Eastern Maine and the Rebellion: being an account of the principal local events in eastern Maine during the war

Introduction It has been our endeavor in these pages, to depict the scenes and incidents occuring at home, during the Rebellion, rather than the giving of a minute description of the varied experiences of the thousands, who marched away from Eastern Maine, at their Country\u27s call. We lay no claim to high literary merit, simply placing before you, in condensed form, the facts; believing that as the memories of the older readers are quickened, and the younger generation learn of the experiences of fathers and mothers, in their efforts to preserve the Union, all will find something of deep interest. R.H. Stanley / Geo.O. Hallhttps://digicom.bpl.lib.me.us/books_pubs/1189/thumbnail.jp

Determinants of Discontinuation of Contraceptive Methods among Women at Kenyatta National Hospital, Kenya

Background: Contraceptive use prevalence in Kenya is at 58% according to the 2014 Kenya Demographic Health Survey. Several factors lead to discontinuation and switch of contraceptives. Discontinuation rate as per the 2008/2009 KDHS for one year was 35.8%. Objectives: To find out the determinants of discontinuation and switching of hormonal and IUD contraceptive methods. Methodology: The study was a cross-sectional hospital based one, where data was collected by use of an interviewer administered questionnaire at Kenyatta National Hospital, where 400 women were interviewed. The data was then analyzed by use of the statistical software, SPSS Version 20. Results: The study population mainly comprised married women with a mean age of 31.45±6.40 years. Most women chose a contraceptive method which they perceived had the least adverse effects. Discontinuation rate by the time of study in the study population was 60.8%, with adverse effects as the most cited reason for discontinuation. The method of contraception and presence of co-morbidity were the factors associated with discontinuation of a contraceptive. Survival analysis showed that depot injection and Jadelle® (Levonorgestrel releasing implant 75mg) had the highest median months of use and Impanon® (Etonogestrel implant 68mg) the least. Conclusion: The reasons for discontinuation of contraceptive use include primarily concerns for adverse effects, use inconvenience, desire for pregnancy, contraceptive failure, and doctor’s advice. Key words: Contraceptive discontinuation, adverse effects, duration of us

Patterns of Prescribing Practices in Makueni County Referral Hospital, Kenya

Background: Prescribing is said to be irrational if it does not conform to good standards of treatment. Irrational prescribing leads to increased cost of drug therapy, increased risk for adverse drug reactions and emergence of drug resistance. Objective: The study objective was to determine the quality and patterns of prescribing in Makueni County Referral Hospital, Kenya, using World Health Organization prescribing indicators. Methodology: The design was a descriptive retrospective cross-sectional study. Data was abstracted from 824 patient encounters selected through quasi-random sampling. Data was collected from the sampled prescriptions using a pre-tested data collection form, entered into and analyzed using Stata version 10.0 software. Results: The mean number of drugs per patient encounter was 2.7. Only 45.5% of the total drugs were prescribed using generic names. Antibiotics and injections were prescribed in 74% and 13.2% of the prescriptions surveyed respectively. Discussion: On average, inpatients received a higher number of drugs per encounter compared to outpatients, probably because they usually have more severe disease than outpatients which may require management with more drugs. Conclusion: The results showed a trend towards irrational prescribing, particularly polypharmacy, underuse of generic names and over-prescription of antibiotics. Relevant educational, managerial and regulatory interventions are recommended to remedy the problems. Keywords: Irrational prescribing, prescribing indicators, polypharmac

Bostonia: The Boston University Alumni Magazine. Volume 12

Founded in 1900, Bostonia magazine is Boston University’s main alumni publication

Delays, fears and training needs: Perspectives of health workers on clinical management of snakebite revealed by a qualitative study in Kitui County, Kenya

