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Indonesia is the biggest cacao producer in Asia and third biggest in the world, however, Indonesian cacao has low quality due to partial fermentation. Late 2010 almost all of the cacao production is exported in dried beans with a lower price than world’s cacao price rate. Export tax of cacao beans policy was changed to 15% in 2011 which conduce replacement of cacao beans export to finished product export. Innovation in cacao beans processing is important to develop escepially for agroindustry field. Cacao beans roasting process is important thing in chocolate processing. During the roasting process, phenolic compounds and methylxanthine of cacao beans were denatured. Vacuum drying oven is one of the alternative process which can preserve bioactive compounds. Thus, the aim of this research is to give information about effect of vacuum drying oven in total phenolic and antioxidant activity. Analysis methods used were total phenolic and antioxidant activity (IC-50) analysis. The result shown that vacuum drying oven has significant effect on total phenolic and antioxidant activity with three times higher in concentration than conventional method. The highest antioxidant activity and total phenolic content at 80°C and 75 minutes. Therefore, vacuum drying oven can be used as an alternative method with an advantage like preserve bioactive compound in cacao beans.Keywords: antioxidant, cacao, phenolic, roasting, vacuum drying

BACKGROUND A prolonged hepatitis E outbreak occurred between 2009 and 2012 among a semi-nomadic pastoralist population in the Karamoja region of Uganda. As data on the public health problems of nomadic pastoralists in sub-Saharan Africa is limited, we sought to characterize the epidemiology and challenges to control of hepatitis E in such a setting. METHODS A retrospective case-series investigation was undertaken. Surveillance line-lists of suspected hepatitis E cases maintained during the outbreak were analyzed. Standardized interviews and focus group discussions were conducted with key informants involved in outbreak control activities. RESULTS Between August 2009 and September 2012, 987 hepatitis E cases with individual case-based data were identified. Of 22 total deaths, almost half occurred during the first 4 months of the outbreak. Infection attack rates were higher among males and young adults. The average time between onset of jaundice and presentation was approximately 1 week. Challenges to control were related to persistent consumption of untreated water, poor sanitation infrastructure, remote geography, nomadic movement and civil insecurity. CONCLUSIONS The hepatitis E outbreak in Karamoja highlights the emergence of sanitation and hygiene-related disease among semi-nomadic pastoralist populations. Improving sanitation and safe water access and extending health education programs to remote pastoralist communities is crucial to prevent such diseases from becoming endemic.

Evidence-based medicine (EBM) has become a watchword for "the new" medical practice in the new century. Whether it represents a paradigm shift or simply a codification of the scientific method in medicine will be debated for years to come. Regardless of the place of EBM in medicine, this "movement" has served an important role in moving physician practice into the realm of becoming more scientific (albeit empirical) and transparent. There are still many problems to be addressed in the global application of the best evidence for medical practice. These include low-quality studies, delays in implementation of clear-cut improvements, outright fraud and deceit, and wariness on the part of physicians to change their practice. By working to understand the underpinnings of EBM (basic statistical concepts and critical thinking) we can advance the practice of medicine along the moral high road of science.

The personal computer version of the REDAPOL apple fruit set prediction model has been validated in Arizona and Washington orchards. The PC-REDAPOL computer simulation model is designed to predict the percentage of blossoms setting fruit on apple trees. PC-REDAPOL predictions were within the 95% CI of the actual average percentage of blossoms setting fruit in 16 out of 23 model validation tests. The model also accurately predicted fruit set on limbs where honey bee, Apis mellifera L., visitation and pollination were stopped at different points during bloom. PC-REDAPOL has all the features of the original REDAPOL model, plus additions such as the ability to update estimates of the honey bee foraging population on apple trees during a simulation, pest management information, and a degree-day calculator. The program runs on IBM compatible personal computers and is available on request.

