Disaster scenario simulation of the 2010 cloudburst in Leh, Ladakh, India

Leh district in the Ladakh region of north-western India experienced a disaster when a cloudburst generated debris flows, killed hundreds of people, destroyed houses, and damaged the hospital, communication infrastructure, the bus station, and vital roads. A simulation of the Leh cloudburst disaster analysed the disaster itself, disaster risk reduction plans in the region, gaps in existing response mechanisms and reducing hazard impacts in the future. The participant group comprised academic researchers and industry experts in natural hazards, social vulnerability, engineering, historical and social sciences, education, journalism, disaster management and disaster risk reduction. Many of the participants had extensive local knowledge of Ladakh or comparable neighbouring Himalayan regions. Following the disaster, Leh Autonomous Hill Development Council (LAHDC), produced a District Disaster Management Plan (DDMP), which addressed many of the gaps identified in the simulation. Most importantly, the document outlined a civil protection mechanism to respond to future hazardous events. This was utilised to assess future disaster response in the simulation scenario. From analysis of the scenario simulation, the role of the army was found to be key in minimizing the impact of the 2010 disaster, although in the future, the army may coordinate with the civil protection body as set out in the DDMP. Participants identified the lack of a local formalized civil protection plan as a major vulnerability, and the most vulnerable populations as the migrant communities. The group also discussed evidence of resilience among the population such as the role of monasteries and spirituality in psychological recovery and the impact of the initial local response. From broader discussion of the simulation scenario, it was possible to identify aspects of resilience for further study in a wider research project, such as identifying hazardous slopes from satellite mapping, informing the fieldwork program, designing social questionnaires to understand risk perception and formulating questions to guide focus-group discussions on community resilience

Preventing food allergy: protocol for a rapid systematic review

BACKGROUND: The European Academy of Allergy and Clinical Immunology is developing guidelines about how to prevent and manage food allergy. As part of the guidelines development process, a systematic review is planned to examine published research about the prevention of food allergy. This systematic review is one of seven inter-linked evidence syntheses that are being undertaken in order to provide a state-of-the-art synopsis of the current evidence base in relation to epidemiology, prevention, diagnosis and clinical management, and impact on quality of life, which will be used to inform clinical recommendations. The aim of this systematic review will be to assess the effectiveness of approaches for the primary prevention of food allergy. METHODS: Seven bibliographic databases will be searched from their inception to September 30, 2012 for systematic reviews, randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials, controlled before-and-after studies, interrupted time series and cohort studies. Cohort studies will be included due to an inability to randomize with interventions such as breastfeeding. Studies that focused on the development of either food sensitization (a proxy measure) or food allergy will also be eligible for inclusion. Studies will be critically appraised using the Critical Appraisal Skills Program and Cochrane Risk of Bias tools, as appropriate. DISCUSSION: There is a lack of rigorous evidence to support recommendations about how to prevent the development of food allergy. It would appear that it is important to see the prevention of food allergy in the context of individual, family and wider factors that may influence its development. There is much left to learn about preventing food allergy, and this is a priority given the high societal and healthcare costs involved. This systematic review will help to further this learning

Patient safety in dentistry: development of a candidate 'never event' list for primary care

Introduction The 'never event' concept is often used in secondary care and refers to an agreed list of patient safety incidents that 'should not happen if the necessary preventative measures are in place'. Such an intervention may raise awareness of patient safety issues and inform team learning and system improvements in primary care dentistry. Objective To identify and develop a candidate never event list for primary care dentistry. Methods A literature review, eight workshops with dental practitioners and a modified Delphi with 'expert' groups were used to identify and agree candidate never events. Results Two-hundred and fifty dental practitioners suggested 507 never events, reduced to 27 distinct possibilities grouped across seven themes. Most frequently occurring themes were: 'checking medical history and prescribing' (119, 23.5%) and 'infection control and decontamination' (71, 14%). 'Experts' endorsed nine candidate never event statements with one graded as 'extreme risk' (failure to check past medical history) and four as 'high risk' (for example, extracting wrong tooth). Conclusion Consensus on a preliminary list of never events was developed. This is the first known attempt to develop this approach and an important step in determining its value to patient safety. Further work is necessary to develop the utility of this method

