Review of Varicella zoster virus : from epidemiology to prevention

The Varicella zoster virus is a human pathogen which causes Varicella after primary infection and herpes zoster after secondary reactivation. Both disease manifestations can occur at any age; however, Varicella is seen more commonly in children whilst herpes zoster is mainly observed in the elderly. Although uncommon, disease complications secondary to Varicella may be severe and life-threatening especially at the extremes of age, during pregnancy and in the immunocompromised. Attenuated Varicella vaccines have been successfully formulated to prevent Varicella and its complications and are part of the routine childhood immunisation programmes in several countries including the US, Canada, Germany and Australia. This review discusses the epidemiology of Varicella, the clinical presentation and management of Varicella zoster virus infections and the potential of preventing Varicella and herpes zoster through immunisation.peer-reviewe

Pedagogical methodologies in teaching critical thinking skills to basic police recruits at Madison Area Technical College

Includes bibliographical references

Ebola : too far or so close?

The year 2014 has witnessed the escalation of the largest ever Ebola outbreak which started in Guinea, and later spread to other countries in West Africa. The associated disease burden has already exceeded the total number of cases in all the sporadic outbreaks that occurred since the first description of Ebola in 1976. The threat of further spread across Africa, and possibly beyond through international travel, is of concern and has led several countries around the world to implement preparedness measures against Ebola. In an attempt to contain the spread of Ebola, WHO and other non- governmental humanitarian organisations have pooled their resources to fuel efforts at improving patient care, isolation facilities, healthcare worker training, and availability of personal protective equipment in the affected countries. The outbreak has brought to light the lack of past investment in research into treatment or potential vaccine development against the Ebola virus, with the only hope of expediting a cure that can be used in the current outbreak being through the launch of clinical trials investigating experimental drugs in the affected countries.peer-reviewe

Behavior and Breakdown of Higher-Order Fermi-Pasta-Ulam-Tsingou Recurrences

We investigate numerically the existence and stability of higher-order recurrences (HoRs), including super-recurrences, super-super-recurrences, etc., in the alpha and beta Fermi-Pasta-Ulam-Tsingou (FPUT) lattices for initial conditions in the fundamental normal mode. Our results represent a considerable extension of the pioneering work of Tuck and Menzel on super-recurrences. For fixed lattice sizes, we observe and study apparent singularities in the periods of these HoRs, speculated to be caused by nonlinear resonances. Interestingly, these singularities depend very sensitively on the initial energy and the respective nonlinear parameters. Furthermore, we compare the mechanisms by which the super-recurrences in the two model's breakdown as the initial energy and respective nonlinear parameters are increased. The breakdown of super-recurrences in the beta-FPUT lattice is associated with the destruction of the so-called metastable state and hence is associated with relaxation towards equilibrium. For the alpha-FPUT lattice, we find this is not the case and show that the super-recurrences break down while the lattice is still metastable. We close with comments on the generality of our results for different lattice sizes

Bilateral microform cleft lip

Microform cleft lip (MCL), also called congenital healed cleft lip or cleft lip "frustré", is a rare congenital anomaly. MCL has been described as having the characteristic appearance of a typical cleft lip which has been corrected in utero. We present a girl with bilateral microform cleft lip associated with a preauricular sinus and bilateral camptodactyly.peer-reviewe

Are local guidelines on investigations in children admitted with acute gastroenteritis being adhered to?

The aim of this article is to assess adherence to local guidelines on the investigation of children admitted with acute gastroenteritis. Children admitted to Mater Dei Hospital with a diagnosis of gastroenteritis between December 2012 and February 2013 were selected. Their investigations were retrospectively assessed in relation to the degree of dehydration and the type of management given. Hospital guidelines relating to investigations performed in children admitted with gastroenteritis were reviewed and compliance was assessed. A total of 411 investigations were carried out in 76 children with the most common investigations being serum electrolytes, urea and creatinine and random blood glucose. Guidelines were met in 4/76 (5.3%) of the study population. Serum electrolytes had the greatest impact on management. The conclusion is that the local guideline on gastroenteritis is not being adhered to in the vast majority of cases. There is an urgent need to raise awareness about the availability and utilisation of this guideline amongst doctors working in paediatrics.peer-reviewe

Are routine investigations in acute paediatric admissions justified?

