Is the Framingham Coronary Heart Disease Absolute Risk Function Applicable to Aboriginal People?

Objective: To determine the extent to which the Framingham function predicts the risk of coronary heart disease (CHD) in Aboriginal people. Design and setting: Cohort study in an Aboriginal community in the Northern Territory. Participants: 687 Aboriginal people aged 20-74 years were followed up from a baseline examination in 1992-1995 through to 31 December 2003. Main outcome measure: First CHD events were identified through hospital and death records during the follow-up period. Methods: An original Framingham function was used to predict CHD risk according to the duration of follow-up and the values of traditional risk factors, which included age, sex, total cholesterol level, high-density lipoprotein (HDL) cholesterol level, blood pressure, the presence of diabetes, and smoking status. The predicted CHD incidence using the Framingham function was 4.4 per 1000 person-years, while the observed incidence was 11.0 (95% CI, 8.7-13.9) per 1000 person-years. The observed number of CHD events (68) was 2.5 times the number predicted (27) using the Framingham function. The observed incidence was about four and three times the predicted incidence for age groups < 35 and 35-44 years, respectively, and about twice the predicted incidence for those over 45 years of age. The Framingham function was a particularly unreliable predictor for women, especially younger women, in whom the observed CHD rate was 30 times the predicted rate. Conclusions: The Framingham function substantially underestimates the actual risk of CHD observed in Aboriginal people in a remote community, especially for women and younger adults. This implies that traditional risk factors have different degrees of impact and/or that other factors are contributing to risk. A population-specific risk function is needed

Rho-Isp Revisited and Basic Stage Mass Estimating for Launch Vehicle Conceptual Sizing Studies

The ideal rocket equation is manipulated to demonstrate the essential link between propellant density and specific impulse as the two primary stage performance drivers for a launch vehicle. This is illustrated by examining volume-limited stages such as first stages and boosters. This proves to be a good approximation for first-order or Phase A vehicle design studies for solid rocket motors and for liquid stages, except when comparing to hydrogen-fueled stages. A next-order mass model is developed that is able to model the mass differences between hydrogen-fueled and other stages. Propellants considered range in density from liquid methane to inhibited red fuming nitric acid. Calculated comparisons are shown for solid rocket boosters, liquid first stages, liquid upper stages, and a balloon-deployed single-stage-to-orbit concept. The derived relationships are ripe for inclusion in a multi-stage design space exploration and optimization algorithm, as well as for single-parameter comparisons such as those shown herein

Nelarabine in the Treatment of Refractory T-Cell Malignancies

Nelarabine is a nucleoside analog indicated for the treatment of adult and pediatric patients with T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoblastic lymphoma (T-LBL) that is refractory or has relapsed after treatment with at least two chemotherapy regimens. After being first synthesized in the late 1970s and receiving FDA approval in 2005, the appropriate use of nelarabine for refractory hematologic malignancies is still being elucidated. Nelarabine is the prodrug of 9-β-D-arabinofuranosylguanine (ara-G) which when phosphorylated intracellularly to ara-G triphosphate (ara-GTP), preferentially accumulates in cancerous T-cells. Dose-dependent toxicities, including neurotoxicity and myelosuppression, have been documented and may, in turn, limit the ability to appropriately treat the diagnosed malignancy. This article will summarize the pharmacologic properties of nelarabine and will address the current place in therapy nelarabine holds based upon the results of the available clinical trials to date

Knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Mother-to-Child Transmission (MTCT) of HIV remains the main mode of acquisition of HIV in children. Transmission of HIV may occur during pregnancy, delivery or breastfeeding. Studies have shown that some specific interventions help to reduce the transmission of the virus to the baby. In order to target safe, rational and effective intervention to reduce MTCT of HIV, it is necessary to ensure that the nurse/midwife has knowledge of the strategies for the prevention of vertical transmission of HIV.</p> <p>Method</p> <p>The cross-sectional design was utilized to determine the knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria. The study sample consisted of 155 nurse/midwives drawn from three selected hospitals through stratified random sampling method. Official permission was obtained from the institutions and consent from participants. Data was collected through the use of a self administered questionnaire. Information sought included respondents' demographic characteristics, knowledge about and behaviour of prevention of vertical transmission as well as factors influencing behaviour.</p> <p>Results</p> <p>Findings revealed that nurse/midwives had moderate level of knowledge with mean score of 51.4%. The mean score on behaviour was 52.5%, major factors that influence behaviour in these settings were mainly fear of getting infected, irregular supply of resources like gloves, goggles, sharp boxes, and water supply was not regular also. Hypotheses tested revealed that there is a positive relationship between knowledge and behaviour (r = 0.583, p = 0.00). Knowledge level of nurse/midwives who had educational exposure was not different from those who did not (t = 1.439, p = 0.152). There was a significant difference in the knowledge of nurse/midwives who had experience in managing pregnant women living with HIV/AIDS and those who did not (t = 2.142, p = 0.03). Also, there was a significant relationship between behaviour and availability of resources (r = 0.318, p = 0.000).</p> <p>Conclusion</p> <p>The study revealed that the nurse/midwives though moderately knowledgeable still had gaps in certain areas. Their behaviours were fairly appropriate. There is need for improved knowledge through structured educational intervention. Resources needed for practice should always be made available and the environment should be much more conducive for practice.</p

Sickness, 'sin' and discrimination: Examining a challenge for UK mental health nursing practice with lesbian, gay and bisexual people

Western psychiatry has a history of pathologising and attempting to ‘cure’ same-sex attraction, the legacy of which can still affect mental health practice today. Lesbian, gay and bisexual (LGB) people have greater risk of experiencing certain types of mental distress, self-harm and suicidal thoughts and behaviour as well as at risk of experiencing discrimination within mental health services. The minority stress model is important for understanding the higher levels of mental distress among LGB people. A type of discrimination in mental health services is appearing that has its origins in certain practitioner religious beliefs where same-sex attraction is interpreted as sinful. This has led to the reappearance of the idea that LGB people can be cured of their same-sex attraction, but with religious rather than psychiatric conceptual underpinnings. This may have particular implications for mental health nursing practice, where nurses have religious beliefs that bring them into conflict with the UK Nursing and Midwifery Council (NMC) Code of Conduct that forbids discrimination, and their legal obligation to work within the UK Equality Act 2010

Influence of process conditions on the formation of 2-4 ring polycyclic aromatic hydrocarbons from the pyrolysis of polyvinyl chloride

Municipal solid waste (MSW) contains significant amounts of polyvinyl chloride (PVC). The reactivity of PVC may form polycyclic aromatic hydrocarbons (PAHs) during the pyrolysis of MSW, which can become a key challenge during the development of pyrolysis technologies. However, there is very limited work in relation to the influence of pyrolysis process conditions in terms of temperature and heating rate on PAHs formation during pyrolysis of PVC. In this work, the formation of 2-4-ring PAHs from the pyrolysis of PVC at temperatures of 500, 600, 700, 800, or 900°C and at fast and slow heating rates was investigated under a N2 atmosphere in a fixed bed reactor. With the increase of temperature from 500 to 900°C, HCl yield decreased from 54.7 to 30.2 wt.%, while the yields of gases and PAHs in the tar increased. Slow pyrolysis generated higher HCl yield, and lower gas and tar yield than fast pyrolysis; the PAH yield obtained from the slow pyrolysis was much lower compared to fast pyrolysis. The results suggest that for fast pyrolysis, the dehydrochlorination of the PVC might be incomplete, resulting in the formation of chlorinated aromatic compounds

Care-seeking behavior and out-of-pocket expenditure for sick newborns among urban poor in Lucknow, northern India: a prospective follow-up study

