Case management

Provides an overview of methods of diagnosis, treatment and patient care in complex emergencies. This chapter: ■ provides guidelines for initial management, including emergency triage – for the rapid identifi cation and treatment of patients at greatest risk of dying – and clinical assessment ■ discusses confi rmatory diagnosis of malaria using microscopy and rapid diagnostic tests (RDTs) ■ outlines factors that determine the choice of antimalarial drug ■ describes antimalarial drug treatment for uncomplicated malaria, subsequent follow-up, and the management of treatment failures ■ describes the assessment and treatment of anaemia ■ describes the treatment of severe P. falciparum malaria and its associated complications, including resuscitation, treatment with antimalarial drugs, and nursing care ■ provides guidance on the prevention and treatment of malaria in special groups (pregnant women, malnourished patients, returning refugees and displaced persons)

Quantum corrections to critical phenomena in gravitational collapse

We investigate conformally coupled quantum matter fields on spherically symmetric, continuously self-similar backgrounds. By exploiting the symmetry associated with the self-similarity the general structure of the renormalized quantum stress-energy tensor can be derived. As an immediate application we consider a combination of classical, and quantum perturbations about exactly critical collapse. Generalizing the standard argument which explains the scaling law for black hole mass, $M \propto |\eta-\eta^*|^\beta$, we demonstrate the existence of a quantum mass gap when the classical critical exponent satisfies $\beta \geq 0.5$. When $\beta < 0.5$ our argument is inconclusive; the semi-classical approximation breaks down in the spacetime region of interest.Comment: RevTeX, 6 pages, 3 figures included using psfi

Criticality and Bifurcation in the Gravitational Collapse of a Self-Coupled Scalar Field

We examine the gravitational collapse of a non-linear sigma model in spherical symmetry. There exists a family of continuously self-similar solutions parameterized by the coupling constant of the theory. These solutions are calculated together with the critical exponents for black hole formation of these collapse models. We also find that the sequence of solutions exhibits a Hopf-type bifurcation as the continuously self-similar solutions become unstable to perturbations away from self-similarity.Comment: 18 pages; one figure, uuencoded postscript; figure is also available at http://www.physics.ucsb.edu/people/eric_hirschman

Dimensional Dependence of Black Hole Formation in Self-Similar Collapse of Scalar Field

We study classical and quantum self-similar collapses of a massless scalar field in higher dimensions, and examine how the increase in the number of dimensions affects gravitational collapse and black hole formation. Higher dimensions seem to favor formation of black hole rather than other final states, in that the initial data space for black hole formation enlarges as dimension increases. On the other hand, the quantum gravity effect on the collapse lessens as dimension increases. We also discuss the gravitational collapse in a brane world with large but compact extra dimensions.Comment: Improved a few arguments and added a figur

The causal structure of dynamical charged black holes

We study the causal structure of dynamical charged black holes, with a sufficient number of massless fields, using numerical simulations. Neglecting Hawking radiation, the inner horizon is a null Cauchy horizon and a curvature singularity due to mass inflation. When we include Hawking radiation, the inner horizon becomes space-like and is separated from the Cauchy horizon, which is parallel to the out-going null direction. Since a charged black hole must eventually transit to a neutral black hole, we studied the neutralization of the black hole and observed that the inner horizon evolves into a space-like singularity, generating a Cauchy horizon which is parallel to the in-going null direction. Since the mass function is finite around the inner horizon, the inner horizon is regular and penetrable in a general relativistic sense. However, since the curvature functions become trans-Planckian, we cannot saymore about the region beyond the inner horizon, and it is natural to say that there is a 'physical' space-like singularity. However, if we assume an exponentially large number of massless scalar fields, our results can be extended beyond the inner horizon. In this case, strong cosmic censorship and black hole complementarity can be violated.Comment: 23 pages, 23 figure

Dynamical formation and evolution of (2+1)-dimensional charged black holes

In this paper, we investigate the dynamical formation and evolution of 2 + 1-dimensional charged black holes. We numerically study dynamical collapses of charged matter fields in an anti de Sitter background and note the formation of black holes using the double-null formalism. Moreover, we include re-normalized energy-momentum tensors assuming the S-wave approximation to determine thermodynamical back-reactions to the internal structures. If there is no semi-classical effects, the amount of charge determines the causal structures. If the charge is sufficiently small, the causal structure has a space-like singularity. However, as the charge increases, an inner Cauchy horizon appears. If we have sufficient charge, we see a space-like outer horizon and a time-like inner horizon, and if we give excessive charge, black hole horizons disappear. We have some circumstantial evidences that weak cosmic censorship is still satisfied, even for such excessive charge cases. Also, we confirm that there is mass inflation along the inner horizon, although the properties are quite different from those of four-dimensional cases. Semi-classical back-reactions will not affect the outer horizon, but they will affect the inner horizon. Near the center, there is a place where negative energy is concentrated. Thus, charged black holes in three dimensions have two types of curvature singularities in general: via mass inflation and via a concentration of negative energy. Finally, we classify possible causal structures.Comment: 40 pages, 15 figure

When do colliding bubbles produce an expanding universe?

It is intriguing to consider the possibility that the Big Bang of the standard (3+1) dimensional cosmology originated from the collision of two branes within a higher dimensional spacetime, leading to the production of a large amount of entropy. In this paper we study, subject to certain well-defined assumptions, under what conditions such a collision leads to an expanding universe. We assume the absence of novel physics, so that ordinary (4+1) -dimensional Einstein gravity remains a valid approximation. It is necessary that the fifth dimension not become degenerate at the moment of collision. First the case of a symmetric collision of infinitely thin branes having a hyperbolic or flat spatial geometry is considered. We find that a symmetric collision results in a collapsing universe on the final brane unless the pre-existing expansion rate in the bulk just prior to the collision is sufficiently large in comparison to the momentum transfer in the fifth dimension. Such prior expansion may either result from negative spatial curvature or from a positive five-dimensional cosmological constant. The relevance of these findings to the Colliding Bubble Braneworld Universe scenario is discussed. Finally, results from a numerical study of colliding thick-wall branes is presented, which confirm the results of the thin-wall approximation.Comment: 24 pages, 13 figures. Minor changes and references include

Alterations in plasma soluble vascular endothelial growth factor receptor-1 (sFlt-1) concentrations during coronary artery bypass graft surgery: relationships with post-operative complications

<p>Abstract</p> <p>Background</p> <p>Plasma concentrations of sFlt-1, the soluble form of the vascular endothelial growth factor receptor (VEGF), markedly increase during coronary artery bypass graft (CABG) surgery with extracorporeal circulation (ECC). We investigated if plasma sFlt-1 values might be related to the occurrence of surgical complications after CABG.</p> <p>Methods</p> <p>Plasma samples were collected from the radial artery catheter before vascular cannulation and after opening the chest, at the end of ECC just before clamp release, after cross release, after weaning from ECC, at the 6^thand 24^thpost-operative hour. Thirty one patients were investigated. The presence of cardiovascular, haematological and respiratory dysfunctions was prospectively assessed. Plasma sFlt-1 levels were measured with commercially ELISA kits.</p> <p>Results</p> <p>Among the 31 investigated patients, 15 had uneventful surgery. Patients with and without complications had similar pre-operative plasma sFlt-1 levels. Lowered plasma sFlt-1 levels were observed at the end of ECC in patients with haematological (p = 0.001, ANOVA) or cardiovascular (p = 0.006) impairments, but not with respiratory ones (p = 0.053), as compared to patients with uneventful surgery.</p> <p>Conclusion</p> <p>These results identify an association between specific post-CABG complication and the lower release of sFlt-1 during ECC. sFlt-1-induced VEGF neutralisation might, thus, be beneficial to reduce the development of post-operative adverse effects after CABG.</p

The use of formative research to inform the design of a seasonal malaria chemoprevention intervention in northern Nigeria

BACKGROUND:Experience of seasonal malaria chemoprevention (SMC) is growing in the Sahel sub-region of Africa, though there remains insufficient evidence to recommend a standard deployment strategy. In 2012, a project was initiated in Katsina state, northern Nigeria, to design an appropriate and effective community-based delivery approach for SMC, in consultation with local stakeholders. Formative research (FR) was conducted locally to explore the potential feasibility and acceptability of SMC and to highlight information gaps and practical considerations to inform the intervention design. METHODS:The FR adopted qualitative methods; 36 in-depth interviews and 18 focus group discussions were conducted across 13 target groups active across the health system and within the community. Analysis followed the 'framework' approach. The process for incorporating the FR results into the project design was iterative which was initiated by a week-long 'intervention design' workshop with relevant stakeholders. RESULTS:The FR highlighted both supportive and hindering factors to be considered in the intervention design. Malaria control was identified as a community priority, the community health workers were a trusted resource and the local leadership exerted strong influence over household decisions. However, there were perceived challenges with quality of care at both community and health facility levels, referral linkage and supportive supervision were weak, literacy levels lower than anticipated and there was the potential for suspicion of 'outside' interventions. There was broad consensus across target groups that community-based SMC drug delivery would better enable a high coverage of beneficiaries and potentially garner wider community support. A mixed approach was recommended, including both community fixed-point and household-to-household SMC delivery. The FR findings were used to inform the overall distribution strategy, mechanisms for integration into the health system, capacity building and training approaches, supportive interventions to strengthen the health system, and the social mobilization strategy. CONCLUSIONS:Formative research played a valuable role in exploring local socio-cultural contexts and health system realities. Both opportunities and challenges for the introduction of SMC delivery were highlighted, which were appropriately considered in the design of the project

Numerical Relativity: A review

Computer simulations are enabling researchers to investigate systems which are extremely difficult to handle analytically. In the particular case of General Relativity, numerical models have proved extremely valuable for investigations of strong field scenarios and been crucial to reveal unexpected phenomena. Considerable efforts are being spent to simulate astrophysically relevant simulations, understand different aspects of the theory and even provide insights in the search for a quantum theory of gravity. In the present article I review the present status of the field of Numerical Relativity, describe the techniques most commonly used and discuss open problems and (some) future prospects.Comment: 2 References added; 1 corrected. 67 pages. To appear in Classical and Quantum Gravity. (uses iopart.cls