Biomechanical understanding of blow-out fractures: A finite element study

Blow-out fractures are one of the most common fractures in maxillofacial trauma. Two mechanisms are thought to cause these fractures, the buckling mechanism and hydraulic mechanism. This study aims to compare between the two mechanisms in terms of intensity and extension using the finite elements method. Three-dimensional model was generated using computed tomography data of young male patient. Virtual loads were applied on the infra-orbital rim and the eyeball separately. Von Mises stress and equivalent elastic strain were examined in each simulation. The simulation predicted fractures on the infra-orbital rim and orbital floor when simulating the buckling mechanism, and on the orbital floor and mesial wall when simulating the hydraulic mechanism. Biomechanical studies are essential in understanding maxillofacial fractures mechanisms. Our results ascertained and confirmed what is seen clinically and explained the two mechanisms of blow-out fractures

Report of the SEAFDEC-ASEAN Regional Workshop on Sea Turtle Conservation and Management

The Southeast Asian Fisheries Development Center (SEAFDEC) ASEAN Regional Workshop on Sea Turtle Conservation and Management was held in Kuala Terengganu, Malysia, from 26 to 28 July 1999. In the first session the Formulation of a Regional Information Base was discussed: the Workshop agreed that development of the information database should comprise of two working components. The first as an educational tool to facilitate access to everybody and also to provide an avenue for information exchange, the second component could be in the form of training. In the second session proposals for regional sea turtle research, conservation and management were presented. Finally the Workshop identified and adopted the following recommendations for the conservation and managements of sea turtle in the region of Southeast Asia

Overview on country policies, programs experiences with artificial reefs, stationary fishing gear establishment of marine protected areas in Malaysia

Marine environments are typically strongly linked to the mixing of water masses and, in coastal areas they are greatly influenced by rivers and land runoff. A marine area can also be strongly influenced by activities in distant areas including those on land and at sea. Artificial reef developments are part of the government programme in Malaysia for habitat enhancement and rehabilitation, and artisanal fishing ground. A total of 99 artificial reefs have been constructed from various materials such as tires, fabricated concrete blocks and cylinders, sunken boats and PVC pipes. Another 221 artificial reefs have also been deployed in coastal waters to provide fishing ground specifically for traditional fishermen. In 1983, the Government of Malaysia initiated the establishment of Marine Parks in Peninsular Malaysia for the conservation of living marine resources. To date, waters of 2 nautical miles off the shores of 40 islands in Peninsular Malaysia have been gazetted as marine parks of Malaysia under the Fisheries Act 1985. These 40 islands are grouped into 5 marine parks and a comprehensive management plan was developed to cater for them. These plans were adopted for the day-to-day management of particular marine parks. Current management issues in these marine parks are the impacts of fisheries and tourism. All fishery activities within the marine park waters are prohibited

Official Secrets Act 1972: looking at citizens' rights / Khazrin Haffiz Khalil, Mohd Asrulnizam Harun and Muhammad Fairuz Abdul Karim

This research was conducted to determine the position of Malaysians* right to information under the Federal Constitution. This research also seeks to look at the constitutionality of Section 2B of the Official Secrets Act 1972 which allegedly erode the citizens' right to information. Finally, the issues of whether the Freedom of Information Act should be introduced in Malaysia will be discussed

Marine parks Malaysia-management strategy

The coral reef is one of the most and productive ecosystems in the world. It provides a variety of resources and services and thus needs to be protected. The Marine Parks Malaysia was established with the objectives of conservation and protection as well as education. The Department of Fisheries has been given the task of managing the Marine Parks Malaysia as its establishment comes under the purview of the Fishery Act 1985. In its effort to manage the Marine Parks Malaysia sustainable the Department of Fisheries has to overcome several issues related to marine protected areas. Having a multi tiered governing structure has somehow added to the complexity of managing the Marine Parks Malaysia. With the Department of Fisheries having only powers within the waters of the marine parks, issues regarding terrestrial developments need to be addressed jointly with the relevant authorities. Other issues that needed attention are with regards to the conflict of use of the Malaysia for tourism and the lack of awareness among the public regarding the importance of the marine environment. The Marine Parks Malaysia also provide sites for long term research to understand marine ecosystems and ecosystem services in developing sustainable management and to explore and evaluate options for new forms of use. Other than these issues the Department of Fisheries also strives to overcome operational and management issues in terms of capacity building and sustainable financing

Microencapsulation of fish oil using Hydroxypropyl methylcellulose as a carrier material by spray drying

Spray drying is an important method in the food industry for the production of encapsulated oil to improve the handling and flow properties of the powder. In this study, the effect of mixture of polymers on the encapsulation of fish oil by spray drying was investigated. Fish oil powder were produced using different ratios of mixtures of hydroxypropyl methylcellulose (HPMC) 15 cps and HPMC 5 cps. Scanning electron microscopy and the amount of extracted oil from the surface revealed that the formulation containing high concentration of polymer mixture provided the highest protective and prolonged effect on the covering of fish oil. The particle sizes of less than 60 μm were obtained for all the formulations. The powder density was very suitable, which improves the flowability of the powder. Microencapsulation efficiency (69.16–74.75%) and surface morphology of encapsulated oil showed that the stability was increased and hence increased its acceptability as alternative primary polymers

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely