Closed Reduction of Anterior Shoulder Dislocations Performed by Ski Patrollers in the Alpine Prehospital Environment: A Retrospective Review Demonstrating Efficacy in a Canadian Ski Resort.

INTRODUCTION: Shoulder dislocations are common ski hill injuries. Rapid reduction is known to improve outcomes; however, advanced providers are not always available to provide care to these patients. In 2017, nonmedical ski patrollers at Sunshine Village ski resort in Alberta, Canada, were trained to perform anterior shoulder dislocation (ASD) reductions. Program success was determined by a chart review after the 2020 ski season. METHODS: This study retrospectively reviewed data on patients who presented to Sunshine Village ski patrol with a suspected ASD and who met the study inclusion criteria from November 2017 through March 2020. Data were collected from ski patrol electronic patient care records regarding general demographics, reduction technique used, analgesia administration, and reduction success rates. RESULTS: Ninety-six cases were available for review after exclusions. Trained nonmedical ski patrollers successfully reduced 82 of these cases, resulting in an overall reduction success rate of 89%. Sixty-three (66%) of these patients had experienced first-time dislocations. Eighty-two (87%) patients were male, with a median age of 25 y. The most used technique was the Cunningham method (75%), and analgesia was administered to 70% of patients. CONCLUSIONS: This retrospective study documents the results of a quality assurance review of the treatment of ASD at Sunshine Village ski resort. With a success rate of 89%, the evidence supports the conclusion that nonmedical ski patrollers can successfully perform ASD reductions. We believe training ski patrollers to reduce ASD improved patient care in our austere environment by providing early definitive treatment with a high success rate.

A high-resolution geospatial surveillance-response system for malaria elimination in Solomon Islands and Vanuatu.

BACKGROUND: A high-resolution surveillance-response system has been developed within a geographic information system (GIS) to support malaria elimination in the Pacific. This paper examines the application of a GIS-based spatial decision support system (SDSS) to automatically locate and map the distribution of confirmed malaria cases, rapidly classify active transmission foci, and guide targeted responses in elimination zones. METHODS: Customized SDSS-based surveillance-response systems were developed in the three elimination provinces of Isabel and Temotu, Solomon Islands and Tafea, Vanuatu. Confirmed malaria cases were reported to provincial malaria offices upon diagnosis and updated into the respective SDSS as part of routine operations throughout 2011. Cases were automatically mapped by household within the SDSS using existing geographical reconnaissance (GR) data. GIS queries were integrated into the SDSS-framework to automatically classify and map transmission foci based on the spatiotemporal distribution of cases, highlight current areas of interest (AOI) regions to conduct foci-specific targeted response, and extract supporting household and population data. GIS simulations were run to detect AOIs triggered throughout 2011 in each elimination province and conduct a sensitivity analysis to calculate the proportion of positive cases, households and population highlighted in AOI regions of a varying geographic radius. RESULTS: A total of 183 confirmed cases were reported and mapped using the SDSS throughout 2011 and used to describe transmission within a target population of 90,354. Automatic AOI regions were also generated within each provincial SDSS identifying geographic areas to conduct response. 82.5% of confirmed cases were automatically geo-referenced and mapped at the household level, with 100% of remaining cases geo-referenced at a village level. Data from the AOI analysis indicated different stages of progress in each province, highlighting operational implications with regards to strategies for implementing surveillance-response in consideration of the spatiotemporal nature of cases as well as logistical and financial constraints of the respective programmes. CONCLUSIONS: Geospatial systems developed to guide Pacific Island malaria elimination demonstrate the application of a high resolution SDSS-based approach to support key elements of surveillance-response including understanding epidemiological variation within target areas, implementing appropriate foci-specific targeted response, and consideration of logistical constraints and costs.

Malaria risk: estimation of the malaria burden.