Key aims of the WHO Strategy to halve snakebite morbidity and mortality include health system strengthening and training of health workers. This requires knowledge of local health system needs and capacity, health worker training needs, and factors influencing health worker decision-making in snakebite management. This study explored health worker experiences and perceptions of snakebite management, both individually and in the context of their local health system. We used a qualitative study design with semi-structured interviews (n = 14) and focus group discussions (n = 4). We employed a combination of sampling strategies aiming to achieve maximum variation among key informants within resource limitations. We recruited health workers (n = 33) of varying roles from purposively selected tier 2, 3 and 4 health facilities (n = 12) and the community (tier 1) in four sub-counties in Kitui County, Kenya. We conducted inductive thematic analysis of all transcripts. The results identified that health workers recognised snake envenoming as a time-critical emergency in which delay in care seeking, sometimes exacerbated by health system referral delays, was a major barrier to effective management of patients. Clinicians strongly voiced a need for training in snakebite management, diagnosis and antivenom administration. Unexpressed needs for training were demonstrated in traditional remedy ineffectiveness, syndromic management, and critical appraisal of treatment effectiveness. Under-resourcing in antivenom, other medication, equipment, infrastructure and staffing also challenged management. Fear of snakebite and fear of antivenom, both linked to past experiences, influenced clinical decision-making. Our findings clearly indicate a need in Kitui County for training programmes that equip health workers for clinical decision-making in snakebite management. We further identify community intervention needs to facilitate prompt presentation to healthcare, including practical affordable transport solutions, and systematic health system resourcing needs. In addition, we recommend supportive supervision and further research in response to the emotional stress resulting from managing difficult cases in under-resourced settings

Evaluation of stroke services in Anglia Stroke Clinical Network to examine the variation in acute services and stroke outcomes.

BACKGROUND: Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors. METHODS/DESIGN: We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy) completed EuroQol (EQ-5D) questionnaires will measure quality of life at baseline and follow-up for cost utility analyses. DISCUSSION: This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Nutritional Quality of Fruits and Vegetables

Horticultural crops are some of the main components of a healthy diet. The constituents obtained by the human body from fruits and vegetables include water, carbohydrates, fats, proteins, fi ber, minerals, organic acids, pigments, vitamins and antioxidants, among others. Fruits and vegetables, especially, are a good source of fi ber, selected minerals, vitamins and antioxidants. Most fruits and vegetables are available almost year-round in a wide variety and they not only taste good, but they also have favorable attributes of texture, color, fl avor and ease of use. They can be fresh, cooked, hot or cold, canned, pickled, frozen or dried. Fruits and vegetables are consumed at all times, and due to their convenient size; they are an excellent between-meal snack. They are relatively low in calories and fat (avocado and olives being the exceptions), they have no cholesterol, they are rich in carbohydrates and fi ber, they contain vitamin C and carotene, and some are a good source of vitamin B 6 . Fruits and vegetables are relatively low in sodium and high in potassium. Ascorbic acid in fruits and vegetables enhances the bioavailability of iron in the diet. Because of all these characteristics, fruits and vegetables have a unique role in a healthy diet. A growing body of research has shown that fruit and vegetable consumption is associated with reduced risk of major diseases, and possibly delayed onset of age-related disorders, promoting good health. However, in many cases fruit and vegetable consumption is still below the dietary guideline goal of consuming 5–10 servings each day. The nutritional value of fruits and vegetables depends on their composition, which shows a wide range of variation depending on the species, cultivar and maturity stage. The composition of fruits and vegetables includes a great number of metabolites however, it could be predicted that no single commodity might be rich in all these constituents. This chapter describes the general characteristics of the components of fruits and vegetables, related to their benefi ts as food sources.Facultad de Ciencias Agrarias y Forestale

“Then they prayed, they did nothing else, they just prayed for the boy and he was well”: A qualitative investigation into the perceptions and behaviours surrounding snakebite and its management in rural communities of Kitui county, Kenya

