Pattern and Outcome of Chest Injuries at Bugando Medical Centre in Northwestern Tanzania.

Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P < 0.001), whereas mortality was significantly associated with pre-morbid illness, associated injuries, trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P < 0.001). Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region

Impact of culture towards disaster risk reduction

Number of natural disasters has risen sharply worldwide making the risk of disasters a global concern. These disasters have created significant losses and damages to humans, economy and society. Despite the losses and damages created by disasters, some individuals and communities do not attached much significance to natural disasters. Risk perception towards a disaster not only depends on the danger it could create but also the behaviour of the communities and individuals that is governed by their culture. Within this context, this study examines the relationship between culture and disaster risk reduction (DRR). A comprehensive literature review is used for the study to evaluate culture, its components and to analyse a series of case studies related to disaster risk. It was evident from the study that in some situations, culture has become a factor for the survival of the communities from disasters where as in some situations culture has acted as a barrier for effective DRR activities. The study suggests community based DRR activities as a mechanism to integrate with culture to effectively manage disaster risk

Everyday vulnerabilities and ''social dispositions'' in the Malian Sahel, an indication for evaluating future adaptability to water crises?

International audienceSince the 1970s, precipitation in the Sahel has decreased and become very irregular, leading to widespread drought, whilst the human need for water has rapidly increased. A new ''dispositions''-based approach was adapted in order to analyse human interactions with environmental hazards and applied to the case of Hombori village in northeastern Mali. This article explores how the population and political stakeholders perceive, live with and respond to the increasing scarcity of water. It also explores how their current vulnerability and ability to cope with variations in available water resources indicate future adaptability to climate shocks. On the one hand, this research shows how the population copes with variations in water resource availability: the population's socio-spatial organisation explains the inhabitants' exposure to this problem and some of the factors affecting vulnerability, the elderly and women being the hardest hit. The water issue is generally managed on a ''day-to-day'' basis and considered a big problem only in the dry season, thus lowering any incentive for self-protection. The main two variables that could explain this kind of risk management are the conflicting local governance and current social rules. On the other hand, the discussion of results, based on a conceptual model of social responses, explains why these current ''social dispositions'' to cope with and even address the water scarcity issue do not guarantee future adaptability to climate change

I will not go, I cannot go: cultural and social limitations of disaster preparedness in Asia, Africa, and Oceania

While much work has been invested in addressing the economic and technical basis of disaster preparedness, less effort has been directed towards understanding the cultural and social obstacles to and opportunities for disaster risk reduction. This paper presents local insights from five different national settings into the cultural and social contexts of disaster preparedness. In most cases, an early warning system was in place, but it failed to alert people to diverse environmental shocks. The research findings show that despite geographical and typological differences in these locations, the limitations of the systems were fairly similar. In Kenya, people received warnings, but from contradictory systems, whereas in the Philippines and on the island of Saipan, people did not understand the messages or take them seriously. In Bangladesh and Nepal, however, a deeper cultural and religious reasoning serves to explain disasters, and how to prevent them or find safety when they strike

Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium

Background The perinatal period is a time of high risk for onset of depressive disorders and is associated with substantial morbidity and mortality, including maternal suicide. Perinatal depression comprises a heterogeneous group of clinical subtypes, and further refinement is needed to improve treatment outcomes. We sought to empirically identify and describe clinically relevant phenotypic subtypes of perinatal depression, and further characterise subtypes by time of symptom onset within pregnancy and three post-partum periods. Methods Data were assembled from a subset of seven of 19 international sites in the Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. In this analysis, the cohort was restricted to women aged 19–40 years with information about onset of depressive symptoms in the perinatal period and complete prospective data for the ten-item Edinburgh postnatal depression scale (EPDS). Principal components and common factor analysis were used to identify symptom dimensions in the EPDS. The National Institute of Mental Health research domain criteria functional constructs of negative valence and arousal were applied to the EPDS dimensions that reflect states of depressed mood, anhedonia, and anxiety. We used k-means clustering to identify subtypes of women sharing symptom patterns. Univariate and bivariate statistics were used to describe the subtypes. Findings Data for 663 women were included in these analyses. We found evidence for three underlying dimensions measured by the EPDS: depressed mood, anxiety, and anhedonia. On the basis of these dimensions, we identified five distinct subtypes of perinatal depression: severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia, and resolved depression. These subtypes have clear differences in symptom quality and time of onset. Anxiety and anhedonia emerged as prominent symptom dimensions with post-partum onset and were notably severe. Interpretation Our findings show that there might be different types and severity of perinatal depression with varying time of onset throughout pregnancy and post partum. These findings support the need for tailored treatments that improve outcomes for women with perinatal depression

Masonry dams : analysis of the historical profiles of Sazilly, Delocre and Rankine

The significant advances in masonry dam design that took place in the second half of the 19th century are analyzed and discussed within the context of the historical development of dam construction. Particular reference is made to the gravity dam profiles proposed by Sazilly, Delocre and Rankine, who pioneered the application of engineering concepts to dam design, basing the dam profile on the allowable stresses for the conditions of empty and full reservoir. These historical profiles are analyzed taking into consideration the present safety assessment procedures, by means of a numerical application developed for this purpose, based on limit analysis equilibrium methods, which considers the sliding failure mechanisms, the most critical for these structures. The study underlines the key role of uplift pressures, which was only addressed by Lévy after the accident of Bouzey dam, and provides a critical understanding of the original design concepts, which is essential for the rehabilitation of these historical structures.This work has been funded by FCT (Portuguese Foundation for Science and Technology) through the PhD grant SFRH/BD/43585/2008, for which the first author is grateful

