Journal articles on the topic 'Other health not elsewhere classified'

Due to the high levels of alcohol use, alcohol-attributable mortality and burden of disease, and detrimental drinking patterns, Lithuania implemented a series of alcohol control policies within a relatively short period of time, between 2008 and 2019. Based on their expected impact on alcohol consumption and alcohol-attributable harm, as well as their target population, these policies have been classified using a set of objective criteria and expert opinion. The classification criteria included: positive vs. negative outcomes, mainly immediate vs. delayed outcomes, and general population vs. specific group outcomes. The judgement of the alcohol policy experts converged on the objective criteria, and, as a result, two tiers of intervention were identified: Tier 1—highly effective general population interventions with an anticipated immediate impact; Tier 2—other interventions aimed at the general population. In addition, interventions directed at specific populations were identified. This adaptable methodological approach to alcohol control policy classification is intended to provide guidance and support for the evaluation of alcohol policies elsewhere, to lay the foundation for the critical assessment of the policies to improve health and increase life expectancy, and to reduce crime and violence.

AbstractObjectivesTo estimate the dietary intakes of heterocyclic amines (HCAs), to examine the intakes in relation to socio-economics, lifestyle and other dietary factors and to compare the classification of subjects by intake of HCA versus intake of meat and fish.DesignCross-sectional analysis within the Malmö Diet and Cancer (MDC) cohort. Data were obtained from a modified diet history, a structured questionnaire on socio-economics and lifestyle, anthropometric measurements and chemical analysis of HCAs. HCA intake was cross-classified against meat and fish intake. The likelihood of being a high consumer of HCAs was estimated by logistic regression analysis. Dietary intakes were examined across quintiles of HCA intake using analysis of variance.SettingBaseline examinations conducted in 1991–1994 in Malmö, Sweden.SubjectsA sub-sample of 8599 women and 6575 men of the MDC cohort.ResultsThe mean daily HCA intake was 583 ng for women and 821 ng for men. Subjects were ranked differently with respect to HCA intake compared with intake of fried and baked meat and fish (κ = 0.13). High HCA intake was significantly associated with lower age, overweight, sedentary lifestyle and smoking. Intakes of dietary fibre, fruits and fermented milk products were negatively associated with HCA intake, while intakes of selenium, vegetables, potatoes, alcohol (among men) and non-milk-based margarines (among women) were positively associated with HCA intake.ConclusionsThe estimated daily HCA intake of 690 ng is similar to values obtained elsewhere. The present study suggests that lifestyle factors (e.g. smoking, physical activity, fruit and vegetable intakes, and types of milk products and margarines) may confound associations between HCA intake and disease. The poor correlation between HCA intake and intakes of fried meat and fish facilitates an isolation of the health effects of HCAs.

AbstractObjective:To determine whether volumetric measures of the hippocampus, entorhinal cortex, and other cortical measures can differentiate between cognitively normal individuals and subjects with mild cognitive impairment (MCI).Method:Magnetic resonance imaging (MRI) data from 46 cognitively normal subjects and 50 subjects with MCI as part of the Boston University Alzheimer’s Disease Center research registry and the Alzheimer’s Disease Neuroimaging Initiative were used in this cross-sectional study. Cortical, subcortical, and hippocampal subfield volumes were generated from each subject’s MRI data using FreeSurfer v6.0. Nominal logistic regression models containing these variables were used to identify subjects as control or MCI.Results:A model containing regions of interest (superior temporal cortex, caudal anterior cingulate, pars opercularis, subiculum, precentral cortex, caudal middle frontal cortex, rostral middle frontal cortex, pars orbitalis, middle temporal cortex, insula, banks of the superior temporal sulcus, parasubiculum, paracentral lobule) fit the data best (R2= .7310, whole model test chi-square = 97.16,p< .0001).Conclusions:MRI data correctly classified most subjects using measures of selected medial temporal lobe structures in combination with those from other cortical areas, yielding an overall classification accuracy of 93.75%. These findings support the notion that, while volumes of medial temporal lobe regions differ between cognitively normal and MCI subjects, differences that can be used to distinguish between these two populations are present elsewhere in the brain.

Purpose: To analyze 10-year trends in utilization of visual field tests for adult glaucoma or glaucoma-suspect patients using the Korean Health Insurance Review and Assessment data.Methods: Health claims for the years 2010 to 2019, as recorded via Korea’s Health Insurance Review and Assessment service, were accessed. We identified glaucoma patients using the glaucoma diagnostic codes H40 (glaucoma) and H42 (glaucoma in other diseases classified elsewhere). For verification of the glaucoma diagnosis, information on any antiglaucoma medication prescriptions and ocular surgery history also was obtained. Visual field testing data was isolated using procedural codes E6690 (kinetic perimetry) and E6691 (standard automated perimetry [SAP]) performed in tertiary hospitals. Any changes in visual field test utilization were identified using regression trend analysis.Results: From 2010 to 2019, the total number of SAP procedures performed in tertiary hospitals for either glaucoma or glaucoma-suspect patients increased gradually from 93,459 to 216,433. With regard to kinetic perimetry examinations, the total number decreased gradually from 6,364 to 3,792. The yearly average SAP number per patient showed a slight increase, from 1.168 to 1.248 (ß = 0.008, R2 = 0.669, p = 0.004). Meanwhile, the yearly average number of kinetic perimeter examinations per patient showed a significant decrease, from 1.093 to 0.940 (ß = -0.013, R2 = 0.580, p = 0.010).Conclusions: Between 2010 and 2019, the yearly average number of SAP procedures performed per glaucoma or glaucoma-suspect patient increased in Korea. Meanwhile, the yearly average number of kinetic perimetry examinations per patient significantly decreased.

Objectives: To review the literature evaluating outcomes resulting from expansion of the bipolar disorder (BD) diagnostic category. We were particularly interested in identifying high-level evidence for improved clinical outcomes as documented by randomized controlled trials (RCTs) or cohort studies. Methods: The English-language literature was searched using Ovid MEDLINE for studies of BD referenced against the key word spectrum. We used bibliographies and other databases to extend this search when no relevant RCTs or relevant cohort studies were identified. Results: In the MEDLINE searches, abstracts and titles of 86 studies were examined and 48 were found to be related to the topic of bipolar spectrum disorders (BSD). No RCTs or prospective cohort studies evaluating modified diagnostic or therapeutic practices were identified. The literature about the BSD consists mostly of expert opinion emphasizing: various links between bipolar and unipolar mood disorders; a proposal that a greater proportion of the population without a mood disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders should be diagnosed under the BD category; and, proposals that syndromes currently classified elsewhere should be subsumed under the BD category. Conclusions: Our search failed to uncover high-level evidence demonstrating the clinical utility of proposed diagnostic realignments. The widespread acceptance of the expanded spectrum concept appears to be based on interpretation of descriptive epidemiologic data by high-profile experts.

Background: Pleomorphic xanthoastrocytoma (PXA) is a rare form of astrocytic neoplasm most commonly found in children and young adults. This neoplasm, which is classified as a Grade II tumor by the World Health Organization classification of tumors of the central nervous system, carries a relatively favorable outcome. It is usually found supratentorially in cortical regions of the cerebral hemispheres, and as such, presenting symptoms are similar to other supratentorial cortical neoplasms; with seizures being a common initial symptom. Due to the rarity of this type of neoplasm, PXA arising elsewhere in the brain is often not included in the initial differential diagnosis. Case Description: This report presents an extremely rare patient with PXA arising in the suprasellar region who presented with progressive peripheral vision loss. Magnetic resonance imaging of the brain demonstrated a heterogeneous suprasellar mass with cystic and enhancing components initially; the most likely differential diagnosis was craniopharyngioma. The patient underwent endoscopic endonasal resection of the tumor. Microscopically, the tumor was consistent with a glial neoplasm with variable morphology. Based on these findings along with further immunohistochemical workup, the patient was diagnosed with a PXA arising in the suprasellar region. At the 1-year follow-up, the patient remained free of recurrence. Although rare PXA originating in other uncommon locations, such as the spinal cord, cerebellum, the ventricular system, and the pineal region have been previously described. Conclusion: Although rare, PXA should be included in the differential diagnosis for solid-cystic tumors arising in the suprasellar region in young adults.

Background: Adverse drug reactions (ADRs) constitute a major clinical problem in terms of human suffering and increased health care costs. To study the adverse drug reactions reported in a tertiary care hospital and study of causality assessment and severity of adverse drug reaction (ADR) cases reported.Methods: A prospective observational study was conducted as part of pharmacovigilance program over 12months between September 2015 and August 2016. Adverse drug reactions reported from hospital were filled into Suspected ADR - CDSCO forms and submitted to pharmacovigilance unit. Causal relationship was assessed and categorized by Naranjo’s algorithm and WHO - UMC causality scale. The severity of each ADR was assessed using Modified Hartwig and Siegel scale.Results: Total 120 cases were reported over 12 months. Among them, 66% were in males and 55% were in females. The majority of ADRs were due to antimicrobial agents (40.78%) followed by haematinics (12%) and anti-epileptics (10%). Maximum number of patients (30.25%) reported with dermatological manifestations. Highest number of ADRs was reported from the department of medicine (45%). As per Naranjo’s scale, 54% reports were assessed as probable and 46% classified as possible. Majority of cases were mild to moderate in severity.Conclusions: The pattern of ADRs reported in our hospital is similar with the pattern of studies conducted in other hospitals elsewhere. This study provides a database of ADRs due to commonly used drugs in our hospital, which will help clinicians for their optimum and safe use. Hence effective pharmacovigilance is required for the use of these drugs and their safety assessment.

Purpose The purpose of this paper is to gather epidemiologicalinformation concerning firesetters with intellectual disabilities (ID) in Denmark to identify the assessment and treatment needs of this population and inform further research in this area. Design/methodology/approach The records held by the Danish Ministry of Justice concerning all firesetters with ID convicted of deliberate firesetting were reviewed for the period January 2001 to December 2010 inclusive. File information was extracted for 83 offenders concerning: demographic and personal characteristics; mental health characteristics; offending behaviour; offence-specific factors; and motives for offending. A sub-group of seven offenders were interviewed to explore some of the themes that emerged from the file review. Findings The majority of study participants were male and were classified as having mild ID and around 50 per cent had additional mental health problems. Many came from disturbed and deprived backgrounds. Two-thirds had set more than one fire and over 60 per cent had convictions for offences other than firesetting. Alcohol was involved in the firesetting behaviour in a significant proportion of cases (25 per cent). The motives for setting fires were – in descending order – communication (of anger, frustration and distress), fire fascination and vandalism. Interviews with participants indicated the important communicative function of firesetting, the difficulties people had in talking about and acknowledging their firesetting behaviour, and lack of access to targeted interventions. Research limitations/implications Interventions for Danish firesetters with ID, as for firesetters with ID elsewhere, need to target the communicative function of this behaviour, along with offenders’ lack of insight and initial reluctance to accept responsibility for their behaviour and associated risks. Adjunctive treatment is required to address the psychiatric comorbidity experienced by many of these offenders, along with the alcohol use/misuse that is associated with many of these offences. Originality/value This is the first study concerning nature and needs of firesetters with ID in Denmark.

