Search

This article explores the impact of cyberchondria, which refers to the anxiety caused by online searches for health information, on surgeons' practices and well-being. The rise in the availability of online health-related information and the use of web-based symptom checker applications have contributed to the increase in cyberchondria. Excessive and repeated internet searches related to patients' perceived health conditions can lead to increased health anxiety. Surgeons need to be aware of the pitfalls of cyberchondria and navigate communication with patients sensitively. It is important to provide accurate and valuable information to combat cyberchondria and manage patient expectations. A multidisciplinary approach, including patient awareness and digital literacy, can help address cyberchondria and promote healthy boundaries of digital self-help. [Extracted from the article]

Purpose: Patients with ureteric stents have symptoms that overlap with infection symptoms. Thus, clinicians unnecessarily give antibiotics to stented patients with bacteriuria despite guidelines. In stented patients, little is known about risk factors for developing bacteriuria or urosepsis. The objectives were to identify the frequency and risk factors for developing bacteriuria and urosepsis in patients with stents. Methods: In this retrospective cohort study, we reviewed patients with ureteric stents placed or exchanged over 1 year. We examined associations between bacteriuria or urosepsis and host risk factors. Univariable and multivariable logistic analyses were performed. Results: Of 286 patients (mean age: 57.2 years), 167 (58.4%) were male. The main stent indications were stone, stricture, cancer and extrinsic compression. The median stented period was 61 days. The frequency of bacteriuria was 59/286 (21%). ASA status 3 and 4 had 5 times the odds of having bacteriuria relative to ASA status 1. Stent duration > 2 months had 5.5 times the odds relative to ≤ 2 months. Urosepsis was infrequent, 13/286 (4.5%). Five patients had bacteraemia. A stent duration over 2 months had nearly 6 times the odds of urosepsis. Conclusion: ASA status higher than 2 and stent time greater than 2 months raise the odds of developing bacteriuria. A stent duration longer than 2 months was the only predictor of urosepsis. Though 21% of patients had bacteriuria, 4.5% had urosepsis. Hence, bacteriuria without sepsis should not be treated with antibiotics, thus aiding antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Toxic leading is by no means a modern problem--it is a human problem. As such, scholars can take a historical view in their analyses of toxic leading, enriching the study of this problem with additional resources. The authors present an example of this broader scholarly approach in the film study of leadership, using the dramatized World War ii television film series Band of Brothers, which compares the leader behaviors of several characters along a spectrum of harm. Among other suggestive conclusions, the analysis indicates that toxic leading combines a disregard for one's organization and a disregard for other people, and that habitual practice of virtuous behavior inhibits progress along a spectrum of harm that would otherwise result in chronic toxic leadership. [ABSTRACT FROM AUTHOR]

Purpose: It is recognised that there are ethnic variations in prostate cancer (PCa) epidemiology, affecting outcomes. South Asians (SA) are less likely to be diagnosed with PCa than others, although recent evidence shows PCa is rising amongst SA. This study examines the differences between ethnicities in PCa presentation, progression risk and prostate-specific antigen (PSA) testing use. Methods: This retrospective study is on biopsy-diagnosed PCa patients from a multi-ethnic area in London. We grouped ethnicities as SA, White, Black and others, compared presenting symptoms, PSA, Gleason score (GS), and clinical stage, and estimated the D'Amico risk across ethnicities. We also evaluated if the presentation was due to symptoms or an elevated PSA. Results: We studied 1176 patients with biopsy-proven PCa. Black patients were diagnosed about 3 years before others (65 ± 8.8 years, p = < 0.001). There was no significant difference between ethnicities in presenting PSAs. At presentation, 65–71% were in the high-risk D'Amico category across all ethnicities. SA were least likely to have PSA test-detected cancers (38%, p = 0.001) and had the highest proportion with advanced GS (30.6%). There was no significant difference in the risk of disease progression between groups. Conclusion: Black men were diagnosed youngest. SA had the highest proportion with advanced GS. Most ethnicities had a high risk of progression. SA had the least PSA test-detected cases. The significance of the study lies in understanding ethnic variations in PCa, which could direct targeted prevention and management. We recommend further ethnicity studies and interventions encouraging SA men to embrace PSA testing. [ABSTRACT FROM AUTHOR]

Introduction: Fournier's gangrene is a necrotizing infection of the external genitalia, perineal or perianal regions and is mainly seen in males. Its main risk factors include diabetes, chronic alcoholism, HIV and other immune-compromised states. Fournier's gangrene has an aggressive course associated with a mortality rate of 20%−30%, making early diagnosis and management very important. The Fournier Gangrene Severity Index (FGSI) has been traditionally used to predict the severity and prognosis. More recently, simplified FGSI (sFGSI) has been proposed and is helpful. However, timely diagnosis, supportive medical management and complete surgical debridement are still the cornerstones of treatment. These must be complemented with early and timely re-look debridements and appropriate reconstruction to cover soft tissue defects. This literature review aims to look at recent relevant research regards risk factors and prognostic features of Fournier's gangrene. Methods: A search was conducted on Google Scholar and PubMed databases for all articles related to Fournier's Gangrene. These included clinical reviews, case reports, case series and retrospective studies. Reports or studies which were not published in English were not reviewed. Various reconstructive techniques to cover the defects have also been revisited. Results: Broad-spectrum antibiotics and urgent surgical debridement are the core management principles of Fournier's gangrene. Repeat debridement after 24 h is also recommended. Adjunctive therapies such as hyperbaric oxygen and vacuum-assisted closure are supported in most aspects of recent literature. Expectedly, there is a lack of randomised controlled studies in such emergency surgical conditions, which limits the widespread use of newer therapies to patients unresponsive to conventional management. Conclusion: Fournier's gangrene is a urological emergency with a high mortality rate. The aggressive nature of the infection necessitates early recognition and immediate surgical intervention. Negative pressure dressing and occasional hyperbaric oxygen as adjuncts should be used more routinely, especially if there is a delayed response to conventional treatment or in severe infections. [ABSTRACT FROM AUTHOR]

Results of an experimental investigation of the heating of the surface of a blunt plate, made of a material having a low heat conductivity, in a wind tunnel in the regime of strong viscous-nonviscous interaction of the boundary layer on the surface of the plate with the incident fluid flow are presented. It is shown that the installation of a wedge on this plate in the vicinity of its trailing edge changes the disturbed flow region and the temperature distribution over the surface of the plate upstream of the wedge as far as the leading edge of the plate. [ABSTRACT FROM AUTHOR]

