Using clinical practice guidelines to manage dengue: a qualitative study in a Malaysian hospital.

BACKGROUND: Malaysia has rising dengue incidence. World Health Organization clinical practice guidelines for managing dengue have been adapted by the Ministry of Health in Malaysia, with evidence of good awareness by clinicians. However, dengue mortality has not reduced. This study aimed to explore the challenges of dengue management for Medical Officers, with a particular focus on use of clinical practice guidelines. METHODS: Qualitative study using six focus groups and 14 semi-structured interviews with doctors responsible for dengue management at a large tertiary hospital in Malaysia. RESULTS: Dengue was recognised as difficult to diagnose and manage. Wide awareness and use of both WHO and Ministry of Health guidelines was reported, but several limitations noted in their coverage of particular patient groups. However, the phrase 'guidelines' also referred to local algorithms for fluid management, which were less clinically evidence-based. Where Medical Officers were well trained in the appropriate use of evidence-based guidelines, barriers to use included: the potential for 'following the algorithm' to undermine junior clinicians' claims to clinical expertise; inability to recognise the pattern of clinical progress; and lack of clinical experience. Other reported barriers to improved case management were resource constraints, poor referral practices, and insufficient awareness of the need for timely help seeking. CONCLUSIONS: Awareness of clinical practice guidelines is a necessary, but not sufficient, condition for optimal dengue management. In high prevalence settings, all clinical staff would benefit from regular dengue management training which should include diagnosis, practice in monitoring disease progression and the use of clinical practice guidelines in a range of clinical contexts

A fusion of minicircle DNA and nanoparticle delivery technologies facilitates therapeutic genetic engineering of autologous canine olfactory mucosal cells

Olfactory ensheathing cells (OECs) promote axonal regeneration and improve locomotor function when transplanted into the injured spinal cord. A recent clinical trial demonstrated improved motor function in domestic dogs with spinal injury following autologous OEC transplantation. Their utility in canines offers promise for human translation, as dogs are comparable to humans in terms of clinical management and genetic/environmental variation. Moreover, the autologous, minimally invasive derivation of OECs makes them viable for human spinal injury investigation. Genetic engineering of transplant populations may augment their therapeutic potential, but relies heavily on viral methods which have several drawbacks for clinical translation. We present here the first proof that magnetic particles deployed with applied magnetic fields and advanced DNA minicircle vectors can safely bioengineer OECs to secrete a key neurotrophic factor, with an efficiency approaching that of viral vectors. We suggest that our alternative approach offers high translational potential for the delivery of augmented clinical cell therapies

Optimisation of solar desalination process: an investigation of the critical parameters affecting solar still water production in the context of a developing country

There is a global need for people to have access to enough potable water to meet their daily needs. However, in developing countries water distribution infrastructure is often inadequate to meet demand. Water demand is anticipated to increase as a result of urbanisation, population growth and climate change. The solutions considered must be feasible for those subject to water scarcity. The current work is concerned with development of a solar desalination still to increase water security in developing countries. Design focus has been on the technical and sociocultural factors which are most important for optimising performance and community acceptance of a still. The work has particular focus toward applications in South Pacific nations where electricity supply, available capital and technical expertise are more limited than in more developed countries. The influence of several environmental, design and operational factors on water productivity have been tested as part of the current work. This testing led to the formulation of an equation set defining system dynamics. The equations were based on fundamental heat transfer and thermodynamics principles. Solar still desalination is an active field of research and a range of empirical and semi-empirical equations have been presented in prior literature. The studies offering a thermodynamic basis for the equations are relatively few. No prior work was found to have integrated relative humidity as a system variable within the equation set, although it has been acknowledged that internal humidity in the still is below saturated. The current work addresses relative humidity as a significant system variable for the equation formulation and the models have excellent fit to the data as a result. The key factors of influence were extracted from the empirical and model-building phase and consolidated into a series of design implications for practitioners focussing on solar stills and their design. These implications also considered the socio-cultural dimensions which are critical factors independent of the unit functionality. A framework was formulated which described a general new product design process, tailored specifically for application in developing countries. This framework was then applied to the solar still case, thereby presenting an implementation pathway relevant for practitioners in the field