In this era of startling developments in the medical field there remains a serious worry about the hazardous potential of various by products which if not properly addressed can lead to consequences of immense public concern. Hospitals and other health care facilities generate waste products which are evidently hazardous to all those exposed to its potentially harmful effects. Need for effective legislation ensuring its safe disposal is supposed to be an integral part of any country's health related policy. This issue is of special importance in developing countries like Pakistan which in spite of framing various regulations for safeguarding public health, seem to overlook its actual implementation. The result unfortunately is the price wehave to pay not only in terms of rampant spread of crippling infections but a significant spending of health budget on combating epidemics which could easily have been avoided through effective waste disposal measures in the first place. Waste classified under the heading 'bio-hazardous' includes any infectious or potentially infectious material which can be injurious or harmful to humans and other living organisms. Amongst the many potential sources are the hospitals or other health delivery centres which are ironically supposed to be the centres of infection control and treatment. Whilst working in these setups, health care workers such as doctors, nurses, paramedical staff and sanitation workers are actually the ones most exposed and vulnerable to these challenges. Biomedical waste may broadly be classified into Infectious and toxic waste. Infectious waste includes sharps, blood, body fluids and tissues etcwhile substances such as radioactive material and by-products of certain drugs qualify as toxic waste. Furthermore health institutions also have to cater for general municipal waste such as carton boxes, paper and plastics. The World Health Organisation has its own general classification of hospital waste divided into almost eight categories of which almost 15% (10% infectious and 5% toxic) is estimated to be of a hazardous nature while the remaining 85% is general non hazardous content.1A recent study from Faisalabad, Pakistan has estimated hospital waste generation around 1 to 1.5 kg / bed /day for public sector hospitals in the region,2while figures quoted from neighbouring India are approximately 0.5 to 2 KG / hospital bed /day.3 Elsewhere in the world variable daily hospital waste production has been observed ranging from as low as 0.14 to 0.49 kg /day in Korea4 and 0.26 to 0.89 kg/day in Greece5to as high as 2.1 to 3.83 kg/day in Turkey6 and 0.84 to 5.8 kg/day in Tanzania.7Ill effects of improper management of hospital waste can manifest as nosocomial infections or occupational hazards such as needle stick injuries. Pathogens or spores can be borne either through the oro-faecal or respiratory routes in addition to direct inoculation through contact with infected needles or sharps. Environmental pollution can result from improper burning of toxic material leading to emission of dioxins, particulate matter or furans into the air. The habitat can also be affected by illegal dumping and landfills or washing up of medical waste released into the sea or river. Potential organisms implicated in diseases secondary to mismanagement of hospital waste disposal include salmonella, cholera, shigella, helminths, strep pneumonia, measles, tuberculosis, herpesvirus, anthrax, meningitis, HIV, hepatitis and candida etc. These infections can cause a considerable strain on the overall health and finances of the community or individuals affected. The basic principal of Public health management i.e 'prevention is better than cure' cannot be more stressed in this scenario as compared to any other health challenge. Health facilities must have a clear policy on hazardous waste management. To ensure a safe environment hospitals need to adopt and implement international and local systems of waste disposal. Hospital waste management plan entails policy and procedures addressing waste generation, accumulation, handling, transportation, storage, treatment and disposal. Waste needs to be collected in marked containers usually colour coded and leak proof. Segregation at source is of vital importance. The standard practice in many countries is the Basic Three Bin System ie to segregate the waste into RED bags/ boxes for sharps, YELLOW bags for biological waste and BLUE or BLACK ones for general/ municipal waste. All hospital staff needs to be trained in the concept of putting the right waste in relevant containers/ bags. They need to know that more than anything else this practice is vital for their own safety. The message can be reinforced through appropriate labelling on the bins and having posters with simple delineations to avoid mixing of different waste types. Sharps essentially should be kept in rigid, leak and puncture-resistant containers which are tightly lidded and labelled. Regular training sessions for nurses and cleaning staff can be organised as they are the personnel who are more likely to deal with waste disposition at the level of their respective departments. Next of course is transportation of waste products to the storage or disposal. Sanitary staff and janitors must be aware of the basic concepts of waste handling and should wear protective clothing, masks and gloves etc, besides ensuring regular practice of disinfection and sterilization techniques.8Special trolleys or vehicles exclusively designed and reserved for biomedical waste and operated by trained individuals should be used for transportation to the dumping or treatment site. Biomedical waste treatment whether on site or off site is a specialised entity involving use of chemicals and equipment intended for curtailing the hazardous potential of the material at hand. Thermal treatment via incinerators, not only results in combustion of organic substances but the final product in the form of non-toxicash is only 10 to 15% of the original solid mass of waste material fed to the machine. Dedicated autoclaves and microwaves can also be used for the purpose of disinfection. Chemicals such as bleach, sodium hydroxides, chlorine dioxide and sodiumhypochlorite are also effective disinfectants having specialised indications. Countries around the world have their own regulations for waste management. United Kingdom practices strict observance of Environmental protection act 1990, Waste managementlicensing regulations 1994 and Hazardous waste regulations 2005 making it one of thesafest countries in terms of hazardous waste disposal. Similar regulations specific for each state have been adopted in United States following passage of the Medical Waste tracking act 1988. In Pakistan, every hospital must comply with the Waste Management Rules 2005 (Environment Protection Act 1997), though actual compliance is far from satisfactory. It is high time that the government and responsible community organisations shape up to seriously tackle the issue of bio hazardous waste management through enforcement of effective policies and standard operating procedures for safeguarding the health and lives of the public in general and health workers in particular.

Abstract The World Health Organization (WHO) central nervous system (CNS) tumor classification has represented the primary source of diagnosis and grading criteria of brain tumors. Nonetheless, recent advances of studies on their molecular alterations require more rapid update of recommendations for clinical practice. To accomplish this, cIMPACT-NOW (the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy) was established in 2016 and has published four updates. For adult gliomas, update 1 clarified the use of the term NOS (Not Otherwise Specified) and proposed a new term NEC (Not Elsewhere Classified); update 2 revised clarifications regarding diffuse astrocytoma/anaplastic astrocytoma, IDH-mutant; update 3 proposed molecular criteria for an IDH-wildtype diffuse or anaplastic astrocytic glioma without histological features of glioblastoma, which would behave similarly to a grade IV glioblastoma. Nonetheless, no consensus on pathologic or molecular markers that could be incorporated into a more clinically relevant grading scheme for IDH-mutant gliomas has been reached. The molecular alterations previously studied using relatively large cohorts include CDKN2A/B homozygous deletion, CDK4 amplification, RB1 mutation/homozygous deletion, PIK3CA or PIK3R1 mutations, PDGFRA amplification, NMYC amplification, global hypomethylation, genomic instability and chromosome 14 loss. The proliferative activity, based on the mitotic count or Ki67 indices, and other morphologic features typical of a high grade that might stratify the risk better than the current criteria have also been evaluated. Despite the discordance among the results of previous studies, CDKN2A/2B homozygous deletions have been shown prognostic significance in high-grade IDH-mutant astrocytomas and microvascular proliferation stratifies IDH-mutant gliomas lacking a CDKN2A homozygous deletion, suggesting that the integration of molecular information and traditional histological findings is still essential for achieving maximum risk stratification of adult cases of IDH-mutant diffuse gliomas. The grading scheme for adult IDH-mutant as well as wild-type gliomas should therefore be revised in the next WHO update.

Abstract Background Diagnostic error leads to delays of care and mistaken therapeutic decisions that can cascade in a downward spiral. Thus, it is important to make accurate diagnostic decisions early on in the clinical care process, such as in the emergency department (ED). Clinical data from the Electronic Health Record (EHR) could identify cases where an initial diagnosis appears unusual in context. This capability could be developed into a quality measure for feedback. To that end, we trained a multiclass machine learning classifier to predict infectious disease diagnoses following an ED visit. Methods To train and evaluate our classifier, we sampled ED visits between December 31, 2016, and December 31, 2019, from Veterans Affairs (VA) Corporate Data Warehouse (CDW). Data elements used for prediction included lab orders and results, medication orders, radiology procedures, and vital signs. A multiclass XGBoost classifier was trained to predict one of five infectious disease classes for each ED visit based on the clinical variables extracted from CDW. Our model was trained on an enriched sample of 916,562 ED visits and evaluated on a non-enriched blind testing set of 356,549 visits. We compared our model against an ensemble of univariate Logistic Regression models as a baseline. Our model was trained to predict for an ED visit one of five infectious disease classes or “No Infection”. Labels were assigned to each ED visit based on ICD-9/10-CM diagnosis codes used elsewhere and other structured EHR data associated with a patient between 24 hours prior to an ED visit and 48 hours after. Results Classifier performance varied across each of the five disease classes (Table 1). The classifier achieved the highest F1 and AUC for UTI, the lowest F1 for Sepsis, and the lowest AUC for URI. We compared the average precision, recall and F1 scores of the multiclass XGBoost with the ensemble of Logistic Regression models (Table 2). XGBoost achieved higher scores in all three metrics. Table 1. Classification performance XGBoost testing set performance in each disease class, visits with no labels, and macro average. The infectious disease classes with the highest score in each metric are shown in bold. Table 2. Baseline comparison Macro average scores for XGBoost and baseline classifiers. Conclusion We trained a model to predict infectious disease diagnoses in the Emergency Department setting. Future work will further explore this technique and combine our supervised classifier with additional signs of medical error such as increased mortality or anomalous treatment patterns in order to study medical misdiagnosis. Disclosures All Authors: No reported disclosures