Purpose: An ageing population has led to many people aged 80 and over requiring urological surgery. There are concerns that operating on octogenarians may be fraught with higher morbidity and mortality risk. Therefore, the purpose was to study postoperative outcomes in people aged 80 years and over undergoing elective urological surgery. Materials and methods: We retrospectively reviewed the 30-day readmissions and deaths in patients aged 80 years and over who had elective urological surgery over a seven and half year period from February 2011 to July 2018 in a district general hospital. Surgeries were stratified into minor, intermediate and major. Our data did not include supra-major surgeries like radical cystectomy as these are done in tertiary centres. We used logistic regression to examine factors associated with readmissions and death. Results: A total of 1239 patients had 2201 operations. The median age was 84.1 years. Procedures on the bladder were the most common, followed by prostate surgery. A 17.9% of operations resulted in an adverse outcome (death or readmission attributable to surgery) within 30 days. There were 21 deaths, equating to 1% of all surgeries undertaken. There was a significant difference in both readmissions and deaths by American Society of Anaesthesiologists (ASA) grade. The median time to readmission from surgery was 18 (IQR 13–23) days. The highest number of readmissions occurred in the third week after surgery. A 94% of the readmissions were for a minor complication (grade I Clavien Dindo), with haematuria and urinary retention being most common. Conclusions: This study informs hospitals, surgeons, patient advocacy groups and insurance, that the morbidity and mortality risks of non-supra major elective urological surgery in patients aged 80 and over are not disproportionately high. [ABSTRACT FROM AUTHOR]

Case: A 75‐year‐old man presented with mixed obstructive and storage lower urinary tract symptoms (LUTS). He had undergone transurethral resection of the prostate (TURP) 5 years and laparoscopic inguinal hernia repair 20 years ago. He had a stone adherent to the bladder wall and an occlusive prostate. Outcome He underwent a re‐do TURP and stone removal. Stone removal revealed an underlying metal coil straddling the bladder wall, which had served as a nidus for stone formation. The metal ring was a ProTack staple from previous hernia surgery, which had detached and wandered into the bladder. At follow‐up after 12 weeks, the patient was asymptomatic, and his urine was sterile. Therefore, he chose to be treated conservatively for the ProTack and was started on periodic follow‐up and cystoscopic surveillance. Shortly after review, he developed intestinal obstruction, which resolved spontaneously and was thought to be secondary to adhesions from other tacks that had migrated into the peritoneal cavity. Conclusion: We have reported a case of a ProTack from a previous hernia repair migrating into the bladder and also causing intestinal obstruction. The case is very rare because of the combination of complications. Clinicians should beware of delayed complications and damage to other organs due to metallic hernia staples. [ABSTRACT FROM AUTHOR]

Background: Papua New Guinea (PNG) has one of the highest burdens of HIV and syphilis in pregnancy in the Asia-Pacific region. Timely and effective diagnosis can alleviate the burden of HIV and syphilis and improve maternal and newborn health. Supply-side factors related to implementation and scale up remain problematic, yet few studies have considered their impact on antenatal testing and treatment for HIV and syphilis. This study explores health service availability and readiness for antenatal HIV and/or syphilis testing and treatment in PNG.Methods: Using data from two sources, we demonstrate health service availability and readiness. Service availability is measured at a province level as the average of three indicators: infrastructure, workforce, and antenatal clinic utilization. The readiness score comprises 28 equally weighted indicators across four domains; and is estimated for 73 health facilities. Bivariate and multivariate robust linear regressions explore associations between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis.Results: Most provinces had fewer than one health facility per 10 000 population. On average, health worker density was 11 health workers per 10 000 population per province, and approximately 22% of pregnant women attended four or more antenatal clinics. Most health facilities had a composite readiness score between 51% and 75%, with urban health facilities faring better than rural ones. The multivariate regression analysis, when controlling for managing authority, catchment population, the number of clinicians employed, health facility type and residence (urban/rural) indicated a weak positive relationship between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis.Conclusion: This study adds to the limited evidence base for the Asia-Pacific region. There is a need to improve antenatal testing and treatment coverage for HIV and syphilis and reduce healthcare inequalities faced by rural and urban communities. Shortages of skilled health workers, tests, and medicines impede the provision of quality antenatal care. Improving service availability and health facility readiness are key to ensuring the effective provision of antenatal care interventions. [ABSTRACT FROM AUTHOR]

Oppositions in electoral authoritarian regimes often boycott sham elections. Yet unfair elections can be game-changing. This article shows how the opposition contested the 9 August 2020 presidential election in Belarus to mobilize a large-scale grassroots prodemocracy movement by: 1) presenting a credible alternative to the regime and unifying efforts, 2) drawing on citizen-led initiatives—including an innovative artificial-intelligence parallel vote-tabulation system—to expose the extent of electoral manipulation, build solidarity, and engender belief in the possibility of change, 3) involving citizens at every stage of the electoral process to credibly demonstrate support for the opposition, and 4) wielding the regime's electoral law against it to publicize electoral violations. The election transformed Belarus's once-apathetic populace into active citizens and created conditions for future change, despite mass state-sanctioned violence. [ABSTRACT FROM AUTHOR]

Background: Globally, nearly half of all deaths among children under the age of 5 years can be attributed to malaria, diarrhoea, and pneumonia. A significant proportion of these deaths occur in sub-Saharan Africa. Despite several programmes implemented in sub-Saharan Africa, the burden of these illnesses remains persistently high. To mobilise resources for such programmes it is necessary to evaluate their costs, costs-effectiveness, and affordability. This study aimed to estimate the provider costs of treating malaria, diarrhoea, and pneumonia among children under the age of 5 years in routine settings at the health facility level in rural Uganda and Mozambique. Methods: Service and cost data was collected from health facilities in midwestern Uganda and Inhambane province, Mozambique from private and public health facilities. Financial and economic costs of providing care for childhood illnesses were investigated from the provider perspective by combining a top-down and bottom-up approach to estimate unit costs and annual total costs for different types of visits for these illnesses. All costs were collected in Ugandan shillings and Mozambican meticais. Costs are presented in 2021 US dollars. Results: In Uganda, the highest number of outpatient visits were for children with uncomplicated malaria and of inpatient admissions were for respiratory infections, including pneumonia. The highest unit cost for outpatient visits was for pneumonia (and other respiratory infections) and ranged from $0.5 to 2.3, while the highest unit cost for inpatient admissions was for malaria ($19.6). In Mozambique, the highest numbers of outpatient and inpatient admissions visits were for malaria. The highest unit costs were for malaria too, ranging from $2.5 to 4.2 for outpatient visits and $3.8 for inpatient admissions. The greatest contributors to costs in both countries were drugs and diagnostics, followed by staff. Conclusions: The findings highlighted the intensive resource use in the treatment of malaria and pneumonia for outpatient and inpatient cases, particularly at higher level health facilities. Timely treatment to prevent severe complications associated with these illnesses can also avoid high costs to health providers, and households. Trial registration: ClinicalTrials.gov, identifier: NCT01972321. [ABSTRACT FROM AUTHOR]

