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Background: This study aimed to determine the predictors of nursing students’ preparedness for disease outbreaks and the relationships between knowledge of Mpox, media exposure, and clinical experience, as moderated by demographic variables. One hundred respondents were selected using stratified random sampling from four academic levels at the University of Gitwe. Methods: The study employed a Quantitative research design. The results indicated that the respondents had high knowledge of Mpox (66%), high media exposure (mean = 2.69, SD = 0.743), and substantial clinical experience (mean = 2.58, SD = 0.794). Despite facing certain challenges, there was a high level of preparedness for disease outbreaks, particularly concerning Mpox (mean = 2.77, SD = 0.73). Findings: The study found that knowledge of Mpox had a negligible and non-significant correlation with preparedness for disease outbreaks (rho = -0.077, p = 0.445). Conversely, media exposure exhibited a moderate positive correlation with preparedness (rho = 0.636, p < 0.001), while clinical experience showed a positive but non-significant relationship (R² = 0.142). Conclusion: The findings suggest that media exposure and clinical training programs enhance students’ preparedness to manage disease outbreaks. Media exposure was identified as the most significant predictor of preparedness. Based on these findings, it is recommended to integrate media literacy, structured clinical training, and disaster preparedness workshops into nursing education curricula to strengthen students’ capacity to respond to public health emergencies effectively.

Background: It is still unelucidated how hormonal alterations affect developing organisms and their descendants. Particularly, the effects of androgen levels are of clinical relevance as they are usually high in women with Polycystic Ovary Syndrome (PCOS). Moreover, it is still unknown how androgens may affect males’ health and their descendants. Objectives: We aimed to evaluate the multigenerational effect of prenatal androgen excess until a second generation at early developmental stages considering both maternal and paternal effects. Design And Methods: This is an animal model study. Female rats (F0) were exposed to androgens during pregnancy by injections of 1 mg of testosterone to obtain prenatally hyperandrogenized (PH) animals (F1), leading to a well—known animal model that resembles PCOS features. A control (C) group was obtained by vehicle injections. The PH-F1 animals were crossed with C males (m) or females (f) and C animals were also mated, thus obtaining 3 different mating groups: Cf × Cm, PHf × Cm, Cf × PHm and their offspring (F2). Results: F1-PHf presented altered glucose metabolism and lipid profile compared to F1-C females. In addition, F1-PHf showed an increased time to mating with control males compared to the C group. At gestational day 14, we found alterations in glucose and total cholesterol serum levels and in the placental size of the pregnant F1-PHf and Cf mated to F1-PHm. The F2 offspring resulting from F1-PH mothers or fathers showed alterations in their growth, size, and glucose metabolism up to early post-natal development in a sex-dependent manner, being the females born to F1-PHf the most affected ones. Conclusion: androgen exposure during intrauterine life leads to programing effects in females and males that affect offspring health in a sex-dependent manner, at least up-to a second generation. In addition, this study suggests paternally mediated effects on the F2 offspring development.

Resumo O objetivo deste artigo é apresentar, a partir dos estudos de gênero e de suas interseccionalidades, reflexões sobre as diferentes formas de ingresso das mulheres no Cangaço e sobre o que a entrada delas representou para a sociedade. Para isso, foram usados livros, artigos, documentários e arquivos do Museu do Cangaço de Serra Talhada-PE, a fim de refletir sobre as contradições que envolvem as narrativas dessas mulheres: por um lado, foram um símbolo de transgressão, rompendo com o papel de gênero que lhes era esperado; por outro, foram acompanhadas constantemente pela violência dos cangaceiros, das forças policiais e da sociedade.

Geothermal exploration has traditionally relied on geological, geochemical, or geophysical surveys for evidence of adequate enthalpy, fluids, and permeability in the subsurface prior to drilling. The recent adoption of play fairway analysis (PFA), a method used in oil and gas exploration, has progressed to include machine learning (ML) for predicting geothermal drill site favorability. This study introduces a novel approach that extends ML PFA predictions with uncertainty characterization. Four ML algorithms—logistic regression, a decision tree, a gradient-boosted forest, and a neural network—are used to evaluate the subsurface enthalpy resource potential for conventional or EGS prospecting. Normalized Shannon entropy is calculated to assess three spatially variable sources of uncertainty in the analysis: model representation, model parameterization, and feature interpolation. When applied to southwest New Mexico, this approach reveals consistent enthalpy trends embedded in a high-dimensional feature set and detected by multiple algorithms. The uncertainty analysis highlights spatial regions where ML models disagree, highly parameterized models are poorly constrained, and predictions show sensitivity to errors in important features. Rapid insights from this analysis enable exploration teams to optimize allocation decisions of limited financial and human resources during the early stages of a geothermal exploration campaign.

