Agenesis of distal segment of right vertebral artery: a case report.

A case is being reported in which the basilar artery was formed only by the left vertebral artery. This was detected incidentally in a female on a non contrast magnetic resonance angiogram. The right vertebral artery arose as a direct branch of the right subclavian artery but terminated blindly at the level of second cervical vertebra. The left vertebral artery which contributed to the formation of basilar artery continued as left posterior cerebral artery while right posterior cerebral artery was seen as a continuation of right posterior communicating artery. The knowledge of variations of the vertebrobasilar arterial complex is important to Clinicians, Radiologists and Surgeons operating on the great vessels and its branches, particularly vascular surgeons dealing with vertebral artery in order to prevent a vascular catastrophe

National Adolescent Sexual and Reproductive Health Programme: Mid-Term Evaluation Report

EXECUTIVE SUMMARY Background and rationale Th e Ministry of Health and Population (MoHP) Nepal has endorsed the Nepal Health Sector Programme (NHSP) II (2010–2015), which aims to introduce 1,000 adolescent-friendly services (AFSs) in Nepal by 2015. Towards this, the Government of Nepal is implementing the National Adolescent Sexual and Reproductive Health (ASRH) Programme, which, by November 2012 had covered 516 health facilities in 36 districts. To assess the implementation of the National ASRH Programme, a mid-term evaluation was conducted by the Health Research and Social Development Forum (HERD) in collaboration with GIZ/GFA in selected health facilities in Doti and Banke. Th e mid-term evaluation is part of an operational research to determine the eff ectiveness of the National ASRH Programme and explored the understanding, perceptions and experiences of service providers and adolescents related to the implementation of the National ASRH Programme. Th e main aims of the mid-term evaluation were to: • understand the implementation processes and the wider context as it aff ects the National ASRH Programme in order to provide detailed explanations for the results of the fi nal evaluation; and • identify improvements that can be made to the intervention to increase access by adolescents to SRH services in the remaining period of the programme and ways of improving the likelihood of scaling up the intervention across Nepal. Data was collected for the evaluation in March 2013 in semi-structured interviews and focus groups discussions, mainly with health workers and adolescents, supplemented by peer ethnography interviews and observation by the researchers. As the study was conducted in selected health facilities in only two districts, the fi ndings may not be generalised to other GIZ-supported districts or to the many other intervention districts of the ASRH Programme that are supported by the Family Health Division or other donors. Th is report presents the fi ndings of this research. Implementation of the ASRH Programme Th e evaluation looked at the understanding of health workers about the National ASRH Programme and the extent of conforming with the programme guidelines. Th e National ARSH Health Programme was introduced in 2011 in 14 health facilities in Doti and 13 health facilities in Banke districts. Under the programme, health workers from selected facilities were provided with a two-day orientation about the programme; a display board with the AFS logo; information, education and communication (IEC) materials; and a small fl exible amount of fi nancial support for benches, curtains, and shelves to make the facility more adolescent friendly. Health workers in both of the study districts had attended orientations and understood that the programme is for young people (aged 10–19) undergoing changes associated with adolescence. Th ey said that the programme aims to create an environment that is conducive for adolescents to visit health facilities and receive services including by providing adolescent-friendly services and maintaining privacy. Th ey also understood that the programme is about providing counselling and services to adolescents related to SRH. Although most of the health workers understood that the programme is designed to address the specifi c needs of adolescents, some said that the programme is only about delivering family planning services and safe motherhood services. Although the School Health Programme and the training of peer educators do not form part of the ASRH Programme, health workers mentioned these activities as part of it. Th ey said that these activities have created awareness about ASRH services, which suggests that there should be more coordination between the ASRH Programme and programmes at the school level to create demand for ASRH services among adolescents. Key fi nding 1: All health workers are aware of the National ASRH Programme and its components, except for a few who said that the programme is only about delivering family planning and maternal health services. While the School Health Programme and the training of peer educators are not part of the National ASRH Programme, health workers stressed that these are effective ways to share about the ASRH services available at health facilities. Health workers were asked what activities have been undertaken to implement the ASRH Programme in their health facilities. In all facilities, health workers reported attending orientations, distributing IEC materials and making physical changes to the facilities, such as erecting curtains for privacy. Facilities had also organised orientations for the members of the health facility operation and management committee (HFOMC), female community health volunteers (FCHVs), students, teachers and members of the village development committee. Researchers observed that all of the health facilities had AFS boards displayed in visible places, except for Doti Hospital. Most HFOMCs did not have any adolescent members although some health workers remembered that adolescents had been members on previous committees. Some health workers mentioned schools, the community and peer educators as important in reaching out to adolescents and imparting SRH messages. Key fi nding 2: Health facilities have oriented selected FCHVs, teachers and other people in the village development committee about the National ASRH programme and health workers perceive community awareness to be a key factor in facilitating adolescents’ access to SRH services. Th e study also looked at how health workers are recording and reporting data on the ASRH Programme and what diffi culties they face in doing so. Health workers stated that they complete the monthly reporting form for the ASRH Programme by referring to diff erent registers and send the data along with the HMIS 32 form. Some health workers said that it is diffi cult for them to keep records because they have to look through several registers and suggested a separate recording format for the ASRH Programme. Irregular reporting appeared to be an issue, as was lack of follow-up or refresher training. In relation to monitoring, health workers reported that GIZ/GFA staff visited the facilities along with the focal person from the District (Public) Health Offi ce. Th e issue of limited resources was raised in the interviews – there is no budget to visit health facilities under the programme. An annual review at the district level was suggested by health workers to enable them to address the diffi culties and challenges in implementing the ASRH Programme. Key fi nding 3: The recording and reporting of the ASRH Programme has not been regular and consistent. Health workers mentioned not having a separate recording register for the programme and suggested that the programme be included in the HMIS 32 (monthly reporting format). Interaction between health workers and adolescent users Th e study examined adolescents’ access to health services and the behaviour of health workers in delivering AFSs. In relation to access to health services, health workers said that adolescents visit health facilities mostly for contraceptives, as well as for other SRH problems. Th ey also mentioned that a few adolescents presented with concerns about physical changes and their appearance. Health workers agreed that unmarried adolescents visit health facilities more than married adolescents and adolescent boys more than girls. However, the demand side of the programme is weak, with only a few adolescents reporting that they had visited a health facility for SRH services. Among the focus group discussion participants who had visited a health facility, most said that they visited the facility to take condoms; a few had gone with friends who had sought services for erection problems and rashes around the sexual organs. Other participants said they buy condoms from the nearby medical store instead of visiting the health facility. Most adolescent girls in Doti had not visited a health facility, but in Banke adolescent girls had been to a facility, either for themselves or accompanying their friends or sisters-in-law. Adolescent girls visited health facilities for menstrual problems, the oral contraceptive pill and condoms; some had friends who had been to a health facility for an abortion. Married adolescents reported visiting health facilities for antenatal checkups and vaccinations. Health workers said that sometimes adolescent girls come to ask about pimples or for a remedy for pain during sexual intercourse. In relation to the behaviour of health workers towards adolescents, all health workers interviewed emphasised that there have been signifi cant | X | | XI | changes in their behaviour since the introduction of the ASRH Programme. Th ey said that they used to think that giving young people access to contraceptives would ‘spoil’ or corrupt them and that adolescents should not be talking about SRH or using contraceptives. Now, some even stated that adolescents have the right to know about and use modern family planning methods. All health workers stressed that they do not ask the marital status of adolescents seeking family planning services. Th e study found an increased realisation of the importance of SRH among health workers and of the need to deal with SRH issues in privacy. Th ere is an evident awareness among health workers of how they need to respond to adolescents’ SRH needs. Some of the health workers mentioned that high patient fl ows mean that they cannot give as much time to adolescents as they should. Some health workers pointed to a knowledge gap regarding specifi c aspects of ASRH (e.g. emergency contraception, sexually transmitted infections) and suggested that a training would be helpful on technical aspects of the programme as well as refresher training on other aspects. Th ese comments and the concerns of the focal person at the central level indicate that health workers require better skills to deal with adolescents and further training could be of use to them. Adolescents were asked how health workers responded when they visited the health facility for SRH services. Adolescent boys had mixed experiences, but most gave positive feedback and said that the health workers counselled them well and answered their queries. Th ey also shared that they could take condoms easily from health facilities. Many participants shared that the health workers taught them how to use condoms properly and advised them not to have unprotected sex with multiple partners. Adolescents