Syndrome packets and health worker training improve sexually transmitted disease case management in rural South Africa: randomized controlled trial

Background: Sexually transmitted diseases (STD) are important co-factors in HIV transmission. We studied the impact of health worker training and STD syndrome packets (containing recommended drugs, condoms, partner notification cards and information leaflets) on the quality of STD case management in primary care clinics in rural South Africa. Methods: A randomized controlled trial of five matched pairs of clinics compared the intervention with routine syndromic management. Outcomes were measured by simulated patients using standardized scripts, and included the proportion given recommended drugs; correctly case managed (given recommended drugs plus condoms and partner cards); adequately counselled; reporting good staff attitude; and consulted in privacy. Results: At baseline, the quality of STD case management was similarly poor in both groups. Only 36 and 46% of simulated patients visiting intervention and control clinics, respectively, were given recommended drugs. After the intervention, intervention clinics provided better case management than controls: 88 versus 50% (P < 0.01) received recommended drugs; 83 versus 12% (P < 0.005) were correctly case managed; 68 versus 46% (P = 0.06) were adequately counselled; 84 versus 58% experienced good staff attitude (P = 0.07); and 92 versus 86% (P = 0.4) were consulted privately. A syndrome packet cost US$1.50; the incremental cost was US$6.80. The total intervention cost equalled 0.3% of annual district health expenditure. Interpretation: A simple and affordable health service intervention achieved substantial improvements in STD case management. Although this is a critical component of STD control and can reduce HIV transmission, community-level interventions to influence health-seeking behaviour are also needed. (C) 2000 Lippincott Williams & Wilkins.

Acute high-intensity interval training improves T-vent and peak power output in highly trained males.

This study examined the effects of four high-intensity interval-training (HIT) sessions performed over 2 weeks on peak volume of oxygen uptake (VO2peak), the first and second ventilatory thresholds (UT VT2) and peak power output (PPO) in highly trained cyclists. Fourteen highly trained male cyclists (VO2peak = 67.5 +/- 3.7 ml . kg(-1) . min(-1)) performed a ramped cycle test to determine VO2peak VT1 VT2, and PPO. Subjects were divided equally into a HIT group and a control group. The HIT group performed four HIT sessions (20 x 60 s at PPO, 120 s recovery); the V-02peak test was repeated <I wk after the HIT program. Control subjects maintained their regular training program and were reassessed under the same timeline. There was no change in V0(2peak) for either group; however, the HIT group showed a significantly greater increase in VT1, (+22% vs. -3%), VT2 (+15% vs. -1%), and PPO (+4.3 vs. -.4%) compared to controls (all P <.05). This study has demonstrated that HIT can improve VT1, VT2,, and PPO, following only four HIT sessions in already highly trained cyclists.

Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors

Objective To determine the association between rural undergraduate training, rural postgraduate training and medical school entry criteria favouring rural students, on likelihood of working in rural Australian general practice. Methods National case - control study of 2414 rural and urban general practitioners (GPs) sampled from the Health Insurance Commission database. Participants completed a questionnaire providing information on demographics, current practice location and rural undergraduate and postgraduate experience. Results Rural GPs were more likely to report having had any rural undergraduate training [ odds ratio ( OR) 1.61, 95% confidence interval (CI) 1.32 - 1.95] than were urban GPs. Rural GPs were much more likely to report having had rural postgraduate training ( OR 3.14, 95% CI 2.57 - 3.83). As the duration of rural postgraduate training increased so did the likelihood of working as a rural GP: those reporting that more than half their postgraduate training was rural were most likely to be rural GPs ( OR 10.52, 95% CI 5.39 - 20.51). South Australians whose final high school year was rural were more likely to be rural GPs ( OR 3.18, 95% CI 0.99 - 10.22). Conclusions Undergraduate rural training, postgraduate training and medical school entry criteria favouring rural students, all are associated with an increased likelihood of being a rural GP. Longer rural postgraduate training is more strongly associated with rural practice. These findings argue for continuation of rural undergraduate training opportunities and rural entry schemes, and an expansion in postgraduate training opportunities for GPs.