The Critically Endangered western lowland gorilla Gorilla gorilla gorilla is found at high density in the swamp forests of Lac Télé Community Reserve, northern Republic of Congo. Preliminary surveys for apes on the Reserve periphery in the 1990s indicated that this area may also contain high densities of apes and we wished to verify this. Using distance sampling methodology we surveyed 1,029 km2 of the south-eastern Reserve periphery including Raphia swamp forests. We recorded 1,021 ape nests along 21 2-km transects. Results indicated that ape density estimated from nest group density, excluding old and very old Raphia nests (which may decay slowly), was very high: 6.81 weaned apes km-2 (95% confidence interval 3.93-11.84). Gorillas built most of the nests recorded: their density was estimated at 5.25 individuals km-2 (2.70-10.19). Most nests were constructed in Raphia swamp forest despite it covering only 25% of the study area. These are among the highest recorded densities of apes in Central Africa but, as nest decay rates in swamps are unstudied, we also estimated densities based on hypothetically slow nest decay rates and published data from other habitats. Gorilla densities may be linked to availability of monocotyledons as food and the natural protection from hunting offered by Raphia swamps. Gorilla density in swamp forest is spatially and temporally variable and surveys are required to estimate ape populations elsewhere in this habitat. Most Raphia swamps in Congo are unprotected, including the periphery of Lac Télé Community Reserve; protection and management are required to assure their continued availability for apes. [ABSTRACT FROM AUTHOR]

Observational data collected during experiments, such as the planned Fire and Smoke Model Evaluation Experiment (FASMEE), are critical for evaluating and transitioning coupled fire-atmosphere models like WRF-SFIRE and WRF-SFIRE-CHEM into operational use. Historical meteorological data, representing typical weather conditions for the anticipated burn locations and times, have been processed to initialize and run a set of simulations representing the planned experimental burns. Based on an analysis of these numerical simulations, this paper provides recommendations on the experimental setup such as size and duration of the burns, and optimal sensor placement. New techniques are developed to initialize coupled fire-atmosphere simulations with weather conditions typical of the planned burn locations and times. The variation and sensitivity analysis of the simulation design to model parameters performed by repeated Latin Hypercube Sampling is used to assess the locations of the sensors. The simulations provide the locations for the measurements that maximize the expected variation of the sensor outputs with varying the model parameters.

Protected areas are fundamental to biodiversity conservation, but there is growing recognition of the need to extend beyond protected areas to meet the ecological requirements of species at larger scales. Landscape-scale conservation requires an evaluation of management impact on biodiversity under different land-use strategies; this is challenging and there exist few empirical studies. In a conservation landscape in northern Republic of Congo we demonstrate the application of a large-scale monitoring program designed to evaluate the impact of conservation interventions on three globally threatened species: western gorillas, chimpanzees and forest elephants, under three land-use types: integral protection, commercial logging, and community-based natural resource management. We applied distance-sampling methods to examine species abundance across different land-use types under varying degrees of management and human disturbance. We found no clear trends in abundance between land-use types. However, units with interventions designed to reduce poaching and protect habitats--irrespective of land-use type--harboured all three species at consistently higher abundance than a neighbouring logging concession undergoing no wildlife management. We applied Generalized-Additive Models to evaluate a priori predictions of species response to different landscape processes. Our results indicate that, given adequate protection from poaching, elephants and gorillas can profit from herbaceous vegetation in recently logged forests and maintain access to ecologically important resources located outside of protected areas. However, proximity to the single integrally protected area in the landscape maintained an overriding positive influence on elephant abundance, and logging roads--even subject to anti-poaching controls--were exploited by elephant poachers and had a major negative influence on elephant distribution. Chimpanzees show a clear preference for unlogged or more mature forests and human disturbance had a negative influence on chimpanzee abundance, in spite of anti-poaching interventions. We caution against the pitfalls of missing and confounded co-variables in model-based estimation approaches and highlight the importance of spatial scale in the response of different species to landscape processes. We stress the importance of a stratified design-based approach to monitoring species status in response to conservation interventions and advocate a holistic framework for landscape-scale monitoring that includes smaller-scale targeted research and punctual assessment of threats.