Background: Understanding factors associated with women's healthcare decision-making during and after pregnancy is important. While there is considerable evidence related to general determinants of women's decision-making abilities or agency, there is little evidence on factors associated with women's decision-making abilities or agency with regards to health care (henceforth, health agency), especially for antenatal and postnatal care. We assessed women's health agency during and after pregnancy in slums in Mumbai, India, and examined factors associated with increased participation in healthcare decisions.Methods: Cross-sectional data were collected from 2,630 women who gave birth and lived in 48 slums in Mumbai. A health agency module was developed to assess participation in healthcare decision-making during and after pregnancy. Linear regression analysis was used to examine factors associated with increased health agency.Results: Around two-thirds of women made decisions about perinatal care by themselves or jointly with their husband, leaving about one-third outside the decision-making process. Participation increased with age, secondary and higher education, and paid employment, but decreased with age at marriage and household size. The strongest associations were with age and household size, each accounting for about a 0.2 standard deviation difference in health agency score for each one standard deviation change (although in different directions). Similar differences were observed for those in paid employment compared to those who were not, and for those with higher education compared to those with no schooling.Conclusion: Exclusion of women from maternal healthcare decision-making threatens the effectiveness of health interventions. Factors such as age, employment, education, and household size need to be considered when designing health interventions targeting new mothers living in challenging conditions, such as urban slums in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

The heating of the surface of a blunted plate made of a material with low thermal conductivity is experimentally investigated in a wind tunnel under the strong interaction regime. The flow in the boundary layer on the plate is nonstationary, since the temperature of the plate surface continuously increases during the start-up, and its distribution over the surface is variable. The installation of a wedge in the vicinity of the trailing edge of the plate leads to changes in the area of the perturbed flow and in the temperature distribution on the surface of the plate in front of it up to the leading edge as compared to the case of flow around a plate without a wedge. These changes are explained by the propagation of pressure perturbations caused by the installation of the wedge along the subsonic part of the boundary layer against the flow. [ABSTRACT FROM AUTHOR]

Background: Timely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distances to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite antenatal care (ANC), delivery and postnatal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four ANC visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.Methods: We use data from the 2016-2017 Burundi Demographic and Health Survey (DHS) collected from 8941 women who reported a live birth in the five years that preceded the survey. We use multivariate regression analysis to explore which individual-, household-, and community-level factors determine the likelihood that women will seek ANC services from a trained health professional, the number of ANC visits they make, and the choice of assisted childbirth.Results: Occupation, marital status, and wealth increase the likelihood that women will seek ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than non-educated women and women not in union. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are to have assisted childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.Conclusions: In Burundi, utilisation of maternal health services is low and is mainly driven by legal union and wealth status. To improve equitable access to maternal health services for vulnerable population groups such as those with lower wealth status and unmarried women, the government should consider certain demand stimulating policy packages targeted at these groups. [ABSTRACT FROM AUTHOR]

Background: Sexually transmitted and genital infections in pregnancy are associated with adverse pregnancy and birth outcomes. Point-of-care tests for these infections facilitate testing and treatment in a single antenatal clinic visit and may reduce the risk of adverse outcomes. Successful implementation and scale-up depends on understanding comparative effectiveness of such programmes and their comparative costs and cost effectiveness. This systematic review synthesises and appraises evidence from economic evaluations of point-of-care testing and treatment for sexually transmitted and genital infections among pregnant women in low- and middle-income countries. Methods: Medline, Embase and Web of Science databases were comprehensively searched using pre-determined criteria. Additional literature was identified by searching Google Scholar and the bibliographies of all included studies. Economic evaluations were eligible if they were set in low- and middle-income countries and assessed antenatal point-of-care testing and treatment for syphilis, chlamydia, gonorrhoea, trichomoniasis, and/or bacterial vaginosis. Studies were analysed using narrative synthesis. Methodological and reporting standards were assessed using two published checklists. Results: Sixteen economic evaluations were included in this review; ten based in Africa, three in Latin and South America and three were cross-continent comparisons. Fifteen studies assessed point-of-care testing and treatment for syphilis, while one evaluated chlamydia. Key drivers of cost and cost-effectiveness included disease prevalence; test, treatment, and staff costs; test sensitivity and specificity; and screening and treatment coverage. All studies met 75% or more of the criteria of the Drummond Checklist and 60% of the Consolidated Health Economics Evaluation Reporting Standards. Conclusions: Generally, point-of-care testing and treatment was cost-effective compared to no screening, syndromic management, and laboratory-based testing. Future economic evaluations should consider other common infections, and their lifetime impact on mothers and babies. Complementary affordability and equity analyses would strengthen the case for greater investment in antenatal point-of-care testing and treatment for sexually transmitted and genital infections. [ABSTRACT FROM AUTHOR]

CARMIL2 is required for CD28-mediated co-stimulation of NF-κB signaling in T cells and its deficiency has been associated with primary immunodeficiency and, recently, very early onset inflammatory bowel disease (IBD). Here we describe the identification of novel biallelic CARMIL2 variants in three patients presenting with pediatric-onset IBD and in one with autoimmune polyendocrine syndrome (APS). None manifested overt clinical signs of immunodeficiency before their diagnosis. The first patient presented with very early onset IBD. His brother was found homozygous for the same CARMIL2 null variant and diagnosed with APS. Two other IBD patients were found homozygous for a nonsense and a missense CARMIL2 variant, respectively, and they both experienced a complicated postoperative course marked by severe infections. Immunostaining of bowel biopsies showed reduced CARMIL2 expression in all the three patients with IBD. Western blot and immunofluorescence of transfected cells revealed an altered expression pattern of the missense variant. Our work expands the genotypic and phenotypic spectrum of CARMIL2 deficiency, which can present with either IBD or APS, aside from classic immunodeficiency manifestations. CARMIL2 should be included in the diagnostic work-up of patients with suspected monogenic IBD. [ABSTRACT FROM AUTHOR]