Aim: To assess the appropriateness of investigations and their impact on management of acute paediatric admissions. Method: All investigations performed within the first six hours in all consecutive paediatric admissions (n=138) over a 6 week period, in a teaching general hospital, were recorded retrospectively and the results were analysed for normality/ abnormality and effect on patient management. Results: Out of a total of 480 emergency investigations performed on 89 patients, the complete blood count, electrolytes and chest X-rays were the three investigations most likely to be deranged and influenced management in 5% (n=3), 25% (n=8) and 46% (n=6) of subjects with an abnormal result, respectively. Impact on management was more evident on analysing a subgroup admitted with mild gastroenteritis, in whom serum electrolytes were abnormal in 50% (n=19), and 42% (n=8) of these needed a change in their management. Conclusion: Rationalising the number of investigations in acute paediatric admissions would result in less discomfort to children and in a significant cost benefit.peer-reviewe

Tour Guides and Access to Trails: Problems in the Baħrija Area of Malta

The Maltese islands barely cover an area of 300 square kilometres and yet, they enjoy a varied landscape characterised by cliffs, ridges, hills and valleys. There are over a hundred valleys on the main island of Malta and many provide important waterways during the rainy season and present some of the most beautiful and varied scenery. The most accessible include the Qlejgħa valley and White Poplar Valley (Wied il-Luq). Both are frequented by thousands of visitors, particularly during the weekends and are also quite popular with tourists during the winter months. Malta’s high population density, the influx of millions of tourists and rampant construction are not being matched by the upkeep of existing rural areas, the designation of new green areas and the expansion of wooded areas. Therefore, such locations are actually suffering from the ravages of too many visitors and need to be expanded and managed better with the help of park managers and environmental wardens. However, many lesser known valleys provide excellent trails for nature treks and active tourism. But, unfortunately, many are becoming increasingly unpassable due to a variety of reasons including the pressures of development from the politically potent construction lobby, the destruction of environmentally sensitive Outside Development Zones (ODZ), lack of proper pathways and signage, privacy signs that may or may not be legitimate, lack of access, squatting, hunting and trapping. This paper explores some of the problems of access which trekkers, hikers and tour guides face while traipsing across the Maltese landscape. Special reference is made to the Baħrija area as a case study, and the methodological approach taken in this research is Participatory Research. The overall conclusion is that there are serious issues of access on the islands of Malta, which need to be addressed by the authorities. Decisions need to be made at a national level regarding the balance between privacy and public access, which consider the pressures of individuals, developers and the tourism industry

Beyond Decoding the Disciplines 1.0: New Directions for the Paradigm

  Decoding the Disciplines has emerged as one of the foremost approaches to the scholarship of teaching and learning (SoTL) and is being used to increase learning across the globe. But it is often not recognized that the paradigm has undergone enormous changes since its appearance in 2004. The original model has been clarified and perfected, but scholars of teaching and learning have also expanded the scope of this work to include emotional, bodily, and social learning; created new roles for students in these investigations; and explored learning beyond the individual. Some of these changes have been so far reaching that they may be said to constitute a new version of the paradigm, Decoding 2.0. It is the purpose of this article to provide an overview of this paradigm’s development since it first appeared on the SoTL stage.

Measles is back

Measles is one of the most deadly vaccine preventable diseases. The incidence of measles, and resultant mortality, had dropped drastically following the introduction of widespread measles immunisation since the 1960s. However, there is currently a worldwide surge in measles cases, with a marked increase over the past 3 years. Measles outbreaks and endemic transmission have been re-established in countries which had previously achieved measles elimination. The rise in measles cases has been mainly attributed to a drop in the recommended two dose vaccination schedule below the 95% uptake threshold necessary for interruption of transmission and sustainment of herd protection. This resurgence of measles is largely a result of the damage done by Andrew Wakefield, who in 1998 incorrectly and maliciously suggested a possible link between the measles, mumps and rubella (MMR) vaccine and autism. Such a possible association has subsequently been disproven by several scientifically robust studies. Still, most cases of measles have occurred in unimmunised individuals, mainly teenagers, who had missed out on vaccination in early childhood, and in infants under one year of age, who are too young to be vaccinated. Measles is highly contagious, with up to 18 people being potentially infected from a single case, so containment measures are important to prevent spread. These include isolation and immediate notification of suspected or confirmed cases, as well as wearing appropriate personal protective equipment when in contact with these patients. Health care professionals have a crucial role in promoting measles immunisation, which is the only rational way of preventing measles.peer-reviewe