Scorpion stings represent a major public health problem in Mexico. Their annual incidence is estimated at 150,000 cases; 800-1,000 people die from them each year, 72.5% of whom are children younger than 5 years old. The states most affected are Aguascalientes, Colima, Durango, Guanajuato, Guerrero, Jalisco, Michoacán, Morelos, Oaxaca, Puebla, Sinaloa, and Zacatecas. Morelos is an endemic zone, and scorpion stings are relatively frequent, but the indigenous population underestimates the risks. In this locality, scorpion stings lead to high morbidity, with an average of 10,219 cases each year, and a prevalence varying from 584.86 per 100,000 inhabitants in 1994 to 2043.3 per 100,000 inhabitants in 2003. Because of this upsurge, systematic medical supervision and serum therapy are necessary if scorpion poisoning is suspected in a child. The indigenous community as well as tourists visiting Mexico must be informed about the substantial risk of scorpion poisoning.

The health professional multimedia workstation is the natural entry point to health and knowledge networks. It should allow an easy and transparent management of all the data necessary for patient management. Multimedia nature of processed information reflects evolution of medical techniques that involve more and more complex objects such as video sequences or digitized signals. Workstations can be considered from 3 points of view: the professional end-users, the developers and the decision makers. The long term goal for the end-user is to establish an easy access in a working environment, that gives him/her the feeling of a single comprehensive application running on a single computer when the information system relies on a set of heterogeneous and geographically distributed components. Development of a workstation requires the integration into the same environment of tools to localize, access, manipulate and communicate the required information within a health information network. Analysis of the 445 Medline-indexed publications for the January 1991 to December 1994 period, that included the word workstation either in their title or in their abstract, helps in refining objectives and challenges both for the health professionals and the decision makers.

Endoscopic snare resection prior to Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenoma. One hundred and thirty four patients were included in the study: 72 with surgical contraindications, 61 for whom surgical resection appeared to be too drastic and 1 who refused surgery. Treatment sessions were repeated every fifteen days until total tumour destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of seven patients. Eight patients were lost to follow up. Treatment results could be analysed in 119 patients. A successful treatment was achieved in 108 patients. Tumour destruction was complete in 85.4 percent of the cases with lesions of at least 4 cm in diameter and in 94.3 percent of the cases with smaller lesions. During the average 101 weeks follow up period, 15.7 percent of the patients with total tumour destruction had recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgical treatment. It would appear that endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method for the destruction of colorectal villous adenomas.

Between February and October 1991, 530 consecutive patients underwent myocardial revascularization or valvular surgery with warm continuous antegrade and retrograde cardioplegia (37 degrees C). Three hundred and thirty three patients had isolated myocardial revascularization, 159 valvular surgery alone and 25 had combined valvular and coronary bypass. The global mortality was 5.1%, 3.7% for coronary bypass, 7.5% for valvular surgery and 8% for combined valvular and coronary surgery. A multivariate analysis identified the "reperfusion time" as the only predictive factor of hospital mortality (p < 0.001). Intraortic balloon counterpulsation was required postoperatively in 3.2% of cases, 5.2% of coronary bypass and 0.8% of the valvular patients. Inotropic drugs were used to come off cardiopulmonary bypass in 16.5% of coronary and 37.5% of valvular patients. There were 0.9% perioperative infarctions: 1.2% in the coronary bypass cases and 0.6% in the valvular cases. Spontaneous return to sinus rythm was observed in 87.9% of cases. The average "reperfusion time" was 20.48 +/- 0.7 mn. Analysis of the influence of aortic cross clamp time on cardiac morbidity in two groups of coronary patients (Group I: short cross clamp time less than 60 mn; Group II: long cross clamp time, 60 to 33 mn) showed that the hospital mortality, the prevalence of the use of inotropic drugs and balloon counterpulsation the postoperative cardiac index, the rate of spontaneous de fibrillation and the reperfusion time did not depend on the aortic cross clamp time. Cardiac morbidity.