We investigated the conditions for forming the single-frequency monopulse operation mode of the transversally diode pumped Yb,Er-phosphate glass laser with a passive Q-switch based on the Co2+:MgAl2O4 crystal. It was shown experimentally that the spectral selectivity that ensures the stable single-frequency operation for the Yb,Er-laser is achieved in the intracavity Fabry–Perot interferometer in the form of the totally reflecting mirror and nearest end surface of an active element with plane-parallel faces, as well as the polarization interference filter (PIF, Lyot filter). Meanwhile, the PIF created by an active element with thermally induced anisotropy and a polarizer in the form of a passive Q-switch plate, oriented at Brewster's angle to the resonator axis, acts as a preliminary spectral selector. The maximum energy of the formed output laser pulses was 6 mJ with a duration of 20.2 ns, a repetition rate of 1 Hz, and a single-frequency lasing spectrum width of 41 MHz. [ABSTRACT FROM AUTHOR]

The results of an experimental wind-tunnel investigation of the plate surface heating in the strong viscous-inviscid interaction regime are presented. It is shown that In the presence of a wedge mounted in the vicinity of the trailing edge of the plate the temperature distribution over the plate surface ahead of the wedge considerably changes up to the leading edge, as compared with the case of flow past the same plate in the absence of the wedge. The boundary layer flow is not steady, since during the run the surface temperature grows continuously, the temperature distribution itself along the plate surface being variable. It is established that in an unsteady boundary layer the upwind propagation of pressure disturbances produced by a thin wedge is fundamentally different in nature from the disturbance propagation in the case of flow past a plate with a constant surface temperature. [ABSTRACT FROM AUTHOR]

Background The rising rate of preterm births (PTBs) is a global concern, and Malawi has a high rate of PTBs (10.5%). The resulting neonatal and under-5 mortality, morbidity and lifelong disability represent a significant loss of human potential affecting individuals, families and society as a whole. This study aims to review the literature to determine the risk factors for PTB in Malawi and to identify effective interventions to prevent PTBs. Methods A literature search yielded 22 studies that were categorized according to risk factors implicated for PTBs and health interventions to reduce the risks. Results The study has shown that maternal pregnancy factors, infections, nutrition, anaemia and young maternal age are the main causes and risk factors of PTBs in Malawi. The literature revealed no evidence of community-based interventions for reducing the rates of PTBs in Malawi. Conclusions Any successful effort to reduce the rate of PTBs will require a multisector, multilevel strategy targeted at the community, homes and individuals as a package to improve the education, nutrition and reproductive health of girls and women as well as focus on improving the delivery of antenatal services in the community. [ABSTRACT FROM AUTHOR]

Purpose: There are few published reviews that have assessed the clinical utility of renal urine cultures following percutaneous nephrostomy (PCN). In this systematic review, we evaluated the published evidence of the clinical utility of nephrostomy urine cultures in the light of emerging antimicrobial resistance and need for stewardship. Methods: We performed a systematic literature search and review for evidence on the utility and role of nephrostomy urine cultures, using Medline, Embase and PubMed. We looked for evidence to assess whether there is any utility in collecting renal urine for culture at the time of percutaneous nephrostomy (PCN) and if the culture results of nephrostomy urine and bladder urine are different. We studied outcomes of treatment based on nephrostomy culture results. We also examined the role of PCN cultures at the time of routine nephrostomy exchange. Finally, we assessed if doing a PCN leads to infection or pyelonephritis. Results: From 94 studies initially identified, we finally selected two randomised clinical trials (RCT), six original articles and five detailed conference abstracts for the review. These studies suggest that PCN urine cultures are overall useful in clinical practice. They are useful in selecting appropriate antimicrobial treatment for urosepsis following upper urinary obstruction. There does not appear to be any advantage in performing PCN cultures at routine nephrostomy exchanges. Occasionally, PCN itself can lead to subsequent urosepsis. Conclusion: Nephrostomy urine cultures have utility in clinical practice and can help support treatment and antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

This paper describes NEREL—a Russian news dataset suited for three tasks: nested named entity recognition, relation extraction, and entity linking. Compared to flat entities, nested named entities provide a richer and more complete annotation while also increasing the coverage of relations annotation and entity linking. Relations between nested named entities may cross entity boundaries to connect to shorter entities nested within longer ones, which makes it harder to detect such relations. NEREL is currently the largest Russian dataset annotated with entities and relations: it comprises 29 named entity types and 49 relation types. At the time of writing, the dataset contains 56 K named entities and 39 K relations annotated in 933 person-oriented news articles. NEREL is annotated with relations at three levels: (1) within nested named entities, (2) within sentences, and (3) with relations crossing sentence boundaries. We provide benchmark evaluation of current state-of-the-art methods in all three tasks. The dataset is freely available at https://github.com/nerel-ds/NEREL. [ABSTRACT FROM AUTHOR]

• Transfer matrix approach for spatial pipelines vibration analysis is presented. • With a usage of exact physical equations it provides high accuracy and flexibility. • The TMA extension for taking into account coupled liquid vibration is developed. • For effective eigenvalues search Williams-Wittrick approach is used. • Its extension is developed for coupled liquid vibration consideration. An effective method for the calculations of stress and residual strength of complex spatial pipelines at static and dynamic loading with taking into account the vibration of internal liquid and Puasson coupling is presented. It based on the well-known transfer matrix approach. The method utilizes the exact mechanical equations for the stress-strained state of straight beam with distributed mass, which connect unknown parameters of forces and displacements at the end of beam calculation element with the parameters at the beginning of the element. At a general level, the solution scheme and calculation models are the same for static and dynamic calculations, the only difference – are the equations. Two different methods are used to find natural vibration frequencies of the distributed mass system: straightforward ("brute force") and quick, based on Williams-Wittrick frequencies counter. Within such counter a special procedure is developed for taking into account fluid vibration with consideration of volumetric balance condition at T-nozzles. The excellent accuracy of the method is demonstrated by the modeling of thin-walled, water filled pipe behavior after the rod impact. Two seismic analysis procedures are implemented on the base of developed method: standard response spectrum procedure and normal-mode summation procedure ("exact" dynamical), which uses accelerograms. These methods and procedures have been already implemented in calculation software for pipeline strength assessment with the possibility of building of arbitrary complexity models by the user-friendly, visual way. Their effectiveness is demonstrated by the seismic calculation for primary circuit pipings of Zaporizhia NPP. [ABSTRACT FROM AUTHOR]

