Low and deficient niacin status and pellagra are endemic in postwar Angola

BACKGROUND: Outbreaks of pellagra were documented during the civil war in Angola, but no contemporary data on the incidence of pellagra or the prevalence of niacin deficiency were available. OBJECTIVE: The objective was to investigate the incidence of pellagra and the prevalence of niacin deficiency in postwar Angola and their relation with dietary intake, poverty, and anthropometric status. DESIGN: Admissions data from 1999 to 2004 from the pellagra treatment clinic in Kuito, Angola, were analyzed. New patients admitted over 1 wk were examined, and urine and blood samples were collected. A multistage cluster population survey collected data on anthropometric measures, household dietary intakes, socioeconomic status, and clinical signs of pellagra for women and children. Urinary excretion of 1-methylnicotinamide, 1-methyl-2-pyridone-5-carboxymide, and creatinine was measured and hemoglobin concentrations were measured with a portable photometer. RESULTS: The incidence of clinical pellagra has not decreased since the end of the civil war in 2002. Low excretion of niacin metabolites was confirmed in 10 of 11 new clinic patients. Survey data were collected for 723 women aged 15-49 y and for 690 children aged 6-59 mo. Excretion of niacin metabolites was low in 29.4% of the women and 6.0% of the children, and the creatinine-adjusted concentrations were significantly lower in the women than in the children (P < 0.001, t test). In children, niacin status was positively correlated with the household consumption of peanuts (r = 0.374, P = 0.001) and eggs (r = 0.290, P = 0.012) but negatively correlated with socioeconomic status (r = -0.228, P = 0.037). CONCLUSIONS: The expected decrease in pellagra incidence after the end of the civil war has not occurred. The identification of niacin deficiency as a public health problem should refocus attention on this nutritional deficiency in Angola and other areas of Africa where maize is the staple

Cateterização venosa central guiada por ultrassom --- abordagem ‘‘Syringe-Free’’

Background and objectives Central venous catheterization of the internal jugular vein is a commonly performed invasive procedure associated with a significant morbidity and even mortality. Ultrasound-guided methods have shown to significantly improve the success of the technique and are recommended by various scientific societies, including the American Society of Anesthesiologists. The aim of this report is to describe an innovative ultrasound-guided central line placement of the internal jugular vein. Technique The authors describe an innovative ultrasound-guided central line placement of the internal jugular vein based on an oblique approach – the “Syringe-Free” approach. This technique allows immediate progression of the guide wire in the venous lumen, while maintaining a real-time continuous ultrasound image. Conclusions The described method adds to the traditional oblique technique the possibility of achieving a continuous real-time ultrasound-guided venipuncture and a guide wire insertion that does not need removing the probe from the puncture field, while having a single operator performing the whole procedure

Experiência no curso de estudantes de 1º ano – um estudo no âmbito das tutorias de acompanhamento na Universidade de Évora

O presente estudo pretende conhecer a experiência no curso de estudantes de 1º ano que ingressaram na Universidade de Évora no final do 1º semestre. Estudos realizados sobre a percepção dos estudantes relativa ao contexto de aprendizagem no ensino superior indicam forte relação com as abordagens à aprendizagem e apresentam forte relevância para a compreensão da forma como os estudantes acedem ao conhecimento e para a definição de processos de aprendizagem de elevada qualidade (Entwistle, 2009; Chaleta & Entwistle, 2011). Os dados foram obtidos através da aplicação do CEQP (Ramsden, 2005; 2006; Chaleta et al, 2012) com 565 estudantes de diferentes cursos e áreas científicas. Os resultados indicaram que a experiência no curso é positiva para o conjunto dos estudantes havendo necessidade de observar com mais atenção as questões relacionadas com a avaliação. A grande maioria dos estudantes revela também satisfação com o curso que frequenta. Palavras-Chave: Experiência no Curso; Tutorias de Acompanhamento; CEQP; Ensino Superior. Abstract This study examine the experience in the course of the 1st year students who entered at the University of Évora. Studies on the perception of students on the learning environment in higher education indicate a strong relationship with the approaches to learning and have strong relevance to the understanding how students access the knowledge and the definition of high quality learning processes (Entwistle, 2009; Chaleta & Entwistle, 2011). The data were obtained by applying the CEQP (Ramsden, 2005, 2006; Chaleta et al, 2012) with 565 students from different courses and scientific areas. The results indicated that the course experience is positive for all the students but we need to look more closely at the issues related to assessment. The vast majority of students also reveals satisfaction with the course who attends Keywords: Course Experience; Mentor Monitoring; CEQP; Higher Education

Exchange Communication Point Modeling in the context of the Enterprise Architecture

It is important to understand the performance and operation of an Internet Exchange Point to improve the management, and to reduce the cost associated with implementation and the information shared. Enterprise Architecture supports the design of systems, according to the business domain processes, network infrastructure and all the different applications running. Existing Enterprise Architecture modelling languages only provide a general concept of a network and do not represent specific information such as the protocols used, the internet protocols or the network addresses used for sharing information. This paper proposes a set of new concepts and attributes to the technology layer of reference language (ArchiMate) to enhance the representation and management of the network infrastructure. The ArchiMate language extensions are then used in modelling two Case Studies of Internet Exchange Point implementation in the Portuguese Public Administration. It was possible to compute which services will have impact in case of failure

