The problem with environmental security: challenging the either/or approach of national versus human security in the context of the Mekong River Basin

One of the most important ideas to emerge from security studies in the past forty years is the field of research known as ‘environmental security studies’ (ESS). It has not, however, had the impact on security studies in general that it might have expected to – given the growing concerns regarding the scale and pace of environmental changes in the 20th and 21st centuries. This thesis therefore firstly seeks to understand the nature of ESS, asking whether ESS has a central theoretical core that enables it to analyse the links between the environment and security. The research shows that the ESS literature does not have a central tenet, nor a united epistemological or methodological approach. The second area of research therefore asks if there is a common theme that can be discerned within the literature. Research indicates that there is a way of understanding ESS in a more coherent fashion in that the majority of ESS scholars endeavour to comprehend the systemic security impact of environmental processes. The problem is that there is no analytical bridge between the environment, the state and the individual. This thesis therefore forwards a unique approach that argues that rather than the current either state-centric or a human security approach to ESS, it must be understood as a combination of both. This approach is termed “Systemic Environmental Security” (SES). SES is an analytical framework that takes into account the way that environmental processes give rise to both state security and human security concerns simultaneously. The thesis finally explores the unique insights provided by SES. This is achieved through a relevant case study of the Mekong River Basin. It is hoped that these unique insights provided by Systemic Environmental Security can be applied in a range of contexts, providing clearer conceptualisations of the complex relationship between security and the environment

Interplays of psychometric abilities on learning gross anatomy

In recent years, there has been international debate concerning how students learn anatomy. The rapid increase in scientific knowledge has put pressure on the place of anatomy within the medical and allied health professional curricula, as well as the design and structure of anatomy courses. In this regard, relatively little is known about what medical and allied health professions students want from an anatomy course or how they learn it. To assess students’ learning approaches and perceptions of anatomy, a series of psychometric tests were administered to Medical (n=82), Podiatry (n=21), and Pharmacy (n=74) students in the United Kingdom. Analysis of the Anatomy Learning Experience (ALE) questionnaire revealed a predominantly positive attitude towards anatomy and the dissection room, with most valuing cadaveric dissection and not regarding it as a daunting environment. Further to this, analysis of the Approaches to Studying Inventory for Students (ASSIST) revealed predominant preferences for strategic and deep approaches. Personality traits were associated with certain learning approaches; neuroticism with surface (p=0.038), conscientiousness with both a deep and strategic approach (p=0.000 and p=0.060 respectively). Certain personality traits were also found to be associated with anatomy experience e.g. neuroticism and achievement striving felt the most effective way to learn was to get their hands in and feel for structures (p=0.044 and p=0.012 respectively). This study concludes that undergraduate students of medicine, podiatry and pharmacy learn anatomy in slightly different ways. Preparation for classroom activities should centre on the promotion of an optimum learning environment and teaching strategies which promote a deep approach to learning. Understanding students’ personality and learning experiences should help teachers improve the students’ learning of anatomy for effective application to clinical practice

Do physical tests have a prognostic value in chronic midportion Achilles tendinopathy?

Objectives: To determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy. Design: Prospective cohort study, secondary analysis of data from a randomized trial. Methods: Patients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24 weeks, patients completed the Victorian Institute of Sports Assessment—Achilles questionnaire and performed the following physical tests: ankle dorsiflexion range of motion with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (Visual Analogue Scale; 0–100) and after 10 hops (Visual Analogue Scale-10-hops). Associations between baseline test results and improvement (Victorian Institute of Sports Assessment—Achilles scores) were determined using a Mixed Linear Model. Results: 80 patients were included. The mean Victorian Institute of Sports Assessment—Achilles score improved 20 points (95 % confidence interval, 16–25, P &lt; .001) after 24 weeks. There were significant associations between the baseline ankle dorsiflexion range of motion with a bent knee (β 0.2, 95 % confidence interval 0.001 to 0.3, P = .049), the baseline pain provocation tests (Visual Analogue Scale palpation: β − 0.2; 95 % confidence interval: − 0.4 to − 0.1; P &lt; .001, Visual Analogue Scale-10-hops: β − 0.3; 95 % confidence interval: − 0.4 to − 0.2; P &lt; .001) and the change in the Victorian Institute of Sports Assessment—Achilles score. Conclusions: In patients with chronic midportion Achilles tendinopathy, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities after 24 weeks than patients with high baseline pain scores.</p

