Ebola virus disease epidemic in West Africa: Lessons learned and issues arising from West African countries

© Royal College of Physicians 2015. All rights reserved.The current Ebola virus disease (EVD) outbreak ravaging three nations in West Africa has affected more than 14,000 persons and killed over 5,000. It is the longest and most widely spread Ebola epidemic ever seen. At the time of this overview (written November 2014), having affected eight different nations, Nigeria and Senegal were able to control and eliminate the virus within a record time. Ghana has successfully, to date, kept the virus away from the country, despite economic and social relationships with affected nations. What lessons can we learn from Nigeria, Senegal and Ghana in the current epidemic? How can the world improve the health systems in low- and middle-income countries to effectively manage future outbreaks? Recently, the Royal College of Physicians launched a new partnership with the West African College of Physicians to curtail the effects of HIV/AIDS, malaria and tuberculosis in the region. We believe that strengthened health systems, skilled human resources for health and national ownership of problems are key to effective management of outbreaks such as EVD

Near or far away? A proximity and emotion, not size and emotion effect using Russian dolls [poster presentation]

The size and emotion effect is the tendency for children to draw people/objects with a positive emotional charge larger than those with a negative or neutral charge. Here we explored the novel idea that drawing size might be acting as a proxy for depth (physical or perceived), in a 2D environment. Forty-two children (aged 3-11 years) chose, from 2 sets of Matryoshka dolls, a doll to represent a person with positive, negative or neutral charge, which they placed in front of themselves on a sheet of 3A paper. We found that the children used proximity and not perceived depth or size, to indicate emotional charge. This is consistent with the notion that, in drawings, children may be using size as a proxy for physical closeness (proximity) as they attempt, with varying success, to put positive charged items closer to, or negative and neutral charge items further away from, themselves

Assessing Competence of NHS Consultants: Challenges and Possible Solutions

Even a mention of formal assessment of senior clinicians can be a contentious issue, to say least, when revalidation is said to be firmly in place in NHS-UK for almost half a decade. Since revalidation is accepted as a standard modality of assessment of performance, some colleagues in NHS wonder ‘stir up a hornets’ nest,’ when the authors allude to limitations of revalidation because poorly performing senior NHS clinicians may ‘slip through the net.’ NHS consultants have clinical as well as training roles. Fundamentally, this assessment (revalidation) is meant to ensure the safety of the public and mitigates the risk of disciplinary action by the GMC. Unfortunately, a disciplinary action is often the first sign of underperformance. In fact, the Bristol and Shipman inquiries have underscored the importance of the non-clinical and behavioural skills like communication, teamworking, personal organization and leadership are as important as clinical skills. Rather than considered an assessment tool, an annual appraisal is aimed to facilitate and improve the way NHS consultants work and provide services. The authors have to wait for five years, to assess the efficacy of the system that was introduced with much ‘fanfare’ since it was projected as a panacea for poor performance by ’bad doctors.’ The objectives of this article are to contextualize the issue of the underperformance among senior clinicians in the current NHS environment and to conceptualize the idea that their performance as trainers is directly related to their performance as clinicians. It is worth identifying the underlying factors of that are related to, or even better, can predict underperformance and will help evolve a strategy to help those consultants who are underperforming

TINJAUAN KRIMINOLOGIS TERHADAP TINDAK PIDANA INCEST DENGAN KORBAN ANAK(STUDI KASUS DI LAPAS KLAS IIA BANDA ACEH)