Accurate estimates of the global burden of malaria are important for planning, monitoring and advocacy. Snow et al. attempt to address the shortcomings of previous estimates of the incidence of malaria caused by Plasmodium falciparum by combining current and historical data. However, we believe that the design of their model and its inputs have led to a significant overestimate of the malaria burden outside Africa--as in the example of the World Health Organization (WHO) western Pacific region (WPR), for which their model predicts 60 times the 2002 incidence reported by national malaria-control programmes.

Lessons from the Pacific programme to eliminate lymphatic filariasis: a case study of 5 countries.

BACKGROUND: Lymphatic Filariasis (LF) is an important Neglected Tropical Disease, being a major cause of disability worldwide. The Global Programme to Eliminate Lymphatic Filariasis aims to eliminate LF as a public health problem by the year 2020, primarily through repeated Mass Drug Administration (MDA). The Pacific region programme commenced in 1999. By June 2007, five of the eleven countries classified as endemic had completed five MDA campaigns and post-MDA prevalence surveys to assess their progress. We review available programme data and discuss their implications for other LF elimination programs in developing countries. METHODS: Reported MDA coverage and results from initial surveys and post-MDA surveys of LF using the immunochromatographic test (ICT) from these five Pacific Island countries (Tonga, Niue, Vanuatu, Samoa and Cook Islands) were analysed to provide an understanding of their quality and programme progress towards LF elimination. Denominator data reported by each country programme for 2001 was compared to official sources to assess the accuracy of MDA coverage data. RESULTS: Initial survey results from these five countries revealed an ICT prevalence of between 2.7 and 8.6 percent in individuals tested prior to commencement of the programme. Country MDA coverage results varied depending on the source of denominator data. Of the five countries in this case study, three countries (Tonga, Niue and Vanuatu) reached the target prevalence of <1% antigenaemia following five rounds of MDA. However, endpoint data could not be reliably compared to baseline data as survey methodology varied. CONCLUSION: Accurate and representative baseline and post-campaign prevalence data is crucial for determining program effectiveness and the factors contributing to effectiveness. This is emphasised by the findings of this case study. While three of the five Pacific countries reported achieving the target prevalence of <1% antigenaemia, limitations in the data preclude identification of key determinants of this achievement.

Current Malaria Situation in Asia-Oceania.

Asia-Oceania is a diverse region that comprises roughly 65% of the global population at risk for malaria. In 2016 WHO estimated the number of malaria cases across the Asia-Oceania to be 17 million, which is only a small part (8%) of the total global malaria burden, and the number of cases is shrinking rapidly. Most countries have brought their cases down to the point where elimination is in sight. Plasmodium vivax (P. vivax) is becoming the dominant malaria species in many of those countries, where malaria occurs in hot spots of transmission frequently along international borders. The challenge is now to concentrate on those areas. This chapter reviews the situation in various areas of the Region and focuses on a number of important issues, including the prevalence of P. vivax and drug-resistant malaria.

A collaborative epidemiological investigation into the criminal fake artesunate trade in South East Asia.

BACKGROUND: Since 1998 the serious public health problem in South East Asia of counterfeit artesunate, containing no or subtherapeutic amounts of the active antimalarial ingredient, has led to deaths from untreated malaria, reduced confidence in this vital drug, large economic losses for the legitimate manufacturers, and concerns that artemisinin resistance might be engendered. METHODS AND FINDINGS: With evidence of a deteriorating situation, a group of police, criminal analysts, chemists, palynologists, and health workers collaborated to determine the source of these counterfeits under the auspices of the International Criminal Police Organization (INTERPOL) and the Western Pacific World Health Organization Regional Office. A total of 391 samples of genuine and counterfeit artesunate collected in Vietnam (75), Cambodia (48), Lao PDR (115), Myanmar (Burma) (137) and the Thai/Myanmar border (16), were available for analysis. Sixteen different fake hologram types were identified. High-performance liquid chromatography and/or mass spectrometry confirmed that all specimens thought to be counterfeit (195/391, 49.9%) on the basis of packaging contained no or small quantities of artesunate (up to 12 mg per tablet as opposed to approximately 50 mg per genuine tablet). Chemical analysis demonstrated a wide diversity of wrong active ingredients, including banned pharmaceuticals, such as metamizole, and safrole, a carcinogen, and raw material for manufacture of methylenedioxymethamphetamine ('ecstasy'). Evidence from chemical, mineralogical, biological, and packaging analysis suggested that at least some of the counterfeits were manufactured in southeast People's Republic of China. This evidence prompted the Chinese Government to act quickly against the criminal traders with arrests and seizures. CONCLUSIONS: An international multi-disciplinary group obtained evidence that some of the counterfeit artesunate was manufactured in China, and this prompted a criminal investigation. International cross-disciplinary collaborations may be appropriate in the investigation of other serious counterfeit medicine public health problems elsewhere, but strengthening of international collaborations and forensic and drug regulatory authority capacity will be required.