Schottky barrier heights at polar metal/semiconductor interfaces

Using a first-principle pseudopotential approach, we have investigated the Schottky barrier heights of abrupt Al/Ge, Al/GaAs, Al/AlAs, and Al/ZnSe (100) junctions, and their dependence on the semiconductor chemical composition and surface termination. A model based on linear-response theory is developed, which provides a simple, yet accurate description of the barrier-height variations with the chemical composition of the semiconductor. The larger barrier values found for the anion- than for the cation-terminated surfaces are explained in terms of the screened charge of the polar semiconductor surface and its image charge at the metal surface. Atomic scale computations show how the classical image charge concept, valid for charges placed at large distances from the metal, extends to distances shorter than the decay length of the metal-induced-gap states.Comment: REVTeX 4, 11 pages, 6 EPS figure

Should the ultrasound probe replace your stethoscope? A SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill

BACKGROUND: In critically ill patients, auscultation might be challenging as dorsal lung fields are difficult to reach in supine-positioned patients, and the environment is often noisy. In recent years, clinicians have started to consider lung ultrasound as a useful diagnostic tool for a variety of pulmonary pathologies, including pulmonary edema. The aim of this study was to compare lung ultrasound and pulmonary auscultation for detecting pulmonary edema in critically ill patients. METHODS: This study was a planned sub-study of the Simple Intensive Care Studies-I, a single-center, prospective observational study. All acutely admitted patients who were 18 years and older with an expected ICU stay of at least 24 h were eligible for inclusion. All patients underwent clinical examination combined with lung ultrasound, conducted by researchers not involved in patient care. Clinical examination included auscultation of the bilateral regions for crepitations and rhonchi. Lung ultrasound was conducted according to the Bedside Lung Ultrasound in Emergency protocol. Pulmonary edema was defined as three or more B lines in at least two (bilateral) scan sites. An agreement was described by using the Cohen κ coefficient, sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy. Subgroup analysis were performed in patients who were not mechanically ventilated. RESULTS: The Simple Intensive Care Studies-I cohort included 1075 patients, of whom 926 (86%) were eligible for inclusion in this analysis. Three hundred seven of the 926 patients (33%) fulfilled the criteria for pulmonary edema on lung ultrasound. In 156 (51%) of these patients, auscultation was normal. A total of 302 patients (32%) had audible crepitations or rhonchi upon auscultation. From 130 patients with crepitations, 86 patients (66%) had pulmonary edema on lung ultrasound, and from 209 patients with rhonchi, 96 patients (46%) had pulmonary edema on lung ultrasound. The agreement between auscultation findings and lung ultrasound diagnosis was poor (κ statistic 0.25). Subgroup analysis showed that the diagnostic accuracy of auscultation was better in non-ventilated than in ventilated patients. CONCLUSION: The agreement between lung ultrasound and auscultation is poor

