Lymphatic filariasis in Fiji: progress towards elimination, 1997–2007

Background: Lymphatic filariasis (LF) is a major public health problem in the Pacific Region, including in Fiji. Through transmission by the mosquito vector Aedes, Fiji has suffered the burden of remaining endemic with LF despite efforts at elimination prior to 1999. In the year 1999, Fiji agreed to take part in the Pacific Programme for Elimination of LF (PacELF) and the Global Programme to Eliminate LF. Methods: This study reviewed and collated past data on LF in Fiji between 1997 and 2007. Sources included published papers as well as unpublished PacELF and WHO program meeting and survey reports. Records were held at Fiji’s Department of Health and Medical Services, James Cook University and the WHO office in Suva, Fiji. Results: Baseline surveys between 1997 and 2002 showed that Fiji was highly endemic for LF with an estimated 16.6% of the population antigen positive and 6.3% microfilaria positive at that time. Five rounds of annual mass drug administration (MDA) using albendazole and diethylcarbamazine commenced in 2002. Programmatic coverage reported was 58–70% per year, but an independent coverage survey in 2006 in Northern Division after the fifth MDA suggested that actual coverage may have been higher. Monitoring of the program consisted of antigen prevalence surveys in all ages with sentinel and spot check surveys carried out in 2002 (pre MDA), 2004, and 2005, together with knowledge, attitude, and practice surveys. The stop-MDA survey (C survey) in 2007 was a nationwide stratified cluster survey of all ages according to PacELF guidelines, designed to sample by administrative division to identify areas still needing MDA. The national antigen prevalence in 2007 was reduced by more than a third to 9.5%, ranging from 0.9% in Western Division to 15.4% in Eastern Division, while microfilaria prevalence was reduced by almost four-fifths to 1.4%. Having not reached the target threshold of 1% prevalence in all ages, Fiji wisely decided to continue MDA after 2007 but to move from nationwide implementation to four (later five) separate evaluation units with independent timelines using global guidelines, building on program experience to put more emphasis on increasing coverage through prioritized communication strategies, community participation, and morbidity alleviation. Conclusion: Fiji conducted nationwide MDA for LF annually between 2002 and 2006, monitored by extensive surveys of prevalence, knowledge, and coverage. From a high baseline prevalence in all divisions, large reductions in overall and age-specific prevalence were achieved, especially in the prevalence of microfilariae, but the threshold for stopping MDA was not reached. Fiji has a large rural and geographically widespread population, program management was not consistent over this period, and coverage achieved was likely not optimal in all areas. After learning from these many challenges and activities, Fiji was able to build on the progress achieved and the heterogeneity observed in prevalence to realign towards a more stratified and improved program after 2007. The information presented here will assist the country to progress towards validating elimination in subsequent years

Computationally efficient 3D analytical magnet loss prediction in surface mounted permanent magnet machines

This study proposes a computationally efficient analytical method, for accurate prediction of three-dimensional (3D) eddy current loss in the rotor magnets of surface mounted permanent magnet (SPM) machines considering slotting effect. Subdomain model incorporating stator tooth tips is employed to generate the information on radial and tangential time-derivatives of 2D magnetic field (eddy current sources) within the magnet. The distribution of the eddy current sources in 3D is established for the magnets by applying the eddy current boundary conditions and the Coulomb gauge imposed on the current vector potential. The 3D eddy current distributions in magnets are derived analytically by employing the method of variable separation and the total eddy current loss in the magnets are subsequently established. The method is validated by 3D time-stepped finite element analysis for 18-slot, 8-pole and 12-slot, 8-pole permanent magnet machines. The eddy current loss variations in the rotor magnets with axial and circumferential number of segmentations are studied. The reduction of magnet eddy current loss is investigated with respect to harmonic wavelength of the source components to suggest a suitable segmentation for the rotor magnets in SPM machines

Transduodenal Sphincteroplasty

We report on the results of elective sphincteroplasty for benign stenosis of the sphincter of Oddi in a prospective study of 32 consecutive cases. All patients underwent combined supraduodenal exploration of the common bile duct and transduodenal sphincteroplasty. All patients were followed up clinically and biochemically for from one to four years. Seventeen patients underwent a barium meal examination a year after surgery and of these patients, ten showed retrograde filling of the common bile duct and four had air in it. The intrabiliary pressures in six patients were abnormal, ranging from 210 to 230 mm HO (normal, 80 to 130) intraoperatively before the exploration of the common bile duct, but were found to be normal after the sphincteroplasty. The mortality was 0% and no serious complications were observed. © 1979, American Medical Association. All rights reserved

Identification of patients with coronary artery disease by assessing diastolic abnormalities during isometric exercise

Background: Previous clinical studies using invasive and noninvasive methods have shown handgrip-induced diastolic abnormalities in patients with coronary artery disease (CAD). Hypothesis: The study was undertaken to determine the utility of Doppler echo- and pressocardiography during handgrip in discriminating patients with coronary artery disease (CAD) and in those with normal coronary arteries. Methods: Both methods were obtained in 96 patients with suspected CAD within 24 h before coronary angiography. An abnormal handgrip-Doppler was defined by an early (E) to late (A) transmittal flow velocities ratio (E/A) < 1 during handgrip and a positive handgrip pressocardiographic test (HAT) by an abnormal increase in the A wave/total excursion or prolongation of the absolute or relative (heart-rate corrected) total relaxation time during isometric exercise. Results: Of the 96 patients studied, 23 had normal coronary arteries and 73 showed CAD. In patients with normal coronary arteries, handgrip-Doppler showed an abnormal average E/A at rest and during handgrip, whereas all variables of HAT were within normal limits. In patients with CAD, handgrip-Doppler showed only a moderate handgrip-induced increase in average A (+19%, p < 0.001), whereas HAT showed a significant (p < 0.001) increase in mean A wave/total excursion (+ 60%) and decrease in the relative total relaxation time (- 17%). Furthermore, handgrip-Doppler and HAT were abnormal in 15 of 23 (65% specificity 35%) and the HAT in 5 of 23 (22%, specificity 78%) patients with normal coronary arteries, as well as in 57 of 73 (sensitivity 78%) and 69 of 73 (95%) patients with CAD. Conclusions: Our study demonstrates that these noninvasive stress tests can become a useful new diagnostic modality for detecting patients with unknown or suspected CAD

Offshore Code Comparison Collaboration Continuation (OC4), Phase I - Results of Coupled Simulations of an Offshore Wind Turbine with Jacket Support Structure: Preprint

This paper presents the results of the IEA Wind Task 30, Offshore Code Comparison Collaboration Continuation Project - Phase 1