Background: The state of Uttar Pradesh, India accounts for one-quarter of India's neonatal deaths and 8 percent of those worldwide. More than half (52%) of these deaths occur due to infections. In order to achieve Millennium Development Goal-4 of reducing child mortality by two-thirds by the year 2015, it is important to study factors which affect neonatal health. In Uttar Pradesh there is meager data for spending on health care in general and neonates in particular. Methods: The study was conducted at an urban Reproductive and Child Health (RCH) center and a District hospital. Neonates were enrolled within 48 hours of birth and were followed-up once at 6 weeks &#177; 15 days at the OPD of the respective hospitals or at home. This study assessed (1) distribution of neonatal illnesses and different health providers sought (2) distribution of out-of-pocket expenditures by type of illness and type of health provider sought (3) socio-economic distribution of neonatal illnesses, care-seeking behavior and out-of-pocket expenditures. Per-protocol analysis was performed. Results: Five hundred and ten neonates were enrolled and 481(94.4%) were followed-up. Parents of 50.3% (242/481) neonates reported at least one symptom of illness. Of these 22.3% (107/481) neonates had illnesses with at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign. Among IMNCI illnesses, point prevalence of septicemia was 6.2% and pneumonia was 5.2% while among non-IMNCI illnesses point prevalence of upper respiratory infection was 9.5%, and diarrhea was 7%. Community based non-government dispensers (NGDs) were leading health providers (37.6%). Mean monthly income of families was 2804 Indian Rupees (INR) (range: 800 to 14000; n = 510), where US$ 1 = 42 INR. Mean out-of-pocket expenditure on neonatal illness was 547.5 INR (range: 1 to 15000; n = 202) and mean out-of-pocket expenditure for hospitalization was 4993 INR (range: 41 to 15000; n = 17). All hospitalizations were for IMNCI illnesses. Neonates from lower income strata were less likely to receive any medical care (p &lt; 0.0001) and were also less likely to be seen by a Government provider (p = 0.03). Conclusion: Since more than half of the neonates have morbidity and out-of-pocket expenditure on neonatal illnesses often exceeds the family income of the lower strata of the low income group in the community, there is a need to either introduce health insurance scheme or subsidize health care for them. Also, since NGDs, half of which could be unqualified are leading health providers, qualified medical care-seeking for sick newborns should be promoted in urban Lucknow

Transient stability enhancement of a gridconnected wind farm using an adaptive neurofuzzy controlled-flywheel energy storage system

With the rapid growth of the wind energy systems in the past years and their interconnection with the existing power system networks, it has become very significant to analyse and enhance the transient stability of the wind energy conversion systems connected to the grid. This study investigates the transient stability enhancement of a grid-connected wind farm using doubly-fed induction machine-based flywheel energy storage system. A cascaded adaptive neuro-fuzzy controller (ANFC) is introduced to control the insulated gate bipolar transistor switches-based frequency converter to enhance the transient stability of the grid-connected wind farm. The performance of the proposed control strategy is analysed under a severe symmetrical fault condition on both a single-machine infinite bus model and the IEEE-39 bus New England test system. The transient performance of the system is investigated by comparing the results of the system using the proposed ANFCs with that of the black-box optimisation technique-based proportional-integral controllers. The validity of the system is verified by the simulation results which are carried out using PSCAD/EMTDC environment

Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) Study: formative protocol for mHealth platform development and piloting

BACKGROUND: There is a high unmet need for sexual and reproductive health (SRH) information and services among youth (ages 15-24) worldwide (MacQuarrie KLD. Unmet Need for Family Planning among Young Women: Levels and Trends 2014). With the proliferation of mobile technology, and its popularity with this age group, mobile phones offer a novel and accessible platform for a discreet, on-demand service providing SRH information. The Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) formative study will inform the development of an intervention, which will use the popular channel of SMS (text messages) to deliver SRH information on-demand to youth. METHODS/DESIGN: Following the development of potential SMS message content in partnership with SRH technical experts and youth, formative research activities will take place over two phases. Phase 1 will use focus group discussions (FGDs) with youth and parents/caregivers to develop and test the appropriateness and acceptability of the SMS messages. Phase 2 will consist of ‘peer piloting’, where youth participants will complete an SRH outcome-focused pretest, be introduced to the system and then have three weeks to interact with the system and share it with friends. Participants will then return to complete the SRH post-test and participate in an in-depth interview about their own and their peers’ opinions and experiences using ARMADILLO. DISCUSSION: The ARMADILLO formative stage will culminate in the finalization of country-specific ARMADILLO messaging. Reach and impact of ARMADILLO will be measured at later stages. We anticipate that the complete ARMADILLO platform will be scalable, with the potential for national-level adoption