said that the health workers assured them that they would maintain confi dentiality and privacy. Th e fi ndings of peer ethnography also suggest that confi dentiality is maintained. While most adolescents were pleased with the health workers’ behaviour and said that they would happily go back to the health facility again, some did not have good experiences. Some adolescents shared that the health workers asked whether or not they were married when they went to take condoms. Some of the adolescent boys mentioned that the health workers asked the question in a teasing way or made ‘fun’ of them. Similarly, adolescent girls, with few exceptions, said that they found the behaviour of health workers good and that the health workers talk to them in a friendly manner. Th ese girls also shared that there are separate toilets for males and females. Th ey mentioned that the ‘sisters’ maintain privacy by taking them into a separate room. However, some adolescent girls in Doti were discouraged by health workers’ behaviour. In some cases, health workers were judgmental. Such behaviour from health workers creates a sense of mistrust among adolescents and discourages them from visiting health facilities and discussing problems with health workers. Key fi nding 4: All health workers stated that there have been signifi cant changes in their behaviour as a result of the programme. They shared their previous reluctance to provide contraceptives to adolescents as they thought it would ‘spoil’ them and their previous belief that adolescents should not talk about SRH or use contraceptives. Now, when asked about changes in their behaviour towards adolescents seeking SRH services, almost all health workers expressed adolescentfriendly attitudes. However, one health worker mentioned a gap in the training of health workers, which was also stressed by the focal person at the central level, namely, that, in addition to managerial aspects, such training should also cover more technical knowledge and skills on SRH topics and on the counselling of adolescents in SRH. Key fi nding 5: Health workers were aware of the importance of maintaining privacy and ensuring confi dentiality while providing services to adolescents. They mentioned using curtains or meeting adolescents in ANC clinics, but that high patient fl ow sometimes does not allow them to give much separate time to adolescents. Key fi nding 6: Few adolescents stated that they had visited health facilities for SRH services. Most of those who had visited related positive experiences, while a few had bad experiences regarding the attitude of health workers. According to health workers, unmarried adolescents visit health facilities to access services related to the ASRH Programme more than married adolescents. Furthermore, adolescent boys visited health facilities more than adolescent girls. At the same time, adolescent girls tended to have detailed knowledge about the specifi c health services offered, e.g., for STIs, menstrual problems, acne, pain during sexual intercourse and even abortions. Most adolescents who visited health facilities shared that they were happy with the health workers’ behaviour and that health workers treated them in a friendly and helpful way, did not ask for their marital status and maintained confi dentiality while providing information and services. Adolescents who said that they had never visited a health facility for SRH services were asked their reasons for not visiting. They said that they feared that their issues would be talked about and that they would feel embarrassed. These adolescents were often not aware that health facilities offer confi dential services in private. Boys in particular said that they feel uncomfortable because the health workers are senior to them. Adolescents also shared that in some cases the health workers are relatives, which adds to their discomfort as they feel shy and fear that the health worker might tell their parents. They also said that they fear running into neighbours or people they know at the health facility. Some adolescents said that they could not fi nd the time to visit a health facility because of the long distance to school and the need to do household chores. Instead they shared their problems with friends or their mother and, hence, did not feel the need to visit a health facility. Key fi nding 7: Those adolescents who had not used SRH services were concerned about confi dentiality, which seems to be one of the main reasons for adolescents not visiting health facilities for SRH services, in addition to feeling embarrassed to talk to health workers who are older than them or acquaintances. A set of eight adolescent-friendly IEC booklets on issues related to adolescents’ SRH and rights have been produced and distributed to all public health facilities that provide AFSs and to schools in the catchment area of these facilities as part of the National ASRH Programme. Both the health workers and adolescents who have read the booklets found these materials to be very helpful. Health workers have said that adolescents visit health facilities to read these booklets. Th e health workers maintain that the materials are adequate in quantity for adolescents to come and read, but not for wider distribution, except for in Baijapur where the health workers said that they have been distributing the booklets. Health workers also said that they had distributed the booklets to school libraries and community libraries. In addition to the booklets, health facilities that provide AFSs are provided with ASRH posters, an ASRH fl ipchart and comic book. Key fi nding 8: Most boys interviewed were aware of the IEC materials available in the health facilities, but only a few boys and girls said that they ha