Cost containment in a school deworming programme targeting over 2.7 million children in Vietnam.

Vietnam is one of the countries in the world most affected by soil-transmitted helminthiases. Large areas of the country, such as the Northern Uplands and the North and Central Coast, are reported as having infection rates of 75-85% for Ascaris lumbricoides, 38-40% for Trichuris trichiura and 27-28% for hookworm infections. Periodical deworming of schoolchildren is therefore strongly recommended. Managers of the Helminth Control Programme decided to apply a number of measures to improve cost efficiency in order to deworm as many schoolchildren as possible with the limited financial resources available. This low-cost intervention targeted over 2.7 million schoolchildren. Coverage was estimated at over 95% and the cost for each treated child was US$ 0.03, which represents a saving of approximately 50% of costs presently reported in the literature. This article describes the measures applied that resulted in cost containment but maintained high treatment coverage.

Determination of iodopropynyl butylcarbamate in cosmetic formulations utilizing pulsed splitless injection, gas chromatography with electron capture detector.

Current analytical methodology for iodopropynyl butylcarbamate (IPBC) analysis focuses on the use of liquid chromatography and mass spectrometer (LC-MS), but the high instrumentation and operator investment required has resulted in the need for a cost effective alternative methodology. Past publications investigating gas chromatography with electron capture detector (GC-ECD) for IPBC quantitation proved largely unsuccessful, likely due to the preservatives limited thermal stability. The use of pulsed injection techniques commonly used for trace analysis of thermally labile pharmaceutical compounds was successfully adapted for IPBC analysis and utilizes the selectivity of GC-ECD analysis. System optimization and sample preparation improvements resulted in substantial performance and reproducibility gains. Cosmetic formulations preserved with IPBC (50-100ppm) were solvated in toluene/isopropyl alcohol and quantified over the 0.3-1.3µg/ml calibration range. The methodology was robust (relative standard deviation 4%), accurate (98% recovery), and sensitive (limit of detection 0.25ng/ml) for use in routine testing of cosmetic formulation preservation.

Taeniasis/cysticercosis trend worldwide and rationale for control.

Pig production has increased significantly worldwide in recent years. Small-scale pig husbandry has become a popular source of income in rural and resource-poor communities in most of developing countries. A parallel increase of human Taenia carrier and human cysticercosis is expected but detailed data are not available. However, Taenia solium is considered responsible for over 10% of acute case admission to the neurological ward of countries where it is endemic. The control strategy that seems at the moment more promising is a combination of the different tools available and includes the identification of areas at high risk and the presumptive treatment of the suspected cases and their families. This active finding and treatment of probable tapeworm carriers should be accompanied by health education and control swine cysticercosis. WHO invites all endemic countries to recognize the importance of taeniasis/cysticercosis control and to collect epidemiological data and to adopt policies and strategies for its control.

Financial costs of deworming children in all primary schools in Cambodia.

In 2002, Cambodia's Ministry of Health launched a deworming programme to deliver an anthelmintic drug (mebendazole 500 mg) and health education to 75% of its school children twice a year. Cambodia's school population is approximately 2.8 million. The deworming programme was organized into two phases: the first phase (December 2002-March 2003) targeted more than one million school children from 11 provinces; and the second phase (July 2003-January 2004) targeted the entire school population. The cost to treat each child was 12 cents (0.11 USD) during the first phase, 6 cents during the second phase, and 3 cents for re-treatment in areas where the campaign was conducted for the second time. The Cambodian experience demonstrates that, with political commitment, high coverage for deworming is achievable even in a country with minimal resources. Cambodia's deworming programme represents a successful model for other developing countries.