In order to evaluate possible correlations between blood pressure levels and sleep quality, 7,901 workers of both sexes living in Paris area have been the subject of a survey during their annual examination performed by workside physicians. The enquiry included questions related to sleep quantity and quality, sleeping pills consumption, awakenings, nightmares, snoring, way of life and working conditions. The information concerning these parameters was available for 7,542 people. Among them, 6,551 (86.9%) did not suffer from high blood pressure (HBP) (blood pressure less than 160/95 mmHg), 618 (8.2%) presented a high blood pressure but were not treated, 371 (4.9%) received a treatment against HBP. The average sleep duration is about 7.4 h (S.D. = 1.0) for men and about 7.6 h (S.D. = 1.0) for women (less than 0.001). It is significatively and negatively correlated with the systolic blood pressure level (SBP) (less than 0.001) and the diastolic blood pressure level (DBP) (less than 0.001). The frequency of patients complaining of nightly awakening and of snoring significatively increase with SBP (p less than 0.05) and DBP (p less than 0.001). The observed association between DBP (but not SBP) and sleep duration and nightly awakening remains significant in multivariate analysis including age, sex, tobacco smoking, alcohol and coffee consumption, use of sleeping pills and hypotensive treatment, as well as the negative correlation between SBP and nightmare frequency. The correlation between SBP or SBP and snoring was no more significant. In conclusion, a significant correlation has been found between the blood pressure levels and the sleep quality whose clinical consequences remain to be explored.(ABSTRACT TRUNCATED AT 250 WORDS)

Taking over a chronic disease like diabetes in a hospital clinic raises multiple problems. Large numbers of diabetic patients and prolonged follow-up periods result in a mass of data that only computers can control. MELLITEE is a computerized system developed to facilitate the longterm management of patients and to help in maintaining a high standard of care. It includes a structured and standardized medical record. Physicians of three Parisian hospital clinics agreed on the minimum content of the record. MELLITEE is operated at the Saint-Louis Hospital on a 68,000 based mini-micro computer (Fortune/Thomson Micromega-32), running under the Unix operating system and with the Lied data base management system. Data are keyed directly into the computer by physicians, nurses and dietitians from throughout the department. On-line registration of information allows the suppression of the corresponding part of the usual paper record. The clinical data base obtained from administrative and medical information can be used to facilitate more effective patient follow-up and clinic management. The system is to be set up in the other collaborating centres in the near future, allowing pooling of data. It will also provide long-term information which can be used for evaluation of care and epidemiological research.

"ARTEMIS" is a standardized and computerized medical file which is intended for improving the follow-up of hypertensive patients, the efficacy of treatment and for realising national-wide surveys. The software "LIED" of data base for "ARTEMIS" is nowadays transposable on mini-computer. In Nephrology Unit of General Hospital from Colmar, the system has been working since September 1985 with MICRO-MEGA E 32 (Thomson). The administrative and medical data are directly acquired by the doctors and secretaries of the Unit on a conversational mode from six terminals. There is no writing collecting of data. An evaluation of the system was realized with the 113 first hypertensive patients. The results were compared to those obtained from patients of Paris area.

An integrated approach is described for the computerized management of a nephrology department. On a medical point of view, the system comprises a minimum medical record for every patient, different specialized records and knowledge bases presently covering hypertension, diabetes and chronic renal failure. From a technical point of view, the methodology used integrates data and knowledge management techniques. Various individual reports facilitate patient management. For hypertensive patients, an expert system is combined with the record system. The results of a preliminary evaluation are reported and future developments considered.

