A Study on the Knowledge, Awareness, Perceptions and Behaviour (KAPB) of Students of the University of the West Indies, St. Augustine (UWI-STA) Towards Climate Change and its Impact on Human Health

Climate change (CC) is defined as long-term weather changes in the Earth's climate. CC has been linked to increased global temperatures. This affects human health both directly and indirectly: Directly, via increased risk of cardiovascular, respiratory, and vector-borne diseases. Indirectly, via reduced agricultural crop yields and accessibility to healthcare due to extreme weather events. Studies show that spreading awareness on the health impacts of CC encourages motivation towards mitigation (1). Early awareness of climate change and its health impacts is necessary for future generations to mitigate its effects.

Water Treatment: Are Membranes the Panacea?

Alongside the rising global water demand, continued stress on current water supplies has sparked interest in using nontraditional source waters for energy, agriculture, industry, and domestic needs. Membrane technologies have emerged as one of the most promising approaches to achieve water security, but implementation of membrane processes for increasingly complex waters remains a challenge. The technical feasibility of membrane processes replacing conventional treatment of alternative water supplies (e.g., wastewater, seawater, and produced water) is considered in the context of typical and emerging water quality goals. This review considers the effectiveness of current technologies (both conventional and membrane based), as well as the potential for recent advancements in membrane research to achieve these water quality goals. We envision the future of water treatment to integrate advanced membranes (e.g., mixed-matrix membranes, block copolymers) into smart treatment trains that achieve several goals, including fit-for-purpose water generation, resource recovery, and energy conservation.

Comparison of 2 days versus 5 days of octreotide infusion along with endoscopic therapy in preventing early rebleed from esophageal varices: a randomized clinical study.

BACKGROUND: Variceal bleeding is a medical emergency with 20% mortality at 6 weeks. The role of vasoactive agents in achieving hemostasis and preventing rebleeding has been well documented. The optimal duration of these agents has not been well established. There are no previous studies yielding the exact duration of octreotide to be administered to prevent rebleed and mortality from esophageal varices. The aim of this study is to evaluate the effect of combination therapy (octreotide and endoscopy), the exact duration of octreotide infusion, its cost-effectiveness, and the outcome in terms of rebleed and mortality. PATIENTS AND METHODS: This was a randomized clinical trial including 124 patients with acute variceal bleeding who underwent endoscopic therapy; they were assigned randomly to 2 days (n=62) and 5 days (n=58) of continuous octreotide infusion (50 µg/kg). Early rebleeding (within 42 days of index bleed according to Baveno IV consensus guidelines), transfusion requirement, and mortality were assessed. RESULTS: The study had predominantly male patients, average age 47 years. Among the patients in the 2-day group, 3 (4.8%) showed early rebleed versus 5 (8.6%) in the 5-day group, but the difference was not statistically significant (P>0.05). Among the patients in the 2-day group, one patient died after 3 weeks and all the patients in the 5-day group survived till 6 weeks on follow-up, and the survival rates were comparable (P>0.05). The treatment in the 5-day group was 2.5 times costlier than that for the 2-day group as shown by a cost-wise analysis. CONCLUSION: Two days of octreotide infusion following endoscopic therapy is sufficient and as efficacious as 5 days of infusion in preventing early rebleed, with reasonably better cost-effectiveness.

[Long-term results after balloon angioplasty of the crural artery]. / Langzeitergebnisse nach Ballonangioplastie kruraler Arterien.