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Reliable data on mortality and morbidity among women of reproductive age are scarce in India. The present study is the Rajasthan component of a large multi-centric study on cause of death by verbal autopsy conducted in five states of India. The data pertaining to deaths among women of reproductive age are presented. </p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>House-to-house surveys of a representative population from rural and urban areas in six districts of Rajasthan were undertaken by Probability of Proportion to Size (PPS) sampling. Information on death was obtained from the relatives of the deceased and cause of death was assigned using the standardized algorithm prepared for the purpose. International Classification of Diseases - ICD-10 was used to code the assigned cause of death. </p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>A total of 231 deaths of women of reproductive age were investigated, of which 36 (16%) were maternal deaths while 195 (84%) were non-maternal deaths. Nine out of ten maternal deaths were in rural area.</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>Certain infectious and parasitic diseases; pregnancy, childbirth and the puerpurium; injury, poisoning and other consequences of external causes; and symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified were found to be the major killers among the women of reproductive age. A comprehensive approach that includes in addition to reproductive health interventions, interventions addressing underlying illiteracy among women and social reforms needs to be undertaken. </p><p class="keywords"><strong><span lang="EN-US">Keywords: </span></strong>Maternal deaths, Non-maternal deaths, Women of reproductive age, Verbal autopsy</p>

Background: The NHSN parameter estimate for predicted number of central-line–associated bloodstream infection (CLABSI) is the same for gastroenterology wards as other specialty wards, such as behavioral health and gerontology. We conducted this study to contribute to the body of knowledge surrounding the risk for hospital-acquired bloodstream infection (HABSI) in patients with and without hepatic failure. The Cleveland Clinic is a 1,200-bed, multispecialty hospital with a solid-organ transplant service. Patients with hepatic failure who do not require critical care are housed on 36-bed unit A. On unit A, 43% of patients are under hepatology or gastroenterology service, although 51% of patients are under general internal medicine. Overall, unit A has a high incidence of HABSI. Methods: Surveillance for HABSI and CLABSI is performed at the Cleveland Clinic per NHSN protocol. All patients with a midnight stay on unit A from January 2019 through September 2021 were dichotomized as having hepatic failure (yes or no) if they ever received the International Classification of Diseases Tenth Revision code for “hepatic failure, not elsewhere classified.” We joined the diagnostic code to patient days and central-line-days databases and summarized the data using Microsoft Excel software. We stratified the number of patients, patient days, device days, infection classification, and hospital length of stay by whether the patient had hepatic failure, and we compared the incidence of HABSI and CLABSI between the 2 groups using OpenEpi version 3.01 software. Results: We identified 72 HABSIs among 4,285 patients who stayed on unit A for 30,910 patient days during the study period. The incidences of HABSI in patients with and without hepatic failure were 39.0 and 13.9 per 10,000 patient days, respectively (P < .001). The incidence of CLABSI was 5.4 and 1.9 per 1,000 line days, respectively (P = .01). Patients with hepatic failure stayed longer (11.5 vs 5.9 days), yet the central-line utilization ratios were not substantially different (0.25 vs 0.24). Enterococcus was the most common pathogen involved in CLABSI in both groups (Table 2). Conclusions: Patients with hepatic failure experienced CLABSI more frequently than patients without hepatic failure, stayed longer in the hospital, and were less likely have HABSI attributed to another primary focus of infection according to NHSN definitions. Although hepatic failure may be among the most severe conditions among patients in a gastroenterology ward, we have demonstrated that these units house a population uniquely susceptible to HABSI and CLABSI.Funding: NoneDisclosures: None

Abstract Background Patients with solid tumors treated at a National Cancer Institute designated cancer center (NCI-CC) have been found to have improved survival when compared to those treated elsewhere. Few population-based studies have evaluated the association between location of care, complications associated with intensive therapy and early mortality (defined here as death ² 60 days from diagnosis) in patients with AML. Methods Using linked data from the California Cancer Registry and Patient Discharge Dataset from 1999 to 2012, we identified patients ³15 years of age diagnosed with AML who received inpatient treatment. Hospitals where patients received their care were classified as either NCI-CC or non-NCI designated facilities (non-NCI-CC). Logistic regression was used to estimate associations between patient characteristics (age, sex, race/ethnicity, year of diagnosis, marital status, neighborhood socioeconomic status, health insurance, and medical comorbidities) and location of care (NCI-CC vs non-NCI-CC facilities), and then to build a propensity score. Inverse probability weighted logistic regression models were used to determine associations between location of care and complications with early mortality. Interactions of complications and location of care with early mortality were also considered. Results are presented as adjusted odds ratios (OR) and 95% confidence intervals (CI). Results Of the 5613 patients with AML identified, 1406 (25%) were treated at an NCI-CC. Compared to patients treated elsewhere, AML patients treated at an NCI-CC were more likely to be <65 years of age, Hispanic (versus non-Hispanic white), live in higher socioeconomic status neighborhoods, have fewer comorbidities and have Medicare or public (versus private) health insurance. Patients treated at NCI-CCs had higher rates of renal failure (21% vs 18%, P=0.03) and lower rates of respiratory failure (11% vs 14%, P=0.002) and sepsis (33% vs 36%, P=0.04) than those treated at non-NCI-CCs. Rates of bleeding, thrombosis, liver failure and cardiac arrest did not differ by location of care. After propensity-score weighting, baseline characteristics were balanced between patients treated at NCI-CCs versus non-NCI-CCs (all standardized mean differences <2.3%). In multivariable, inverse probability weighted models, treatment at an NCI-CC (versus non-NCI-CC) was associated with lower early mortality (OR 0.50, CI 0.42-0.59) (Table). Complications associated with higher early mortality, regardless of treatment location, included: bleeding (OR 1.91, CI 1.54-2.37), liver (OR 3.41, CI 1.91-6.09), renal (OR 2.39, CI 1.97-2.90) and respiratory (OR 6.08, CI 4.88-7.57) failure and cardiac arrest (OR 15.28, CI 8.11-27.78) (Table). The impact of complications on early mortality did not differ by location of care with the exception of respiratory failure (P for interaction=0.001); AML patients with respiratory failure had a higher odds of early mortality when treated at non-NCI-CCs (OR 8.59, CI 6.66-11.07) versus NCI-CCs (OR 4.43, CI 2.68-7.33). Other factors significantly associated with early mortality included younger age, treatment after 2002, non-Hispanic White race/ethnicity (versus African Americans, Hispanics and Asians), single marital status (versus married), residence in low socioeconomic status neighborhoods (versus high) and presence of any comorbidities (versus none). Conclusions In patients with AML, initial treatment at a NCI-CC is associated with 50% reduction in early mortality than treatment at a non-NCI-CC, adjusted for baseline socio-demographic variables, comorbidities and complications within 60 days. Lower early mortality may result from differences in supportive care practices, hospital or provider experience and access to clinical trials at NCI-CCs. Future studies should evaluate the specific differences in care at NCI-CCs to inform strategies to improve early mortality outcomes for all AML patients. Table. Table. Disclosures No relevant conflicts of interest to declare.

Background Long-term PI-based treatment is associated with improved outcomes in MM. Nonetheless, prolonged therapy with parenteral PIs (e.g. bortezomib) can be challenging in the real world, with median duration of therapy (DOT) of 4-7 months. Barriers to this long-term approach may include the burden of repeated intravenous/subcutaneous administration, difficulty travelling to/accessing treatment centers (e.g. due to environmental factors, travel restrictions, social/family situations), patient preference for treatment outside of a hospital or clinic setting, comorbidities, and toxicity. The US MM-6 study (NCT03173092) is investigating in-class transition (iCT) from parenteral bortezomib-based induction to all-oral ixazomib-based therapy (ixazomib-lenalidomide-dexamethasone; IRd) in the diverse US community population with the aim of increasing PI-based treatment duration while maintaining quality of life and improving outcomes. We report updated efficacy and safety for the first 101 patients. Methods Transplant-ineligible/delayed-transplant (&gt;24 months) NDMM patients with stable disease or better after 3 cycles of bortezomib-based induction are being enrolled at US community sites (including Veterans Affairs hospitals) to receive IRd (ixazomib 4 mg, days 1, 8, 15; lenalidomide 25 mg, days 1-21; dexamethasone 40 mg, days 1, 8, 15, 22) for up to 39 x 28-day cycles or until progression/toxicity. The primary endpoint is progression-free survival (PFS); key secondary endpoints include rates of partial (PR), very good PR (VGPR), and complete response (CR), and DOT. Results As of June 1 2020, 101 patients had been treated at 21 sites. Median age was 73 years (range 48-90), with 46% aged ≥75 years; 16% and 10% were of African American and Hispanic ethnicity, respectively. Table 1 summarizes the key characteristics of these real-world patients. A total of 95% of patients had ≥1 comorbidity at the start of IRd therapy including renal and urinary disorders (38%), cardiac disorders (29%), peripheral neuropathy (PN; 14%), and diabetes mellitus (13%) (Table 2). With 53 (52%) patients remaining on therapy and enrollment ongoing, mean duration of PI therapy from the start of bortezomib-based induction was 12.4 months, and mean duration of IRd therapy after iCT was 9.2 months (Table 3). Patients have received up to 29.4 months (31 cycles) of IRd to date. The overall response rate (ORR) after bortezomib-based induction was 62% (7% CR, 32% ≥VGPR). After iCT to IRd, the ORR increased to 71%, with the CR and ≥VGPR rates increasing to 29% and 53%, respectively (Figure); of 33 patients with stable disease following bortezomib-based induction, 14 (42%) achieved CR (n=10) or VGPR (n=4) after iCT. With a median follow-up of 12 months and enrollment ongoing, 13 patients had progressed and two had died during PFS analysis. The 12-month PFS rate was 84% (95% CI, 73-91) from the start of bortezomib-based induction and 80% (95% CI, 69-88) from the start of IRd. During IRd treatment to date, 91% of patients have had treatment-emergent adverse events (TEAEs) (54% grade ≥3). Grade 3 TEAEs (≥5% of patients) were diarrhea (8%), pneumonia (7%), and syncope (5%). TEAEs led to study drug modification in 52% of patients and discontinuation in 7% of patients; 37% had serious TEAEs. Diarrhea, nausea, and vomiting occurred in 43%, 23%, and 14% of patients (8%, 2%, 2% grade 3), and led to dose modification in 11%, 5%, and 2%. PN (not elsewhere classified; high-level term) occurred in 32% of patients (2% grade 3) and led to dose modification in 9%. There were three on-study deaths (i.e. occurring &lt;30 days after last dose). Conclusions US MM-6 patients reflect the heterogeneous real-world US MM population; the population for this study includes patients from the community who may not be eligible for traditional clinical trials. These updated data in mostly elderly, comorbid, NDMM patients treated in the community setting demonstrate the feasibility and tolerability of iCT to IRd after 3 cycles of bortezomib-based induction; approximately half of patients remain on treatment, and enrollment is ongoing. iCT to IRd resulted in improved responses, with increased rates of ≥VGPR, and prolonged DOT and may thereby improve outcomes for real-world patients. iCT to an all oral regimen could also prevent treatment interruptions for patients who are unable to or prefer not to travel in the context of travel restrictions or other factors. Disclosures Girnius: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Yimer:TG Therapeutics: Consultancy; AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Sanofi: Speakers Bureau; Texas Oncology: Current Employment; BeiGene: Other: TRAVEL, ACCOMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding, Speakers Bureau; Janssen: Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding, Speakers Bureau; Takeda: Speakers Bureau; Celgene, a Bristol-Myers Squibb Company: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Karyopharm: Consultancy, Divested equity in a private or publicly-traded company in the past 24 months, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; Epizyme: Consultancy, Divested equity in a private or publicly-traded company in the past 24 months. Noga:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Manda:AbbVie: Other: Investigator in AbbVie-sponsored clinical trials. Lyons:Texas Oncology/US Oncology: Current Employment; Novartis: Honoraria. Bogard:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Whidden:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Cherepanov:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Lu:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Current Employment. Aiello:Takeda: Honoraria; Travera: Honoraria; Celgene: Honoraria; Karyopharm: Honoraria. Richter:Celgene: Consultancy, Speakers Bureau; Adaptive Biotechnologies: Consultancy, Speakers Bureau; Janssen: Speakers Bureau; Sanofi: Consultancy; Karyopharm: Consultancy; Takeda: Consultancy; AstraZeneca: Consultancy; Secura Bio: Consultancy; Bristol Myers Squibb: Consultancy; X4 Pharmaceuticals: Consultancy; Oncopeptides: Consultancy; Antengene: Consultancy. Rifkin:McKesson: Current equity holder in publicly-traded company, Ended employment in the past 24 months, Other: Stock ownership; Takeda, Amgen, Celgene, BMS, Mylan, Coherus BioSciences, Fresenius: Consultancy; AbbVie: Other: Investigator in AbbVie sponsored clinical trials; Takeda, Amgen, BMS (Celgene): Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: Real-world evaluation of long-term proteasome inhibition with ixazomib in combination with lenalidomide and dexamethasone for the treatment of newly diagnosed multiple myeloma in non-transplant patients with stable disease after 3 cycles of a bortezomib-based induction.

