47 research outputs found
Food from peace: breaking the links between conflict and hunger
No full text"In this paper, Ellen Messer, Marc J. Cohen, and Jashinta D'Costa show how hunger is often a direct result of violence ... [and] how hunger can reciprocally cause conflict. ... The authors call for including conflict prevention in food security and development efforts, as well as new linkages between food security and development on the one hand, and emergency relief on the other" Foreword.Social conflict., Hunger., Conflict management.,
The anatomic substrate of irreversible airway obstruction and barotrauma in a case of hurricane-triggered fatal status asthmaticus during puerperium: Lessons from an autopsy
No full textNon-fully reversible airway obstruction in fatal asthma is often seen in association with profound structural changes of the bronchial wall, termed airway remodeling. Evidence suggests that heavy precipitation events can trigger epidemics of severe asthma. We present a case of fatal asthma in a young woman with no prior near-fatal exacerbations and postulate that the patient's extensive airway remodeling and puerperal state (susceptibility factors), in combination with a massive allergen challenge during a hurricane landfall (triggering factor), played a central role in her death. The autopsy revealed diffuse obstruction of proximal and distal bronchi by mucous plugs together with transmural chronic inflammation, tissue eosinophilia, extensive goblet cell hyperplasia with MUC-5 expression and airway smooth muscle (ASM) thickening. The observed distribution of airway remodeling was heterogeneous with sparing of the lingula, which exhibited hyperinflation and expansion of perivascular spaces indicative of dissecting air. The massive stagnation of mucus and significant inter-airway structural heterogeneity created an anatomical substrate for unequal airflow distribution facilitating the development of barotrauma. Although not considered conventional risk factors for fatal asthma, we believe that in this case, the patient's puerperal state in conjunction with an extreme environmental event dispersing aeroallergens were major contributors to the development of a fatal asthma attack. Our autopsy findings suggest that effective strategies to evacuate stagnated mucus and induce relaxation of thickened ASM are crucial in the management of life-threatening asthma exacerbations. Keywords: Fatal asthma, Airway remodeling, Barotrauma, Thunderstorm, Hurricane, Autops
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Effect of histamine on tracheal mucosal perfusion, water content and airway smooth muscle in sheep
No full textWe examined the response of tracheal mucosal blood flow normalized for systemic arterial pressure (Q̇trn), water content (V
H
2O
) and luminal dead spac anesthetized sheep. Nebulized histamine produced rapid increases in mean Q̇trn ( + 84%) and V
H
2O
(+ 85%), and a decrease in mean Vtr(−17%)(
P<0.05) within 5 min post completion of challenge. Mean Vtr rapidly returned to baseline, while mean
Q
̇
trn and V
H
2O
remained elevated for 60 and 90 min after challenge, respectively. Pretreatment with chlorpheniramine (H
1-antagonist) blocked the changes in Vtr and V
H
2O
, and attenuated the increase in Q̇trn. Metiamide (H
2-antagonist) pretreatment abolished the increase in Q̇trn and blunted the increase in V
H
2O
, but had no effect on the decrease in Vtr. 2-methylhistamine (H
1-agonist) decreased mean Q̇trn and Vtr (
P<0.05) and dimaprit (H
2-agonist) increased mean Q̇trn (
P<0.05) without changing Vtr. Neither 2-methylhistamine nor dimapritsignificantly altered V
H
2O
Atropine blocked histamine induced decreases in Vtr and slightly attenuatedthe increases in Q̇trn and V
H
2O
. Thus, histamine increased airway smooth muscle tone and mucosal water content principally via H
1 receptors, and mucosal perfusion via H
2 receptors. The airway smooth muscle contraction involved muscarinic pathways
Impact of order set use on outcome of patients with sepsis
No full textAbstract
In an effort to improve outcome of patients with sepsis, we developed and implemented a disease-specific alert and order set for our computerized physician order entry system. This alert and order set were implemented in 2015. We have produced a progressive decrease in mortality for patients at our hospital with diagnosis of sepsis. We see a significant decrease in mortality for patients who had the sepsis order set used compared to those who did not have the order set used. We recommend use of an order set for patients with sepsis
Ignorance in the time of AIDS: what we do, and do not know about the ABC message in Uganda
No full textThe reduction of the HIV prevalence rate in Uganda during the early 1990s is often attributed to the introduction of an ABC policy. The Ugandan government is thought to have maintained a consistent message that suggested behaviour change in response to the HIV epidemic - encouraging citizens to Abstain, Be faithful, and/or use Condoms. It is thought that such a policy provides individuals with behavioural 'options', allowing them to choose a manner of protecting themselves against HIV infection. Although often used as an example of a successful social policy, many questions regarding the case are still unanswered. This dissertation establishes what is and is not known about the decline in prevalence in Uganda, as well as the role played by the ABC policy in that decline. The dissertation takes the form of a literature survey using key terms relating to the case. The ABC concept and the issues relevant to its implementation are initially discussed on an abstract level. The dissertation then turns to the implementation