THE PALAEOLANDSCAPE SOUTH OF PLYMOUTH BREAKWATER

With the recent interest in the Earth’s current climatic shift, technology has shifted towards attempting to estimate the impacts sustained upon the landscape from similar previous shifts. One such mean is by analysis of palaeolandscapes situated in coastal regions. Numerous projects have already been successfully conducted along the west coast of the UK, using 2D seismic reflective data obtained through the use of sub-bottom profilers and other pieces of equipment. These have all aided in the understanding of how such northerly regions, such as the UK, were affected. From the 29th of November, 2013 seismic survey operations were conducted south of the Plymouth Breakwater (Devon) lasting three days in total. The objective was to identify the submerged valley(s) in the area, predicted to be a river, and identify its/their course. Through software analysis packages including DMagic, Fledermaus and ArcGIS, analysis of the survey area was successful. In this report two clear channels were identified in both the central and western regions of the survey area. A highly possible third channel was also identified running along the eastern coastline. All channels appeared to flow in a north to south direction towards the English Channel. A secondary survey area, located 1.5km away from the primary survey area, was also analysed and identified a delta-like topography in the area. This represents that high levels of sediment were apparent prior to its submergence and could also help explain the infilling of the valleys themselves. It appears that infilling of the submerged valley occurred during the Holocene marine transgression where the sea levels increased. This caused an increase in erosional effects and through this greater amounts of sedimentation accumulated in rivers. These impacts resulted in the forming of the modern Plymouth Sound area as we see it today

Principles of Product Design in Developing Countries

Problem—The conventional view of new product development (NPD) methodologies focuses on marketing and commercial prospects in developed countries. There is a need to identify both the barriers and the enablers to design within a rural context in developing countries (DC). Method—A researcher was embedded in a rural DC design project. Issues were observed and critical success and failure factors determined. These were abstracted into a set of design principles, and a new model of the NPD process was created. Findings—Whereas commercial NPD emphasizes market intelligence and a highly directive approach to the engineering workflow, in the DC situation the objective is to fulfil community needs and this necessitates co-determination regarding the engineering. There is commonality between the two NPD processes, with ours having a greater emphasis on the socio-cultural factors. The deployment principles are categorized into technical and socio-cultural. Within these are included project management, design, material selection, visualization, communication, maintainability, safety, and health. Originality—A novel representation of the process for conducting design in developing countries is provided. Critical success factors are identified. The socio-cultural perspective is explicitly included, which is absent from the conventional engineering and business perspectives

New Old English : The place of Old English in twentieth- and twenty-first-century poetry

This article begins by noting that the narrative coherence of literary history as a genre, and the inclusions and exclusions that it is forced to make, depend on the often unacknowledged metaphors that attend its practice. Literary history which is conceived as an unbroken continuity (‘the living stream of English’) has found the incorporation of Old English (also called Anglo-Saxon) to be problematic and an issue of contention. After surveying the kind of arguments that are made about the place of Old English as being within or without English literary tradition, this article notes that a vast body of twentieth and twenty-first century poetry, oblivious to those turf-wars, has concerned itself with Old English as a compositional resource. It is proposed that this poetry, a disparate and varied body of work, could be recognized as part of a cultural phenomenon: ‘The New Old English’. Academic research in this area is surveyed, from the 1970s to the present, noting that the rate of production and level of interest in New Old English has been rapidly escalating in the last decade. A range of poets and poems that display knowledge and use of Old English largely overlooked by criticism to date is then catalogued, with minimal critical discussion, in order to facilitate further investigation by other scholars. This essay argues that the widespread and large-scale reincorporation of an early phase of English poetic tradition, not in contiguous contact with contemporary writing for so many centuries, is such an unprecedented episode in the history of any vernacular that it challenges many of the metaphors through which we attempt to pattern texts into literary historical narrative. It is suggested that the weight of evidence in this area strongly suggests that in recent decades we have been living through 'The Anglo-Saxon Poetic Renaissance'.PostprintPeer reviewe