BackgroundThis is an exploratory study of readmission in mood disorder.MethodThe study is naturalistic and employs survival analysis. We identified 821 individuals with ICD–9 diagnoses, drawn from the Tasmanian Mental Health Register.ResultsNo demographic variables influence the time to readmission. Two groups emerge: those with affective psychoses, and those with neurotic depression, brief depressive reaction and depressive disorders not elsewhere classified. The former group demonstrated shorter times to readmission than the latter. There was no support for a unipolar–bipolar distinction.ConclusionsAffective psychoses have a less favourable outcome than expected. There was support for an endogenous-neurotic distinction.

Purpose – The purpose of this paper is to provide a viewpoint on homelessness and health gained from a practical public health perspective. Design/methodology/approach – Views derived from local review as well as other national epidemiology and research. Findings – That housing has real impacts upon health especially for those who are homeless. Research limitations/implications – This is a viewpoint from a major city in England. Practical implications – Homelessness leads to extreme vulnerability. There are other aspects of the home environment that impact elsewhere in the public sector, especially the health service. Vulnerable individuals are more likely to become homeless which can lead to exacerbation of vulnerability. Originality/value – This is a viewpoint derived solely from local practice.

This article offers an approach through administrative and cultural history to the problems associated with gathering and processing data for the Spanish national census of 1920, and by implication for earlier Spanish censuses. It focuses on the Basque province of Guipúzcoa, making use of correspondence between the central statistical office in Madrid, the provincial jefe de estadística and the localities, and of reports on three problematic towns within the province. The issues that emerge regarding ‘undercounting’, the definition of administrative boundaries and the classification of demographic characteristics are set in the wider context of census-taking practices and problems elsewhere in Spain and in other cultures.

AbstractThe author examines Williams’ appraisal of Collingwood both in his eponymous essay on Collingwood, in the posthumously published Sense of the Past (2006), and elsewhere in his work. The similarities and differences between their philosophies are explored: in particular, with regard to the relationship between philosophy and history and the relationship between the study of history and our present-day moral attitudes. It is argued that, despite Williams usually being classified as an analytic philosopher and Collingwood being classified as an idealist, there is substantial common ground between them. Williams was aware of this and made clear his sympathy for Collingwood; but, nonetheless, the relationship between Williams and Collingwood has not previously been explored in any detail. After establishing the common ground between these philosophers, and the areas of disagreement, the author suggests that both may have something to gain from the other.

AbstractBuilders of medical informatics applications need controlled medical vocabularies to support their applications and it is to their advantage to use available standards. In order to do so, however, these standards need to address the requirements of their intended users. Overthe past decade, medical informatics researchers have begun to articulate some of these requirements. This paper brings together some of the common themes which have been described, including: vocabulary content, concept orientation, concept permanence, nonsemantic concept identifiers, polyhierarchy, formal definitions, rejection of “not elsewhere classified” terms, multiple granularities, mUltiple consistent views, context representation, graceful evolution, and recognized redundancy. Standards developers are beginning to recognize and address these desiderata and adapt their offerings to meet them.

ABSTRACTWe investigated the extent to which the geographic proximity of adult children affected the relocations of older people in the Netherlands in 2008. A major contribution of this study is the examination of the differentiation between relocation to care institutions and elsewhere. Data from the Dutch population register linked to complementary datasets were analysed for nearly one million inhabitants aged 75 and above, using multinomial logistic regression models to estimate the effects of intergenerational proximity and of other factors on the propensity to relocate to an institution and elsewhere. An interaction of proximity with partnership status as an indicator of the presence of an important care provider was considered. We found that older people were less likely to move elsewhere when their children were living very close by, and were more likely to do so when their children were living farther away. Having children living close was negatively associated with the likelihood of moving to a care institution. Very close proximity had an additional negative effect on the propensity of older people with a partner to relocate elsewhere whereas the negative effect was less for older people without a partner on moving elsewhere. Our findings did, however, show that (recently) widowed people were more likely to move elsewhere when their children were living more than 40 kilometres away.

AbstractManic depression, or bipolar disorder, is a multifaceted illness with an inevitably complex treatment. The current article summarizes the current status of our knowledge and practice concerning its diagnosis and treatment. While the prototypic clinical picture concerns the “classic” bipolar disorder, today mixed episodes with incomplete recovery and significant psychosocial impairment are more frequent. The clinical picture of these mixed episodes is variable, eludes contemporary classification systems, and possibly includes a constellation of mental syndromes currently classified elsewhere. Treatment includes the careful combination of lithium, antiepileptics, atypical antipsychotics, and antidepressants, but not all of the agents in these broad categories are effective for the treatment of bipolar disorder.

In various countries it has been reported that patients who receive hospital care, for example assisted birth, are detained inside the health facility until they pay their bills. The practice of hospital detention, whose magnitude is unknown, has been criticized as anti-humanitarian by UNICEF and human rights organizations. However, according to the author, leaving the hospital with a confirmed diagnosis and the recommended treatment can prove more difficult than simply being detained, particularly when health budgets are allocated with disregard for the social conditions in which people live, as in Latin America and elsewhere.

SummaryThe family registration records from a village population in a small island of Japan are used to assess the effect of demographic differentiation within a population on genetic measures. When the couples studied are classified by birth cohorts and origins, wives of the couples where one spouse came from elsewhere were older at marriage and had a shorter duration of marriage or registration than wives where both spouses were natives of the village. The mean number of offspring is statistically smaller in the former except for the latest cohort, due mainly to out-migration during the reproductive ages which also resulted in low rates of marriage among the offspring within the village. This leads to a small effective population size and an increased likelihood of genetic drift in the overall population.

This paper outlines a diagnostic entity called ‘Pathological Habit Disorder’ which is suggested for inclusion in the DSM as an Axis II option. Specific areas of concern, either mental (Axis I) or physical (Axis III), would delineate the syndrome. Pathological Habit Disorder (PHD) points to treatment options where the syndrome is wholly or partly habit-driven. Whether the syndrome is habit-driven or not will remain a clinical judgement even though many conditions, previously thought immutable except by medication, are proving accessible to behavioural engineering. In the ICD system, PHD seems to fit in “Special Symptoms or Syndromes not elsewhere Classified”. It is demonstrably useful to have a diagnosis such as PHD and to incorporate it into the body of medical classification, recognizing current practices for dealing with unwelcome or damaging habits.

ABSTRACT:A province wide prevalence study on multiple sclerosis (MS) was conducted in British Columbia (B.C.). The prevalence date was July 1, 1982. The major portion of this study was a review of all the files of neurologists practicing in B.C. as this was judged to be the most accurate source for identifying MS patients. 239,412 neurologists' files were hand searched by one researcher using modified Schumacher criteria for classification. Other sources used during the study for identifying MS patients were the MS Clinic, general practitioners, ophthalmologists, urologists, specialized facilities such as long term care facilities and rehabilitation centres, and patient self-referrals.A total of 4,620 non-duplicated cases were identified and classified. 4,112 of these (89%) were classified according to information contained in neurologists' records.The prevalence estimate for definite/probable MS in B.C. was 93.3/100,000 population. This increased to 130.5/100,000 population if possible MS and optic neuritis were also included. These rates are among the highest reported in Canada or elsewhere. The cooperation of B.C. neurologists made this study unique in its scope and accuracy of diagnosis.

AbstractGaze behavior was assessed in 20 autistic individuels and in an age- and mental-age-matched mentally retarded control group. A time-sample technique was used to collect frequency of gaze directed at staff, at task, and elsewhere (at other) in familiar educational settings as subjects interacted with familiar staff and engaged in familiar educational activities. Gaze behaviors were sampled in each of three interactional conditions defined by staff-subject ratio. Significant effects of the intensity of the interactional condition were observed for both groups. Overall autistic subjects were more likely to look elsewhere than the matched control cases and looked less at staff during one-to-one interaction. Relationships to age, developmental level, and other measures are discussed.

