Projecto Angolano de Formação e Desenvolvimento da Dermatologia: Avanços e Desafios

Introduction: Despite the burden of skin disorders and their physical, psychological and social repercussions, the development of Dermatology and the training of technicians in this discipline face serious challenges in Angola, with a negative impact on the access and quality of care and services provided to the population.Methods: A retrospective study of the Dermatology Training and Development Project was carried out. The Project, launched in 2010 with the support of the Ministry of Health and the Angolan College of Dermatology and Venereology (CADV), aims at increasing the number of dermatologists and the access of patients to clinical referral services. Data on the training activities, other gains and limitations of the Project are presented.Results: Up to 2013, the residency in Dermatology was confined to a single Service in Luanda, which trained eight dermatologists from 1975 to 2013. Five new Regional Dermatology services were opened in 2013 in Cabinda, Malange, Huambo, Benguela and Huíla. As a result the total number of residents in Dermatology increased to 26 in 2017.Conclusion: In the context of Angola, the decentralization of clinical training services, the periodic update of the postgraduate training program and the active promotion of research attitudes and activities are key factors for the development of Dermatology and the provision of referral services closer to the populations.Introdução: Apesar do fardo e das repercussões físicas, psicológicas e sociais que as doenças da pele representam, o desenvolvimento da Dermatologia e a formação de técnicos nessa disciplina defrontam em Angola sérios desafios, com repercussões no acesso e na qualidade dos serviços e cuidados prestados a população.Metodologia: Foi realizado um estudo retrospectivo do Projecto de Formação e Desenvolvimento da Dermatologia, iniciado em 2010 com o apoio do Ministério da Saúde e do Colégio Angolano de Dermatologia e Venereologia (CADV). O projecto tem por objectivo a formação de mais dermatologistas e de aumentar o acesso dos doentes a Serviços de referência. São apresentados dados sobre a formação dos internos, bem como outros ganhos e limitações do Projecto.Resultados: Até 2013, o internato médico complementar em Dermatologia estava reservado apenas a um Serviço de Dermatologia em Luanda, tendo formado oito dermatologistas desde 1975. Em 2013, cinco novos Serviços Regionais, abertos em Cabinda, Malange, Huambo, Benguela e Huíla, iniciaram a formação de especialistas, aumentando em 2017 a 26 o número total de internos em formação.Conclusão: No contexto de Angola, a descentralização dos serviços clínicos de formação, a afinação periódica do programa de pós-graduação e a promoção activa de atitudes e actividades de pesquisa são elementos chave no desenvolvimento da Dermatologia e na prestação de serviços de referência mais próximos das populações

Using street view imagery for 3-D survey of rock slope failures

We discuss here different challenges and limitations of surveying rock slope failures using 3-D reconstruction from image sets acquired from street view imagery (SVI). We show how rock slope surveying can be performed using two or more image sets using online imagery with photographs from the same site but acquired at different instances. Three sites in the French alps were selected as pilot study areas: (1) a cliff beside a road where a protective wall collapsed, consisting of two image sets (60 and 50 images in each set) captured within a 6-year time frame; (2) a large-scale active landslide located on a slope at 250m from the road, using seven image sets (50 to 80 images per set) from five different time periods with three image sets for one period; (3) a cliff over a tunnel which has collapsed, using two image sets captured in a 4-year time frame. The analysis include the use of different structure from motion (SfM) programs and a comparison between the extracted photogrammetric point clouds and a lidar-derived mesh that was used as a ground truth. Results show that both landslide deformation and estimation of fallen volumes were clearly identified in the different point clouds. Results are site- and software-dependent, as a function of the image set and number of images, with model accuracies ranging between 0.2 and 3.8m in the best and worst scenario, respectively. Although some limitations derived from the generation of 3-D models from SVI were observed, this approach allowed us to obtain preliminary 3-D models of an area without on-field images, allowing extraction of the pre-failure topography that would not be available otherwise

Efficacy and safety of continuous infusions with elastomeric pumps for outpatient parenteral antimicrobial therapy (OPAT): an observational study.

This study aimed to evaluate the efficacy and safety of continuous antimicrobial infusion using elastomeric pumps in an outpatient setting, while simultaneously documenting circulating antibiotic concentration exposure achieved with this mode of administration. Clinical outcomes, adverse events and antibiotic plasma concentrations were recorded for all patients treated by continuous infusion with elastomeric pumps at the outpatient parenteral antimicrobial therapy (OPAT) unit of the University Hospital of Lausanne between December 2013 and January 2017. The study was registered under ClinicalTrials.gov identifier NCT03221140. One hundred and fifty outpatients were treated by continuous intravenous infusions using flucloxacillin (70 patients), cefepime (36), vancomycin (32) and piperacillin/tazobactam (12). The calculated free fractions of each antibiotic were above the epidemiological cut-off values for resistance (ECOFF) of the treated microorganisms in 92% of measurements. Cure was achieved in 143 patients (95%) 3 months after the end of treatment. Four patients needed unexpected readmission and three had a relapse. In none of the patients with unsuccessful treatment was the ratio of free antibiotic plasma concentration/ECOFF <1. Sixteen patients (11%) had an adverse event, none of them being of severity grade 4 or 5. Continuous infusions of flucloxacillin, cefepime, vancomycin and piperacillin/tazobactam using elastomeric pumps seem to be an effective and safe approach to treat outpatients. The number of treatment successes was very high and adverse events occurred at a similar rate as reported by other OPAT centres. The measured antibiotic plasma concentrations confirmed adequate drug concentration exposure for the vast majority of patients

Geriatric palliative care: a view of its concept, challenges and strategies.

In aging societies, the last phase of people's lives changes profoundly, challenging traditional care provision in geriatric medicine and palliative care. Both specialties have to collaborate closely and geriatric palliative care (GPC) should be conceptualized as an interdisciplinary field of care and research based on the synergies of the two and an ethics of care.Major challenges characterizing the emerging field of GPC concern (1) the development of methodologically creative and ethically sound research to promote evidence-based care and teaching; (2) the promotion of responsible care and treatment decision making in the face of multiple complicating factors related to decisional capacity, communication and behavioural problems, extended disease trajectories and complex social contexts; (3) the implementation of coordinated, continuous care despite the increasing fragmentation, sectorization and specialization in health care.Exemplary strategies to address these challenges are presented: (1) GPC research could be enhanced by specific funding programs, specific patient registries and anticipatory consent procedures; (2) treatment decision making can be significantly improved using advance care planning programs that include adequate decision aids, including those that address proxies of patient who have lost decisional capacity; (3) care coordination and continuity require multiple approaches, such as care transition programs, electronic solutions, and professionals who act as key integrators

A capacitance prope to characterize gas bubbles in stirred tank reactors

An invasive plate and frame capacitance probe was designed for dielec. const. measurements over a wide frequency range (10-5000 kHz) in a 5-L stirred-tank reactor. Preliminary measurements with polyethylene beads showed a linear variation of the effective permittivity with the vol. fraction of the beads, in accordance with the Maxwell-Wagner theory. Results obtained by bubbling air under various agitation and aeration rates at 500 kHz in deionized water and the effect of a non-ionic antifoam on permittivity variations are shown and discussed; the technique is thought to allow precise local holdup measurements. Existing limitations and possible further improvements of the technique are discussed, esp. in view of the information that can be gained from the std. deviation of the measurements. [on SciFinder (R)