Mutilating granuloma inguinale after rape A case report

A woman with extensive mutilating lesions of genital granuloma inguinale following rape is described. As far as is known granuloma inguinale has not previously been reported in a rape victim

The impact of hospital accreditation on quality measures:An interrupted time series analysis

BACKGROUND: Developing countries frequently use hospital accreditation to guarantee quality and patient safety. However, implementation of accreditation standards is demanding on organisations. Furthermore, the empirical literature on the benefits of accreditation is sparse and this is the first empirical interrupted time series analysis designed to examine the impact of healthcare accreditation on hospital quality measures. METHODS: The study was conducted in a 150-bed multispecialty hospital in Abu Dhabi, United Arab Emirates. The quality performance outcomes were observed over a 48 month period. The quality performance differences were compared across monthly intervals between two time segments, 1 year pre- accreditation (2009) and 3 years post-accreditation (2010, 2011 and 2012) for the twenty-seven quality measures. The principal data source was a random sample of 12,000 patient records drawn from a population of 50,000 during the study period (January 2009 to December 2012). Each month (during the study period), a simple random sample of 24 percent of patient records was selected and audited, resulting in 324,000 observations. The measures (structure, process and outcome) are related to important dimensions of quality and patient safety. RESULTS: The study findings showed that preparation for the accreditation survey results in significant improvement as 74% of the measures had a significant positive pre-accreditation slope. Accreditation had a larger significant negative effect (48% of measures) than a positive effect (4%) on the post accreditation slope of performance. Similarly, accreditation had a larger significant negative change in level (26%) than a positive change in level (7%) after the accreditation survey. Moreover, accreditation had no significant impact on 11 out of the 27 measures. However, there is residual benefit from accreditation three years later with performance maintained at approximately 90%, which is 20 percentage points higher than the baseline level in 2009. CONCLUSIONS: Although there is a transient drop in performance immediately after the survey, this study shows that the improvement achieved from accreditation is maintained during the three year accreditation cycle

Continuous Transition between Antiferromagnetic Insulator and Paramagnetic Metal in the Pyrochlore Iridate Eu2Ir2O7

Our single crystal study of the magneto-thermal and transport properties of the pyrochlore iridate Eu2Ir2O7 reveals a continuous phase transition from a paramagnetic metal to an antiferromagnetic insulator for a sample with stoichiometry within ~1% resolution. The insulating phase has strong proximity to an antiferromagnetic semimetal, which is stabilized by several % level of the off-stoichiometry. Our observations suggest that in addition to electronic correlation and spin-orbit coupling the magnetic order is essential for opening the charge gap.Comment: 6 pages, 6 figure

Efficacy of various single-dose regimens of ceftriaxone in uncomplicated acute gonococcal urethritis in adult males

The therapeutic efficacy of single intramuscular doses of ceftriaxone (Rocephin; Roche) (62,S, 125 and 250 mg), administered without probenecid, was evaluated in 167 adult males with uncomplicated acute gonococcal urethritis. Cure rates of 100% were achieved at 62,5 mg and 250 mg. In the 125 mg dose group, Neisseria gonorrhoeae was isolated from 1 patient at follow-up after therapy. Reinfection was suspected, since this patient returned on day 10 and admitted to sexual contact 2 days previously. Side-effects were minimal, and patient acceptance was better for ceftriaxone dissolved in lignocaine than in sterile water. Chlamydia trachomatis was detected at follow-up in 14,4% patients, confirming that ceftriaxone has no significant effect on chlamydial infection and additional treatment is necessary for patients with coexistent infection

Population-level effect of HSV-2 therapy on the incidence of HIV in sub-Saharan Africa.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) infection increases acquisition and transmission of HIV, but the results of trials measuring the impact of HSV-2 therapy on HIV genital shedding and HIV acquisition are mixed, and the potential impact of HSV-2 therapy on the incidence of HIV at the population level is unknown. METHODS: The effects of episodic and suppressive HSV-2 therapy were simulated using the individual-level model STDSIM fitted to data from Cotonou, Benin (relatively low HIV prevalence) and Kisumu, Kenya (high HIV prevalence). Clinician- and patient-initiated episodic therapy, started when symptomatic, were assumed to reduce ulcer duration. Suppressive therapy, given regardless of symptoms, was also assumed to reduce ulcer frequency and HSV-2 infectiousness. RESULTS: Clinician-initiated episodic therapy in the general population had almost no effect on the incidence of HIV. The impact of patient-initiated therapy was higher because of earlier treatment initiation, but still low (20% in the long term. Impact was increased in both cities by also treating a proportion of their clients. Long-term suppressive therapy with high coverage in the general population could reduce HIV incidence by more than 30%. CONCLUSIONS: These results show that HSV-2 therapy could potentially have a population-level impact on the incidence of HIV, especially in more concentrated epidemics. However, a substantial impact requires high coverage and long duration therapy, or very high symptom recognition and treatment-seeking behaviour