PurposeThis research aimed to determine the differences and similarities in each pilot project to understand the primary design forms and concepts of sponge city concept (SCC) projects in China. It also aimed to examine ten pilot projects in Shanghai to extrapolate their main characteristics and the processes necessary for implementing SCC projects effectively.Design/methodology/approachA literature review and field survey case study were employed. Data were mostly collected through a field survey in Shanghai, focusing on both the projects and the surrounding environment. Based on these projects' examination, a comparative method was used to determine the characteristics of the ten pilot SCC projects and programs in Shanghai.FindingsSix main types of SCC projects among 30 pilot cities were classified in this research to find differences and similarities among the pilot cities. Four sponge design methods were classified into ten pilot projects. After comparing each project size using the same geographical size, three geometrical types were categorized into both existing and new city areas. SCC project characteristics could be identified by combining four methods and three geometrical types and those of the SCC programs by comparing the change in land-use and the surrounding environment in ten pilot projects.Originality/valueThe results are valuable for implementing SCC projects in China and elsewhere and future research on the impact of SCC projects.

The study of fatal suicides in York, 1990–1994, by Elwood & De Silva (1998) is valuable confirmation that other people than general practitioners (GPs) and psychiatrists have responsibilities in averting such deaths, but does not go far enough. It is assumed that the GP or general hospital doctor has failed to recognise the suicidal risk, and better teaching would have increased their diagnostic awareness and so saved lives. But examining the detailed sequence of events leading up to death (medical audit) will show that in a number of cases medical diagnosis was not lacking, and the problem lay elsewhere.

Background Plasmodium vivax has been recently discovered as a significant cause of malaria in Mauritania, although very rare elsewhere in West Africa. It has not been known if this is a recently introduced or locally remnant parasite population, nor whether the genetic structure reflects epidemic or endemic transmission. Methodology/Principal findings To investigate the P. vivax population genetic structure in Mauritania and compare with populations previously analysed elsewhere, multi-locus genotyping was undertaken on 100 clinical isolates, using a genome-wide panel of 38 single nucleotide polymorphisms (SNPs), plus seven SNPs in drug resistance genes. The Mauritanian P. vivax population is shown to be genetically diverse and divergent from populations elsewhere, indicated consistently by genetic distance matrix analysis, principal components analyses, and fixation indices. Only one isolate had a genotype clearly indicating recent importation, from a southeast Asian source. There was no linkage disequilibrium in the local parasite population, and only a small number of infections appeared to be closely genetically related, indicating that there is ongoing genetic recombination consistent with endemic transmission. The P. vivax diversity in a remote mining town was similar to that in the capital Nouakchott, with no indication of local substructure or of epidemic population structure. Drug resistance alleles were virtually absent in Mauritania, in contrast with P. vivax in other areas of the world. Conclusions/Significance The molecular epidemiology indicates that there is long-standing endemic transmission that will be very challenging to eliminate. The virtual absence of drug resistance alleles suggests that most infections have been untreated, and that this endemic infection has been more neglected in comparison to P. vivax elsewhere.

BackgroundGambling disorder is a relatively common psychiatric disorder recently re-classified within the DSM-5 under the category of ‘substance-related and addictive disorders'.AimsTo compare white matter integrity in patients with gambling disorder with healthy controls; to explore relationships between white matter integrity and disease severity in gambling disorder.MethodIn total, 16 participants with treatment-resistant gambling disorder and 15 healthy controls underwent magnetic resonance imaging (MRI). White matter integrity was analysed using tract-based spatial statistics.ResultsGambling disorder was associated with reduced fractional anisotropy in the corpus callosum and superior longitudinal fasciculus. Fractional anisotropy in distributed white matter tracts elsewhere correlated positively with disease severity.ConclusionsReduced corpus callosum fractional anisotropy is suggestive of disorganised/damaged tracts in patients with gambling disorder, and this may represent a trait/vulnerability marker for the disorder. Future research should explore these measures in a larger sample, ideally incorporating a range of imaging markers (for example functional MRI) and enrolling unaffected first-degree relatives of patients.

AbstractSchizophrenia is a frequent psychiatric disorder whose prevalence appears to be relatively stable across different patient groups. However, attitudes to care and resources devoted to mental health care may differ between countries. The objective of this analysis was to compare sociodemographic and psychopathological features of patients, antipsychotic treatment and frequency of hospitalisation between four European countries (Germany, Greece, Italy and Spain) collected as part of a large survey of the characteristics of patients with schizophrenia. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients. Information on 39 variables was collected. A number of between-country differences were observed which tended to distinguish Germany on the one hand, from the Mediterranean countries, and Greece in particular, on the other. While demographic features and clinical features were essentially similar, more patients in Germany were considered to have severe disease by their psychiatrist (59.0% versus 35.9% in Greece) and to be hospitalised (49.3% versus 15.0%). 46.7% of German patients were living alone compared to less than 20% in the Mediterranean countries and 50.2% were living with their family (versus over70% elsewhere). Smoking and addictive behaviours were more frequently reported for patients in Spain. With regard to empirically derived patient subgroups, Subgroup 2, corresponding to well-integrated and autonomous patients with mild to moderate disease severity was most highly represented in Greece (23.6% of patients compared to less than 10% elsewhere) elsewhere, Subgroup 6 (poorly-integrated patients with moderately severe disease who require caregiver support) was under-represented in Germany (4.5% versus over 17% elsewhere). Patterns of treatment were essentially similar, although quetiapine was more frequently prescribed and paliperidone less frequently prescribed in Germany than elsewhere. Reasons for treatment choice were comparable between countries, primarily related to good tolerability and control of positive symptoms. The differences observed may be attributed to differences in mental health care resource provision, socio-cultural or educational differences or to resource issues.

This paper will focus primarily on the most recent research studies involving doctors in the UK. We will not discuss the treatment of doctors who are psychiatrically unwell as this is covered in other papers elsewhere in this issue. Before reviewing specific studies, we will consider the measurement of psychiatric disorder, stress and burn-out.