The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale

Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset. Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA. Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01). Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted

Pluralitas Agama dalam Keluarga Jawa

Dalam masyarakat Jawa terdapat pemahaman dan pemaknaan sendiri terhadap agama yaitu â€agami ageming ajiâ€. Artinya apa pun agama yang dipeluk sama saja karena semua agama mengajarkan keselamatan. Oleh sebab itu menjadi sebuah fenomena menarik di kalangan masyarakat Jawa karena mereka cenderung lebih toleran dalam menyikapi perbedaaan dan keragaman beragama. Salah satu contoh masyarakat yang menghargai pluralitas agama adalah masyarakat Desa Getas Kaloran Temanggung. Tujuan penelitian ini adalah untuk menjelaskan tentang sejumlah keluarga yang dapat menerima pluralitas agama dan toleransi terhadap pluralitas agama dalam keluarga Jawa. Tulisan ini merupakan hasil penelitian yang menggunakan pendekatan deskriptif kualitatif. Subyek penelitian adalah masyarakat Desa Getas yang memiliki keragaman agama dalam keluarganya. Berdasarkan hasil penelitian dapat disimpulkan bahwa masyarakat Desa Getas dapat menerima pluralitas agama karena menurut mereka agama adalah urusan pribadi seseorang jadi tidak ada pihak yang dapat memaksakan suatu keyakinan kepada individu lain. Pluralitas agama tersebut tidak menimbulkan masalah berarti karena masyarakat memiliki derajat toleransi yang tinggi antar anggota keluarga, yang ditunjukkan melalui saling menghargai dan mengormati dan tidak mencampuri urusan keagamaan orang lain, serta saling membantu antar anggota keluarga untuk memperlancar kegiatan ibadah masing – masing. In Javanese community there is a specific principle on the meaning of religion, namely â€agami ageming ajiâ€. This pilosophy means whatever religion people believe, it doesn’t matter because they all teach salvation. This is an interesting phenomenon among the Javanese community because they tend to be tolerant in dealing with differences and diversity of religion that happen in one household. The objective of this article is to discuss the practices of religious tolerance found in a rural community of Getas, Kaloran, Temanggung Central Java. Techniques of data collection is done by interviews and observation. The study subjects were villagers of Getas, which has a diversity of religion in families. Based on the research results, it can be concluded that the villagers embrace a tradition of religious pluralism because they think religion is one’s personal affairs so that no party can impose a conviction for another individual. The plurality of religion does not cause significant problems because the public has a high degree of tolerance among family members, which is demonstrated through mutual respect and attitude not to interfere in religious affairs of others, and mutual help among family members to facilitate the worship activities of their relatives

Fearing the knock on the door:critical security studies insights into limited cooperation with disaster management regimes

In seeking to provide for the safety of local communities in the global south, there has been an apparent policy focus on making early warning systems more robust, and improving the operation of disaster management programmes. However, the critical security studies literature has highlighted the ways in which security practices, including those nominally implemented on behalf of local communities can have negative impacts on peoples. Human security literature, in particular, highlights the ways in which the state security apparatus, which is often relied upon to notify and enforce evacuations, may often be perceived as a serious risk to communities. At the same time individuals live within complex security situations where daily threats to peoples’ lives may outweigh geological hazards. Grounded within critical literature on the social construction of risk (Lupton; Beck, Douglas), the ways in which volcanic risk is calculated, communicated, and enacted upon, will be assessed in relation to the local communities’ security dilemmas.Drawing on field work in communities at risk from lahars generated from Cotopaxi in Sangolqui, Ecuador, explores the ways in which competing claims of what constitutes security challenge the operating assumptions in emergency preparedness. In June 2012, 158 primary interviews were undertaken as a part of the EU funded VUELCO project in Ecuador. The findings were analyzed using quantitative and qualitative methodologies, drawing most heavily on interpretive methodologies to argue that the scientific representation of volcanic hazards, and the resultant disaster management strategies, do not account for local context. Indeed, the majority of interviewees indicated a lack of trust in either scientific expertise or government representatives, on questions of security. By incorporating a broader narrative of security beyond a narrow focus on natural hazards, disaster preparedness and communication plans can be more effective

HSV-2 glycoprotein gD targets the CC domain of tetherin and promotes tetherin degradation via lysosomal pathway.

BACKGROUND: HSV-2 is the major cause of genital herpes. We previously demonstrated that the host viral restriction factor tetherin restricts HSV-2 release and is antagonized by several HSV-2 glycoproteins. However, the mechanisms underlying HSV-2 glycoproteins mediated counteraction of tetherin remain unclear. In this study, we investigated whether tetherin restricts the cell-to-cell spread of HSV-2 and the mechanisms underlying HSV-2 gD mediated antagonism of tetherin. METHODS: Infectious center assays were used to test whether tetherin could affect cell-to-cell spread of HSV-2. Coimmunoprecipitation assays were performed to map the tetherin domains required for HSV-2 gD-mediated downregulation. Immunoflurence assays were performed to detect the accumulation of tetherin in lysosomes or proteasomes. All experiments were repeated for at least three times and the data were performed statistical analysis. RESULTS: 1) Tetherin restricts cell-to-cell spread of HSV-2; 2) HSV-2 gD specifically interacts with the CC domain of tetherin; 3) HSV-2 gD promotes tetherin to the lysosomal degradation pathway. CONCLUSIONS: Tetherin not only restricts HSV-2 release but also its cell-to-cell spread. In turn, HSV-2 gD targets the CC domain of tetherin and promotes its degradation in the lysosome. Findings in this study have increased our understanding of tetherin restriction and viral countermeasures