WHO International Pilot Study of Schizophrenia

The results are described of a transcultural psychiatric study of schizophrenia undertaken by WHO in nine countries. The study proved that such a collaboration was feasible, that it was possible to develop research procedures for international use, and that similar types of schizophrenia could be found in each of the countries involved. One thousand two hundred and two patients were studied and over 2 million items of information obtaine

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery.Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres.Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery.Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 - 0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 - 0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 - 1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 - 0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL.Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation

Meningotheliomatöses Meningeom in einem reifen zystischen Teratom des Ovars

Zusammenfassung: Reife Teratome des Ovars zählen zu den Keimzelltumoren. Sie machen 27-44% aller Neoplasien des Ovars und bis zu 58% der benignen Ovarialtumoren aus. In reifen und unreifen Teratomen können sich sekundäre Tumoren der 3Keimblätter entwickeln. Diese können sowohl benigne als auch maligne sein. Wir berichten über den Fall eines meningotheliomatösen Meningeoms als Anteil eines reifen zystischen Teratoms bei einer 32-jährigen Patientin. Die typische Histomorphologie und die immunhistochemisch nachweisbare Expression von epithelialem Membranantigen (EMA) und Desmoplakin sind diagnostisch wegweisen

Elevated international normalised ratios correlate with severity of injury and outcome

Background. Haemorrhagic shock is the leading cause of preventable early deaths from trauma. Acute coagulopathy on admission to a trauma unit is associated with worse outcomes. The relationship of haemorrhage to early mortality remains consistent regardless of mechanism of injury. Haemorrhage and haemorrhagic shock are increasingly amenable to interventions that result in reductions in morbidity and mortality.Objectives. To assess the prevalence of coagulopathy in patients admitted to the level 1 trauma unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa, and correlate it with in-hospital mortality.Methods. A retrospective analysis of the first 1 000 patients admitted to the trauma unit during the years 2007 - 2011 was performed. The admission international normalised ratios (INRs) were correlated with Injury Severity Scores (ISSs) and in-hospital mortality. A multivariable Poisson model with robust standard errors was used to assess the relationship between coagulopathy and mortality after adjustment for the confounding influence of age and gender. The data were analysed using the R statistics program.Results. Of the 1 000 patients, 752 were male. There were 261 admissions directly from the scene and 739 inter-hospital transfers (nonscene). The mean INRs among survivors for all, scene and non-scene patients were 1.33, 1.30 and 1.34, respectively, and those among non-survivors 1.92, 2.01 and 1.88, respectively (p<0.001). The overall prevalence of coagulopathy was 48.7%, 46.9% in scene patients and 49.2% in non-scene patients. The mortality rate of scene patients with abnormal INR levels was 41.1% (adjusted relative risk (aRR) 3.59, 95% confidence interval (CI) 2.11 - 6.44; p<0.001) v. 25.1% for non-scene patients (aRR 1.67, 95% CI 1.15 - 2.05; p=0.004) (p=0.001).Conclusions. There was a high prevalence of coagulopathy in our study. Raised admission INRs were associated with worse outcomes. There was a direct correlation between the INR and the ISS. INRs may offer predictive capabilities in resource-depleted environments where the ISS is not routinely calculated. Early recognition of acute coagulopathy may help reduce morbidity and mortality

Frequency locking of modulated waves

We consider the behavior of a modulated wave solution to an $\mathbb{S}^1$-equivariant autonomous system of differential equations under an external forcing of modulated wave type. The modulation frequency of the forcing is assumed to be close to the modulation frequency of the modulated wave solution, while the wave frequency of the forcing is supposed to be far from that of the modulated wave solution. We describe the domain in the three-dimensional control parameter space (of frequencies and amplitude of the forcing) where stable locking of the modulation frequencies of the forcing and the modulated wave solution occurs. Our system is a simplest case scenario for the behavior of self-pulsating lasers under the influence of external periodically modulated optical signals

Implementation of REACH in the New Member States - Part two: Business Case Studies in Selected New Member States