The results of a cross-sectional study were analysed in order to assess the therapeutic control of hypertension in relation to alcohol consumption. 6,665 subjects, employed in small and medium-sized companies of the Paris region were examined in a cross sectionnal study. Among the 1,008 hypertensive subjects, awareness of hypertension decreased with increasing alcohol consumption, from 72% among the 304 non-drinkers to 59% among the 201 heavy drinkers (six glasses/day and more) (p less than 0.05). Similarly, the percentage of subjects under current antihypertensive medication on the day of examination was lower in heavy drinkers, 19%, than among tetotalers, 42% (p less than 0.001). An antihypertensive treatment had been prescribed to 510 subjects. Among them, compliance, as stated by the interview, decreased with increasing alcohol consumption, from 70% to 34% (p less than 0.001). Using a logistic regression, the adjusted relative risk of non-compliance among heavy drinkers (6 glasses/day or more) was found to be 1.9. Among the 344 subjects under antihypertensive treatment on the day of examination, systolic and diastolic blood pressure were higher among heavy drinkers, 167/102 mmHg, than among teetotallers, 154/95 mmHg (p less than 0.01 both). The relative hypertension awareness, treatment and control status was thus poorer among, moderate and heavy drinkers than among the light and non-drinkers (table I). (Table: see text). The importance of the problem of alcoholism is thus emphasized, in both the fields of hypertension prevalence and control.

Benefits of using bicarbonate (B) containing dialysates instead of acetate (A) dialysates is still controversial. A single blind study was therefore performed using patients as their own control. Thirteen males and 10 females (mean age 44 years), with a poor dialysis tolerance were included in the study. 14 patients were dialyzed one week with dialysate A (A 38 mmol/l, CO3H 0, Na 140, K 1.5, Ca 1.75, Mg 0.75, Cl 108.5) and then one week with dialysate B (A 9, CO3H 29, Na 140, K 1.5, Ca 1.75, Mg 0.75, Cl 108.5); 9 patients were dialyzed one week with B and then one week with A. Measured osmolarity was 302 mOsm/l for dialysate A and 291 for dialysate B. A Unimat dialysate generator from Bellco was used in both cases. Student paired t tests were used for comparisons. Predialysis mean values of body weight, systolic and diastolic blood pressures, serum Na, K, Ca, P, BUN, and creatinin did not differed significantly with A and B dialysates. Hypotensive episodes (19.6% vs 36.2% p less than 0.05), headaches (5.8% vs 14.5%, p less than 0.05), and vomiting (8.0% vs 18.5%, p less than 0.10) were less frequent with B than with A. Postdialysis blood CO3H, K and P were higher with B than with A (all p less than 0.05). Results confirm, in acute conditions, the better tolerance of bicarbonate dialysis comparatively to acetate dialysis.

A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values less than 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather then three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index (less than 20 kg/m2), low cholesterol (less than 4.5 mmol/l) and low mean predialysis blood urea (less than 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.

The health benefits of hypertension treatment at the community level depend both of the quality of the blood pressure control obtained for each patient treated individually and of the percentage of the hypertensive patients actually aware, treated and controlled for hypertension in the entire population. The data collected in 1987 in a group of 7,901 subjects working in medium-sized companies of the Paris region were analysed, and compared with those obtained in a very comparable population in 1979-80. Among patients aware of their disease, the percentage of treated patients was higher in 1987 than in 1979, 55 p. 100 and 46 p. 100 respectively in men (p less than 0.001); 70 p. 100 in 87, 59 p. 100 in 79 for women (p less than 0.01). Hypertension was treated and controlled in 27 p. 100 of the men (16 p. 100 in 1979), and 42 p. 100 of women (27 p. 100 in 1979). Awareness was significantly lower among migrant workers than among european personnel (p less than 0.001). The lower the educational level, the lower the compliance with antihypertensive treatment, ranging from 99 p. 100 for the highest educational level, to 82 p. 100 among low educated subjects (p less than 0.001). The hospitalization rate did not differ according to sociocultural factors. Hypertension was detected by the worksite physician in 51 p. 100 of the male hypertensive patients. He was the sole physician who examined 17 p. 100 of the patients in the previous year. These results suggest a moderate improvement in hypertension detection and control. However, development of intervention strategies and their evaluation are clearly needed.

A survival analysis was performed in 1,453 patients treated by chronic haemodialysis and prospectively followed up in the computerised French Diaphane Dialysis Registry. Risk factors found for overall and cardiovascular mortality are age, male sex, high systolic of diastolic blood pressure, low body mass index and low predialysis values of cholesterol, triglycerides, haematocrit, urea, creatinine and potassium. These results confirm the importance of optimal blood pressure control. They indicate that the nutritional state may play a more vital role than certain cardio-vascular risk factors found in the general population.