ABSTRAKTRI KARUNIA PUTRI AMELIA,TINJAUAN KRIMINOLOGIS TERHADAP 2015 TINDAK PIDANA INCEST DENGAN KORBAN ANAK (STUDI KASUS DI LAPAS KLAS IIA BANDA ACEH)Fakultas Hukum Universitas Syiah Kuala(v,54),pp.,bibl(Dr. DAHLAN ALI., S.H., M.Hum., M.Kn.,)Salah satu kejahatan yang sering terjadi adalah tindak pidana perkosaan. Tindak pidana perkosaan merupakan salah satu dari tindak pidana terhadap kesusilaan. Dalam Bab XIV dalam Buku II KUHP memuat kejahatan terhadap kesusilaan yang tersebar pada pasal 281 hingga 303 KUHP. Di dalamnya yang dimaksud dengan kesusilaan sebagian besar berkaitan dengan seksualitas. Salah satu jenis kelainan seksual adalah hubungan seks yang dilakukan secara paksa bersama seseorang yang masih ada hubungan darah yaitu incest, dan yang biasanya menjadi korban ialah anak-anak. Incest sebagaimana dirumuskan dalam kamus besar bahasa Indonesia adalah hubungan seksual antara orang-orang yang bersaudara dekat yang dianggap melanggar adat, hukum dan agama. Sanksi mengenai incest dengan korban anak dapat dilihat dalam Pasal 81 dan Pasal 82 Undang-Undang No. 23 Tahun 2002 Tentang Perlindungan Anak.Penelitian ini bertujuan untuk menjelaskan faktor penyebab terjadinya tindak pidana incest, dan untuk mengetahui upaya yang perlu dilakukan untuk menanggulangi tindak pidana incest di provinsi Aceh.Untuk memperoleh data dalam penelitian skripsi ini, dilakukan penelitian pustaka (library research) dan penelitian lapangan (field research) yang dilaksanakan di Banda Aceh dengan lokasi penelitian pada Lembaga Pemasyarakatan Klas IIA dengan tipe penelitian deskriptif yaitu menganalisis data yang diperoleh dari studi lapangan dan kepustakaan dengan cara menjelaskan dan menggambarkan kenyataan objek. Hasil penelitian menunjukkan bahwa faktor-faktor penyebab terjadinya tindak pidana incest adalah: Faktor rendahnya pendidikan dan ekonomi, Faktor lingkungan atau tempat tinggal, Faktor alkohol, Faktor kurangnya pemahaman terhadap agama, dan Peranan korban. Penanggulangan tindak pidana incest dapat dilakukan dengan cara mengadakan pelayanan emergency call kepada masyarakat, mengadakan pengedukasian bagi para orang tua, dan juga pembinaan mental kepada pelaku dan korban tindak pidana incest.Disarankan kepada pemerintah agar hendaknya memperbanyak wadah tempat pengaduan untuk masyarakat, serta diadakan penyuluhan hukum agar dapat menumbuhkan kesadaran masyarakat untuk benar-benar mentaati hukum. Selain itu disarankan agar sistem pembuktian dalam kasus perkosaan dapat lebih permudah, khususnya incest.Banda Ace

Nonlinear evolution of linear optimal perturbations of strongly stratified shear layers

The Miles-Howard theorem states that a necessary condition for normal-mode instability in parallel, inviscid, steady stratified shear flows is that the minimum gradient Richardson number, $Ri_{g,min}$, is less than 1/4 somewhere in the flow. However, the non-normality of the Navier-Stokes and buoyancy equations may allow for substantial perturbation energy growth at finite times. We calculate numerically the linear optimal perturbations which maximize the perturbation energy gain for a stably stratified shear layer consisting of a hyperbolic tangent velocity distribution with characteristic velocity $U_{0}^{*}$ and a uniform stratification with constant buoyancy frequency $N_{0}^{*}$. We vary the bulk Richardson number $Ri_b$=$N_{0}^{*}$$^2$$h^{*2}$/$U_{0}^{*}$$^2$ (corresponding to $Ri_{g,min}$) between 0.20 and 0.50 and the Reynolds numbers $Re$=$U_{0}^{*}$$h^{*}$/$v^{*}$ between 1000 and 8000, with the Prandtl number held fixed at $Pr$=1. We find the transient growth of non-normal perturbations may be sufficient to trigger strongly nonlinear effects and breakdown into small-scale structures, thereby leading to enhanced dissipation and non-trivial modification of the background flow even in flows where $Ri_{g,min}$>1/4. We show that the effects of nonlinearity are more significant for flows with higher $Re$, lower $Ri_b$ and higher initial perturbation amplitude $E_0$. Enhanced kinetic energy dissipation is observed for higher-$Re$ and lower-$Ri_b$ flows, and the mixing efficiency, quantified here by $\epsilon_p$/($\epsilon_p$+$\epsilon_k$) where $\epsilon_p$ is the dissipation rate of density variance and $\epsilon_k$is the dissipation rate of kinetic energy, is found to be approximately 0.35 for the most strongly nonlinear cases.EPSR

Cosmesis and breast-related quality of life outcomes following intra-operative radiotherapy for early breast cancer - a sub-study of the TARGIT - a trial

