Address African conflicts with a stronger African union

Dr Suda Perera argues that the current political crisis in DR Congo demonstrates that the idea that a fairly-won election is necessary to create a certain and solid basis for democratic state-building is faulty

Nations torn asunder: The challenge of civil war

The question of what makes civil wars so attractive, in the context of the supposed change in the nature of warfare post-WWII, was lucidly discussed at the LSE Literary Festival event ‘Nations Torn Asunder’

[Accepted Manuscript] Nurses’ perceptions of universal health coverage and its implications for the Kenyan health sector

Universal health coverage, comprehensive access to affordable and quality health services, is a key component of the newly adopted 2015 Sustainable Development Goals. Prior to the UN resolution, several countries began incorporating elements of universal health coverage into their domestic policy arenas. In 2013, the newly elected President of Kenya announced initiatives aimed at moving towards universal health coverage, which have proven to be controversial. Little is known about how frontline workers, increasingly politically active and responsible for executing these mandates, view these changes. To understand more about how actors make sense of universal health coverage policies, we conducted an interpretive policy analysis using well-established methods from critical policy studies. This study utilized in-depth semi-structured interviews from a cross section of 60 nurses in three health facilities (public and private) in Kenya. Nurses were found to be largely unfamiliar with universal health coverage and interpreted it in myriad ways. One policy in particular, free maternal health care, was interpreted positively in theory and negatively in practice. Nurses often relied on symbolic language to express powerlessness in the wake of significant health systems reform. Study participants linked many of these frustrations to disorganization in the health sector as well as the changing political landscape in Kenya. These interpretations provide insight into charged policy positions held by frontline workers that threaten to interrupt service delivery and undermine the movement towards universal health coverage in Kenya

Engineering standards for trauma and orthopaedic implants worldwide : a systematic review protocol

Introduction Despite multiple scandals in the medical implant sector, premarket testing has been the attention of little published research. Complications related to new devices, such as the DePuy Articular Surface Replacement (ASR, DePuy Synthes, USA), have raised the issue of how designs are tested and whether engineering standards remain up to date with our understanding of implant biomechanics. Despite much work setting up national joint registries to improve implant monitoring, there have been few academic studies examining the premarket engineering standards new implants must meet. Emerging global economies mean that the markets have changed, and it is unknown to what degree engineering standards vary around the world. Governments, industry and independent regulatory bodies all produce engineering standards; therefore, the comparison of surgical implants across different manufacturers and jurisdictions is difficult. In this review, we will systematically collate and compare engineering standards for trauma and orthopaedic implants around the world. This will help inform patient, hospital and surgeon choice and provide an evidence base for future research in this area. Methods and analysis This protocol is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. We will conduct a systematic review of trauma and orthopaedic engineering standards from four main sources of information as identified in our preliminary scoping searches: governments, industry, independent regulatory bodies and engineering and medical publications. Any current standard relevant to trauma and orthopaedic implants will be included. We will use a predefined search strategy and follow the recommendations of the Cochrane handbook where applicable. We will undertake a narrative synthesis with qualitative evaluation of homogeneity between engineering standards. Ethics and dissemination No ethics approval is required as no primary data are being collected. The results will be made available by peer-reviewed publication and reported according to PRISMA-P guidelines

Correlation of sonographic with intraoperative findings in laparoscopic managed ectopic pregnancies, a 10-year synopsis: a retrospective observational study

Background: Ectopic pregnancies (EP) are a common pregnancy complication that\u27s associated with significant morbidity and rarely mortality if not managed properly. Ultrasound examination forms the cornerstone of diagnosis of EP with some sonographic features occasionally not correlating with intraoperative findings. We set out to conduct an audit of EP managed surgically at our hospital for a 10-year period and discern the correlation and prediction of sonographic findings to intraoperative findings. Methods: This study was designed as a Retrospective Observational Study based at the Aga Khan University Hospital (AKUH). Study population was all women admitted to AKUH with a diagnosis of ectopic pregnancy that was surgically managed between the period of January 1st 2011 to December 31st 2020. Analysis of data was done against a pre-set checklist. Descriptive statistics for continuous variables was calculated and tabulated in graphs and tables. SPSS version 22 was used for analysis of data. Results: A total of 337 patients in this study had ultrasound findings. 99.7% (n = 336) of these patients had an intraoperatively confirmed EP. The commonest ultrasound finding was an adnexal mass in 97.1% (n = 309) of patients. These were confirmed surgically in 290 patients at the following locations: 76.6% (n = 222) were ampullary in location; 10.7% (n = 31) were fimbrial in location; 8.6%(n = 25) were isthmic in location; 2.4%(n = 7) were interstitial in location; 1%(n = 3) were abdominal in location; while 0.3% were located in the ovary(n = 1) or round ligament(n = 1) each. Interstitial EP on ultrasound were all (100%) confirmed in the same location intraoperatively, with ampullary EP also correlating fairly well with intraoperative location (75%). The distribution of location in the minor hemoperitoneum (HP) versus major HP groups were similar except for interstitial EP that increased from 1.4% in the minor HP group to 9.5% in the major HP group. Conclusion: In conclusion, ultrasonography still represents the best imaging modality for EP. The most common finding is usually an adnexal mass with no specific location. Most (99.7%) of the patients with this sonographic finding usually have a confirmed EP. Interstitial EP are the most well localized with ultrasound followed by ampullary EP. Furthermore, the presence of major (\u3e 500mls) hemoperitoneum may act as an adjunct for diagnosis of an interstitial EP

