criteria and sub-criteria. Then, the Decisionmaking Trial and Evaluation Laboratory (DEMATEL) is used for evaluating the interrelations and feedback among criteria and sub-criteria. The Technique for Order of Preferences by Similarity to Ideal Solution (TOPSIS) is finally implemented to rank three classifiers (Lazy IBk – knearest neighbors, Naïve bayes, and J48 decision tree) according to their ability to model technology adoption. A real case study considering is presented to validate the proposed approach

A consistent picture for large penguins in D -> pi+ pi-, K+ K-

A long-standing puzzle in charm physics is the large difference between the D0 -> K+ K- and D0 -> pi+ pi- decay rates. Recently, the LHCb and CDF collaborations reported a surprisingly large difference between the direct CP asymmetries, Delta A_CP, in these two modes. We show that the two puzzles are naturally related in the Standard Model via s- and d-quark "penguin contractions". Their sum gives rise to Delta A_CP, while their difference contributes to the two branching ratios with opposite sign. Assuming nominal SU(3) breaking, a U-spin fit to the D0 -> K+ pi-, pi+ K-, pi+ pi-, K+ K- decay rates yields large penguin contractions that naturally explain Delta A_CP. Expectations for the individual CP asymmetries are also discussed.Comment: 24 pages, 8 figure