SUMMARYIn sub-Saharan Africa, many nomadic pastoralists have begun to settle in permanent communities as a result of long-term water, food, and civil insecurity. Little is known about the epidemiology of cholera in these emerging semi-nomadic populations. We report the results of a case-control study conducted during a cholera outbreak among semi-nomadic pastoralists in the Karamoja sub-region of northeastern Uganda in 2010. Data from 99 cases and 99 controls were analysed. In multivariate analyses, risk factors identified were: residing in the same household as another cholera case [adjusted odds ratio (aOR) 6·67, 95% confidence interval (CI) 2·83–15·70], eating roadside food (aOR 2·91, 95% CI 1·24–6·81), not disposing of children's faeces in a latrine (aOR 15·76, 95% CI 1·54–161·25), not treating drinking water with chlorine (aOR 3·86, 95% CI 1·63–9·14), female gender (aOR 2·43, 95% CI 1·09–5·43), and childhood age (10–17 years) (aOR 7·14, 95% CI 1·97–25·83). This is the first epidemiological study of cholera reported from a setting of semi-nomadic pastoralism in sub-Saharan Africa. Public health interventions among semi-nomadic pastoralists should include a two-faceted approach to cholera prevention: intensive health education programmes to address behaviours inherited from insecure nomadic lifestyles, as well as improvements in water and sanitation infrastructure. The utilization of community-based village health teams provides an important method of implementing such activities.

Recommendations for a core curriculum for undergraduate emergency medicine education have been published. It is expected that a combination of bedside teaching and didactic sessions will cover all aspects of the curriculum, but this has not been demonstrated. This study describes a method of using the distribution of clinical cases to shape the mix of clinical and didactic learning in an emergency medicine clerkship. All senior students at the Albany Medical College participate in a four-week emergency medicine rotation. A brief log describing each clinical encounter is maintained by the students. Data from one year were sorted into 32 categories adapted from American College of Emergency Physicians guidelines and were tabulated. A criterion of 80% of students encountering at least one case in each category was chosen to ensure a reasonable level of exposure to a particular case or topic. One hundred twenty-three students were exposed to an average of 63.7 +/- 27.5 (SD) patients. Seven categories met the criterion, and the remaining 25 categories failed the criterion. Results indicate that exposure to certain categories of patients with appropriate monitoring can be reasonably ensured in our clinical setting. The didactic portion of the curriculum can be adjusted so that categories not meeting the clinical criterion will be emphasized, whereas those meeting the criterion will be de-emphasized. A method has been described that identifies gaps in the clinical exposure of students and permits appropriate identification of didactic sessions to create a clerkship more consistent with recommended guidelines.

This article reflects the proceedings of a workshop session, Postgraduate Education and Knowledge Translation, at the 2007 Academic Emergency Medicine Consensus Conference on knowledge translation (KT) in emergency medicine (EM). The objective was to develop a research strategy that incorporates KT into EM graduate medical education (GME). To bridge the gap between the best evidence and optimal patient care, Pathman et al. suggested a multistage model for moving from evidence to action. Using this theoretical knowledge-to-action framework, the KT consensus conference group focused on four key components: acceptance, application, ability, and remembering to act on the existing evidence. The possibility that basic familiarity, along with the pipeline by Pathman et al., may improve KT uptake may be an initial starting point for research on GME and KT. Current residents are limited by faculty GME role models to demonstrate bedside KT principles. The rapid uptake of KT theory will depend on developing KT champions locally and internationally for resident physicians to emulate. The consensus participants combined published evidence with expert opinion to outline recommendations for identifying the barriers to KT by asking four specific questions: 1) What are the barriers that influence a resident's ability to act on valid health care evidence? 2) How do we break down these barriers? 3) How do we incorporate this into residency training? 4) How do we monitor the longevity of this intervention? Research in the fields of GME and KT is currently limited. GME educators assume that if we teach residents, they will learn and apply what they have been taught. This is a bold assumption with very little supporting evidence. This article is not an attempt to provide a complete overview of KT and GME, but, instead, aims to create a starting point for future work and discussions in the realm of KT and GM.

Evidence Based Medicine (EBM) is a movement within the field of medicine to assure that physicians use the best available evidence from well done clinical research studies in making the decisions regarding the types of therapies and diagnostic tests used for their patients. EBM uses many of the tools of “clinical epidemiology” to help physicians appraise the quality of scientific medical research studies. However, it is the blending of critical appraisal of the best evidence, patient preferences, the clinical predicament and clinical judgment that allow the best evidence to be used in patient care. The critical appraisal function of EBM becomes synonymous with improved critical thinking by physicians and other members of the health care team.