Embracing ligands. A synthetic strategy towards new nitrogen-thioether multidentate ligands and characterization of the cobalt(III) complexes

The synthesis of the hexadentate ligand 2,2,9,9-tetra(methyleneamine)-4,7-dithiadecane (EtN(4)S(2)amp) is reported. The ligand is of a type in which bifurcations of the chain occur at atoms other than donor atoms. The cobalt(III) complex [Co(EtN(4)S(2)amp)](3+) (1) was isolated and characterized. The synthetic methodology also results in a number of by-products, notably 2,9,9-tris(methyleneamine)-9-methylenehydroxy-4,7-dithiadecane (Et(HO)N(3)S(2)amp) and an eleven-membered pendant arm macrocyclic ligand 6,10-dimethyl-6,10-bis(methyleneamine)-1,4-dithia-8-azaacycloundec-7- ene (dmatue). The complexes [Co(Et(HO)N(3)S(2)amp)](3+) (2), in which the alcohol is coordinated to the metal ion, and [Co(dmatue)Cl](2+) (4) were isolated and characterized. Et(HO)N(3)S(2)amp also undergoes complexation with cobalt(III) to produce two isomers endo-[Co(Et(HO) N(3)S(2)amp)Cl](2+) (endo-3) and exo-[Co(Et(HO) N(3)S(2)amp)Cl](2+) (exo-3), both with an uncoordinated alcohol group. endo- 3 has the alcohol positioned cis, and exo-3 trans, to the sixth metal coordination site. Reaction of 1 with isobutyraldehyde, paraformaldehyde and base in dimethylformamide results in the encapsulated complex [Co(1,5,5,9,13,13-hexamethyl-18,21-dithia-3,7,11,15-tetraazabicyclo[7.7.6]docosa- 3,14-diene)](ClO4)(3) . 2H(2)O ([Co(Me(6)docosadieneN(4)S(2))](3+) ( 5). All complexes have been characterized by single crystal X-ray study. The low-temperature (11 K) absorption spectrum of 1 has been measured in Nafion films with spin-allowed (1)A(1g) --> T-1(1g) and (1)A(1g) --> T-1(2g) and spin forbidden (1)A(1g) --> T-3(1g) and (1)A(1g) --> T-3(2g) bands observed. The octahedral ligand-field parameters were determined (10Dq = 22570 cm(-1), B = 551 cm(-1); C = 3500 cm(-1)). For 5 10Dq and B were determined (20580 cm(-1); 516 cm(-1), respectively) and compared with those for similar expanded cavity complexes [Co(Me(8)tricosatrieneN(6))](3+) and [Co(Me(5)tricosatrieneN(6))](3+).

GREEN MANAGEMENT, CLIMATE CHANGE AND SMALL BUSINESS IN BRAZIL: IMPLICATIONS FOR TRAINING AND EDUCATION FOR SUSTAINABLE DEVELOPMENT

This paper presents the results of a study on the analysis of training needs regarding environmental (green) management and climate change topics in micro and small enterprises (MSEs) in Brazil and its implications on education for sustainable development. It reports on an e-mail survey of Brazilian small enterprises, whose results indicate that they are indeed interested in environmental management and climate change topics in an education for sustainable development context. The study indicates that proposals for courses on environmental management and climate change should follow a systemic perspective and take sustainable development into account. By applying factor analysis, it was found that the topics of interest can be grouped into thematic modules, which can be useful in the design of training courses for the top management leaders of those companies.

Effect of chloride concentration on the electrochemical treatment of a synthetic tannery wastewater

The electrochemical treatment of a synthetic tannery wastewater prepared with 30 compounds used in animal skin processing was studied. Electrolyses were performed in a one-compartment flow cell at a current density of 20 mA cm(-2), using a dimensionally stable anode (DSA (R)) of composition Ti/Ir(0.10)Sn(0.90)O(2) as the working electrode. Effects of chloride concentration and presence of sulfate were evaluated. Variation in the concentration of phenolic compounds as a function of electrolysis time revealed a first-order exponential decay; faster phenol removals were obtained with increasing chloride concentration in the wastewater. Lower phenol removals were obtained in the presence of sulfate. Higher chloride concentrations led to a faster decrease in total organic carbon (TOC), chemical oxygen demand (COD), and absorbance values at 228 nm. Faster wastewater color removal, higher current efficiency and lower energy consumption were also obtained. This electrochemical treatment was also able to reduce the wastewater toxicity for Daphnia similis. (C) 2008 Elsevier Ltd. All rights reserved.