Introduction: Human-snake interactions are common in tropical regions where subsistence-farming and livestock-herding activities predominate alongside proliferation of snakes. Local beliefs and perceptions about snakes and snakebites influence human behaviour. Understanding these beliefs and perceptions can inform the development of resources to drive behaviour change and to minimise the risk of injury to both humans and snakes. This qualitative study, conducted between May and July 2019, sought to explore the beliefs and perceptions regarding snakes and snakebites, and methods of prevention and management among members of the community in Kitui County, Kenya. Methods: Semi-structured interviews were used to collect qualitative data from 23 participants, recruited using a stratified purposeful sampling strategy in four selected sub-counties of Kitui county. Interview data was anonymised and coded and a thematic analysis was conducted using NVivo 12. Results: People from Kitui county mostly had negative perceptions about snakes. There was a generalised awareness of the need to prevent snakebite, predominantly through keeping snakes away from homes/compounds. However, implementation was limited by financial constraints. Participants also identified logistic and financial obstacles to early hospital presentation following a snakebite, and they expressed a strong preference of having their snakebites treated in a hospital over consulting traditional healers. There was a universal recognition of the benefit of early intervention with a specific appreciation of the utility of the black stone. Furthermore, the removal of a snake’s “teeth” was an expected treatment outcome for some community members, with the failure to do so perceived as causing poor wound healing or persistence of symptoms. Some religious groups held views which differed from most participants. Conclusion: There is a need to explore and clarify common misconceptions about snakes and first aid treatment of snakebites, encourage learning about the true nature of snakes, and highlight beneficial uses of snakes. A change in the epistemological conception of community education material by enhancing the value and use of local forms of knowledge, and the employment of art techniques to transmit this knowledge, could improve community perception and methods of snakebite prevention. Patient expectations should be appropriately managed by discussing possible outcomes, incorporating follow-up visits and addressing long-term complications of snakebites

Relations between lipoprotein(a) concentrations, LPA genetic variants, and the risk of mortality in patients with established coronary heart disease: a molecular and genetic association study

Background: Lipoprotein(a) concentrations in plasma are associated with cardiovascular risk in the general population. Whether lipoprotein(a) concentrations or LPA genetic variants predict long-term mortality in patients with established coronary heart disease remains less clear. Methods: We obtained data from 3313 patients with established coronary heart disease in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. We tested associations of tertiles of lipoprotein(a) concentration in plasma and two LPA single-nucleotide polymorphisms ([SNPs] rs10455872 and rs3798220) with all-cause mortality and cardiovascular mortality by Cox regression analysis and with severity of disease by generalised linear modelling, with and without adjustment for age, sex, diabetes diagnosis, systolic blood pressure, BMI, smoking status, estimated glomerular filtration rate, LDL-cholesterol concentration, and use of lipid-lowering therapy. Results for plasma lipoprotein(a) concentrations were validated in five independent studies involving 10 195 patients with established coronary heart disease. Results for genetic associations were replicated through large-scale collaborative analysis in the GENIUS-CHD consortium, comprising 106 353 patients with established coronary heart disease and 19 332 deaths in 22 studies or cohorts. Findings: The median follow-up was 9·9 years. Increased severity of coronary heart disease was associated with lipoprotein(a) concentrations in plasma in the highest tertile (adjusted hazard radio [HR] 1·44, 95% CI 1·14–1·83) and the presence of either LPA SNP (1·88, 1·40–2·53). No associations were found in LURIC with all-cause mortality (highest tertile of lipoprotein(a) concentration in plasma 0·95, 0·81–1·11 and either LPA SNP 1·10, 0·92–1·31) or cardiovascular mortality (0·99, 0·81–1·2 and 1·13, 0·90–1·40, respectively) or in the validation studies. Interpretation: In patients with prevalent coronary heart disease, lipoprotein(a) concentrations and genetic variants showed no associations with mortality. We conclude that these variables are not useful risk factors to measure to predict progression to death after coronary heart disease is established. Funding: Seventh Framework Programme for Research and Technical Development (AtheroRemo and RiskyCAD), INTERREG IV Oberrhein Programme, Deutsche Nierenstiftung, Else-Kroener Fresenius Foundation, Deutsche Stiftung für Herzforschung, Deutsche Forschungsgemeinschaft, Saarland University, German Federal Ministry of Education and Research, Willy Robert Pitzer Foundation, and Waldburg-Zeil Clinics Isny