In this era of startling developments in the medical field there remains a serious worry about the hazardous potential of various by products which if not properly addressed can lead to consequences of immense public concern. Hospitals and other health care facilities generate waste products which are evidently hazardous to all those exposed to its potentially harmful effects. Need for effective legislation ensuring its safe disposal is supposed to be an integral part of any country's health related policy. This issue is of special importance in developing countries like Pakistan which in spite of framing various regulations for safeguarding public health, seem to overlook its actual implementation. The result unfortunately is the price wehave to pay not only in terms of rampant spread of crippling infections but a significant spending of health budget on combating epidemics which could easily have been avoided through effective waste disposal measures in the first place. Waste classified under the heading 'bio-hazardous' includes any infectious or potentially infectious material which can be injurious or harmful to humans and other living organisms. Amongst the many potential sources are the hospitals or other health delivery centres which are ironically supposed to be the centres of infection control and treatment. Whilst working in these setups, health care workers such as doctors, nurses, paramedical staff and sanitation workers are actually the ones most exposed and vulnerable to these challenges. Biomedical waste may broadly be classified into Infectious and toxic waste. Infectious waste includes sharps, blood, body fluids and tissues etcwhile substances such as radioactive material and by-products of certain drugs qualify as toxic waste. Furthermore health institutions also have to cater for general municipal waste such as carton boxes, paper and plastics. The World Health Organisation has its own general classification of hospital waste divided into almost eight categories of which almost 15% (10% infectious and 5% toxic) is estimated to be of a hazardous nature while the remaining 85% is general non hazardous content.1A recent study from Faisalabad, Pakistan has estimated hospital waste generation around 1 to 1.5 kg / bed /day for public sector hospitals in the region,2while figures quoted from neighbouring India are approximately 0.5 to 2 KG / hospital bed /day.3 Elsewhere in the world variable daily hospital waste production has been observed ranging from as low as 0.14 to 0.49 kg /day in Korea4 and 0.26 to 0.89 kg/day in Greece5to as high as 2.1 to 3.83 kg/day in Turkey6 and 0.84 to 5.8 kg/day in Tanzania.7Ill effects of improper management of hospital waste can manifest as nosocomial infections or occupational hazards such as needle stick injuries. Pathogens or spores can be borne either through the oro-faecal or respiratory routes in addition to direct inoculation through contact with infected needles or sharps. Environmental pollution can result from improper burning of toxic material leading to emission of dioxins, particulate matter or furans into the air. The habitat can also be affected by illegal dumping and landfills or washing up of medical waste released into the sea or river. Potential organisms implicated in diseases secondary to mismanagement of hospital waste disposal include salmonella, cholera, shigella, helminths, strep pneumonia, measles, tuberculosis, herpesvirus, anthrax, meningitis, HIV, hepatitis and candida etc. These infections can cause a considerable strain on the overall health and finances of the community or individuals affected. The basic principal of Public health management i.e 'prevention is better than cure' cannot be more stressed in this scenario as compared to any other health challenge. Health facilities must have a clear policy on hazardous waste management. To ensure a safe environment hospitals need to adopt and implement international and local systems of waste disposal. Hospital waste management plan entails policy and procedures addressing waste generation, accumulation, handling, transportation, storage, treatment and disposal. Waste needs to be collected in marked containers usually colour coded and leak proof. Segregation at source is of vital importance. The standard practice in many countries is the Basic Three Bin System ie to segregate the waste into RED bags/ boxes for sharps, YELLOW bags for biological waste and BLUE or BLACK ones for general/ municipal waste. All hospital staff needs to be trained in the concept of putting the right waste in relevant containers/ bags. They need to know that more than anything else this practice is vital for their own safety. The message can be reinforced through appropriate labelling on the bins and having posters with simple delineations to avoid mixing of different waste types. Sharps essentially should be kept in rigid, leak and puncture-resistant containers which are tightly lidded and labelled. Regular training sessions for nurses and cleaning staff can be organised as they are the personnel who are more likely to deal with waste disposition at the level of their respective departments. Next of course is transportation of waste products to the storage or disposal. Sanitary staff and janitors must be aware of the basic concepts of waste handling and should wear protective clothing, masks and gloves etc, besides ensuring regular practice of disinfection and sterilization techniques.8Special trolleys or vehicles exclusively designed and reserved for biomedical waste and operated by trained individuals should be used for transportation to the dumping or treatment site. Biomedical waste treatment whether on site or off site is a specialised entity involving use of chemicals and equipment intended for curtailing the hazardous potential of the material at hand. Thermal treatment via incinerators, not only results in combustion of organic substances but the final product in the form of non-toxicash is only 10 to 15% of the original solid mass of waste material fed to the machine. Dedicated autoclaves and microwaves can also be used for the purpose of disinfection. Chemicals such as bleach, sodium hydroxides, chlorine dioxide and sodiumhypochlorite are also effective disinfectants having specialised indications. Countries around the world have their own regulations for waste management. United Kingdom practices strict observance of Environmental protection act 1990, Waste managementlicensing regulations 1994 and Hazardous waste regulations 2005 making it one of thesafest countries in terms of hazardous waste disposal. Similar regulations specific for each state have been adopted in United States following passage of the Medical Waste tracking act 1988. In Pakistan, every hospital must comply with the Waste Management Rules 2005 (Environment Protection Act 1997), though actual compliance is far from satisfactory. It is high time that the government and responsible community organisations shape up to seriously tackle the issue of bio hazardous waste management through enforcement of effective policies and standard operating procedures for safeguarding the health and lives of the public in general and health workers in particular. Outbreaks, defined as excess cases of a particular disease or illness which outweighs the response capabilities, have the capacity to overwhelm health care facilities and need timely response and attention to details in order to avoid potentially disastrous sequelae . In this day and age when improvement in public health practices have significantly curtailed outbreak of various diseases, certain viral illnesses continue to make headlines. One of the notable vector borne infectious disease affecting significant portions of south east Asia in the early part of twenty first century is 'Dengue fever'. Dreaded as it is by those suffering from the illness, a lot of the hysteria created is secondary to a lack of education and understanding of the nature of the disease and at times a result of disinformation campaign for vested interests by certain political and media sections.'Dengue' in fact is a Spanish word, assumed to have originated from the Swahili phrase -ka dinga peppo -which describes the disease as being caused by evil spirit. 1 Over the course of time it has been called 'breakbone fever', 'bilious vomiting fever', 'break heart fever', 'dandy fever', 'la dengue' and 'Phillipine, Thai and Singapore hemorrhagic fever' Whilst the first reported case referring to dengue fever as a water poison spread by flying insects, exists in the Chinese medical encyclopedia from Jin Dynasty (265-420 AD), the disease is believed to have disseminated from Africa with the spread of the primary vector, aedes egypti, in the 15th to 19th century as a result of globalisation of slave trade 45In 80% of the patients affected by this condition the presentation is rather insidious and at best characterized by mild fever. The classical 'Dengue fever' present in about 5% of the cases is characterized by high temperature, body aches, vomiting and at times a skin rash. The disease may regresses in two to seven days. However inrare instances (<5%) it may develop into more serious conditions such as Dengue hemorrhagic fever whereby the platelet count is significantly reduced leading to bleeding tendencies and may even culminate in a more life threatening presentation i.e Dengue shock syndrome.6To understand the actual dynamics of Dengue epidemic it is important to understand the mode of its spread in affected areas. Aedes mosquito (significantly Aedes Egypti) acts a vector for this disease. Early morning and evening times7 are favoured by these mosquitos to feed on their prey. There is some evidence that the disease may be transmitted via blood products and organ donation. 8 Moreover vertical transmission (mother to child) has also been reported 9Diagnostic investigations include blood antigen detection through NS-I or nucleic acid detection via PCR. IO Cell cultures and specific serology may also be used for confirming the underlying disease. Whilst sporadic and endemic cases are part of routine medical practice and may not raise any alarm bells, outbreaks certainly need mobilization of appropriate resources for effective control. Needless to say 'prevention is better than cure' and should be the primary target of the health authorities in devising strategies for disease control.The WHO recommended 'Integrated Vector control programme', lays stress on social mobilisation and strengthening of public health bodies, coherent response of health and related departments and effective capacity building of relevant personnel and organisations as well as the community at risk. For Aedes Egypti the primary control revolves around eliminating its habitats such as open sources of water. In a local perspective in our city Peshawar, venue of the recent dengue epidemic, it may be seen in the form of incidental reservoirs such as receptacles and tyres dumped in open areas such as roof tops with rain water accumulating in them and provtdjng excellent breeding habitats, Larvicidal and insecticides may be added to more permanent sources such as watertanks and farm lands. There is not much of a role for spraying with organophosphorous agents which is at times resorted to for public consumption. Public education is the key to any effective strategy which must highlight the need for wearing clothing that fully covers the skin, avoiding unnecessary early morning and evening exposure to vector agents, application of insect repellents and use of mosquito nets. It is also important not to panic if affliction with the disease is suspected as in a vast majority of instances it is a self limiting illness without any long term harmful effects and needs simple conservative management like antipyretics and analgesics.An important consideration for responsible authorities in a dengue epidemic is to ensure that maximum management facilities for simple cases are provided at the community level through primary and secondary health care facilities and that the tertiary care hospitals are not inundated with all sort of patients demanding consultation. These later facilities should be reserved for those patients who end up with any complications or more severe manifestation of the disease.Research is underway to develop an ideal vaccine for Dengue fever. In 2016, a vaccine by the name 'Dengvaxia' was marketed in Phillipines and Indonesia. However with development of new serotypes of the virus, its efficacy has been somewhat compromised.As for treatment , there are no specific antiviral drugs. Management is symptomatic revolving mainly around oral and intravenous hydration. Paracetamol (Acetaminophen) is used for fever as compared to NSAIDS such as Ibuprophen infusion as well as blood and platelet transfusion.Data to date shows that slightly more than twenty three thousand people have been diagnosed with dengue over the past three months ie August to October there is a lower risk of bleeding with the former. Those with more severe form of the disease may need Dextran 2017, in Peshawar, Pakistan with around fourteen thousand needing admission and about sixty nine recorded deaths. The mortality is well within the acceptable international standards of less than 1% for the disease. In the backdrop of all the debate surrounding the current epidemic, one can infer that such outbreaks are best addressed with effective planningwell ahead of the time before the disease threatens to spiral out of control. Simple measures such as covering water storage facilities, using larvicidals where practical, use of insect repellents, mosquito nets and avoiding unnecessary exposure can offerthe best protection. Public health messages via print and electronic media can help educate people in affected areas and allay any anxiety building up from a fear of developing life threatening complications. Health department must mobilise all its resources to ensure local management of diagnosed patients with simple dengue fever and facilitate hospital admission only for those suffering from more severe form of the disease. Moreover the media hype into such situations needs to be addressed through constant updates and discouraging any negative politicking on the issue. To sum up Dengue fever is not really an affliction to be dreaded provided it is viewed and managed in the right perspective.