Cerebral Perfusion and the Occurrence of Nonfocal Transient Neurological Attacks

INTRODUCTION: Nonfocal transient neurological attacks (TNAs) are associated with an increased risk of cardiac events, stroke and dementia. Their etiology is still unknown. Global cerebral hypoperfusion has been suggested to play a role in their etiology, but this has not been investigated. We assessed whether lower total brain perfusion is associated with a higher occurrence of TNAs. METHODS: Between 2015 and 2018, patients with heart failure were included in the Heart Brain Connection study. Patients underwent brain magnetic resonance imaging, including quantitative magnetic resonance angiography (QMRA) to measure cerebral blood flow (CBF). We calculated total brain perfusion of each participant by dividing total CBF by brain volume. Patients were interviewed with a standardized questionnaire on the occurrence of TNAs by physicians who were blinded to QMRA flow status. We assessed the relation between total brain perfusion and the occurrence of TNAs with Poisson regression analysis. RESULTS: Of 136 patients (mean age 70 years, 68% men), 29 (21%) experienced ≥1 TNAs. Nonrotatory dizziness was the most common subtype of TNA. Patients with TNAs were more often female and more often had angina pectoris than patients without TNAs, but total CBF and total brain perfusion were not different between both groups. Total brain perfusion was not associated with the occurrence of TNAs (adjusted risk ratio 1.12, 95% CI 0.88-1.42). CONCLUSION: We found no association between total brain perfusion and the occurrence of TNAs in patients with heart failure

No relation between body temperature and arterial recanalization at three days in patients with acute ischaemic stroke

Background: Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods: We included 278 patients with acute ischaemic stroke within nine hours after symptom onset, who had an intracranial arterial occlusion on admission CT angiography, in 13 participating centres. We calculated the relation per every 0.1°Celsius increase in admission body temperature and recanalization at three days. Results: Recanalization occurred in 80% of occluded arteries. There was no relation between body temperature and recanalization at three days after adjustments for age, NIHSS score on admission and treatment with alteplase (adjusted odds ratio per 0.1°Celsius, 0.99; 95% confidence interval, 0.94-1.05; p = 0.70). Results for patients treated or not treated with alteplase were essentially the same. Conclusions: Our findings suggest that in patients with acute ischaemic stroke there is no relation between body temperature on admission and recanalization of an occluded intracranial artery three days later, irrespective of treatment with alteplase

The burden of headache disorders in the Eastern Mediterranean Region, 1990-2016: Findings from the Global Burden of Disease study 2016

Objectives: Using the findings of the Global Burden of Disease Study (GBD), we report the burden of primary headache disorders in the Eastern Mediterranean Region (EMR) from 1990 to 2016. Methods: We modelled headache disorders using DisMod-MR 2.1 Bayesian meta-regression tool to ensure consistency between prevalence, incidence, and remission. Years lived with disability (YLDs) were calculated by multiplying prevalence and disability weight (DW) of migraine and tension-type headache (TTH). We assumed primary headache disorders as non-fatal, so their YLD is equal to disability-adjusted life years (DALYs). Results: Migraine and TTH were the second and twentieth leading causes of YLDs in EMR. Between 1990 and 2016, the absolute YLD numbers of migraine and TTH increased from 2.3 million (95 uncertainty interval (UI): 1.5-3.2) to 4.7 million (95UI: 3-6.5) and from 383 thousand (95UI: 240-562) to 816 thousand (95UI: 516-1221), respectively. During the same period, age-standardised YLD rates of migraine and TTH in EMR increased by 0.7 and 2.5, respectively, in comparison to a small decrease in the global rates (0.2 decrease in migraine and TTH). The bulk of burden due to headache occurred in the 30-49 year age group, with a peak at ages 35-44 years. The age-standardised YLD rates of both headache disorders were higher in women with female to male ratio of 1.69 for migraine and 1.38 for TTH. All countries of the EMR except for Somalia and Djibouti had higher age-standardised YLD rates for migraine and TTH in compare to the global rates. Libya and Saudi Arabia had the highest increase in age-standardised YLD rates of migraine and TTH, respectively. Conclusion: The findings of this study show that primary headache disorders are a major and a growing cause of disability in EMR. Since 1990, burden of primary headache disorders has constantly been higher in EMR compared to rest of the world, which indicates that health systems in EMR must focus further on developing and implementing preventive and management strategies to control headache. © 2019 The Author(s)