Purpose: Elderly patients with upper tract urothelial cancer (UTUC) may present with colic and microscopic haematuria, mimicking urolithiasis. Patients presenting to emergency departments with acute ureteric colic are investigated with a CT KUB. CT urography (CTU) identifies UTUC better than a CT KUB. Thus, there is a possibility that a CT KUB may miss UTUC.Methods: We studied patients aged 65 years or over presenting to the emergency department with ureteric colic and microscopic haematuria who had a CT KUB between January 2014 and October 2016. Patients who had both CT KUB and CTU were then compared to determine if CT KUB had missed a UTUC and if the diagnoses were concordant by the two tests. A radiologist independent from the reporting radiologists reviewed images as well as their reports. According to the Health Research Authority, England regulations, we did not obtain an ethical review on a voluntary basis for this retrospective study.Results: Four hundred eighty-five patients [228 (47.01%) male and 257 (52.99%) female] had a CT KUB scan over the 34-month period. Their mean age was 74 (SD 6.97) [males 73 (SD 6.42), females 75 (SD 7.42)] years. One hundred eighty-seven scans were normal. Ureteric calculi (167), renal calculi (58) and renal cysts (28) were most frequent diagnoses. The diagnosis was uncertain in 33 patients (6.8%) [16 (48.49%) males and 17 (51.51%) females]. The mean age of this group of patients was 74 (SD 6.64) [males 73 (SD4.43), females 74 (SD7.64)] years. These patients had a CTU for clarity. CTU identified one UTUC not identified by CT KUB (0.2%), corroborated the diagnosis of a ureteric tumour in one patient and excluded UTUC in two others. CTU diagnosed two new bladder tumours and an endometrial tumour. Diagnoses were concordant between CT KUB and CTU in 17 of 33 patients (51.5%).Conclusions: CT KUB scans for patients 65 years and over presenting with ureteric colic is justified. Only a small proportion of patients will subsequently require the higher radiation dose CTU as the probability of missing UTUC is low. [ABSTRACT FROM AUTHOR]

The aim of this research is to develop an original probabilistic method for an underground onshore gas transmission pipelines maintenance risk estimation. The method considers a population of the anomalies detected by an in-line inspection . In the methodology, features are considered as a family with certain defect depth and shape distribution derived from the repeated in-line diagnostics of a steel pipeline under operation. A growth rate in the radial direction is determined based on a defects size change between two or more inspections. The number of non-detected hypothetical anomalies were taken into account due to probability of detection and sizing uncertainties by means of a non-perfect inspection device. Metal losses of the pipe wall are assessed by a fracture mechanics method based on a limit load theory and considered as a leak or rupture. Gas pressure distribution and temperature along the pipeline are calculated in steady state conditions. Particular attention was paid to the evaluation of the probabilistic pipeline failure consequences to the surrounding area with parameters as population density and road traffic taken into consideration. Although the presented risk estimation is universally applicable, the novel methodology was applied to the high pressure gas transmission pipeline situated in the area similar conditions typical for Europe. The failure probability calculations are carried out for different pipeline modes of the fluid transportation. A significant connection of the risk evaluation with pressure distribution along the pipeline was observed based on the differences in risk distributions between Summer, Autumn and Winter operational modes. [ABSTRACT FROM AUTHOR]

Background: Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) are encountered worldwide, particularly in certain regions of the world and in certain ethnic groups. Simple criteria for identification of patients likely to be infected with ESBLE may enable clinicians to select appropriate empirical antibiotics for treatment. The aim of this study was to explore the association between ESBLE bacteriuria and readily available key demographic characteristics (age, gender and ethnicity) in a multiethnic population. Methods: In this cross-sectional observational study, we explored the association between ESBLE bacteriuria and age, gender and ethnicity in 134 831 patients who submitted urine specimens for culture during 2007-2009 in two multiethnic boroughs in London, UK. Results: In multivariate analysis, the risk of ESBLE bacteriuria was higher in males (odds ratio, OR = 1.3) and in patients older than 60 years (OR > 2). Patients from an Asian ethnic group were significantly more likely than White British subjects to have ESBLE bacteriuria (Indians, OR = 2.7; Asians of any other background, OR = 2.4; and Pakistanis, OR = 1.8). In contrast, patients who were of white ethnic background other than Irish were 0.66 times less likely to have ESBLE bacteriuria than White British patients (p = 0.025). Conclusions: Our study shows that in our local multiethnic population, older patients (> 60 years), males and those of South Asian ethnicity were significantly more likely to have ESBLE bacteriuria than others. Knowledge of these simple and readily available demographic data can help identify groups of patients at risk of urinary tract infection (UTI) with ESBLE and may aid in choice of empirical antibiotics. [ABSTRACT FROM AUTHOR]

Background: Job satisfaction is an important predictor of an individual's intention to leave the workplace. It is increasingly being used to consider the retention of health workers in low-income countries. However, the determinants of job satisfaction vary in different contexts, and it is important to use measurement methods that are contextually appropriate. We identified a measurement tool developed by Paul Spector, and used mixed methods to assess its validity and reliability in measuring job satisfaction among maternal and newborn health workers (MNHWs) in government facilities in rural Nepal.Methods: We administered the tool to 137 MNHWs and collected qualitative data from 78 MNHWs, and district and central level stakeholders to explore definitions of job satisfaction and factors that affected it. We calculated a job satisfaction index for all MNHWs using quantitative data and tested for validity, reliability and sensitivity. We conducted qualitative content analysis and compared the job satisfaction indices with qualitative data.Results: Results from the internal consistency tests offer encouraging evidence of the validity, reliability and sensitivity of the tool. Overall, the job satisfaction indices reflected the qualitative data. The tool was able to distinguish levels of job satisfaction among MNHWs. However, the work environment and promotion dimensions of the tool did not adequately reflect local conditions. Further, community fit was found to impact job satisfaction but was not captured by the tool. The relatively high incidence of missing responses may suggest that responding to some statements was perceived as risky.Conclusion: Our findings indicate that the adapted job satisfaction survey was able to measure job satisfaction in Nepal. However, it did not include key contextual factors affecting job satisfaction of MNHWs, and as such may have been less sensitive than a more inclusive measure. The findings suggest that this tool can be used in similar settings and populations, with the addition of statements reflecting the nature of the work environment and structure of the local health system. Qualitative data on job satisfaction should be collected before using the tool in a new context, to highlight any locally relevant dimensions of job satisfaction not already captured in the standard survey. [ABSTRACT FROM AUTHOR]

General approach for numerical treatment of the integro-differential equation of flat crack problem is considered. It consists in presenting the crack surface loading as a set of polynomial functions of two Cartesian coordinates while the corresponding crack surface displacements are chosen as similar polynomials multiplied by the function of form (FoF) to reflect the required singularity of their behavior. Two methods of getting the relations matrixes between these two sets are examined: the first is classical one (when initially the Laplace operator is analytically applied to the integral part of equation and later the resulting hypersingular equation is considered); and the second one is so called direct method (values of the integral are calculated at chosen points of the crack surface, and then these are fitted by polynomial series with subsequent application of the Laplace operator to them). In both these methods the most efforts are devoted to the choice of the FoFs. Three different types of them are tested as to accuracy of results. The first is a usual one when the conditional center of crack is chosen and the FoF is taken as a square root of 1 minus squared relative polar radius of considered surface point. What is unusual here is investigation of shift of the center even for the circular crack. The second one is presentation of the FoF as a square root of products of equations of straight and circular lines of crack boundary. And the third one is based on new idea to use the Burns–Oore FoF, previously suggested in their famous 3D weight function method. Comprehensive investigation of the accuracy of above methods with different combination of FoFs on examples of circular, elliptic, semicircular and square cracks are performed. [ABSTRACT FROM AUTHOR]