Electrochemical oxidation of synthetic tannery wastewater in chloride-free aqueous media

The electrochemical treatment of a synthetic tannery wastewater, prepared with several compounds used by finishing tanneries, was studied in chloride-free media. Boron-doped diamond (Si/BDD), antimony-doped tin dioxide (Ti/SnO(2)-Sb), and iridium-antimony-doped tin dioxide (Ti/SnO(2)-Sb-Ir)were evaluated as anode. The influence of pH and current density on the treatment was assessed by means of the parameters used to measure the level of organic contaminants in the wastewater; i.e., total phenols, chemical oxygen demand (COD), total organic carbon (TOC), and absorbance. Results showed that faster decrease in these parameters occurred when the Si/BDD anode was used. Good results were obtained with the Ti/SnO(2)-Sb anode, but its complete deactivation was reached after 4h of electrolysis at 25 mA cm(-2), indicating that the service life of this electrode is short. The Ti/SnO(2)-Sb-Ir anode is chemically and electrochemically more stable than the Ti/SnO(2)-Sb anode, but it is not suitable for the electrochemical treatment under the studied conditions. No significant changes were observed for electrolyses performed at different pH conditions with Si/BDD, and this electrode led to almost complete mineralization after 4 h of electrolysis at 100mAcm(-2). The increase in current density resulted in faster wastewater oxidation, with lower current efficiency and higher energy consumption. Si/BBD proved to be the best electrodic material for the direct electrooxidation of tannery wastewaters. (C) 2010 Elsevier B.V. All rights reserved.

The neurosurgical training curriculum in Australia and New Zealand is changing. Why?

The Neurosurgical Advanced Training curriculum of the Royal Australasian College of Surgeons (RACS) is currently undergoing change. Given the high standard of neurosurgery in Australia and New Zealand, it may be questioned why such change is necessary. However, the curriculum has not kept pace with developments in professional practice, educational practice or educational theory, particularly in the assessment of medical competence and performance. The curriculum must also adapt to the changing training environment, particularly the effects of reduced working hours, reducing caseloads due to shorter inpatient hospital stays and restricted access to public hospital beds and operating theatres, and the effects of subspecialisation. A formal review of the curriculum is timely. (c) 2004 Elsevier Ltd. All rights reserved.

Biomimetic in silico devices

We introduce biomimetic in silico devices, and means for validation along with methods for testing and refining them. The devices are constructed from adaptable software components designed to map logically to biological components at multiple levels of resolution. In this report we focus on the liver; the goal is to validate components that mimic features of the lobule (the hepatic primary functional unit) and dynamic aspects of liver behavior, structure, and function. An assembly of lobule-mimetic devices represents an in silico liver. We validate against outflow profiles for sucrose administered as a bolus to isolated, perfused rat livers. Acceptable in silico profiles are experimentally indistinguishable from those of the in situ referent. This new technology is intended to provide powerful Dew tools for challenging our understanding of how biological functional units function in vivo.

Characterization of mechanical properties of silicon nitride thin films for MEMS devices by nanoindentation

An experimental investigation of mechanical properties of thin films using nanoindentation was reported. Silicon nitride thin films with different thicknesses were deposited using plasma enhanced chemical vapor deposition (PECVD) on Si substrate. Nanoindentation was used to measure their elastic modulus and hardness. The results indicated that for a film/substrate bilayer system, the measured mechanical properties are significantly affected by the substrate properties. Empirical formulas were proposed for deconvoluting the film properties from the measured bilayer properties.