PURPOSE: To evaluate the technical success rate, procedure-related complications, and clinical long-term results for patients who underwent infrapopliteal angioplasty. MATERIALS AND METHODS: We retrospectively evaluated all patients who underwent infrapopliteal angioplasty to treat critical chronic limb ischemia or severe claudication from 1/1997 to 12/1999. We excluded patients with acute (< 2 weeks) limb ischemia. Procedure-related data were prospectively documented in a database and analyzed with a focus on the technical success rate and procedure-related complications. In addition all clinical documents were analyzed, and a follow-up examination was performed or telephone interviews were conducted with patients, relatives and referring doctors for follow-up. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and walking distance. RESULTS: 112 patients with a mean age of 72 years (41 women, 71 men) underwent crural angioplasty on 121 limbs. Four patients suffered from severe claudication (Rutherford category 3) and all others had critical chronic limb ischemia (category 4 to 6). The complication rate was 2.7 %. The technical success rate was 92 %. The ankle brachial index increased from 0.59 to 0.88. The mean walking distance increased significantly from 52 +/- 66 to 284 +/- 346 meters at the time of follow-up. The limb salvage rate was 83.6 % after one year and 81.1 % after three years. The mean survival rate according to Kaplan-Meier was 79.4 %, 69.2 %, and 54.2 % at 1, 2, and 3 years, respectively. Patients with at least one patent run-off vessel after angioplasty had a significantly better limb salvage rate. Diabetes was not a risk factor for limb salvage. CONCLUSION: Infrapopliteal angioplasty shows a high technical success rate with an acceptable complication rate. The clinical long-term success seems favorable if a least one open run-off vessel was able to be achieved. However, the survival rate was limited by the co-morbidity in this patient group.

The effect of a six-week program of yoga and meditation on brachial artery reactivity: do psychosocial interventions affect vascular tone?

BACKGROUND: Chronic stress is estimated to increase the risk of cardiovascular (CV) events two-fold. Although stress reduction has been linked to a reduction in CV events, little is known regarding its exact mechanism of benefit. HYPOTHESIS: Yoga and meditation will improve parameters of endothelial function. METHODS: We examined the effects of yoga and meditation on hemodynamic and laboratory parameters as well as on endothelial function in a 6-week pilot study. Systolic and diastolic blood pressures, heart rate, body mass index (BMI), fasting glucose, lipids, hs C-reactive protein (CRP), and endothelial function (as assessed by brachial artery reactivity) were all studied at baseline and after 6 weeks of yoga practice. RESULTS: A course in yoga and meditation was given to the subjects for 1.5 h three times weekly for 6 weeks and subjects were instructed to continue their efforts at home. This prospective cohort study included 33 subjects (mean age 55 +/- 11 years) both with (30%) and without (70%) established coronary artery disease (CAD). There were significant reductions in blood pressure, heart rate, and BMI in the total cohort with yoga. None of the laboratory parameters changed significantly with yoga. For the total cohort there was no significant improvement in endothelial-dependent vasodilatation with yoga training and meditation compared with baseline (16.7% relative improvement from 7.2-8.4%; p = 0.3). In the group with CAD, endothelial-dependent vasodilatation improved 69% with yoga training (6.38-10.78%; p = 0.09). CONCLUSION: Yoga and meditation appear to improve endothelial function in subjects with CAD.

[From clinical guidelines to clinical pathways: development of a management-oriented algorithm for the treatment of polytraumatized patients in the acute period]. / Von der Leitlinie zum Behandlungspfad. Entwicklung eines prozessmanagementorientierten Algorithmus zur Akutversorgung polytraumatisierter Patienten.

INTRODUCTION: The treatment of polytraumatized patients in the acute period is an exemplary model of multidisciplinary cooperation in a very critical timeframe. Implementing standards formulated in the clinical guidelines of the German Association of Traumatology requires a detailed description of "how to do it." METHODS: Based on the guidelines and validated quality indictors, the optimal standard of care as the goal was defined. A clinical algorithm was developed and personal responsibilities and time limits were clearly assigned to each decision step and action. Checklists, documentation charts, and a full text supplement the algorithm. The complete pathway was adopted by representatives of all occupational groups involved in early trauma care in a consensus process. RESULTS: Improvement potentials were identified in those areas for which the guidelines did not provide explicit recommendations. These represent the key elements of the algorithm. Pathway-specific review criteria (quality indicators) were defined for scheduled reevaluation. CONCLUSIONS: Implementing clinical guidelines at the local level requires a problem-oriented and management-oriented elaboration towards a clinical pathway as the basis for a quantitative process and cost analysis.

Rotational digital cholangiography (RDC) and 3D-cholangiography (3DC) for guidance of percutaneous biliary drainage procedures.