Based on the introduced measure of experimental information, an approach is suggested that simplifies the planning of an experiment, as well as the processing and interpretation of its results. The approach considered is quite universal and can be used in experimental investigation of a wide range of processes (phenomena) described by linear (relative to the parameters investigated) models. The results of numerical calculation that illustrate the effectiveness of the proposed approach are presented. The calculation is carried out with the aid of the example of solving a model problem of processing the results of nonstationary temperature measurements. [ABSTRACT FROM AUTHOR]

In the EU, the repeated application of the universal service review mechanism has not resulted in any changes to the universal service scope so far. Due to the fact that the design of an exercise shapes its outcomes, this contribution explores the legal framework and the practice of the said review mechanism in order to determine whether its construction effectively corresponds to its intended functionality. The analysis determines a number of serious shortcomings in the legal procedural and substantive provisions on the review mechanism that result in its inconsistent and deficient application and its puzzling results. Drawing on the identified shortcomings and gaps of the regulatory framework and practice, concrete recommendations are made which could improve the transparency of the review process and the quality and plausibility of the examination of the universal service scope. [ABSTRACT FROM AUTHOR]

Scholars often have ignored Playboy magazine's role in the Vietnam War because many have assumed its only function was to provide soldiers with erotic images of women. This article analyzes Playboy's content to explain its popularity in the Vietnam War. While acknowledging the importance of erotic images, this examination explores alternative reasons soldiers and the military embraced this "girlie mag." Centerfolds provided soldiers with "round-eyed" sexuality, but the magazine also fulfilled other needs of the soldiers. Playboy provided a conduit through which soldiers understood social, cultural, and political issues of the time. Playboy's treatment of racial tension, military life, the politics of the Vietnam War, and the individual soldier combined with the girl-next-door sexuality that appealed to soldiers on multiple levels made Playboy the magazine of the Vietnam War. Considering what surrounds the centerfold in Playboy illustrates the surprising importance of Playboy to soldiers and the military. [ABSTRACT FROM AUTHOR]

Background: A global shortage of health workers in rural areas increases the salience of motivating and supporting existing health workers. Understandings of motivation may vary in different settings, and it is important to use measurement methods that are contextually appropriate. We identified a measurement tool, previously used in Kenya, and explored its validity and reliability to measure the motivation of auxiliary nurse midwives (ANM) and staff nurses (SN) in rural Nepal. Method: Qualitative and quantitative methods were used to assess the content validity, the construct validity, the internal consistency and the reliability of the tool. We translated the tool into Nepali and it was administered to 137 ANMs and SNs in three districts. We collected qualitative data from 78 nursing personnel and district- and central-level stakeholders using interviews and focus group discussions. We calculated motivation scores for ANMs and SNs using the quantitative data and conducted statistical tests for validity and reliability. Motivation scores were compared with qualitative data. Descriptive exploratory analysis compared mean motivation scores by ANM and SN sociodemographic characteristics. Results: The concept of self-efficacy was added to the tool before data collection. Motivation was revealed through conscientiousness. Teamwork and the exertion of extra effort were not adequately captured by the tool, but important in illustrating motivation. The statement on punctuality was problematic in quantitative analysis, and attendance was more expressive of motivation. The calculated motivation scores usually reflected ANM and SN interview data, with some variation in other stakeholder responses. The tool scored within acceptable limits in validity and reliability testing and was able to distinguish motivation of nursing personnel with different sociodemographic characteristics. Conclusions: We found that with minor modifications, the tool provided valid and internally consistent measures of motivation among ANMs and SNs in this context. We recommend the use of this tool in similar contexts, with the addition of statements about self-efficacy, teamwork and exertion of extra effort. Absenteeism should replace the punctuality statement, and statements should be worded both positively and negatively to mitigate positive response bias. Collection of qualitative data on motivation creates a more nuanced understanding of quantitative scores. [ABSTRACT FROM AUTHOR]

McCormack and Anderson () present a case for using homohysteria as a lens through which to examine the effects of declining homophobia. This commentary addresses limitations of the concept of homohysteria, and offers suggestions on ways to improve the concept as a theoretical lens. We identify two central concerns in this presentation of homohysteria; a definitional problem in operationalizing the construct of homohysteria, and a logical weakness in the construction of the definition of a homohysteric society. We offer suggestions based in psychological and historical data aimed to improve homohysteria as a lens through which to view shifts in attitudes toward sexual orientation minorities. [ABSTRACT FROM AUTHOR]

The media plays a vital role in informing the public about new developments in cancer research and influencing cancer policy. This is no easy task, in view of the myriad of trials and wonder drugs that purport to be the 'magic bullet'. However, misrepresentation can have profound consequences. In this qualitative study, we sought to understand the interaction between the media and cancer through the perspective of European science journalists by defining their attitudes towards current cancer research and challenges faced when reporting science news. A total of 67 respondents took part in this online survey, which was distributed by the European CanCer Organisation (ECCO) to all its media contacts between June and September 2013. Fifty-three per cent had over 20 years experience in reporting science news stories. The respondents utilised a number of media formats, including newsprint, online services, and radio. Fifty per cent ranked public interest as the greatest influence on their selection of cancer research topics, followed by topicality. Respondents were conscious of being fed ambiguous and exaggerated results from trials by the research community. Sixty-five per cent of respondents would appreciate access to a forum of experts willing to provide comment on new research findings. Seventy per cent highlighted the importance of prompt responses from scientists and researchers during correspondence, and the need to have advance warning of new developments (49%). To conclude - coverage of cancer related issues and scientific advances require greater collaboration between the press and cancer healthcare community to provide both credibility and accountability for the health information disseminated. Key areas include a more precise definition of the research context and differentiation of absolute and relative risks, as well as individual and population risks and an informed discussion about the realities and limitations of cancer care and research. [ABSTRACT FROM AUTHOR]