Component redundancy allocation in optimal cost preventive maintenance scheduling

This work presents a methodology to assist maintenance teams in defining the maintenance schedule and redundancy allocation that minimise the life-cycle average cost of a system. The minimal data required are three average costs and one reliability function. This methodology is useful in a system design phase, since in this situation data is usually scarce or inaccurate, but can also be applied in the exploration phase. It consists of an adaptation of the classical optimal age replacement method, combined with a redundancy allocation problem. A set of simple illustrative examples covering a variety of operating conditions is presented, demonstrating quantitatively the applicability of the methodology to a range of maintenance optimisation decisions

A new laser Doppler flowmeter prototype for depth dependent monitoring of skin microcirculation

Laser Doppler flowmetry (LDF) is now commonly used in clinical research to monitor microvascular blood flow. However, the dependence of the LDF signal on the microvascular architecture is still unknown. That is why we propose a new laser Doppler flowmeter for depth dependent monitoring of skin microvascular perfusion. This new laser Doppler flowmeter combines for the first time, in a device, several wavelengths and different spaced detection optical fibres. The calibration of the new apparatus is herein presented together with in vivo validation. Two in vivo validation tests are performed. In the first test, signals collected in the ventral side of the forearm are analyzed; in the second test, signals collected in the ventral side of the forearm are compared with signals collected in the hand palm. There are good indicators that show that different wavelengths and fibre distances probe different skin perfusion layers. However, multiple scattering may affect the results, namely the ones obtained with the larger fibre distance. To clearly understand the wavelength effect in LDF measurements, other tests have to be performed

What elements of a systems approach to bereavement are most effective in times of mass bereavement?:A narrative systematic review with lessons for COVID-19

Background: The global COVID-19 pandemic has left health and social care systems facing the challenge of supporting large numbers of bereaved people in difficult and unprecedented social conditions. Previous reviews have not comprehensively synthesised the evidence on the response of health and social care systems to mass bereavement events. Aim: To synthesise the evidence regarding system-level responses to mass bereavement events, including natural and human-made disasters as well as pandemics, to inform service provision and policy during the COVID-19 pandemic and beyond. Design: A rapid systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively (www.crd.york.ac.uk/prospero, CRD 42020180723). Data sources: MEDLINE, Global Health, PsycINFO and Scopus databases were searched for studies published between 2000 and 2020. Reference lists were screened for further relevant publications, and citation tracking was performed. Results: Six studies were included reporting on system responses to mass bereavement following human-made and natural disasters, involving a range of individual and group-based support initiatives. Positive impacts were reported, but study quality was generally low and reliant on data from retrospective evaluation designs. Key features of service delivery were identified: a proactive outreach approach, centrally organised but locally delivered interventions, event-specific professional competencies and an emphasis on psycho-educational content. Conclusion: Despite the limitations in the quantity and quality of the evidence base, consistent messages are identified for bereavement support provision during the pandemic. High quality primary studies are needed to ensure service improvement in the current crisis and to guide future disaster response efforts

Observed development of the vertical structure of the marine boundary layer during the LASIE experiment in the Ligurian Sea

In the marine environment, complete datasets describing the surface layer and the vertical structure of the Marine Atmospheric Boundary Layer (MABL), through its entire depth, are less frequent than over land, due to the high cost of measuring campaigns. During the seven days of the Ligurian Air-Sea Interaction Experiment (LASIE), organized by the NATO Undersea Research Centre (NURC) in the Mediterranean Sea, extensive in situ and remote sensing measurements were collected from instruments placed on a spar buoy and a ship. Standard surface meteorological measurements were collected by meteorological sensors mounted on the buoy ODAS Italia1 located in the centre of the Gulf of Genoa. The evolution of the height (&lt;I&gt;z&lt;sub&gt;i&lt;/sub&gt;&lt;/I&gt;) of the MABL was monitored using radiosondes and a ceilometer on board of the N/O Urania. &lt;br&gt;&lt;br&gt; Here, we present the database and an uncommon case study of the evolution of the vertical structure of the MABL, observed by two independent measuring systems: the ceilometer and radiosondes. Following the changes of surface flow conditions, in a sequence of onshore – offshore – onshore wind direction shifting episodes, during the mid part of the campaign, the overall structure of the MABL changed. Warm and dry air from land advected over a colder sea, induced a stably stratified Internal Boundary Layer (IBL) and a consequent change in the structure of the vertical profiles of potential temperature and relative humidity

De la visibilité à la lisibilité : le tourisme domestique en Asie

Du fait d’une focalisation sur le tourisme international occidental, l’ampleur du tourisme domestique est longtemps restée ignorée dans les pays dits du Sud. L’enjeu est pourtant d’importance en particulier en Asie, eu égard aux masses mobilisées, à la signification que revêtent ces nouvelles mobilités et aux formes touristiques auxquelles elles donnent lieu, celles-ci relevant d’une hybridation complexe entre intégration de pratiques et de lieux occidentaux et invention de formes spécifiques