PURPOSE: To evaluate whether RDC and 3DC help clarifying anatomic details in biliary duct disease and is useful for guidance of drainage procedures. MATERIALS AND METHODS: RDC was conducted in 11 consecutive patients (8 male, 3 female, mean age 63 years). Nine patients underwent PTBD for malignant biliary duct stenosis, one patient because of ischemic stenosis after hepaticojejunostomy and one patient presented with an infected biloma. Images were obtained after initial bile duct puncture during single breath hold from 120 projection angles using a rotating C-arm. These images were immediately available and evaluated in order to facilitate the definitive drainage procedure. For additional 3D reconstruction, data were sent to a dedicated workstation and judged by a blinded observer. RESULTS: The availability of a rotating data set of images was judged to be helpful in three patients with complex anatomical situations. Additionally, RDC holds the potential to reduce fluoroscopy time. 3DC allowed analysis of the hepatic bifurcation from different viewing angles in 10 cases with high spatial resolution (mean voxel size 480 micro micro m 3). This may allow a better classification of hilar obstructions according to our preliminary observations. CONCLUSION: Images from RDC and 3DC are helpful in guiding PTBD procedures and for better diagnosis in selected patients with hilar biliary duct stenoses.

[Pathomorphology, diagnosis and treatment of "hangman's fractures"]. / Zur Pathomorphologie, Diagnostik und Therapie der "hangman's fractures"

In a retrospective study diagnostic procedures and outcome of treatment were evaluated in 33 patients with traumatic spondylolisthesis of the axis (Hangman's fracture) who were treated in our department between 1986 and 1999. There were 18 men and 15 women with an average age of 41 (17-88) years. The cause of the injury was in 23 cases an accident as a driver of a car, in 2 cases an accident with a bike, 2 patients had an accident as a pedestrian. 5 patients fell on their head and 1 patient was hit by a beam. In 15 cases there were relevant accompanying injuries. To assess the stability of the injury, a subtle radiological examination was performed including functional X-rays. After introduction of the MRI and increasing experience with the method as a standard procedure in clinical practice it was used instead of functional X-rays to get a direct image of the involvement of the discoligamental structures.17 patients with stable lesions were treated conservatively, 15 with a Minerva-cast, 2 with a halo-jacket. One polytraumatized patient had temporary immobilization with a stiff-neck. 16 patients with discoligamental instability C2/3 were treated operatively by Robinson-spondylodesis with additional anterior plating. In one case an additional posterior fusion was necessary. After 6-8 weeks all of the conservative treated patients achieved solid bony consolidation. The patients operated on did so as well within 6 to 8 weeks. Two polytraumatized patients died. 18 of the 31 surviving patients were free of pain. 12 patients complained of pain or tension of the cervical muscles during physical stress. 1 patient suffered of paresthesia of the ulnar left hand. Average duration of hospital stay was 12,9 days (1-47). All working people returned to their job. Differences in the outcome of the conservative and the operative treatment group could not be seen. We derive from these results that Hangman's fractures, mostly caused by a hyperextension trauma, achieve solid bony fusion by conservative treatment in most of the cases. The Minerva-cast has proved its capability. In cases of instable luxation fractures including tearment of the anterior longitudinal ligament and affection of the intervertebral disc C2/3 we suggest operative stabilization. We prefer the modified Robinson-spondylodesis with additional anterior plating which proved its value as a method achieving solid bony fusion combined with low rate of complications.

Multiplanar reconstructions and three-dimensional imaging (computed rotational osteography) of complex fractures by using a C-arm system: initial results.

With use of a calibrated angiographic C-arm system and a postprocessing workstation, the authors acquired volume data sets from two-dimensional digital projection images obtained during a C-arm rotation around the patient axis. Multiplanar reconstruction and three-dimensional images of complex fractures were reconstructed and compared with spiral computed tomographic studies in a cadaveric pig study and in eight patients. Computed rotational osteography provided high-resolution multiplanar reconstruction and three-dimensional images of complex fractures.

The accuracy of mortality reporting in displaced persons camps during the post-emergency phase.

