John Chalmers DaCosta (1863-1933): restoration of the old operating table.

John Chalmers DaCosta was an influential chairman and the first Samuel D. Gross Professor of Surgery at Jefferson Medical College in Philadelphia. He was well known throughout the field as a skilled surgeon, passionate speaker, and exceptional writer. In addition to countless accomplishments during his career, DaCosta was deeply dedicated to the preservation and commemoration of surgical history. This ideology was exemplified when he set out on a mission to recover the old wooden operating table used by many of his iconic mentors including Samuel D. Gross, Joseph Pancoast, and William W. Keen. This table was originally used for surgical demonstrations and anatomy lessons in a lecture room of the Ely Building and later in the great amphitheater of the Jefferson Sansom Street Hospital. It was found forgotten in the basement of the College Building and was promptly refurbished, donned with dedicatory plaques, and returned to its honored position in the medical college. Dr. DaCosta also contributed a detailed article recalling the history of the table and the notable leaders in surgery who taught and practiced on its surface. The old table currently stands proudly in the entranceway of the Department of Surgery where it will remain as a cherished symbol of the early beginnings of surgical practice and education

Impact of Climate Variability on Irrigation Water Needs and Irrigation Schedules of Maize and Cucumber in Aba, Abia State

In an attempt to address the discrepancies in the food production and population growth rates in Nigeria, this study estimated the irrigation water requirements of maize and cucumber in Aba, Abia State. Meteorological parameters (rainfall, minimum and maximum temperature, relative humidity, wind speed, sunshine hours) were collected from NiMet Abuja for 20 years (2000 to 2020). CROPWAT version 8.0 was applied to determine the Crop ETo and irrigation schedule of maize and cucumber. The hypothesis: Impact of climate variability does not influence irrigation of maize and cucumber was tested using Pearson correlation coefficient. The result shows that during the early and late planting season of maize, the crop water used are 338.6mm and 276.6mm, effective rainfall 478.8mm and 782.8mm and the total rainfall 740.0mm and 1028.6mm. For cucumber, the water used by the crop is 334.9mm and 285.8mm, and effective rainfall 332.6mm and 663.9mm. There was no irrigation schedule for maize and cucumber during the early and late plating seasons. It shows that water requirement for maize and cucumber was enough during the seasons. The highest crop ETo and temperature was in the month of March (4.57mm/day) and January (33.7°C). The study also reveals that the impact of climate change on irrigation water need at 0.05 significant level is IR=192.811-0.089(TR). The result shows a negative slope (-0.089), which means a negative relationship between Irrigation required and total rainfall over the 20 years period. This indicates that as rainfall increases, irrigation required decreases. The study therefore, suggests that maize and cucumber should be planted in Aba all year round; since there is enough rainfall for the crop

The Cost of Defensive Medicine in the United States

In this paper we present the costs of defensive medicine in thirty-five clinical specialties to determine whether malpractice liability reforms would greatly reduce health care costs. Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated

An analysis of civil aviation industry safety needs for the introduction of liquid hydrogen propulsion technology

Over the next few decades air travel is predicted to grow, with international agencies, manufacturers and governments predicting a considerable increase in aviation use. However, based on current fuel type, International Civil Aviation Organization (ICAO) project emissions from aviation are estimated to be seven to ten times higher in 2050 than in 1990. These conflicting needs are problematic and have led to the EU Flightpath 2050 targeting dramatic emissions reductions for the sector (75% CO2, 90% NOX by 2050). One proposed solution, decreasing carbon emissions without stunting the increase in air travel, is hydrogen propulsion; a technology with clear environmental benefits. However, enabling the safe application of this fuel to aviation systems and industrial infrastructure would be a significant challenge. High-profile catastrophic incidents involving hydrogen, and the flammable and cryogenic nature of liquid hydrogen (LH2) have led to its reputation as a more dangerous substance than existing or alternative fuels. But, where they are used (in industry, transport, energy), with sufficient protocols, hydrogen can have a similar level of safety to other fuels. A knowledge of hazards, risks and the management of these becomes key to the integration of any new technology. Using assessments, and a gap analysis approach, this paper examines the civil aviation industry requirements, from a safety perspective, for the introduction of LH2 fuel use. Specific proposed technology assessments are used to analyze incident likelihood, consequence impact, and ease of remediation for hazards in LH2 systems, and a gap analysis approach is utilized to identify if existing data is sufficient for reliable technology safety assessment. Outstanding industry needs are exposed by both examining challenges that have been identified in transport and industrial areas, and by identifying the gaps in current knowledge that are preventing credible assessment, reliable comparison to other fuels and the development of engineering systems. This paper demonstrates that while hydrogen can be a safe and environmentally friendly fuel option, a significant amount of work is required for the implementation of LH2 technology from a mass market perspective

Detection of Coronary Artery Disease on CT Chest Imaging

Overall aim: Improve diagnosis and management of CAD based on CT chest imaging. Improve diagnosis of silent CAD based on CT chest imaging: more patients who have findings of CAC on CT chest imaging will be diagnosed with CAD. Increase the number of appropriate statin prescriptions based on CAD findings on CT chest imaging

"When someone becomes old then every part of the body too becomes old": Experiences of living with dementia in Kintampo, rural Ghana.

