Systems Approach to Health-care Waste Management

This thesis attempts to examine the situation of health-care waste management in Guyana using a systems approach and to understand the roles of government in mandating, facilitating, and initiating a reduction of the adverse impacts related to human health and environment. It examines the existing situation of health-care waste management using the principles of the viable system model to guide the analysis and to identify the function(s) and level of interactions among the actors. Health-care waste management is of serious concern in Guyana. Region 4, which includes the capital city of Georgetown, is the largest generator of health-care waste in the country and the country’s largest hospital, the Georgetown Public Hospital Corporation is the main contributor. Moreover, smaller facilities such as Health Centres are widely dispersed throughout the country thereby increasing the risks in the absence of environmentally sound management. The research focused on private and public hospitals and health centres in Georgetown and the rural region of West Demerara. In Guyana waste separation is a recent phenomenon for health-care facilities. However it is limited and depends on awareness and the availability of necessary equipment such as bin liners and sharp boxes. These facilities lack the requisite standards and procedures for waste management. In the absence of treatment, poor handling practices and rudimentary methods for disposal, there are adverse effects on public health and environment. Interventions by government are necessary in order to achieve environmentally benign behaviour. The government has a key role in collaborating with the stakeholders involved in health-care waste management as well as changing behaviour through regulation and increasing the level of awareness. This research therefore concludes the key role of government is to mandate changes through mandatory instruments to immediately address the situation of health-care waste in Guyana

The Interplay of the Oral-Gut Microbiome with Chronic Inflammation in Rheumatoid Arthritis and Crohn\u27s Disease

Abstract Rheumatoid Arthritis (RA) and Crohn’s Disease (CD) are both chronic inflammatory diseases that share developmental and treatment similarities. RA’s symptoms include swelling, stiffness, and pain in synovial joints, corresponding with bone and cartilage destruction. CD’s symptoms include abdominal pain, bowel obstruction, bloating, diarrhea, and fever. The purpose of this literature review was to investigate the links between these two diseases and propose future treatment and prevention targets. Current treatment for RA and CD aims to suppress inflammation by targeting its mediators. However, this review noted that there should be greater focus on resolving inflammation. Both diseases are characterized by the non-resolution of chronic inflammation due to the interplay of specific cytokines (IL-1, IL-6, TNF), which are proteins that function in cell to cell communication, and due to the dysbiosis of the oral and gut microbiome, which involves a compositional change of residing bacteria. Individuals are predisposed to both diseases via heritability and environmental factors, such as smoking. Finally, development and severity of both diseases depend on mutations in specific regulatory genes, such as STAT4 and PTPN2/22. Targeting the influx of immune cells, stimulating pro-resolving mediators such as IL-9 and 10, and restoring eubiosis are possible inflammation-resolving mechanisms. There should also be a movement towards prevention rather than disease intervention. Prevention tactics may include the promotion of oral and gut health, quitting smoking, and screening for genetic susceptibility. Keywords: Rheumatoid Arthritis, Crohn’s Disease, dysbiosis, inflammatio

Sharing-Aware Resource Management Algorithms For Virtual Computing Environments

Virtualization technologies in cloud computing are ubiquitous throughout data centers around the world where providers consider operational costs and fast delivery guarantees for a variety of profitable services. These providers should consistently invoke measures for increasing the efficiencies of their virtualized services in a competitive environment where fast entry to market, technology advancement, and service price differentials separate sustaining providers from antiquated ones. Therefore, providers seeking further efficiencies and profit opportunities should consider how their resources are managed in virtual computing environments which leverage memory reclamation techniques, specifically page-sharing; motivating the design of new memory sharing-aware resource management algorithms. In this dissertation, we design families of offline and online sharing-aware algorithms for resource management in virtual computing environments and investigate their properties and relationships to various sharing models. Our contribution consists of the design of new online and approximation algorithms offering relevant performance guarantees and their applications to next-generation virtualization technologies

An Index to Measure Health Status

In this study we developed a health status index using the commonly recorded health measures by doctors and hospitals. This health status index has a minimum possible value of 7 (the least healthy) and a maximum value of 21 (the healthiest). Using the NHANES data, we explored the relationship of this health status index and nutrient intakes, lifestyle, and demographics of the respondent. Regression results showed that as the age of the respondent, being non-Hispanic black, participants of food stamp programs, high percent of calories that came from fat intakes, high percent of calories in beverages that came from soft drinks, smoking, and on special diets are negatively related to the value of the health status index (i.e., the person became less healthy); household income, college education, eating breakfast, and the amount of exercise are positively related value of the health status index (the person became healthier). These results indicate that the health status index developed in this study had the desired properties.health index, HNANES, nutrients, Food Consumption/Nutrition/Food Safety,