This report informs about potential impacts of the European regulation concerning the registration, evaluation, authorisation and restriction of chemicals REACH (Regulation (EC) No 1907/2006) in the New Member States . It consists of two parts: 1) "Implementation of REACH in the New Member States – Part one: overview of the chemical and specialty chemical sector in the New Member States", and 2) "Implementation of REACH in the New Member States – Part two: Business case studies in selected New Member States". The first report gives a general overview of the chemical sector in all New Member States and provides key macroeconomic data for the description of the chemical sector as a whole in each of the countries. This includes the sectors development, major developments including trade with EU-15 and non-EU countries, and a description of sub-sectors according to NACE categories. Furthermore, the first report describes the impact on the chemical industry through the implementation of the Chemicals Acquis and the Accession to the EU, and derives the implications for the adoption of REACH in the New Member States. Finally, the report outlines REACH Impact studies which are available in the New Member States . The second report analyses the ability of specialty chemicals companies in selected countries to implement REACH . This ability is examined on the basis of techno-economic case studies. From the economic aspect, the impact on costs and prices is analysed, substance withdrawal, administrative impact, capacity needs and the competitiveness on European and international markets. From the technological point of view the impact of REACH on innovation, replacement of substances and process adaptation is looked at. The strategic analysis looked at alternatives to cope with REACH (such as the import of components, relocation to non-EU countries etc.), the potential of companies to adapt to the changing legal framework (including the implementation of the environmental acquis) and the relative importance of REACH as one amongst different drivers for change.JRC.J.2-Competitiveness and Sustainabilit

The effects of combined exposure of solvents and noise on auditory function - A systematic review and meta-analysis.

BACKGROUND:  Chemical substances can negatively affect the auditory system. Chemical substances alone or combined with high-level noise have recently become a major concern as a cause of occupational hearing loss. OBJECTIVE:  To assess the combined effect of solvents and noise versus solvents only, or noise only, on the auditory function of workers. METHOD:  Published articles which included noise and/or solvent exposure or combined effects of solvents and noise, studies conducted on human beings only and the use of audiological tests on participants. RESULTS:  Thirteen papers were eligible for inclusion. The participants' ages ranged from 18 to 68 years. Results revealed that 24.5% presented with hearing loss as a result of noise exposure only; 18% presented with hearing loss owing to solvent exposure only; and a total of 43.3% presented with hearing loss owing to combined noise and solvent exposure. Furthermore, the prevalence of hearing loss in the noise and solvent group was significantly (p < 0.001) higher than the other groups in 10 out of the 13 studies analysed, with a pooled odds ratio (OR) of 2.754. Of the 178 participants (total of all participants exposed to solvents), a total of 32 participants presented with auditory pathology as a result of exposure to solvents only. There was a significantly higher pooled odds of hearing loss in noise and solvent-exposed group compared to solvent-only group (pooled OR = 2.15, 95% CI: 1.24-3.72, p = 0.006). CONCLUSION:  The findings revealed significantly higher odds of acquiring hearing loss when workers were exposed to a combination of solvents and noise as opposed to solvents only, motivating for its inclusion into hearing conservation programmes

Topographic mapping of the interfaces between human and aquatic mosquito habitats to enable barrier targeting of interventions against malaria vectors.

Geophysical topographic metrics of local water accumulation potential are freely available and have long been known as high-resolution predictors of where aquatic habitats for immature mosquitoes are most abundant, resulting in elevated densities of adult malaria vectors and human infection burden. Using existing entomological and epidemiological survey data, here we illustrate how topography can also be used to map out the interfaces between wet, unoccupied valleys and dry, densely populated uplands, where malaria vector densities and infection risk are focally exacerbated. These topographically identifiable geophysical boundaries experience disproportionately high vector densities and malaria transmission risk, because this is where mosquitoes first encounter humans when they search for blood after emerging or ovipositing in the valleys. Geophysical topographic indicators accounted for 67% of variance for vector density but for only 43% for infection prevalence, so they could enable very selective targeting of interventions against the former but not the latter (targeting ratios of 5.7 versus 1.5 to 1, respectively). So, in addition to being useful for targeting larval source management to wet valleys, geophysical topographic indicators may also be used to selectively target adult mosquitoes with insecticidal residual sprays, fencing, vapour emanators or space sprays to barrier areas along their fringes

An investigation of the efficiency of South Africa’s sector education and training authorities (SETA’s)

The performance of South African Sector Education and Training Authorities (SETA’s) has been increasingly questioned. On this premise, the paper investigated the efficiency of the SETAs with respect to their utilization of funds in order to promote a range of education and training outputs was investigated. More specifically, the study investigated the quantity and quality of five training and education outputs, set by the National Skills Development Strategy (NSDS), in relation to the funding received. Furthermore, the study examined the amount of money spend on administrative expenditure by the various SETAs, as well as the SETAs management of financial reserves. In order to guide the study, as well as analyze the data, a conceptual framework to measure efficiency was based on an input-output model developed by Gupta and Verhoeven (2001). Data were obtained from the published accounting and annual reports for the period 2006 – 2009. The results indicated only two of the SETA’s were efficient with respect to their utilization of funds and that only five SETA’s consistently met their own targets. The study also shows that if the SETA’ s funds had been applied to education and training outputs, rather than for investment purposes, training outputs could have been considerably increased. The paper has implications for the use of public funds with respect to the critical skills shortage confronting the economy