In this era of startling developments in the medical field there remains a serious worry about the hazardous potential of various by products which if not properly addressed can lead to consequences of immense public concern. Hospitals and other health care facilities generate waste products which are evidently hazardous to all those exposed to its potentially harmful effects. Need for effective legislation ensuring its safe disposal is supposed to be an integral part of any country's health related policy. This issue is of special importance in developing countries like Pakistan which in spite of framing various regulations for safeguarding public health, seem to overlook its actual implementation. The result unfortunately is the price wehave to pay not only in terms of rampant spread of crippling infections but a significant spending of health budget on combating epidemics which could easily have been avoided through effective waste disposal measures in the first place. Waste classified under the heading 'bio-hazardous' includes any infectious or potentially infectious material which can be injurious or harmful to humans and other living organisms. Amongst the many potential sources are the hospitals or other health delivery centres which are ironically supposed to be the centres of infection control and treatment. Whilst working in these setups, health care workers such as doctors, nurses, paramedical staff and sanitation workers are actually the ones most exposed and vulnerable to these challenges. Biomedical waste may broadly be classified into Infectious and toxic waste. Infectious waste includes sharps, blood, body fluids and tissues etcwhile substances such as radioactive material and by-products of certain drugs qualify as toxic waste. Furthermore health institutions also have to cater for general municipal waste such as carton boxes, paper and plastics. The World Health Organisation has its own general classification of hospital waste divided into almost eight categories of which almost 15% (10% infectious and 5% toxic) is estimated to be of a hazardous nature while the remaining 85% is general non hazardous content.1A recent study from Faisalabad, Pakistan has estimated hospital waste generation around 1 to 1.5 kg / bed /day for public sector hospitals in the region,2while figures quoted from neighbouring India are approximately 0.5 to 2 KG / hospital bed /day.3 Elsewhere in the world variable daily hospital waste production has been observed ranging from as low as 0.14 to 0.49 kg /day in Korea4 and 0.26 to 0.89 kg/day in Greece5to as high as 2.1 to 3.83 kg/day in Turkey6 and 0.84 to 5.8 kg/day in Tanzania.7Ill effects of improper management of hospital waste can manifest as nosocomial infections or occupational hazards such as needle stick injuries. Pathogens or spores can be borne either through the oro-faecal or respiratory routes in addition to direct inoculation through contact with infected needles or sharps. Environmental pollution can result from improper burning of toxic material leading to emission of dioxins, particulate matter or furans into the air. The habitat can also be affected by illegal dumping and landfills or washing up of medical waste released into the sea or river. Potential organisms implicated in diseases secondary to mismanagement of hospital waste disposal include salmonella, cholera, shigella, helminths, strep pneumonia, measles, tuberculosis, herpesvirus, anthrax, meningitis, HIV, hepatitis and candida etc. These infections can cause a considerable strain on the overall health and finances of the community or individuals affected. The basic principal of Public health management i.e 'prevention is better than cure' cannot be more stressed in this scenario as compared to any other health challenge. Health facilities must have a clear policy on hazardous waste management. To ensure a safe environment hospitals need to adopt and implement international and local systems of waste disposal. Hospital waste management plan entails policy and procedures addressing waste generation, accumulation, handling, transportation, storage, treatment and disposal. Waste needs to be collected in marked containers usually colour coded and leak proof. Segregation at source is of vital importance. The standard practice in many countries is the Basic Three Bin System ie to segregate the waste into RED bags/ boxes for sharps, YELLOW bags for biological waste and BLUE or BLACK ones for general/ municipal waste. All hospital staff needs to be trained in the concept of putting the right waste in relevant containers/ bags. They need to know that more than anything else this practice is vital for their own safety. The message can be reinforced through appropriate labelling on the bins and having posters with simple delineations to avoid mixing of different waste types. Sharps essentially should be kept in rigid, leak and puncture-resistant containers which are tightly lidded and labelled. Regular training sessions for nurses and cleaning staff can be organised as they are the personnel who are more likely to deal with waste disposition at the level of their respective departments. Next of course is transportation of waste products to the storage or disposal. Sanitary staff and janitors must be aware of the basic concepts of waste handling and should wear protective clothing, masks and gloves etc, besides ensuring regular practice of disinfection and sterilization techniques.8Special trolleys or vehicles exclusively designed and reserved for biomedical waste and operated by trained individuals should be used for transportation to the dumping or treatment site. Biomedical waste treatment whether on site or off site is a specialised entity involving use of chemicals and equipment intended for curtailing the hazardous potential of the material at hand. Thermal treatment via incinerators, not only results in combustion of organic substances but the final product in the form of non-toxicash is only 10 to 15% of the original solid mass of waste material fed to the machine. Dedicated autoclaves and microwaves can also be used for the purpose of disinfection. Chemicals such as bleach, sodium hydroxides, chlorine dioxide and sodiumhypochlorite are also effective disinfectants having specialised indications. Countries around the world have their own regulations for waste management. United Kingdom practices strict observance of Environmental protection act 1990, Waste managementlicensing regulations 1994 and Hazardous waste regulations 2005 making it one of thesafest countries in terms of hazardous waste disposal. Similar regulations specific for each state have been adopted in United States following passage of the Medical Waste tracking act 1988. In Pakistan, every hospital must comply with the Waste Management Rules 2005 (Environment Protection Act 1997), though actual compliance is far from satisfactory. It is high time that the government and responsible community organisations shape up to seriously tackle the issue of bio hazardous waste management through enforcement of effective policies and standard operating procedures for safeguarding the health and lives of the public in general and health workers in particular. Outbreaks, defined as excess cases of a particular disease or illness which outweighs the response capabilities, have the capacity to overwhelm health care facilities and need timely response and attention to details in order to avoid potentially disastrous sequelae . In this day and age when improvement in public health practices have significantly curtailed outbreak of various diseases, certain viral illnesses continue to make headlines. One of the notable vector borne infectious disease affecting significant portions of south east Asia in the early part of twenty first century is 'Dengue fever'. Dreaded as it is by those suffering from the illness, a lot of the hysteria created is secondary to a lack of education and understanding of the nature of the disease and at times a result of disinformation campaign for vested interests by certain political and media sections.'Dengue' in fact is a Spanish word, assumed to have originated from the Swahili phrase -ka dinga peppo -which describes the disease as being caused by evil spirit. 1 Over the course of time it has been called 'breakbone fever', 'bilious vomiting fever', 'break heart fever', 'dandy fever', 'la dengue' and 'Phillipine, Thai and Singapore hemorrhagic fever' Whilst the first reported case referring to dengue fever as a water poison spread by flying insects, exists in the Chinese medical encyclopedia from Jin Dynasty (265-420 AD), the disease is believed to have disseminated from Africa with the spread of the primary vector, aedes egypti, in the 15th to 19th century as a result of globalisation of slave trade 45In 80% of the patients affected by this condition the presentation is rather insidious and at best characterized by mild fever. The classical 'Dengue fever' present in about 5% of the cases is characterized by high temperature, body aches, vomiting and at times a skin rash. The disease may regresses in two to seven days. However inrare instances (<5%) it may develop into more serious conditions such as Dengue hemorrhagic fever whereby the platelet count is significantly reduced leading to bleeding tendencies and may even culminate in a more life threatening presentation i.e Dengue shock syndrome.6To understand the actual dynamics of Dengue epidemic it is important to understand the mode of its spread in affected areas. Aedes mosquito (significantly Aedes Egypti) acts a vector for this disease. Early morning and evening times7 are favoured by these mosquitos to feed on their prey. There is some evidence that the disease may be transmitted via blood products and organ donation. 8 Moreover vertical transmission (mother to child) has also been reported 9Diagnostic investigations include blood antigen detection through NS-I or nucleic acid detection via PCR. IO Cell cultures and specific serology may also be used for confirming the underlying disease. Whilst sporadic and endemic cases are part of routine medical practice and may not raise any alarm bells, outbreaks certainly need mobilization of appropriate resources for effective control. Needless to say 'prevention is better than cure' and should be the primary target of the health authorities in devising strategies for disease control.The WHO recommended 'Integrated Vector control programme', lays stress on social mobilisation and strengthening of public health bodies, coherent response of health and related departments and effective capacity building of relevant personnel and organisations as well as the community at risk. For Aedes Egypti the primary control revolves around eliminating its habitats such as open sources of water. In a local perspective in our city Peshawar, venue of the recent dengue epidemic, it may be seen in the form of incidental reservoirs such as receptacles and tyres dumped in open areas such as roof tops with rain water accumulating in them and provtdjng excellent breeding habitats, Larvicidal and insecticides may be added to more permanent sources such as watertanks and farm lands. There is not much of a role for spraying with organophosphorous agents which is at times resorted to for public consumption. Public education is the key to any effective strategy which must highlight the need for wearing clothing that fully covers the skin, avoiding unnecessary early morning and evening exposure to vector agents, application of insect repellents and use of mosquito nets. It is also important not to panic if affliction with the disease is suspected as in a vast majority of instances it is a self limiting illness without any long term harmful effects and needs simple conservative management like antipyretics and analgesics.An important consideration for responsible authorities in a dengue epidemic is to ensure that maximum management facilities for simple cases are provided at the community level through primary and secondary health care facilities and that the tertiary care hospitals are not inundated with all sort of patients demanding consultation. These later facilities should be reserved for those patients who end up with any complications or more severe manifestation of the disease.Research is underway to develop an ideal vaccine for Dengue fever. In 2016, a vaccine by the name 'Dengvaxia' was marketed in Phillipines and Indonesia. However with development of new serotypes of the virus, its efficacy has been somewhat compromised.As for treatment , there are no specific antiviral drugs. Management is symptomatic revolving mainly around oral and intravenous hydration. Paracetamol (Acetaminophen) is used for fever as compared to NSAIDS such as Ibuprophen infusion as well as blood and platelet transfusion.Data to date shows that slightly more than twenty three thousand people have been diagnosed with dengue over the past three months ie August to October there is a lower risk of bleeding with the former. Those with more severe form of the disease may need Dextran 2017, in Peshawar, Pakistan with around fourteen thousand needing admission and about sixty nine recorded deaths. The mortality is well within the acceptable international standards of less than 1% for the disease. In the backdrop of all the debate surrounding the current epidemic, one can infer that such outbreaks are best addressed with effective planningwell ahead of the time before the disease threatens to spiral out of control. Simple measures such as covering water storage facilities, using larvicidals where practical, use of insect repellents, mosquito nets and avoiding unnecessary exposure can offerthe best protection. Public health messages via print and electronic media can help educate people in affected areas and allay any anxiety building up from a fear of developing life threatening complications. Health department must mobilise all its resources to ensure local management of diagnosed patients with simple dengue fever and facilitate hospital admission only for those suffering from more severe form of the disease. Moreover the media hype into such situations needs to be addressed through constant updates and discouraging any negative politicking on the issue. To sum up Dengue fever is not really an affliction to be dreaded provided it is viewed and managed in the right perspective.

Introduction The assessment of social and emotional wellbeing (SEWB) among Aboriginal people in Australia and elsewhere is complex and challenging task. A culturally appropriate tool for screening SEWB among Aboriginal adults known as the Here and Now Aboriginal Assessment (HANAA) has been developed and evaluated. The HANAA is based on exploring key domains of Aboriginal concept of SEWB and is based on a yarning process aimed to initiate a semi-structured interview that covers each domain. Over the last ten years the HANAA has been widely used by Aboriginal mental health service providers around Australia and elsewhere. Objectives There have been multiple requests by service providers for a similar tool to be developed for young Aboriginal people. The aim of this study was to develop a youth version of the HANAA. Methods A Working Group was established to guide the development of the youth HANAA. This work included discussion of assessment domains, prompt words and other adolescent specific considerations that were needed. The evlauation process was also discussed. Results The adult version of HANAA was well accepted by participants. Reliability was good with kappa agreements between Aboriginal and non-Aboriginal interviewers ranging from 0.5 to 1.0. Agreement between interviewers and treating clinicians on ecommended course of action was good. Conclusions Based on the previous field test results, it is expected that the youth HANAA will also be a culturally appropriate and useful tool which can be used by a range of service providers with differing levels of mental health training to assess SEWB among young Aboriginal people. Disclosure No significant relationships.

Functional foods are generally defined as foods that, due to their physiologically active substances, benefit health in addition to providing basic nourishment. As Brazilian legislation does not provide a definition for functional foods, the only possible actions is to claim that some foods have functional health proprieties. Based on a review of legislation, this paper discusses not only the lack of transparency in relation to the categories of products classified as foods and medicinal plants, but also the interactions and contradictions of functional food product legislation. Products may be classified either within the "New Food/or Ingredient category" or as "Bioactive Substances or Isolated Probiotics with Functional Properties and/ or Health Claims". Products such as garlic can also be classified into multiple food categories and as medicinal plants. Intersections in food legislation, especially with respect to functional and new food products, lead to misunderstandings and even omissions on the part of Brazilian National Sanitary Surveillance Agency (ANVISA). Moreover, health claims on food product labels can make distinction between foods and medicines difficult for consumers. In Brazil, clearer rules for the industry are necessary so that the consumer is not deceived by false cure promises.

This study examines the link between self-rated health and two aspects of gender: an individual’s gender identity, and whether strangers classify that person’s voice as male or female. In a phone-based general health survey, interviewers classified the sex of transgender women ( n = 722) and transgender men ( n = 446) based on assumptions they made after hearing respondents’ voices. The flawed design of the original survey produced inconsistent sex classification among transgender men and transgender women respondents; this study repurposes these discrepancies to look more closely at the implications of voice-based gender classification for the health of transgender men and women. Average marginal effects from logistic regression models show transgender men who are classified as women based on their voices are more likely to report poor self-rated health compared to transgender men who are classified as men. Conversely, transgender women who are classified as men are less likely to report poor self-rated health than are transgender women who are classified as women. Additionally, Black transgender men are more likely than any other group to be classified inconsistently with their gender identity, suggesting a link between race/ethnicity and gender perception.

Abstract Using previously unused or underused primary evidence, this article analyses the National Health Service in Scotland from its inception in 1947 to the reorganization of 1974. A thematic approach is adopted to show that, on the one hand, the Scottish health services were subject to similar Treasury constraints on expenditure as elsewhere in Great Britain; but that, on the other, there is a strong case for seeing the N.H.S. in Scotland as exhibiting a high degree of autonomy. It is further argued that this was, from the outset, justified and consolidated by the particular characteristics of Scottish history, geography and governance.