Type I (Hannis - Steinthal) Capitellar Fracture: Case Report

Capitellar fractures of the elbow present with pain and swelling of the elbow following a fall on an outstretched arm and are rare injuries comprising 0.5-1% of all elbow fractures (1). This is a case report of an adult female who sustained this injury following a fall on her outstretched arm. CT scans revealed a Type I capitellar fracture of the right elbow. Open reduction and internal fixation was done with a functionally good result. Because of the cartilaginous nature of the capitellum humeri these injuries are easily missed on radiography. One must have a high index of suspicion especially when elbow movement is noticeably restricted. These injuries are discussed and the literature reviewed. Although controversial, treatment is mainly operative. One should carefully review radiographs of patients who present with injuries of the elbow with pain, swelling and markedly restricted joint range of motion and whose mechanism of injury(fall on an outstretched arm) is consistent with capitellar fracture. CT scans often clinch the diagnosis. Type I fractures may be treated conservatively but Type II injuries require operative intervention

Electrical Percolation in Metal Nanowire Networks for Bulk Polymer Nanocomposites and Transparent Conductors, and Resistive Switching in Metal/Polymer Nano-Gap Devices

This dissertation describes the electrical properties of metal nanowire-polymer hybrid systems. The first part of the thesis discusses electrical percolation of metal nanowire networks in bulk polymer nanocomposites (3D) and nanowire films (quasi-2D). Specifically, we integrate simulations of rod networks and experiments of model metal nanowire systems to establish the dependence of their electrical properties on the nanowire aspect ratio (L/D) and network structure. For bulk polymer nanocomposites, we find that narrow Gaussian distributions in filler size do not impact the electrical percolation threshold, while mixing small fractions of high-L/D rods with modest-L/D rods significantly reduces the threshold. We also generalize the widely used excluded volume model of percolation, which was originally formulated for infinite-L/D, monodisperse rod networks, to account for both finite-L/D and arbitrary distribution in the rod dimensions. Next, we adapt our 3D simulation approach to model the electrical properties quasi-2D rod networks, which are relevant to nanowire films that are being pursued for flexible, transparent conductors. We present the first quantitative predictions of the dependence of the sheet resistance in nanowire films on the aspect ratio and areal density of mono- and poly-disperse nanowires. Moreover, by combining our simulations of sheet resistance and an empirical diameter-dependent expression for the optical transmittance, we produced a fully calculated plot of optical transmittance versus sheet resistance, the primary performance criteria for transparent conductors. Further, by fitting simulation results to experimental data, we obtain an effective average contact resistance, Rc_effective, between two nanowires. Rc_effective extracted using our integrated approach enables direct comparisons between nanowires of different compositions or networks fabricated by distinct means. We also report the critical area fraction of rods required to form a percolated network in nanowire films and provide a semi-empirical analytical expression for the critical area fraction as a function of L/D for mono- and poly-disperse rods. Our simulations of electrical percolation in quasi-2D and 3D rod networks, coupled with our extensions of existing analytical models, provide critical guidance for engineering bulk conducting nanocomposites and nanowire films with well-defined properties that are optimized for specific applications. In the second part of this thesis, we demonstrate reversible resistive switching in silver/polystyrene/silver nano-gap devices comprised of Ag nano-strips separated by a nanoscale gap and encapsulated in polystyrene (PS). These devices show highly reversible switching behavior with high on-off ratios during cyclic switching tests over many cycles. We also observe evolution of the gap after extensive testing, which is consistent with metal filament formation as the switching mechanism in Ag/PS/Ag nano-gap devices. The reversible electrical bistability demonstrated here was accomplished with an electrically inactive polymer, thereby extending the range of polymers suitable for organic digital memory applications

Planning in emergencies and disasters

No Abstract