Isolated talus fractures are very uncommon and are usually associated with severe trauma. Five cases of isolated talus fracture associated with relatively minor trauma are reported. These five patients had one clinical sign in common, pain out of proportion to the severity of their injury. The treatment of talus fractures is reviewed.

A case of bilateral vocal cord hematomas caused by a shoulder harness injury is presented. The patient was restrained by a three-point belt system and was involved in a front-end collision. She presented with mild facial and chest injuries and a contusion of the neck. One hour after injury she began to complain of hoarseness without airway compromise. Fiberoptic laryngoscopy showed bilateral true vocal cord hematomas. The patient had an uneventiul hospital course and a full recovery. The importance of the mechanism of injury and associated injuries is discussed.

The formation of delayed intracranial hematomas should be considered in a head-injured patient who experiences clinical deterioration, especially after surgical evacuation of an initial hematoma or placement of an ICP monitor. Development of increased ICP or neurological deterioration following the administration of mannitol should also raise suspicion of new lesions. Immediate follow-up CT should be performed for declining neurological status. Repeat CT is recommended within 24 hours of admission or within 24 hours after craniotomy, even if the patient's neurological status has not deteriorated. New mass effects are often seen in patients who deteriorate neurologically after head injury.

A 71-year-old woman presented with altered level of consciousness following episodes of diarrhea and abdominal pain. Shigella sonnei was later cultured from her stool. Although neurological complications, primarily seizures, have been reported sequelase in children affilicted with shigellosis, there are only rare cases of encephalopathy in affected adults. A brief discussion of the neurological complications of Shigella infection and the yet undetermined role of Shiga toxin in producing neurotoxicity are presented.

Should be integrated into current clinical scenarios Teaching clinical epidemiology has always been challenging, seen as too mathematical and remote from normal clinical practice. Evidence based medicine (EBM) evolved to provide the skills needed to manage the potential information overload of modern medical schools, especially at McMaster, the shortest medical programme in the world. Students have to grasp two essential principles of EBM: its empirical approach to optimal clinical decisions (regardless of pathophysiology, does the bottom line of the balance sheet show gain or loss?); and its quantitative expression (how big is that gain or loss?). These require some mastery of epidemiology and statistics, both repellent to many doctors, even in teaching hospitals.1 2 Now most medical programmes in the United States attempt to teach EBM, although few succeed (the two most important barriers being inadequate access to electronic information at the point of care, and inadequate faculty training).3 What are the best ways of teaching this stuff? By breaking its elements …

In this pair of articles, Gavin Falk and Tom Fahey (doi:10.1136/bmj.b2899) set out what to consider when using a clinical prediction rule, and Dan Mayer (doi:10.1136/bmj.b2901) shows how one such rule, the Ottawa ankle rules, is applied

Patients generally have the right to refuse medical care, a right based on certain legal precedents. Its application in the emergency department leads to difficult decisions for the emergency physician. A model that allows the emergency physician to determine the capacity of a patient to refuse care is presented. Certain types of patients regularly present problems in their treatment. These include psychiatric patients, narcotics abusers, alcoholics, "street people," and some patients with migraine headaches. They represent some of our most difficult decisions because the treatment required for the patient is often clear and the patient refuses care or demands inappropriate care.