Background: Current guidelines for the conduct of cost-effectiveness analysis (CEA) are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle-income settings. Objective: This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle- income countries. Design: We describe the generally accepted methods (norms) for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted. Results: When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute 'startup' costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity building process within the research teams. Conclusions: Given the practical reality of conducting randomised, controlled trials of public health interventions in low- and middle- income countries, it is not always possible to adhere to prescribed guidelines for the analysis of cost effectiveness. Compromises are frequently required as researchers seek a pragmatic balance between rigor and feasibility. There is no single solution to this tension but researchers are encouraged to be mindful of the limitations that accompany compromise, whilst being reassured that meaningful analyses can still be conducted with the resulting data. [ABSTRACT FROM AUTHOR]

[Display omitted] • The size of liquid-ordered phase domains increases with the pH of the buffer solution. • The hydrophobic mismatch decreases with the lowering of pH. • The mobility of the lipids composing both phases is not influenced by pH changes. • The formation of domains occurs during lipids rearrangement on the solid support. • Domains with predefined sizes can be used as platforms for protein binding. Many studies have been devoted to investigation of phase separation and formation of lipid domains, which play crucial role in many biological processes. Here we present a complex study on the formation, dynamics, and stability of the phase-separated supported lipid membranes under varying pH conditions. The size and distribution of liquid-ordered (L o) phase domains were investigated in a wide range (1.7–9.0) of buffer pH values and a strong correlation was found between the size of the L o domains and pH of the buffer hydrating the lipid bilayer. Interestingly, the dynamics of lipids composing both L o and L d phase are insensitive to the pH of the buffer. Our findings demonstrate that by varying pH of the environment one can induce formation of domains with a specific size and shape without any external modification of the solid support or altering the membrane composition. Finally, we show that the architecture of the lipid membrane is stable even upon replacement of the aqueous medium with the buffer of neutral pH. Consequently, this method of patterning of L o phase domains in biomimetic membranes is applicable to the studies involving binding of proteins or incorporation of other pH-sensitive molecules. [ABSTRACT FROM AUTHOR]

Introduction: COPD is a chronic inflammatory disease leading to preserved and poor irreversible airway obstruction. Previous research and the author's own studies showed that matrix metalloproteinases (MMPs), especially MMP-9 may influence progression of inflammatory process in COPD. COPD patients constitute a high risk group for Candida infections. Increasing number of Candida infections in this group has drawn attention to hypothetical Candida influence on the balance between metalloproteinases and their inhibitors. Aim of the study: 1. Estimation and comparison of Candida occurrence in induced sputum in COPD and healthy group. 2. Evaluation of correlation between sputum MMP-9, MMP-1, MMP-9/TIMP-1 concentration and Candida presence in both patients groups. Material and methods: 40 COPD patients and 30 healthy controls were enrolled in the study. The sputum induced hypertonic NaCI solution was used. Candida species were grown on Sabouraud's ground and identified using ID C 32 test. MMP-9 and TIMP-1 concentration in the sputum taken from both groups was measured using ELISA technique. Results: 1. There were no differences between Candida presence in induced sputum in both groups. The COPD patients had increased level of MMP-9 (p=0,000), TIMP-1 (p=0,000) and MMP-9/TIMP-1 ratio (p=0,033) in comparison with the control group. There was a significant difference in MMP-9/TIMP-1 ratio and close to significant differences in TIMP-1 concentration between the COPD group with positive and negative mycological examination. This difference was not observed in the healthy group. Conclusions: The Candida strains present in induced sputum in COPD patients may intensify the structural lung changes by influencing proteases and their endogenic inhibitors balance. [ABSTRACT FROM AUTHOR]

The paper addresses forced vibrations in piping subsystems, which are induced due to the formation and separation of turbulent vortices in the flow of a fluid being transported. The excitation frequency is not a constant number but can take on values from a certain range, thus leading to difficulties and ambiguities in the vibration analysis of piping. To solve this problem, a so-called energy approach is put forward which enables one to determine the most physically governed frequencies of forced vibrations. The approach essentially consists in searching for the natural frequencies and modes of the fluid hydrodynamic vibrations whereby the minimum amount of energy leaves the piping subsystem, while the maximum one remains inside. The validity of the proposed approach is verified by test examples. The proposed methods have been used to analyze piping forced vibrations induced by turbulent vortices in the steam flow in the secondary coolant piping of nuclear power plants with WWER-1000 reactor. Natural frequencies and modes of mechanical, hydrodynamic, and coupled hydrodynamic vibrations have been determined; some recommendations of how to minimize the level of vibrations have been worked out. [ABSTRACT FROM AUTHOR]

The paper presents a modification of the method of initial parameters as employed to allow for harmonic vibrations of a fluid transported in piping. The existing parameters that describe mechanical vibrations of piping are supplemented with the parameters representing the fluid displacement and pressure pulsation. For these hydrodynamic parameters the authors have derived equations of coupling within the design elements and equations of conjugation of parameters at the boundaries between the elements. Equations of conjugation of hydrodynamic and mechanical parameters are derived which allow for their mutual influence and make it possible to analyze the coupled hydromechanical vibrations. In general, the algorithm of the method of initial parameters and the method for constructing a design model have remained unchanged. Some examples are presented which demonstrate the accuracy of the proposed methods as used for the analysis of natural and forced vibrations of a fluid in a pipeline, with and without mutual influence of the fluid and the pipe. [ABSTRACT FROM AUTHOR]

The paper describes the method of initial parameters which is used for stress analysis of complex branched piping systems under static loading as well as under natural and forced harmonic vibrations, including the case of kinematic loading by displacement amplitudes. For the purpose of modeling arbitrary curved elements, in particular three-dimensional ones, the authors propose an inertialess rotary element of zero length, which turns coordinate axes of neighbor elements. The paper demonstrates the potentialities of the method for vibrodiagnostics of piping. [ABSTRACT FROM AUTHOR]

OBJECTIVE • To examine the efficacy of adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in preventing transrectal ultrasonography-guided prostate biopsy (TGB) associated infections. PATIENTS AND METHODS • Infections after TGB were compared before adding amikacin to antimicrobial prophylaxis (2006) with those that occurred after adding amikacin to the prophylaxis (2007 and 2008). • During both periods antimicrobial prophylaxis consisted of ciprofloxacin, coamoxiclav and metronidazole except after August 2008 when co-amoxiclav was discontinued. • Amikacin was added to the prophylaxis protocol in the period 2007 and 2008. RESULTS • Before adding amikacin 11 of 281 (3.9%) patients developed infections after TGB (seven urinary tract infections (UTIs) and seven bacteraemias) whereas after adding amikacin six UTIs and two bacteraemias occurred in 590 (1.4%) patients. • In both periods, most of the strains causing the infections were ciprofloxacin resistant (2006: 13 of 14; 2007 and 2008: seven of eight). • Overall, there is strong statistical evidence that the total infection rate was significantly reduced after the inclusion of amikacin into the prostate biopsy prophylaxis regimen. • In 2007 and 2008 when amikacin was included in prophylaxis, the bacteraemia rate was reduced to just over one-tenth of the rate in 2006 before introducing amikacin ( P = 0.002). • Although just failing to reach the conventional significance level of 0.05, the evidence suggests a reduction in UTI by an estimated 60% after adding amikacin. CONCLUSION • We conclude that adding amikacin to fluoroquinolone-based antimicrobial prophylaxis in areas with high fluoroquinolone resistance confers significant benefit in preventing infections after TGB. [ABSTRACT FROM AUTHOR]