A High-Resolution Sensor Network for Monitoring Glacier Dynamics

This paper provides an overview of a wide area wireless sensor network that was deployed on the calving front of the Helheim Glacier in Greenland during the summer of 2013. The purpose of the network was to measure the flow rate of the glacier using accurate satellite positioning data. The challenge in this extreme environment was to collect data in real time at the calving edge of the glacier. This was achieved using a solar powered 2.4-GHz Zigbee wireless sensor network operated in a novel hybrid cellular/mesh access architecture consisting of ice nodes communicating with base stations placed on the rock adjacent to the glacier. This highly challenging transmission environment created substantial signal outage conditions, which were successfully mitigated by a radio network diversity scheme. The network development and measurement campaign were highly successful yielding significant results on glacial dynamics associated with climate change

Temporal lobe (TL) damage following surgery and high-dose photon and proton irradiation in 96 patients affected by chordomas and chondrosarcomas of the base of the skull

Purpose: To determine the temporal lobe (TL) damage rate in 96 patients treated with high-dose proton and photon irradiation for chordomas and chondrosarcomas of the base of the skull. Methods and Materials: The records of 96 consecutive patients treated at Massachusetts General Hospital (MGH) and Harvard Cyclotron Laboratory (HCL) between June 1984 and 1993, for chordomas and chondrosarcomas of the base of the skull were reviewed. All the patients had undergone some degree of resection of the tumor prior to radiation therapy. Seventy-five patients were classified as 'primary tumors' and 21 as recurrent or regrowing tumors after one or more surgical procedures. All the patients were randomized to receive 66.6 or 72 cobalt Gray equivalent (CGE) on a prospective dose-searching study by proton and photon irradiation (Radiation Therapy Oncology Group No.85-26) with conventional fractionation (1.8 CGE/day, 5 fractions/week). All treatments were planned using the three-dimensional (3D) planning system developed at the Massachusetts General Hospital, and the dose was delivered using opposed lateral fields for the photon component and a noncoplanar isocentric technique for the proton component. Clinical symptoms of TL damage were classified into 4 grades. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans were evaluated for white matter changes. Abnormalities associated with persistent or recurrent tumor were distinguished from radiation-induced changes. TLs were delineated on the original scans of the 10 patients with damage and those of a group of 33 patients with no clinical or MRI evidence of injury. Dose distributions were calculated and dose- volume histograms were obtained for these patients. Results: Of the patients, 10 developed TL damage, with bilateral injury in 2 and unilateral injury in 8. The cumulative TL damage incidence at 2 and 5 years was 7.6 and 13.2%, respectively. The MRI areas suggestive of TL damage were always separated from the tumor bed. Symptoms were severe to moderate in 8 patients. Several baseline factors, tumor- or host-related, were analyzed to evaluate their predictivity for TL damage: age, gender, tumor site, histology, type of presentation, type and number of surgical procedures, primary tumor volume, prescribed dose, normal tissue involvement, and volume of TL receiving doses ranging between 10 and 50 CGE or more. Only gender, in a univariate analysis (log rank) was a significant predictor of damage (0.0155), with male patients being at significantly higher risk of TL injury. In a stepwise Cox regression that included gender as a variable, no other baseline variable improved the prediction of damage. Conclusions: The 2- and 5-year cumulative TL damage rates were 7.6 and 13.2%, respectively. Despite the different TL damage rates related to age, tumor volume, number of surgical procedures prior to radiation therapy, and prescribed doses to the tumor, only gender was a significant predictor of damage (p = 0.0155) using a univariate (log rank) test. Chordomas and chondrosarcomas of the base of the skull may represent an interesting model to evaluate the TL damage rates because of their extradural origin, displacing the white matter instead of infiltrating it as gliomas do, because of their longer local recurrence-free survival other than gliomas and other brain tumors and because of the high doses of irradiation delivered to the target volume to obtain local control

Exploitation and Survival of River Shannon Reared Salmon

Following the construction of the River Shannon hydroelectric scheme the Electricity Supply Board (ESB) have maintained a juvenile salmon restocking programme. Tagging of smolts with coded wire tags (microtags) was initiated in 1980 to examine the migration and survival of these stocked fish. In 1991, an estimated 292,000 hatchery reared salmon smolts (micro tagged and adipose finclipped) migrated from the River Shannon, County Limerick. This allowed an assessment to be made of the contribution of these fish to the high seas fisheries at West Greenland and Faroes, and also to homewater net and rod fisheries. Over 12,000 grilse from this release programme were estimated to have been taken by commercial nets with 525 taken on rods and 3,147 surviving to spawn. The return rate of 2 sea winter fish was much lower with 150 taken by commercial nets, 93 taken by rods and 202 estimated to have spawned. The Greenland fishery took approximately 107 potential 2 sea winter fish which is a high proportion of the overall 2 sea winter stock. Tag returns from groups of smolts released by helicopter proved to be highest. Groups released above the dams and which had to navigate through these installations also showed comparatively good returns. Early presmolt and smolt releases (i.e. December and February) did not give as good return rate in comparison to the other release groups