Hematological parameters and anaerobic threshold in Brazilian soccer players throughout a training program

We assessed the responses of hematological parameters and their relationship to the anaerobic threshold of Brazilian soccer players during a training program. Twelve athletes were evaluated at the beginning (week 0, T1), in the middle (week 6, T2), and at the end (week 12, T3) of the soccer training program. On the first day at 7:30 AM, before collecting the blood sample at rest for the determination of the hematological parameters, the athletes were conducted to the anthropometric evaluation. On the second day at 8:30 AM, the athletes had their anaerobic threshold measured. Analysis of variance with Newman-Keuls`post hoc was used for statistical comparisons between the parameters measured during the soccer training program. Correlations between the parameters analyzed were determined using the Pearson`s correlation coefficient. Erythrocytes concentration, hemoglobin, and hematocrit were significantly increased from T1 to T2. The specific soccer training program led to a rise in erythrocytes, hemoglobin, and hematocrit from T1 to T2. We assumed that these results occurred due to the plasma volume reduction and may be explained by the soccer training program characteristics. Furthermore, we did not observe any correlation between the anaerobic threshold and the hematological parameters.

Chronic absence of baroreceptor inputs prevents training-induced cardiovascular adjustments in normotensive and spontaneously hypertensive rats

We investigate whether arterial baroreceptors mediate the training-induced blood pressure fall and resting bradycardia in hypertensive (SHR) and normotensive rats (WKY). Male SHR and WKY rats, submitted to sino-aortic denervation (SAD) or sham surgery (SHAM group), were allocated to training (T; 55% of maximal exercise capacity) or sedentary (S) protocols for 3 months. Rats were instrumented with arterial and venous catheters for haemodynamic measurements at rest (power spectral analysis) and baroreceptor testing. Kidney and skeletal muscles were processed for morphometric analysis of arterioles. Elevated mean arterial pressure (MAP) and heart rate (HR) in SHAM SHRS were accompanied by increased sympathetic variability and arteriolar wall/lumen ratio [+3.4-fold on low-frequency (LF) power and +70%, respectively, versus WKYS, P < 0.05]. Training caused significant HR (similar to 9% in WKY and SHR) and MAP reductions (-8% in the SHR), simultaneously with improvement of baroreceptor reflex control of HR (SHR and WKY), LF reduction (with a positive correlation between LF power and MAP levels in the SHR) and normalization of wall/lumen ratio of the skeletal muscle arterioles (SHR only). In contrast, SAD increased pressure variability in both strains of rats, causing reductions in MAP (-13%) and arteriolar wall/lumen ratio (-35%) only in the SHRS. Training effects were completely blocked by SAD in both strains; in addition, after SAD the resting MAP and HR and the wall/lumen ratio of skeletal muscle arterioles were higher in SHRT versus SHRS and similar to those of SHAM SHRS. The lack of training-induced effects in the chronic absence of baroreceptor inputs strongly suggests that baroreceptor signalling plays a decisive role in driving beneficial training-induced cardiovascular adjustments.

The role of micro-anchor devices in medial canthopexy

Telecanthus, the lateral displacement of the medial canthus, can be a congenital deformity or can occur after facial trauma or tumor resection. Treatment of telecanthus remains a challenge for plastic surgeons. For proper correction, it is necessary to shift the medial canthus medially, fixing its tendon to the bone. The ideal technique would allow easy, safe, and stable fixation of the tendon, permit a unilateral approach with minimal incisions, and be cost-effective. The purpose of this study was to evaluate the feasibility and results (immediate and long-term) of medial telecanthus repair using ipsilateral titanium microanchor fixation. Nine patients, 7 with unilateral telecanthus and 2 with bilateral telecanthus, underwent ipsilateral canthopexy involving a microanchor device. Anthropometric measurements of the orbital regions were taken before, immediately after, and at 1 year after surgery. Data for the affected sides were compared with those for the unaffected sides, and the evolution of those values was assessed throughout the 1-year follow-up period. For all patients, the final values were lower than those initially obtained. At 1 year after surgery, the intercanthal distance was reduced to age-adjusted normal values in all cases. On the operated side, stable improvement was observed in terms of the distance from the medial canthus to the midline, although some degree of recurrence was noted in most of the patients. The use of a microanchor system for medial canthopexy can be considered an easily performed and effective option for treating canthal dystopia, especially when an ipsilateral approach is preferred.