Developing agreement on never events in primary care dentistry:an international eDelphi study

Introduction: Never events (NEs) are a subset of serious patient safety incidents that should not occur if appropriate preventive measures are implemented. Although there is a consensus in medicine, there is no agreement on NEs in dentistry. Aim: To identify NEs in primary care dentistry. Method: We undertook an electronic Delphi exercise to develop an international agreement on NEs for primary care dentistry. Results: We initially identified candidate NEs through a scoping review of the literature and then analysed dentistry-related reports in a national incident reporting system. Next, we invited an international panel of 41 experts to complete two rounds of questionnaires; 32 agreed to participate (78%) and completed the first round and 29/41 (71%) members completed the second round. We provided anonymised controlled feedback between rounds and used a cut-off of 80% agreement to define consensus. Consensus was achieved for 23 out of 42 candidate NEs. These related to routine assessment, and pre-operative, intra-operative and post-operative stages of dental procedures. Discussion and conclusion: To our knowledge, this is the first international expert consensus-based approach that has identified NEs for primary care dentistry. We suggest that dental regulators consider these to support quality assessment and governance activities

Making subaltern shikaris: histories of the hunted in colonial central India

Academic histories of hunting or shikar in India have almost entirely focused on the sports hunting of British colonists and Indian royalty. This article attempts to balance this elite bias by focusing on the meaning of shikar in the construction of the Gond ‘tribal’ identity in late nineteenth and early twentieth-century colonial central India. Coining the term ‘subaltern shikaris’ to refer to the class of poor, rural hunters, typically ignored in this historiography, the article explores how the British managed to use hunting as a means of state penetration into central India’s forest interior, where they came to regard their Gond forest-dwelling subjects as essentially and eternally primitive hunting tribes. Subaltern shikaris were employed by elite sportsmen and were also paid to hunt in the colonial regime’s vermin eradication programme, which targeted tigers, wolves, bears and other species identified by the state as ‘dangerous beasts’. When offered economic incentives, forest dwellers usually willingly participated in new modes of hunting, even as impact on wildlife rapidly accelerated and became unsustainable. Yet as non-indigenous approaches to nature became normative, there was sometimes also resistance from Gond communities. As overkill accelerated, this led to exclusion of local peoples from natural resources, to their increasing incorporation into dominant political and economic systems, and to the eventual collapse of hunting as a livelihood. All of this raises the question: To what extent were subaltern subjects, like wildlife, ‘the hunted’ in colonial India

Endothelin profile in essential hypertension.

Background: Patients with Essential Hypertension have been found to have elevated plasma levels of Endothelin. Objectives: To evaluate the contribution of Endothelin to blood pressure regulation in patients with Essential Hypertension by studying their plasma Endothelin profile. Methods: The study included 50 patients with essential hypertension with a mean age of 52.4±2.1 years. The control group consisted of 25 healthy subjects (mean age, 49.7±2.7 years) Plasma immunoreactive levels of Endothelin (ET-1) were determined by sensitive Enzyme-linked Immunosorbant assay (ELISA). The detection limit for Plasma Endothelin was 1.5pg/ml. Within and between assay coefficients of variation were less than 10%. Assay accuracy was demonstrated by consistent recovery of added ET-1 over the entire physiologic range of Plasma concentration and by the linearity of ET-1 concentration measured in serially diluted plasma extracts. Results: The mean (±SE) plasma Endothelin concentration was 6.0±4.0 pg/ml in normal subjects, with no correlation to age and plasma (P=0.421). In patients with essential hypertension, the mean plasma Endothelin concentration was 11.8±0.6pg/ml; significant correlation was observed between plasma Endothelin and the stage of hypertension (P=0.001) Conclusions: Plasma Endothelin levels are elevated in patients with essential hypertension compared to normal subjects; suggesting that Endothelin is relevant in the development and maintenance of elevated blood pressure. This Pathophysiologic importance of Endothelin in essential hypertension may help in future development of new drugs (Endothelin Receptor Blockers) for optimal management of these patients