Surgical approaches to apical thoracic malignancies

ObjectiveSeveral surgical approaches have been described to access apical thoracic malignancies extending into the thoracic inlet. However, most publications have focused on a specific approach and considered the thoracic inlet as 1 entity. In the present analysis, we divided the thoracic inlet into 5 different zones requiring specific surgical considerations to identify the best approach for each zone.MethodsA review of 22 consecutive patients undergoing surgery for apical thoracic malignancies extending into the thoracic inlet from January 2005 to November 2011 was performed.ResultsDifferent surgical approaches were used for each zone. The first (anterolateral) zone required a subclavicular approach to open the costoclavicular space and expose the subclavian vein with or without elevating or removing the clavicle (n = 4). The second (anterocentral) zone required a transverse supraclavicular approach with or without extension to a partial (trapdoor) or full sternotomy (n = 10). The third (posterosuperior) zone located between the top of the subclavian artery and the T1 vertebra along the posterior superior border of the first rib was the most difficult area to access (n = 5). The transclavicular approach was ideally suited to expose this zone in our experience. The fourth (posteroinferior) zone and fifth (inferolateral) zone located posteriorly and laterally along the inferior border of the first rib were accessed using a posterolateral and posterotransaxillary approach, respectively (n = 3).ConclusionsThe thoracic inlet could be divided into 5 zones requiring specific surgical considerations and different approaches. Division of the thoracic inlet into these zones could provide more clarity and guidance for thoracic surgeons to select the correct surgical approach

Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study

Journal ArticleIntroduction: Considerable variability exists in the management of thoracolumbar (TL) spine injuries. Although there are many influences, one significant factor may be the treating surgeon's specialty and training (ie, orthopedic surgery vs. neurosurgery). Our objective was to assess the agreement between spinal orthopedic and neurologic surgeons in rating the severity of TL spine injuries with a new treatment algorithm. This information could be important in establishing consensus-based protocols for managing these challenging injuries. Methods: Twenty-eight spinal surgeons (8 neurosurgeons and 20 orthopedic surgeons) reviewed 56 TL injury case histories. Each case was classified and scored according to the TL injury severity score (TLISS). The case histories were reordered and the physicians repeated the exercise 3 months later. At both intervals the surgeons were asked if they agreed with the final treatment recommendation of the TLISS algorithm. The reliability and decision validity of the TLISS was compared. Results: Between-group interrater reliability was similar to within group reliabilities. Intrarater reliability was also similar between groups. The between speciality interrater reliability of the TLISS management recommendation was moderate (74% agreement, k=0.532). Orthopedic and neurosurgeons agreed with the TLISS management recommendation 91.4% and 94.4% of the time, respectively. Conclusions: The TLISS demonstrated good reliability in terms of intraobserver and interobserver agreement on the algorithmic treatment recommendations. The recommendation for operation seems to be consistent between fellowship-trained orthopedic and neurosurgical spine surgeons. This type of classification system may reduce the existing variability and initial management decision for treatment of TL injuries

Whole genomewide linkage screen for neural tube defects reveals regions of interest on chromosomes 7 and 10

Neural tube defects (NTDs) are the second most common birth defects (1 in 1000 live births) in the world. Periconceptional maternal folate supplementation reduces NTD risk by 50–70%; however, studies of folate related and other developmental genes in humans have failed to definitively identify a major causal gene for NTD. The aetiology of NTDs remains unknown and both genetic and environmental factors are implicated. We present findings from a microsatellite based screen of 44 multiplex pedigrees ascertained through the NTD Collaborative Group. For the linkage analysis, we defined our phenotype narrowly by considering individuals with a lumbosacral level myelomeningocele as affected, then we expanded the phenotype to include all types of NTDs. Two point parametric analyses were performed using VITESSE and HOMOG. Multipoint parametric and nonparametric analyses were performed using ALLEGRO. Initial results identified chromosomes 7 and 10, both with maximum parametric multipoint lod scores (Mlod) >2.0. Chromosome 7 produced the highest score in the 24 cM interval between D7S3056 and D7S3051 (parametric Mlod 2.45; nonparametric Mlod 1.89). Further investigation demonstrated that results on chromosome 7 were being primarily driven by a single large pedigree (parametric Mlod 2.40). When this family was removed from analysis, chromosome 10 was the most interesting region, with a peak Mlod of 2.25 at D10S1731. Based on mouse human synteny, two candidate genes (Meox2, Twist1) were identified on chromosome 7. A review of public databases revealed three biologically plausible candidates (FGFR2, GFRA1, Pax2) on chromosome 10. The results from this screen provide valuable positional data for prioritisation of candidate gene assessment in future studies of NTDs

Identifcation and Characterization of Inerolysin, the Cholesterol Dependent Cytolysin Produced by Lactobacillus Iners

Lactobacillus iners, is a gram positive organism recently identified through the use of culture independent techniques. Identified as a major constituent of the vaginal microbiota, epidemiological studies have suggested that this organism may not provide the protective effects ascribed to other vaginal lactobacilli. Our work here has identified and characterized a pore forming toxin, Inerolysin, produced by this organism. This pore forming toxin was present in all strains of L. iners tested and possessed characteristics which firmly categorize it as a member of the Cholesterol Dependent Cytolsin superfamily. Additionally, we identified pH as a regulatory factor for the activity of Inerolysin as well as other CDCs. Inerolysin was shown to had optimal activity at acidic pH, while other toxins such as pneumolysin and arcanolysin had optimal activity at basic pH. We demonstrate that pH induced changes in activity were reversible, suggesting that a reversible conformational change takes place in the protein. Furthermore, our results show that it is the last step in pore formation, the transition from pre-pore to pore, which is impaired. Our attempts to localize this to particular residues were unsuccessful. Finally, we sought to understand what the vaginal environment of a Lactobacillus dominated flora would look like. We demonstrate that L. iners induced unique signaling in the vaginal epithelium, leading to the production of a unique profile of proinflammatory cytokines as well as antimicrobial peptides. We further demonstrate that some of these responses are mediated by the activity of the pore forming toxin of L. iners, Inerolysin