Study objectives: This study describes an experience of fourth-year medical students using evidence-based medicine at the point of care in their required emergency medicine rotation. All of these students had undergone evidence-based medicine training as part of their regular teaching before entering the clerkship. Methods: This observational prospective study was performed in a tertiary care referral center between August 2002 and May 2003. All 117 fourth-year students on rotation in the emergency department (ED) performed at least 1 evidence-based medicine search for a clinically relevant question during a shift. The resident or attending physician suggested a clinical question about a patient in the ED for which the most current data were desired. Students were asked to first formulate a clinical query using the PICO (Patient, Intervention, Comparison, and Outcome) format. They then used an ED computer to search the library databases for the best evidence and completed a data form. The searches were an assignment for the informatics course, and the evidence evaluation was an assignment for the evidence-based health care course during that rotation. Results: Ninety percent of the students found relevant and useful information about a clinical question about a patient in the ED. The average search time was 45 minutes, with no difference in times for successful versus unsuccessful. The search times reported were done in a start-to-stop fashion and included the time spent with interruptions and multitasking typical of ED practice, as well as the time to fill out a lengthy data sheet. There was no difference in times across rotation months or by specialty choice of the students. Conclusion: The majority of students were able to use evidence-based medicine at the point of care to uncover useful information for patients in the ED. Under the constraints of the assignment, the times involved were generally long. Further assessment of evidence-based medicine point-of-care searching will need to be done for student and nonstudent practitioners.

Six series of tests were conducted with insecticides applied to 0.01 acre plots of alfalfa. Treatments were made with a hand sprayer, using 25 psi pressure and applying 25 gal/acre. Residual test exposures were replicated 4 times by caging 50-100 honey bees (HB), 15-30 alkali bees (AB), or 20-40 alfalfa leafcutting bees (LB) with each of 4 samples per treatment and time interval. HB were placed in petri dish cages with screen inserts, fed sugar syrup, and held at 75-78°F. AB and LB were placed in petri dish bottoms covered with screened plates, fed honey syrup, and held at 85-88°F.

Five series of tests were conducted with insecticides applied to 0.01 acre plots of alfalfa. Treatments were made with a hand sprayer, using 25 psi pressure and applying 25 gal/acre. Residual test exposures were replicated 4 times by caging 50-100 honey bees (HB), 15-30 alkali bees (AB), or 20-40 alfalfa leafcutting bees (LB) with each of 4 samples per treatment and time interval. HB were placed in petri dish cages with screen inserts, fed sugar syrup, and held at 75-78°F. AB and LB were placed in petri dish bottoms covered with screened plates, fed honey syrup, and held at 85-88°F.

Eight chemical and microbial treatments were applied to 'Jubilee' sweet corn using fixedwing aircraft. Four applications were made at 5-day intervals beginning September 2 , 1976 (10% silk). Plots were one acre each, replicated four times in randomized blocks. Fifteen days after the last application, 50 ears were sampled from the center of each plot. Each ear was checked for earworm damage and the number of ears with one or more living earworms was also recorded. Extent of damage was rated for length using an index of 1 to 5 where 1 = 0 - 0 . 5 cm, 2 = 0 . 5 - 1 cm, 3 = 1 - 2 cm, 4 = 2 - 3 cm, and 5 = > 3 cm in length and for circumference where 1 = 1 - 2 kernels, 2 = up to 1/4, 3 = up to 1 / 2 , 4 = up to 3 / 4 , and 5 = up to entire circumference. Materials tested were also evaluated for toxicity to honey bees, using an index of 0 to 5 where 0 has no hazard, 1 having a short residual hazard, and 5 a long residual hazard.

Sevin XLR was evaluated on corn and alfalfa for bee-poisoning hazard. Treatments on alfalfa were made with a hand sprayer, using 25 psi pressure and applying 25 gal/acre. Residual test exposures were replicated 4 times by caging 100 honey bees with each of 4 samples per treatment and time interval. Treatments on corn were made by helicopter at 1.5 lb ai/acre to pollen shedding corn. Four applications were applied on 1 acre plots and 2 applications on a 130 acre plot. The number of dead bees in Todd dead bee traps on colonies placed near the plots was recorded daily.

Five chemical treatments were applied to corn ‘Jubilee’ using fixed-wing aircraft. Four applications were made at 5-day intervals beginning August 30-31, 1975 (10% silk). Plots were one acre each, replicated four times in randomized blocks. Ten days after the last application, 100 ears were sampled from the centers of each plot. Each sample was checked for number with one or more living earworms and number with earworm damage. Materials tested were also evaluated for toxicity to honey bees. They are rated by using an index of 0 to 5 where 0 has no hazard, 1 has a short residual hazard and 5 has a long residual hazard.