Purpose: The international randomized TARGIT-A trial compared risk-adapted single-dose intra-operative radiotherapy (TARGIT-IORT) to 3-7 weeks of daily conventional external beam radiotherapy (EBRT) in women with early breast cancer treatable with breast conserving surgery. TARGIT-A showed TARGIT-IORT to be non-inferior compared to EBRT in terms of reducing the risk of local cancer recurrence and found no difference in breast cancer survival however its effect on patient reported cosmesis and breast-related quality of life (QOL) have not yet been described. Methods and Materials: Longitudinal cosmesis and QOL data were collected from a sub-set of TARGIT-A participants who received TARGIT-IORT as a separate procedure (post-pathology). Patients completed a cosmetic assessment before radiotherapy and annually thereafter for at least five years. Patients also completed the combined EORTC core questionnaire (QLQ-C30) and Breast Specific Module (BR23) in addition to the Body Image after Breast Cancer Questionnaire (BIABC) at baseline and annually thereafter. The combined EORTC questionnaires were also collected 3, 6, and 9 months after wide local excision (WLE). Results: An Excellent-Good (EG) cosmetic result was scored more often than a Fair-Poor (FP) result for both treatment groups across all time points. TARGIT-IORT patients reported better breast-related QOL than EBRT patients. Statistically and clinically significant differences were seen at month-6 and Year-1, with EBRT patients having moderately worse breast symptoms (a statistically significant difference of more than 10 in a 100 point scale) than TARGIT-IORT patients at these time points. Conclusion: Patients treated with TARGIT-IORT on the TARGIT-A trial have similar self-reported cosmetic outcome but better breast-related QOL outcomes than patients treated with EBRT. This important evidence can facilitate the treatment decision making process for patients who have early breast cancer suitable for breast conserving surgery and inform their clinicians

A candidate tolerance gene identified in a natural population of field voles (Microtus agrestis)

The animal immune response has hitherto been viewed primarily in the context of resistance only. However, individuals, can also employ a tolerance strategy to maintain good health in the face of on-going infection. To shed light on the genetic and physiological basis of tolerance, we use a natural population of field voles, Microtus agrestis, to search for an association between the expression of the transcription factor Gata3, previously identified as a marker of tolerance in this system, and polymorphism in 84 immune and non-immune genes. Our results show clear evidence for an association between Gata3 expression and polymorphism in the Fcer1a gene, with the explanatory power of this polymorphism being comparable to that of other non-genetic variables previously identified as important predictors of Gata3 expression. We also uncover the possible mechanism behind this association using an existing protein-protein interaction network for the mouse model rodent, Mus musculus, which we validate using our own expression network for M. agrestis. Our results suggest that the polymorphism in question may be working at the transcriptional level, leading to changes in the expression of the Th2-related genes, Tyrosine-protein kinase BTK and Tyrosine-protein kinase TXK, and hence potentially altering the strength of the Th2 response, of which Gata3 is a mediator. We believe our work has implications for both treatment and control of infectious disease

Formation of Methane Hydrate in the Presence of Natural and Synthetic Nanoparticles

Natural gas hydrates occur widely on the ocean-bed and in permafrost regions, and have potential as an untapped energy resource. Their formation and growth, however, poses major problems for the energy sector due to their tendency to block oil and gas pipelines, whereas their melting is viewed as a potential contributor to climate change. Although recent advances have been made in understanding bulk methane hydrate formation, the effect of impurity particles, which are always present under conditions relevant to industry and the environment, remains an open question. Here we present results from neutron scattering experiments and molecular dynamics simulations that show that the formation of methane hydrate is insensitive to the addition of a wide range of impurity particles. Our analysis shows that this is due to the different chemical natures of methane and water, with methane generally excluded from the volume surrounding the nanoparticles. This has important consequences for our understanding of the mechanism of hydrate nucleation and the design of new inhibitor molecules

Characteristics associated with quality of life among people with drug-resistant epilepsy

Quality of Life (QoL) is the preferred outcome in non-pharmacological trials, but there is little UK population evidence of QoL in epilepsy. In advance of evaluating an epilepsy self-management course we aimed to describe, among UK participants, what clinical and psycho-social characteristics are associated with QoL. We recruited 404 adults attending specialist clinics, with at least two seizures in the prior year and measured their self-reported seizure frequency, co-morbidity, psychological distress, social characteristics, including self-mastery and stigma, and epilepsy-specific QoL (QOLIE-31-P). Mean age was 42 years, 54% were female, and 75% white. Median time since diagnosis was 18 years, and 69% experienced ≥10 seizures in the prior year. Nearly half (46%) reported additional medical or psychiatric conditions, 54% reported current anxiety and 28% reported current depression symptoms at borderline or case level, with 63% reporting felt stigma. While a maximum QOLIE-31-P score is 100, participants’ mean score was 66, with a wide range (25–99). In order of large to small magnitude: depression, low self-mastery, anxiety, felt stigma, a history of medical and psychiatric comorbidity, low self-reported medication adherence, and greater seizure frequency were associated with low QOLIE-31-P scores. Despite specialist care, UK people with epilepsy and persistent seizures experience low QoL. If QoL is the main outcome in epilepsy trials, developing and evaluating ways to reduce psychological and social disadvantage are likely to be of primary importance. Educational courses may not change QoL, but be one component supporting self-management for people with long-term conditions, like epilepsy