Surgical Treatment of Unstable Distal Radius Fractures With a Volar Variable-Angle Locking Plate: Clinical and Radiological Outcomes

Background: Unstable distal end radius fractures are difficult to manage and so various treatment modalities have been described. The use of variable-angle locking plates is promoted for the management of these fractures. Objectives: This study aimed to evaluate the functional and radiological outcomes in unstable distal end radius fractures treated with variable-angle locking plates. Patients and Methods: We reviewed 23 unstable distal end radius fractures that were treated at our institution with volar variable-angle locking plates. The mean age of the patients was 32.82 ± 11.81 years (range 19 to 62) and the mean duration of follow-up was 11.04 ± 2.47 months (range 6 to 15). All of the patients underwent open reduction and internal fixation with a variable-angle locking plate. Radiological parameters such as radial inclination, length, tilt, and ulnar variance were measured at six weeks and at the final follow-up. The functional evaluation was conducted by measuring the range of motion at the wrist joint as well as the grip strength. Gartland and Werley’s demerit scoring system was used to assess the final outcome. Results: There were two cases of superficial infection that responded to oral antibiotics. One patient had developed a hypertrophic scar, while another had carpal tunnel syndrome that was conservatively managed. There was a significant improvement in the functional indices from six weeks to the final follow-up, while the radiological parameters were maintained. According to Gartland and Werley, excellent results were reported in 65.2% cases, while good results were present in 35% cases. Conclusions: The use of variable-angle locking plates in treating unstable distal end radius fractures is associated with excellent to good functional outcomes with minimal complications

Communications systems technology assessment study. Volume 2: Results

The cost and technology characteristics are examined for providing special satellite services at UHF, 2.5 GHz, and 14/12 GHz. Considered are primarily health, educational, informational and emergency disaster type services. The total cost of each configuration including space segment, earth station, installation operation and maintenance was optimized to reduce the user's total annual cost and establish preferred equipment performance parameters. Technology expected to be available between now and 1985 is identified and comparisons made between selected alternatives. A key element of the study is a survey of earth station equipment updating past work in the field, providing new insight into technology, and evaluating production and test methods that can reduce costs in large production runs. Various satellite configurations were examined. The cost impact of rain attenuation at Ku-band was evaluated. The factors affecting the ultimate capacity achievable with the available orbital arc and available bandwidth were analyzed

Spinal Cord Injury Without Radiological Abnormality in Adult Thoracic Spinal Trauma

Introduction: Spinal cord injury without radiological abnormality (SCIWORA) is a rare entity and usually involves the cervical spine. Thoracic spine involvement is very rare due to the stability provided by the rib cage. The mechanisms of injury and pathophysiology are still debatable. Case Presentation: We present a case of an adult male who had road traffic accident and presented with paraplegia. The initial radiological investigations carried out in the emergency department were reported to be normal, however, subsequent magnetic resonance imaging revealed spinal cord contusion without vertebral column disruption. The patient recovered partially with conservative treatment measures including bed rest and methylprednisolone. Conclusions: Spinal trauma patients presenting with neurological deficit but no radiological abnormality should be treated as a case of SCIWORA

Foxi3 is necessary for the induction of the chick otic placode in response to FGF signaling