Studies have suggested that in African countries, symptoms of cognitive decline are commonly seen as part of "normal ageing" or attributed to supernatural causes. The impact of folk beliefs about causality upon help-seeking is unclear. Likewise, there is a lack of evidence relating to how families cope with living with an older resident with dementia. Our study's aim was to explore the sociocultural beliefs, understandings, perceptions and behaviours relating to living with dementia in Kintampo, Ghana. We conducted in-depth interviews with a total of 28 people, using a series of case studies among 10 older people living with dementia and their families. Results revealed that symptoms of cognitive impairment were generally linked to inexorable bodily decline understood to be characteristic of "normal" ageing. Stigma was therefore perceived to be non-existent. Whilst managing the costs of care was often a challenge, care-giving was largely accepted as a filial duty, commonly shared among female residents of large compound households. Families experimented with biomedical and traditional medicine for chronic conditions they perceived to be treatable. Our findings suggest that whilst families offer a holistic approach to the needs of older people living with chronic conditions including dementia, health and social policies offer inadequate scaffolding to support this work. In the future, it will be important to develop policy frameworks that acknowledge the continued social and economic potential of older people and strengthen the existing approach of families, optimising the management of non-communicable diseases within primary care

A pentapeptide as minimal antigenic determinant for MHC class I-restricted T lymphocytes

Peptides that are antigenic for T lymphocytes are ligands for two receptors, the class I or II glycoproteins that are encoded by genes in the major histocompatibility complex, and the idiotypic / chain T-cell antigen receptor1–9. That a peptide must bind to an MHC molecule to interact with a T-cell antigen receptor is the molecular basis of the MHC restriction of antigen-recognition by T lymphocytes10,11. In such a trimolecular interaction the amino-acid sequence of the peptide must specify the contact with both receptors: agretope residues bind to the MHC receptor and epitope residues bind to the T-cell antigen receptor12,13. From a compilation of known antigenic peptides, two algorithms have been proposed to predict antigenic sites in proteins. One algorithm uses linear motifs in the sequence14, whereas the other considers peptide conformation and predicts antigenicity for amphipathic -helices15,16. We report here that a systematic delimitation of an antigenic site precisely identifies a predicted pentapeptide motif as the minimal antigenic determinant presented by a class I MHC molecule and recognized by a cytolytic T lymphocyte clone

Validation of Wound-QoL Questionnaire among Patients with Acute Wounds in Enugu, South-east Nigeria

Globally, health related quality of life (HRQoL) has become an essential wound outcome measure in evaluating holistic care, clinical practice and research. In Nigeria, there is a dearth of validated studies on standardised instruments to assess quality-of-life in patients with acute wounds. This study validated the Wound-QoL questionnaire in Nigeria. It was a single-blinded randomized controlled study, carried out amongst 42 participants using simple blocked randomization to assign patients to different groups (Biodress, honey and povidone-iodine). Wound-QoL was used for data collection with due ethical consideration and data analysis. The median age of the participants was 32.5 years, with a slight male preponderance (52.4%). The global score was above 0.7 at both times tested with the subscale scores ranging from 0.420 to 0.754. The mean values for both Wound-QoL global scores (T0: 0.83, T1: 0.79) and two subscale scores (body: T0: 1.28, T1: 1.17, everyday life: T0: 0.61, T1: 0.58) decreased over time while the psyche subscale remained unchanged (T0: 0.53, T1: 0.53). On item selectivity, the global score was significantly correlated to each of the items and the subscales. This result showed that acute wounds affect patients’ quality of life. It also indicates that the Wound-QoL questionnaire has positive psychometric properties. The Wound-QoL is a valid and reliable tool in assessing quality of life of people with acute wounds in Nigeria. A large-scale study in different regions of the country is recommended bearing in mind the cultural differences

Medical Provider Recommendations to Massage Therapy: a Card Study

Background: Communication between massage therapy patients and their medical providers has not been widely described, especially with respect to health care in the United States. Purpose: To examine which type of medical providers recommend massage therapy (MT), and how often massage therapy patients tell their providers about their treatment. Setting: Independent massage therapy practices in a Practice-based Research Network (PBRN) in Northeast Ohio.Participants: 21 licensed massage therapists (LMT). Research Design: A cross-sectional descriptive study. For consecutive, nonrepeating visits to their practices, each LMT completed up to 20 cards with information on the patient and visit. Analysis compared visits for patients based on whether they reported telling their health provider about their use of MT or being recommended for massage by a health provider.Results: Among 403 visits to 21 LMTs, 51% of patients had told their primary care clinician about seeing an LMT, and for 23%, a health-care provider had recommended visiting an LMT for that visit. Patients who told their primary care provider that they use massage therapy were more likely to be established patients, or to be seen for chronic pain complaints. Visits recommended by a physi-cian were more likely to be for chronic conditions.Conclusion: Patients who are established in the massage practice and those receiving massage for a specific condition are more likely to tell their primary care provider that they use massage and are also more likely to have been recommended for massage by a health-care provider. This information will help LMTs target and inform patients about the importance of talking with their health-care providers about their use of massage, and provide LMTs with a starting point of which types of health-care providers already recommend massage. This information will further open the dialogue about the integration of massage therapy in conventional health care.