Extreme Risk Makes the Journey Feasible: Decision-Making amongst Migrants in the Horn of Africa

Abstract This article explores how some potential migrants in the Horn of Africa incorporate the prospects of extreme danger into their journeys. It draws on evidence from qualitative interviews and focus group discussions with over 400 respondents, mainly from Ethiopian and Somali communities. It shows that the risks of migration within the Horn of Africa are often well known, thanks to strong migrant networks and improved mobile communications. Indeed, migrants may be better informed of the risks of the journey than they are about their prospects of securing a good living upon arrival. However, rather than discouraging people’s migration, high risk may open up new possibilities. This article supports this argument with two examples. First, as Yemen descended into civil war, the breakdown of state control created new opportunities to move undetected, notwithstanding the threat of injury and death. This helps explain why the number of Ethiopians passing through Yemen increased with the conflict, contrary to expectations. Second, some young Somalis are soliciting the services of smugglers to help them move towards Europe, knowing that they are likely to be abused and held for ransom en route. They gamble on their captors’ demands being met by family members, who would not otherwise have endorsed or paid for their journey. These findings challenge common assumptions about risk and decision-making, and suggests that some migrants may move because of, rather than in spite of, the risks involved. It also calls into question initiatives that seek to deter migration by raising awareness about the risks of the journey

An unusual cause of hypoxia: getting to the heart of the matter

A 63-year-old female presented to hospital with progressive exertional dyspnoea over a 6-month period. In the year preceding her admission, she reported an intercurrent history of abdominal pain, diarrhoea and weight loss. She was found to be hypoxic, the cause for which was initially unclear. A ventilation–perfusion scan identified a right-to-left shunt. Transoesophageal echocardiography (TOE) demonstrated a significant right-to-left intracardiac shunt through a patent foramen ovale (PFO); additionally severe tricuspid regurgitation was noted through a highly abnormal tricuspid valve. The findings were consistent with carcinoid heart disease with a haemodynamically significant shunt, resulting in profound systemic hypoxia. 24-h urinary 5-hydroxyindoleacetic acid (5-HIAA) and imaging were consistent with a terminal ileal primary carcinoid cancer with hepatic metastasis. Liver biopsy confirmed a tissue diagnosis. The patient was commenced on medical therapy for carcinoid syndrome. She subsequently passed away while undergoing anaesthetic induction for valvular surgery to treat her carcinoid heart disease and PFO

Fractional exhaled nitric oxide in the assessment of exercise- induced bronchoconstriction: A multicenter retrospective analysis of UK- based athletes

Introduction: Exercise-induced bronchoconstriction (EIB) is not only highly prevalent in people with asthma, but can also occur independently, particularly in athletes. Fractional exhaled nitric oxide (FeNO) is an indirect biomarker of type 2 airway inflammation that has an established role in the assessment and management of asthma. The aim was to evaluate the value of FeNO in the assessment of EIB in athletes. Method: Multicenter retrospective analysis. In total, 488 athletes (male: 76%) performed baseline FeNO, and spirometry pre- and post-indirect bronchial provocation via eucapnic voluntary hyperpnea (EVH). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for established FeNO thresholds—that is, intermediate (≥25ppb) and high FeNO (≥40ppb and≥50ppb)—and were evaluated against objective evidence of EIB (≥10% fall in FEV1). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC-AUC). Results: Thirty-nine percent of the athletes had a post-EVH fall in FEV1 consistent with EIB. FeNO values ≥25ppb, ≥40ppb, and≥50ppb were observed in 42%, 23%, and 17% of the cohort, respectively. The sensitivity of FeNO ≥25ppb was 55%, which decreased to 37% and 27% at ≥40ppb and≥50ppb, respectively. The specificity of FeNO ≥25ppb, ≥40ppb, and≥50ppb was 66%, 86%, and 89%, respectively. The ROC-AUC for FeNO was 0.656. Conclusions: FeNO ≥40ppb provides good specificity, that is, the ability to rulein a diagnosis of EIB. However, due to the poor sensitivity and predictive values, FeNO should not be employed as a replacement for indirect bronchial provocation in athletes

Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure

Resting echocardiography measurements are poor predictors of exercise capacity and symptoms in patients with heart failure (HF). Stress echocardiography may provide additional information and can be expressed using left ventricular ejection fraction (LVEF), or diastolic parameters (E/E′), but LVEF has some major limitations. Systolic annular velocity (S′) provides a measure of longitudinal systolic function, which is relatively easy to obtain and shows a good relationship with exercise capacity. The objective of this study was to investigate the relationship among S′, E/E′ and LVEF obtained during stress echocardiography and both mortality and hospitalisation. A secondary objective was to compare S′ measured using a simplified two-wall model. A total of 80 patients with stable HF underwent exercise stress echocardiography and simultaneous cardiopulmonary exercise testing. Volumetric and tissue velocity imaging (TVI) measurements were obtained, as was peak oxygen uptake (VO(2) peak). Of the total number of patients, 11 died and 22 required cardiac hospitalisation. S′ at peak exertion was a powerful predictor for death and hospitalisation. Cut-off points of 5.3 cm/s for death and 5.7 cm/s for hospitalisation provided optimum sensitivity and specificity. This study suggests that, in patients with systolic HF, S′ at peak exertion calculated from the averaged spectral TVI systolic velocity of six myocardial segments, or using a simplified measure of two myocardial segments, is a powerful predictor of future events and stronger than LVEF, diastolic velocities at rest or exercise and VO(2) peak. Results indicate that measuring S′ during exercise echocardiography might play an important role in understanding the likelihood of adverse clinical outcomes in patients with HF

Fractional exhaled nitric oxide in the assessment of exercise-induced bronchoconstriction: A multicenter retrospective analysis of UK-based athletes

Introduction: Exercise-induced bronchoconstriction (EIB) is not only highly prevalent in people with asthma, but can also occur independently, particularly in athletes. Fractional exhaled nitric oxide (FeNO) is an indirect biomarker of type 2 airway inflammation that has an established role in the assessment and management of asthma. The aim was to evaluate the value of FeNO in the assessment of EIB in athletes. Method: Multicenter retrospective analysis. In total, 488 athletes (male: 76%) performed baseline FeNO, and spirometry pre- and post-indirect bronchial provocation via eucapnic voluntary hyperpnea (EVH). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for established FeNO thresholds—that is, intermediate (≥25 ppb) and high FeNO (≥40 ppb and ≥ 50 ppb)—and were evaluated against objective evidence of EIB (≥10% fall in FEV1). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC-AUC). Results: Thirty-nine percent of the athletes had a post-EVH fall in FEV1 consistent with EIB. FeNO values ≥25 ppb, ≥40 ppb, and ≥ 50 ppb were observed in 42%, 23%, and 17% of the cohort, respectively. The sensitivity of FeNO ≥25 ppb was 55%, which decreased to 37% and 27% at ≥40 ppb and ≥ 50 ppb, respectively. The specificity of FeNO ≥25 ppb, ≥40 ppb, and ≥ 50 ppb was 66%, 86%, and 89%, respectively. The ROC-AUC for FeNO was 0.656. Conclusions: FeNO ≥40 ppb provides good specificity, that is, the ability to rule-in a diagnosis of EIB. However, due to the poor sensitivity and predictive values, FeNO should not be employed as a replacement for indirect bronchial provocation in athletes

The longitude problem from the 1700s to today: An international and general education physics course

For instructors wishing to use physics as part of an international or general education course, the framework for a course based on the “longitude problem” from the 1700s is described. The longitude problem is teeming with basic principles of physics and astronomy, which makes it ideal for a non-science-major-based college-level course. This paper summarizes the longitude problem in the context of conceptual physics and astronomy and outlines an appropriate curriculum. Specifics on teaching such a course in London, as part of an international studies program, are discussed