of the ABC policy in Uganda and the alleged success thereof. Three key topics are discussed in relation to the case: 1) the available statistical evidence pertaining to HIV/AIDS rates, 2) the available statistical evidence of behaviour change in Uganda, and 3) the national policy employed by the Ugandan government during the past three decades. The ideological debate surrounding the current Ugandan policy is also discussed. From the analysis of the available literature on the ABC policy and the Ugandan case, it becomes evident that certain things are known about the topic while others are not. The literature shows that a decline in prevalence did indeed take place, but that the extent and timing of this decline are unclear. The literature also shows that prevention messages in the country did suggest a change in behaviour in response to the threat of HIV, but that the content of these messages was not consistent on a national level. 6 Most importantly, the literature does not support a clear link between the implementation of an ABC policy and behaviour change in Uganda, nor does it clearly support a link between an ABC policy and a decline in HIV prevalence. Further research on the effectiveness and potential negative impact of the ABC concept is necessary before it is widely implemented in other countries
Interictal brain activity differs in migraine with and without aura: resting state fMRI study
No full textBackground: Migraine is one of the most severe primary headache disorders. The nature of the headache and the associated symptoms during the attack suggest underlying functional alterations in the brain. In this study, we examined amplitude, the resting state fMRI fluctuation in migraineurs with and without aura (MWA, MWoA respectively) and healthy controls. Methods: Resting state functional MRI images and T1 high-resolution images were acquired from all participants. For data analysis we compared the groups (MWA-Control, MWA-MWoA, MWoA-Control). The resting state networks were identified by MELODIC. The mean time courses of the networks were identified for each participant for all networks. The time-courses were decomposed into five frequency bands by discrete wavelet decomposition. The amplitude of the frequency-specific activity was compared between groups. Furthermore, the preprocessed resting state images were decomposed by wavelet analysis into five specific frequency bands voxel-wise. The voxel-wise amplitudes were compared between groups by non-parametric permutation test. Results: In the MWA-Control comparison the discrete wavelet decomposition found alterations in the lateral visual network. Higher activity was measured in the MWA group in the highest frequency band (0.16–0.08 Hz). In case of the MWA-MWoA comparison all networks showed higher activity in the 0.08–0.04 Hz frequency range in MWA, and the lateral visual network in in higher frequencies. In MWoA-Control comparison only the default mode network revealed decreased activity in MWoA group in the 0.08–0.04 Hz band. The voxel-wise frequency specific analysis of the amplitudes found higher amplitudes in MWA as compared to MWoA in the in fronto-parietal regions, anterior cingulate cortex and cerebellum. Discussion: The amplitude of the resting state fMRI activity fluctuation is higher in MWA than in MWoA. These results are in concordance with former studies, which found cortical hyperexcitability in MWA. © 2017, The Author(s)
Alternatives to prohibition illicit drugs: how we can stop killing and criminalising young Australians
No full textThis report follows from a Roundtable discussion held in July 2012 to consider new approaches to public policy about illicit drugs in Australia. An earlier Australia21 report launched in April 2012 had concluded that attempts to control drug use through the criminal justice system have clearly failed. They have also caused the needless and damaging criminalisation of too many young people, often with adverse life-changing consequences, including premature death from overdose
Outcomes of Patients Who Have Do Not Resuscitate Status prior to Being Admitted to an Intensive Care Unit
No full textAdmission of patients who have do not resuscitate (DNR) status to an intensive care unit (ICU) is potentially a misallocation of limited resources to patients who may neither need nor want intensive care. Yet, patients who have DNR status are often admitted to the ICU. This is a retrospective review of patients who had a valid DNR status at the time that they were admitted to an ICU in a single hospital over an eighteen-month period. Thirty-five patients met the criteria for inclusion in the study. The primary reasons for admission to the ICU were respiratory distress (54.2%) and sepsis (45.7%). Sixteen (45.7%) of the patients died, compared to a 5.4% mortality rate for all patients admitted to our ICU during this period (p<0.001). APACHE II score was a significant predictor of mortality (18.5 ± 1.3 alive and 23.4 ± 1.4 dead; p=0.038). Of the 19 patients discharged alive, 9 were discharged home, 5 to hospice, and 4 to a post-acute care facility. Conclusions. Patients who have DNR status and are admitted to the ICU have a higher mortality than other ICU patients. Those who survive have a high likelihood of being discharged to hospice or a post-acute care facility. The value of intensive intervention for these patients is not supported by these results. Only a minority of patients were seen by palliative care and chaplain teams, services which the literature supports as valuable for DNR patients. Our study supports the need for less expensive and less intensive but more appropriate resources for patients and families who have chosen DNR status