The Mecsek Mts and the Villány Hills represent the most southern (low)mountain region of Hungary. Here 63 grasshopper species were detected (=51,6% of the total Hungarian Orthoptera fauna), however, several in Hungary elsewhere common species were not found. High percentage of some Mediterranean, Balkan and other, elsewhere in Hungary rare or missing Orthoptera species (as e.g. Poecilimon fussi, Poecilimon intermedius, Isophya costata, I. modestior, I. modesta, I. camptoxypha, Sagapedo, Odontopodisma decipiens, O. schmidtii, Aiolopus strepens, Acrotylus insubricus, etc.), are characteristic to this fauna and to these grasshopper assemblages. The joint and frequent occurrence of bigger, mostly predaceous decticines (3 Pholidoptera spp., Pachytrachis gracilis, Pterolepis germanica) is also remarkable. Species being under legislative nature protection in Hungary amounted to 10 taxons (=15,9 %) in the Mecsek, - among them with two sub-endemics for the Carpathian Basin: Isophya costata and /. camptoxypha. However, during the last decades some flightless phaneropterids (/. modesta, I. camptoxypha, I. modestior) seem to have suffered local extiction around settlements due to the urbanization pressure. Species occurring in the Mecsek Mts were classified according to their phenology. The northernmost sites of the area of Aiolopus strepens - the adults overwinter - were detected in the Mecsek. Places of occurrence of rare and protected species {Isophya spp., Poecilimon intermedius, Aiolopus strepens) are endangered by habitat destruction, especially around the city Pécs, that is extending to parts of the southern slopes of the Misina Mt (535 m).

In most areas of Australia, mammals constitute the staple diets of cats, foxes and dingoes. In central Australia the abundance of mammals is often too low to meet the dietary requirements of these carnivores and yet populations of cats, foxes and dingoes persist. To investigate alternative feeding strategies of cats, foxes and dingoes in arid environments, their diets were monitored in relation to prey availability in two areas of the Tanami Desert where rabbits do not occur. Dietary information was obtained by analysing predator scats collected between 1995 and 1997. Prey availability was monitored by track counts, pitfall trapping, Elliott trapping, and bird counts along walked transects. In contrast to dietary studies elsewhere in Australia, it was found that reptiles were an important component of the diets of predators in the Tanami Desert, and should be classified as seasonal staples. Birds increased in importance in the diets of cats and foxes during the winter, when reptiles were less active. There was considerable overlap between the diets of all three predators, although dingoes ate more large prey items (e.g.�macropods) than the other two predators. Results highlight the opportunistic feeding habits of cats, foxes and dingoes and show that, although mammalian prey are less important in central Australia than has been found elsewhere, species that are vulnerable to extinction, such as the bilby (Macrotis lagotis), mulgara (Dasycercus cristicauda) and marsupial mole (Notoryctes typhlops), are also consumed by these predators.

Abstract Background Retention in care is critical for treatment and prevention of HIV. Many HIV care clinics measure retention rate, but data are often incomplete for patients who are classified as lost to follow-up but may be actually in care elsewhere, moved, or died. The Data to Care (D2C) initiative supports data sharing between health departments and HIV providers to confirm patient care status and facilitate reengagement efforts for out of care HIV patients. Methods The University of Chicago Medicine (UCM) provided an electronic list to the Chicago Department of Public Health (CDPH) of adult HIV-positive patients whose retention status was not certain. Retention in care was defined as at least 2 visits &gt;90 days apart within the prior 12 months. CDPH matched this list of patients with data from the Chicago electronic HIV surveillance database. Matches were based on patient name, including alternative spellings and phonetics, and birth date. CDPH also cross-checked patient names with the CDC’s national enhanced HIV-AIDS Reporting System (eHARS) database. CDPH provided UCM with patient current care status, i.e., patient was in care elsewhere (as verified by lab data), moved out of state, or deceased. Results 780 HIV-positive patients received care in the UCM adult HIV clinic from January 1, 2013 to March 31, 2017. Of these, 360 were retained in care as of March 2017. We shared data with CDPH for 492 patients. Of these, 294 (59.8%) were matched, and 168 (34.1%) had a date of last medical care provided. See Table 1 for patient dispositions, before and after data sharing. 24 (13.4%) of patients believed to be lost to follow up according to UCM records were confirmed either transferred care or deceased according to health department data. Conclusion Data sharing between the health department and HIV providers can improve data accuracy regarding retention in care among people living with HIV. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient

Arguing that the life chances of the Irish emigration in different countries of destination are a highly significant topic for sociologists, this article examines aspects of the health of people of Irish descent born in Britain. This is the subject of a research programme in the Medical Sociology Unit in Glasgow, funded by the UK's Medical Research Council. This historical background to this venture lies in the discovery of a health disadvantage among the Irish in Britain, and the establishment of links between the Irish emigration and high mortality in British cities, despite low mortality in Ireland when the migration was at its height. Theoretical accounts which have guided investigation of this issue include the possibility of prolonged effects from early capitalism in Britain, or that of entrenched effects from cultural exclusion, whether derived from competition for jobs and housing, or from political and religious divisions. These varying accounts lead to competing predictions, and the paper concludes by reviewing progress in testing these predictions, and by suggesting implications for research in other countries of destination.

AbstractThe recent description and re-classification of the mesentery as an organ prompted renewed interest in its role in physiological and pathological processes. With an improved understanding of its anatomy, accurately and reliably assessing the mesentery with non-invasive radiological investigation becomes more feasible.Multi-detector computed tomography is the main radiological modality employed to assess the mesentery due to its speed, widespread availability, and diagnostic accuracy.Pathologies affecting the mesentery can be classified as primary or secondary mesenteropathies. Primary mesenteropathies originate in the mesentery and subsequently progress to involve other organ systems (e.g., mesenteric ischemia or mesenteric volvulus). Secondary mesenteropathies describe disease processes that originate elsewhere and progress to involve the mesentery with varying degrees of severity (e.g., lymphoma).The implementation of standardized radiological imaging protocols, nomenclature, and reporting format with regard to the mesentery will be essential in improving the assessment of mesenteric anatomy and various mesenteropathies.In this article, we describe and illustrate the current state of art in respect of the radiological assessment of the mesentery.

Abstract In California, Drosophila simulans females from some populations (type W) produce relatively few adult progeny when crossed to males from some other populations (type R), but the productivity of the reciprocal cross is comparable to within-population controls. These two incompatibility types are widespread in North America and are also present elsewhere. Both types sometimes occur in the same population. Type R females always produce type R progeny irrespective of the father's type. However, matings between R males and females from stocks classified as type W produce type R progeny at low frequency. This suggests rare paternal transmission of the R incompatibility type, as we have found no evidence for segregation of incompatibility types in the W stocks. There is quantitative variation among type R lines for compatibility with W females, but not vice versa. Population cage studies and productivity tests suggest that deleterious side effects are associated with the type R cytoplasm.

Magnetic imaging can be performed both on conventional (projection) and scanning TEM (CTEM/STEM). The CTEM-based magnetic imaging, classified into Fresnel, Foucault, holography, and other modes, has proven successful by now in observing various magnetic objects, and has accordingly been well documented elsewhere. The STEMbased one has emerged relatively recently prompted by the rapid growth of current STEM technology.The most ubiquitous implementation of Lorentz microscopy on a STEM is the differential phase contrast (DPC) mode. Each scanning signal obtained in the DPC mode is linear to Lorentz deflection, thus reflects the magnitude of an in-plane component of magnetic induction integrated along the optical axis(Fig.l). The signals therefore suffice to generate integrated in-plane magnetic induction maps(Fig.2). Furthermore, by making use of the fact that the Lorentz deflection distribution across the image plane forms an irrotational (vortex-free) 2D vector field, a pertinent numerical image processing yields a function equivalent to the electron phase function representing magnetically distorted electron wavefront.

Background The term Nodding Syndrome (NS) refers to an atypical and severe form of childhood epilepsy characterized by a repetitive head nodding (HN). The disease has been for a long time limited to East Africa, and the cause is still unknown. The objective of this study was to confirm the existence of NS cases in Central African Republic (CAR). Methodology/Principal findings This was a cross-sectional descriptive study in the general population. The identification of NS cases was conducted through a door-to-door survey in a village near Bangui along the Ubangui River. Based on Winkler’s 2008 and the World Health Organization (WHO)’s 2012 classifications, the confirmation of cases was done by a neurologist who also performed the electroencephalograms. No laboratory tests were done during this investigation. Treatment was offered to all patients. A total of 6,175 individuals was surveyed in 799 households. After reviewing the cases, we identified 5 NS cases in girls aged between 8 and 16. The age of onset of the seizures was between 5 and 12 years of age. Two cases were classified as "HN plus" according to Winkler’s 2008 classification. Four NS cases were classified as probable and one as confirmed according to the WHO’s 2012 classification. Three of them presented with developmental delay and cognitive decline, and one had an abnormally low height-for-age z-score. Electroencephalographic abnormalities were found in four patients. Conclusions/Significance Nodding Syndrome cases were described in CAR for the first time. Despite certain peculiarities, these cases are similar to those described elsewhere. Given that only a small part of the affected area was investigated, the study area along the Ubangui River needs to be expanded in order to investigate the association between Onchocerca volvulus and NS and also evaluate the real burden of NS in CAR.

Many developing countries still rely on conventional hard copy images to transfer information among physicians. We have developed a low-cost alternative method of printing computerised tomography (CT) scan images where there is no dedicated camera. A digital camera is used to photograph images from the CT scan screen monitor. The images are then transferred to a PC via a USB port, before being printed on glossy paper using an inkjet printer. The method can be applied to other imaging modalities like ultrasound and MRI and appears worthy of emulation elsewhere in the developing world where resources and technical expertise are scarce.

It is widely accepted that policy-makers (in Nepal and elsewhere) can learn valuable lessons from the way other countries run their health and social services. We highlight some of the specific contributions the discipline of sociology can make to cross-national comparative research in the public health field. Sociologists call attention to often unnoticed social and cultural factors that influence the way national reproductive health care systems are created and operated. In this paper we address questions such as: ‘Why do these health services appear to be operating successfully in one country, but not another?’; ‘What is it in one country that makes a particular public health intervention successful and how is the cultural context different in a neighbouring country?’ The key examples in this paper focus on maternity care and sex education in the Netherlands and the UK, as examples to highlight the power of cross-national research. Our key messages are: a) Cross-national comparative research can help us to understand the design and running of health services in one country, say Nepal, by learning from a comparison with other countries, for example Sri Lanka or India. b) Cultural factors unique to a country affect the way that reproductive health care systems operate. c) Therefore,we need to understand why and how services work in a certain cultural context before we start trying to implement them in another cultural context.