AbstractVertebrate cranial sensory organs are derived from region at the border of the anterior neural plate called the pre-placodal region (PPR). The otic placode, the anlagen of the inner ear, is induced from PPR ectoderm by FGF signaling. We have previously shown that competence of embryonic ectoderm to respond to FGF signaling during otic placode induction correlates with the expression of PPR genes, but the molecular basis of this competence is poorly understood. Here, we characterize the function of a transcription factor, Foxi3 that is expressed at very early stages in the non-neural ectoderm and later in the PPR of chick embryos. Ablation experiments showed that the underlying hypoblast is necessary for the initiation of Foxi3 expression. Mis-expression of Foxi3 was sufficient to induce markers of non-neural ectoderm such as Dlx5, and the PPR such as Six1 and Eya2. Electroporation of Dlx5, or Six1 together with Eya1 also induced Foxi3, suggesting direct or indirect positive regulation between non-neural ectoderm genes and PPR genes. Knockdown of Foxi3 in chick embryos prevented the induction of otic placode markers, and was able to prevent competent cranial ectoderm from expressing otic markers in response to FGF2. In contrast, Foxi3 expression alone was not sufficient to confer competence to respond to FGF on embryonic ectoderm. Our analysis of PPR and FGF-responsive genes after Foxi3 knockdown at gastrula stages suggests it is not necessary for the expression of PPR genes at these stages, nor for the transduction of FGF signals. The early expression but late requirement for Foxi3 in ear induction suggests it may have some of the properties associated with pioneer transcription factors

A Study of Emerging Cloud Computing Technology Benefits and Challenges

Paper gives an overview of cloud computing. Discusses the concept of cloud computing, its different service and deployment models, its benefits and challenges and how the challenges can be overcome. Also talk about the requirement of cloud computing infrastructure properties

Cardiovascular responses during deep water running versus shallow water running in school children

Overview: As the school going children especially the adolescents’ need workout routine; it is advisable that the routine is imbibed in the school’s class time table. In India as growing number of schools provide swimming as one of the recreational activities; school staff often fails to notice the boredom that is caused by the same activity. Deep as well as shallow water running can be one of the best alternatives to swimming. Hence the present study was conducted to find out the cardiovascular response in these individuals. Methods: This was a Prospective Cross-Sectional Comparative Study done in 72 healthy school going students (males) grouped into 2 according to the interventions (Deep water running and Shallow water running). Cardiovascular parameters such as Heart rate (HR), Saturation of oxygen (SpO2), Maximal oxygen consumption (VO2max) and Rate of Perceived Exertion (RPE) were assessed. Results: Significant improvements in cardiovascular parameters were seen in both the groups i.e. by both the interventions. Conclusion: Deep water running and Shallow water running can be used to improve cardiac function in terms of various outcome measures used in the study

Factors Affecting the Productivity of Coffee in Gulmi and Arghakhanchi Districts of Nepal

Coffee is one of the major potential cash crops with lucrative export value grown in mid-hills of Nepal. Nepalese coffee production has suffered long by low productivity. Research was conducted from February to May, 2019 to analyze the factors affecting the productivity of coffee in Arghakhanchi and Gulmi districts of Nepal. These two districts were, purposively selected for this study taking account of comparative advantage and past studies recommendations for coffee sector. Altogether, 100 coffee growing households 50 from each, Arghakhanchi and Gulmi, were sampled by using multistage sampling technique. A pre-tested semi-structured interview schedule was used to collect the primary information while secondary information was collected reviewing the relevant publications. Ordinary Least Square (OLS) regression model was used to determine the factors affecting the productivity of coffee. The study revealed that the number of active family members involved in coffee production (0.000), adoption of income diversification through intercropping (0.005), training (0.072) and technical assistance (0.021) had positive and significant effect on coffee productivity. Encouraging the household to have coffee production as their primary occupation, providing technical assistance on rational land utilization and intercropping and strengthening the skill and knowledge of farmers through trainings could significantly support in increasing the productivity of coffee