For humanitarian organisations, accurate data are essential to identify emerging health problems and determine programme needs. We visited 45 post-emergency phase displaced persons camps and collected three months' mortality data which we compared with organisations' routine mortality reports. Organisations reported 612 deaths and we identified 741 deaths, for a mortality-reporting ratio, defined as the number of organisation-reported deaths divided by the number of investigator-identified deaths, of 83 per cent. For the majority of camps which under-reported deaths, mortality reporting ratios were significantly higher for women than men, and for camps with central mortality registers rather than those without. In the few camps which over-reported deaths, these occurred primarily among children younger than five years of age, probably due to the inclusion of abortions and stillbirths. Despite the overall under-reporting of deaths by humanitarian organisations, the existing health information systems appear to estimate mortality rates adequately in these post-emergency camps. However, organisations should improve the precision and completeness with which they report the characteristics of deaths in order to provide valuable data to target their programmes at the most vulnerable people.

Needs assessment of the displaced population following the August 1999 earthquake in Turkey.

In August 1999 a major earthquake struck north-western Turkey. An assessment followed to identify the immediate needs of the displaced population. A random cluster sample of displaced families living in temporary shelter outside of organised relief camps was designed. Representatives of 230 households from the four communities worse affected by the earthquake were interviewed. Most families lived in makeshift shelters (84 per cent), used bottled water (91 per cent), obtained food from relief organisations (61 per cent), had access to latrines (90 per cent), had a member on routine medication (53 per cent) and obtained information by word of mouth (81 per cent). Many respondents reported having family members who were over the age of 65 (32 per cent) or under age three (20 per cent), who were pregnant (6 per cent), or who had been ill since the earthquake (64 per cent). The greatest immediate need reported by most families was shelter requirements (37 per cent), followed by food (23 per cent) and hygiene requirements (19 per cent). Ten days after the earthquake, basic environmental health needs of food, shelter and hygiene still predominated in this displaced population. Significant portions may have special needs due to age or illness.

Acute colonic diverticulitis: visualization in magnetic resonance imaging.

The incidence of acute colonic diverticulitis (ACD) is increasing. To allow rational therapeutic decisions to be made, a timely diagnosis is required. The feasibility of "on-admission-MRI" to establish the diagnosis has not yet been studied. Therefore, a prospective observational study was carried out in 20 patients with an established diagnosis of ACD. The diagnostic criteria for the MRI diagnosis of ACD were the demonstration of at least one diverticulum, pericolic exudation, and edema of the colonic wall. MRI was diagnostic in all but one patient. It is concluded that MRI has considerable diagnostic potential in ACD and should be formally evaluated.

Feasibility of C-arm-supported CT fluoroscopy in percutaneous abscess drainage procedures.

PURPOSE: Evaluation of C-arm-supported CT fluoroscopy to facilitate percutaneous abscess drainage procedures. METHODS: Prospectively, 40 percutaneous drainage procedures were performed either with C-arm-supported CT fluoroscopy or with CT fluoroscopy alone. Hybrid imaging was performed on the CT couch after complementing a CT fluoroscopy scanner with a C-arm fluoroscopy unit. Procedure times, drainage revisions during follow-up, and postinterventional drainage periods were analyzed. RESULTS: When compared with exclusive CT fluoroscopic guidance, a median procedure time of 9 +/- 3.7 min versus 14.8 +/- 7.3 min was required for C-arm-supported CT fluoroscopy (p < 0.005, t-test). During follow-up, eight drainage catheters had to be revised within the exclusive CT fluoroscopy group, while only two revisions were necessary within the C-arm-supported CT fluoroscopy group. With C-arm-supported CT fluoroscopy, postinterventional drainage periods were reduced (median 13 vs 19 days; p < 0.001, t-test). CONCLUSION: Compared with exclusive cross-sectional image guidance, C-arm-supported CT fluoroscopy seems to improve placement of abscess drainage catheters to possibly reduce procedure times, drainage catheter revisions, and postinterventional drainage periods.

Protonation constants of N,N'-ethylene-bis-[2-(o-Hydroxyphenyl]glycine.

Protonation constants of N,N'-ethylene-bis-[2-(o-Hydroxyphenyl]glycine have been determined potentiometrically, with least-squares treatment of the results. The constants (0.1 M NaNO(3)) are log k(1) = 10.80; log k(2) = 10.58; log k(3) = 8.75: log k(4) = 6.29.