Mekong malaria. II. Update of malaria, multi-drug resistance and economic development in the Mekong region of Southeast Asia.

In an expansion of the first Mekong Malaria monograph published in 1999, this second monograph updates the malaria database in the countries comprising the Mekong region of Southeast Asia. The update adds another 3 years' information to cover cumulative data from the 6 Mekong countries (Cambodia, China/Yunnan, Lao PDR, Myanmar, Thailand, Viet Nam) for the six-year period 1999-2001. The objective is to generate a more comprehensive regional perspective in what is a global epicenter of drug resistant falciparum malaria, in order to improve malaria control on a regional basis in the context of social and economic change. The further application of geographical information systems (GIS) to the analysis has underscored the overall asymmetry of disease patterns in the region, with increased emphasis on population mobility in disease spread. Of great importance is the continuing expansion of resistance of P. falciparum to antimalarial drugs in common use and the increasing employment of differing drug combinations as a result. The variation in drug policy among the 6 countries still represents a major obstacle to the institution of region-wide restrictions on drug misuse. An important step forward has been the establishment of 36 sentinel sites throughout the 6 countries, with the objective of standardizing the drug monitoring process; while not all sentinel sites are fully operational yet, the initial implementation has already given encouraging results in relation to disease monitoring. Some decreases in malaria mortality have been recorded. The disease patterns delineated by GIS are particularly instructive when focused on inter-country distribution, which is where more local collaborative effort can be made to rationalize resource utilization and policy development. Placing disease data in the context of socio-economic trends within and between countries serves to further identify the needs and the potential for placing emphasis on resource rationalization on a regional basis. Despite the difficulties, the 6-year time frame represented in this monograph gives confidence that the now well established collaboration is becoming a major factor in improving malaria control on a regional basis and hopefully redressing to a substantial degree the key problem of spread of drug resistance regionally and eventually globally.

Use of the DNA flow-thru chip, a three-dimensional biochip, for typing and subtyping of influenza viruses.

Influenza A viruses, which are further subtyped on the basis of antigenic differences in external hemagglutinin and neuraminidase glycoproteins, and influenza B viruses are prominent among the viral causes of respiratory diseases and can cause a wide spectrum of illness. Each year these viruses are responsible for recurrent epidemics, frequently in association with genetic variation. There is a requirement for sensitive and rapid diagnostic techniques in order to improve both the diagnosis of infections and the quality of surveillance systems. A new three-dimensional biochip platform (Flow-Thru Chip; MetriGenix) was used to develop a rapid and reliable molecular method for the typing and subtyping of influenza viruses. Oligonucleotide probes immobilized in microchannels of a silicon wafer were selected to recognize multiple fragments of the influenza A virus matrix protein gene; the influenza B virus NS gene; the H1, H3, and H5 hemagglutinin genes; and the N1 and N2 neuraminidase genes. Biotinylated amplicons resulting from either multiplex or random reverse transcription-PCR were hybridized to arrayed oligonucleotides on the influenza virus chip before they were stained with horseradish peroxidase-streptavidin and were imaged by use of a chemiluminescent substrate. The chip analysis procedure, from the time of pipetting of the sample into the chip cartridge to the time of analysis of the results, was performed in less than 5 h. The random PCR exhibited a higher level of performance than the multiplex PCR in terms of the specificity of product hybridization to the influenza virus chip. Analysis of influenza A viruses (H1N1, H3N2, H1N2, and H5N1) and influenza B viruses showed that this microarray-based method is capable of the rapid and unambiguous identification of all types and subtypes of viruses by use of random PCR products. The redundancy of the probes designed for each gene selected yielded an additional criterion of confidence for the subtyping of viruses which are known for antigenic variations in some of their components.