Study Type - Prevalence (non-consecutive cohort) Level of Evidence 3b OBJECTIVE To determine the prevalence of antimicrobial resistance in intestinal flora of patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsies (TGB) and to examine if this information is useful in selecting appropriate antimicrobial agents for prophylaxis and treatment of biopsy-associated infections. PATIENTS AND METHODS In 2007 and 2008, rectal swabs were cultured from patients before undergoing TGB. Antimicrobial sensitivity of coliforms to amikacin, ciprofloxacin and coamoxiclav was determined. Laboratory records were used to identify patients who had bacteraemia or significant bacteriuria within 30 days of the TGB and the antimicrobial sensitivity pattern of these organisms were compared to those from the rectal swab. RESULTS Of 592 patients who had TGB, 445 (75.1%) had a rectal swab beforehand; 0.2%,10.6% and 13.3% of the coliforms were resistant to amikacin, ciprofloxacin and coamoxiclav, respectively. After TGB, six patients presented with urinary tract infections (UTI) and two with bacteraemia. All the infections were caused by coliforms except one UTI which was caused by ciprofloxacin-sensitive Pseudomonas aeruginosa. The blood culture isolates were sensitive to amikacin but resistant to ciprofloxacin and coamoxiclav. All the coliforms in the urine were resistant to ciprofloxacin but sensitive to coamoxiclav. Urine isolates were not tested for amikacin sensitivity. There was a strong correlation between the antimicrobial sensitivity of the coliforms from the rectal swabs and those cultured from urine or blood in both patients for amikacin, six of eight for ciprofloxacin and seven of eight for coamoxiclav. CONCLUSIONS Our study shows that in the coliforms in the bowel flora of our local population there is a relatively high level of resistance to ciprofloxacin and coamoxiclav, and very low level of resistance to amikacin. As there was a strong correlation between the antimicrobial sensitivity of organisms causing infections after TGB and those isolated from the rectal swabs, we conclude that rectal swab cultures before TGB provide useful evidence for selecting appropriate antimicrobials for prophylaxis and treatment of TGB-associated infections. [ABSTRACT FROM AUTHOR]

The article discusses the long-term oncological efficacy of laparoscopic surgery for cancers of the kidney. It was found that technical feasibility and perioperability efficacy laparoscopic radical nephrectomy, laparoscopic partial nephrectomy and laparoscopic nephrouretectomy have already been well established over the past decade and currently available data suggest excellent oncological outcomes.

Background: Although global poverty rates have declined in the last decade, the fall in the Asia-Pacific region has been slow relative to the rest of the world. Poverty continues to be a major cause of poor maternal and newborn health, and a barrier to accessing timely antenatal care. Papua New Guinea has one of the highest poverty rates and some of the worst maternal and neonatal outcomes in the Asia-Pacific region. Few studies have investigated equity in antenatal care utilization in this setting. We explored equity in antenatal care utilization and the determinants of service utilization, which include a measure of multidimensional poverty in Papua New Guinea. Methods: To explore the association between poverty and antenatal care utilization this study uses data from a ten-cluster randomized controlled trial. The poverty headcount, average poverty gap, adjusted poverty headcount, and multidimensional poverty index of antenatal clinic attendees are derived using the Alkire-Foster method. The distribution of service utilization is explored using the multidimensional poverty index, followed by multivariate regression analyses to evaluate the determinants of service utilization. Results: The poverty headcount was 61.06%, the average poverty gap 47.71%, the adjusted poverty headcount 29.13% and the average multidimensional poverty index was 0.363. Further, antenatal care utilization was regressive with respect to poverty. The regression analyses indicated that older women; being a widow (small number of widows (n = 3) asserts interpreting result with caution); or formally employed increase the likelihood of accessing antenatal care more often in pregnancy. Travelling for over an hour to receive care was negatively associated with utilization. Conclusion: This study indicated high levels of multidimensional poverty in PNG and that ANC utilization was regressive; highlighting the need to encourage pregnant women, especially those who are economically more vulnerable to visit clinics regularly throughout pregnancy. [ABSTRACT FROM AUTHOR]

Presents information on a study which investigated the mass distribution of particles produced in the high-current vacuum arc. Experimental procedure; Discussion of experimental results; Conclusions.

Cystic fibrosis (CF) is a genetic disease that is caused by a defect in the gene coding for the transmembrane cystic fibrosis transmembrane conductance regulator (CFTR). Research papers published so far point out that despite the numerous dental treatment needs of CF patients, there are no oral care guidelines for this group of patients. The aim of the article is to propose standards of dental prophylactic and therapeutic procedures for CF patients in different age groups. Regardless of the CF patient's age, dental check-ups should be scheduled at least every 6 months. However, taking into account the actual condition of the individual CF patients, therapeutic visits may be scheduled for earlier dates, to provide well-fitting treatment, considering the level of risk of oral diseases. The described management standards may be helpful and may improve the quality of dental care provided to CF patients. [ABSTRACT FROM AUTHOR]

Transrectal ultrasound-guided needle biopsies (TGBs) are the mainstay of prostate cancer diagnosis. An average of 72 500 TGBs were performed in England and Wales in 2008. Current guidelines recommend fluoroquinolone prophylaxis for TGBs. However, emerging fluoroquinolone resistance has led to increased frequency and morbidity due to post-TGB infections. Following TGB, 2.15%–3.6% of patients are readmitted with infective complications. We estimate readmissions result in 25 745–37 062 bed days at an annual cost of £7.7–11.1 million in England and Wales. Clearly, an increase in post-TGB infections with resistant organisms has a profound clinical and economic impact. We suggest alternative approaches to prophylaxis to reduce post-TGB infections. These include prophylaxis based on local antibiotic resistance surveillance and targeted prophylaxis based on antibiograms of coliforms detected in pre-biopsy rectal swabs. Other strategies include selective prostate-specific antigen (PSA) screening and the use of biomarkers like prostate cancer antigen 3 (PCA3) to reduce the number of TGBs. Furthermore, transperineal biopsy has been shown to be associated with fewer infections. [ABSTRACT FROM PUBLISHER]