Proboscis lateralis: A rare facial anomaly

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Engineering Secure Adaptable Web Services Compositions

Service-oriented architecture defines a paradigm for building applications by assembling autonomous components such as web services to create web service compositions. Web services are executed in complex contexts where unforeseen events may compromise the security of the web services composition. If such compositions perform critical functions, prompt action may be required as new security threats may arise at runtime. Manual interventions may not be ideal or feasible. To automatically decide on valid security changes to make at runtime, the composition needs to make use of current security context information. Such security changes are referred to as dynamic adaptation. This research proposes a framework to develop web services compositions that can dynamically adapt to maintain the same level of security when unforeseen security events occur at runtime. The framework is supported by mechanisms that map revised security requirements arising at runtime to a new security configuration plan that is used to adapt the web services composition

Oral midazolam in paediatric premedication

In a premedication study involving 135 children, aged 1 - 10 years, four regimens were investigated: (I) no premedication; (il) oral trimeprazine tartrate 2 mg/kg, methadone 0,1 mg/kg, droperidol 0,15 mg/kg (TMD); (iil) intramuscular midazolam . (Dormicum; Roche) 0,15 mg/kg; and (iv) oral midazolam 0,45 mg/kg. All premedications were given 60 'minutes before a standard halothane anaesthetic. No impairment of cardiovascular stability occurred but after premedication the mean oxygen saturation decreased by 1,6% and 1,1%, respectively, in the intramuscular midazolam and TMDgroups. Overall, children under 5 years of age behaved less satisfactorily in the holding room and at induction, than those over 5 years (P < 0,01). Midazolam, intramuscularty and orally, produced more satisfactory behaviour than the other two regimens (P< 0,05) and, combined with a 70% more rapid recovery than the TMD regimen (P < 0,05), suggests that oral midazolam is a more effective paediatric premedication agent than placebo orTMD

Creative strategies to support student learning through reflection

Reflective practice has become a key attribute of promoting quality teaching and learning. Learning is an active process and include reflective writing, visualising and verbalising to promote critical thinking. In our experience most often than not superficial reflective writing is used. We explored the design of opportunities for students to engage in critical reflection. Theoretical data were obtained through in-depth exploration of the literature to allow contextualisation while arguing a case. A qualitative approach was used. Judgements were not made about the measured quality of reported findings, but on the relevance of reflective strategies to support students, enhance critical reflection and transform practice. Combined with narration and dialogue, reflection can bridge the gap between theoretical ideals and realities of the practice context. Four reflective activities have been identified that could be used to engage students in critical reflection

The 2013 clinical course descriptors for multiple sclerosis: A clarification

The clinical courses of multiple sclerosis were defined in 1996 and refined in 2013 to provide a time-based assessment of the current status of the individual. These definitions have been successfully used by clinicians, clinical trialists, and regulatory authorities. Recent regulatory decisions produced variations and discrepancies in the use of the clinical course descriptions. We provide here a clarification of the concepts underlying these descriptions and restate the principles used in their development. Importantly, we highlight the critical importance of time framing the disease course modifiers activity and progression and clarify the difference between the terms worsening and progressing

Public health lessons from a pilot programme to reduce mother-to-child transmission of HIV-1 in Khayelitsha

Objective. Short-course antiretroviral therapy (ART) has been shown to be effective in reducing mother-to-child transmission (MTCT) of HIV-1. This article details the public health lessons learnt from a district-based pilot programme where a short-murse zidovudine (ZDV) regimen has been used in a typical South African peri-urban setting.Methods. The pilot programme was initiated at two midwife obstetric units in January 1999. Lay counsellors conducted pre- and post-test counselling and nurses took blood for HIV enzyme-linked imrnunosorbent assay (EUSA) testing. Shortcourse ZDV was administered antenatally (from 36 weeks gestation) and during labour. Mother-infant pairs were followed up at eight child health clinics where free formula feed was dispensed weekly. Infants received co-trimoxazole prophylaxis and were EUSA tested for HIV at 9 and 18 months. After 17 months protocol changes aimed at eliminating weaknesses included initiation of ZDV at 34 weeks, self-administration of the first dose of ZDV with the onset of labour, and rapid HIV testing for both mothers and infants.Results. Voluntary counselling and testing was shown to be highly acceptable, with individual counselling more effective than group counselling. Based on less than optimal availability of records, ZDV utilisation was encouraging with up to 59% of subjects initiating treatment, 3 weeks' median duration of ZDV use, and up to 88% receiving at least one intrapartum ZDV dose. Self-administration of the intrapartum dose reached 41%.Conclusions. Short-course antenatal and intrapartum ART to prevent MTCT of HIV1 was shown to be feasible

Progressive MS Alliance Industry Forum: maximizing collective impact to enable drug development

The Progressive MS Alliance Industry Forum describes a new approach to address barriers to developing treatments for progressive multiple sclerosis (MS). This innovative model promises to facilitate robust collaboration between industry, academia, and patient organizations and accelerate research towards the overarching goal of developing safe and effective treatments for progressive MS

The South African child death review pilot: A multiagency approach to strengthen healthcare and protection for children

Background. Child mortality trends in South Africa (SA) show a decrease, but remain high and appear to have plateaued. To attain the new sustainable development goals, we need a better understanding of causes of death and the associated factors.Objectives. To describe the SA child death review (CDR) pilot, the pattern of child deaths reviewed and the factors associated with these deaths.Methods. CDR teams were established at two pilot sites, Salt River mortuary (Western Cape Province) and Phoenix mortuary (KwaZulu-Natal Province). All child deaths were reviewed by a multidisciplinary team at the pilot sites for the period 1 January 2014 - 31 December 2014.Results. The CDR pilot reviewed 711 cases. Over half (53.3%) were natural deaths, as opposed to 42.6% non-natural deaths. Most infant deaths (83.9%) were due to natural causes, while 91.7% of deaths in the 15 - 17-year-old age group were due to injuries. The leading cause of deaths reviewed (30.8%) was respiratory tract infection (RTI), mainly among infants (51.6%). Homicide was the second most common cause of death and affected children of all ages, with the highest burden (52.8%) in the 15 - 17-year age group. Child abuse and neglect accounted for 11.3% of deaths. RTI was shown to be more likely after the neonatal period (odds ratio (OR) 2.92; p<0.000) and in preterm infants (OR 1.98; p=0.005).Conclusions. CDR teams have been effective in improving identification of the causes of out-of-hospital deaths, as well as by identifying remediable factors critical to reducing child deaths further

Moral distress among critical care nurses when excecuting do-not-resuscitate (DNR) orders in a public critical care unit in Gauteng

Background. A critical care unit admits on a daily basis patients who are critically ill or injured. The condition of these patients’ may deteriorate to a point where the medical practitioner may prescribe or decide on a ‘do not resuscitate’ (DNR) order which must be executed by a professional nurse, leading to moral distress which may manifest as poor teamwork, depression or absenteeism. Objective. To explore and describe factors contributing to moral distress of critical care nurses executing DNR orders. Design. The explorative descriptive qualitative design was selected to answer the research questions posed. Methods. Critical care nurses of a selected public hospital in Gauteng Province were selected via purposive sampling to participate in the study, and data were collected through semi-structured interviews. Participants. A shift leader assisted with selection of participants who met the eligibility criteria. The mean age of the participants was 36 years; most of them had more than five years’ critical care nursing experience. Twelve critical care nurses were interviewed when data saturation was reached. Thereafter two more interviews were conducted to confirm data saturation. A total of 14 interviews were conducted. Results. Tesch’s eight-step method was utilised for data analysis. The findings were classified under three main themes: moral distress, communication of DNR orders and unavailability of psychological support for nurses. Conclusion. The findings revealed that execution of DNR orders is a contributory factor for moral distress in critical care nurses. National guidelines and/or legal frameworks are required to regulate processes pertaining to the execution of DNR orders. The study further demonstrated the need for unit-based ethical platforms and debriefing sessions for critical care nurses