On point estimation of the abnormality of a Mahalanobis index

Open Access funded by Medical Research Council Acknowledgment The work reported here was funded by a grant from the Medical Research Council, UK, grant number: MR/J013838/1.

Age determination on monazite from Forefinger Point granulites, East Antarctica (Table 2.6-1)

Electron microprobe (EMP) dating on monazite in granulite- facies rocks from Forefinger Point, East Antarctica, yielded dominant ages of 500 Ma on matrix monazites.They are associated with secondary cordierite, biotite and sapphirine, formed during nearly isothermal decompression after the high P-T assemblages involving garnet, orthopyroxene and sillimanite. Older ages around 750-1000 Ma are detected in monazite cores and in monazite inclusions in garnet porphyroblast. Combining the available age data and the reaction textures, it becomes evident that the Forefinger Point granulites have been overprinted by a granulite-facies decompressional event of Pan-African age. Moreover, EMP monazite dating imply that the Forefinger Point granulites have experienced at least two stages of metamorphic evolution.

Heart failure in sub-Saharan Africa: review of the aetiology of heart failure and the role of point-of-care biomarker diagnostics

Within Africa, the burden of heart failure is significant. This arises from the increase in cardiovascular disease and associated risk factors such as hypertension and diabetes, as well as causes of heart failure which are particular to sub-Saharan Africa, such as endomyocardial fibrosis. The lack of access to echocardiography and other imaging modalities, from a cost and technical perspective, combined with the predominantly rural nature of many countries with poor transport links, means that the vast majority of people never obtain an appropriate diagnosis. Similarly, research has been limited on the causes and treatment of heart failure in Africa and in particular endemic causes such as EMF and rheumatic heart disease. This review outlines the burden of heart failure in Africa and highlights the opportunity to expand diagnosis through the use of biomarkers, in particular natriuretic peptides. This builds on the success of point-of-care testing in human immunodeficiency virus and tuberculosis which have been extensively deployed in community settings in Africa.

Cedar Point Chaussee

This pictures shows a stream of automobiles making their was down the Cedar Point Chaussee (Chaussee is French for a paved road.) Realizing that access to Cedar Point by the automobile was an essential to the park's success, owner George Boeckling built a road that ran the length of the Cedar Point peninsula. This was a distance of seven miles, beginning at U.S. Route 6 to the entrance of Cedar Point.

Point of View: The importance of Leadership towards universal health coverage in Low Income Countries

Universal health coverage—defined as access to the full range of the most appropriate health care and technology for all people at the lowest possible price or with social health protection—was the goal of the 1978 Alma-Ata Conference on Primary Health Care in Kazakhstan. Many low-income (developing) countries are currently unable to reach this goal despite having articulated the same in their health-related documents. In this paper we argue that, over 30 years on, inadequate political and technical leadership has prevented the realization of universal health coverage in low-income countries.

A non-contrast self-navigated 3-dimensional MR technique for aortic root and vascular access route assessment in the context of transcatheter aortic valve replacement: proof of concept.

OBJECTIVES: Due to the high prevalence of renal failure in transcatheter aortic valve replacement (TAVR) candidates, a non-contrast MR technique is desirable for pre-procedural planning. We sought to evaluate the feasibility of a novel, non-contrast, free-breathing, self-navigated three-dimensional (SN3D) MR sequence for imaging the aorta from its root to the iliofemoral run-off in comparison to non-contrast two-dimensional-balanced steady-state free-precession (2D-bSSFP) imaging. METHODS: SN3D [field of view (FOV), 220-370 mm(3); slice thickness, 1.15 mm; repetition/echo time (TR/TE), 3.1/1.5 ms; and flip angle, 115°] and 2D-bSSFP acquisitions (FOV, 340 mm; slice thickness, 6 mm; TR/TE, 2.3/1.1 ms; flip angle, 77°) were performed in 10 healthy subjects (all male; mean age, 30.3 ± 4.3 yrs) using a 1.5-T MRI system. Aortic root measurements and qualitative image ratings (four-point Likert-scale) were compared. RESULTS: The mean effective aortic annulus diameter was similar for 2D-bSSFP and SN3D (26.7 ± 0.7 vs. 26.1 ± 0.9 mm, p = 0.23). The mean image quality of 2D-bSSFP (4; IQR 3-4) was rated slightly higher (p = 0.03) than SN3D (3; IQR 2-4). The mean total acquisition time for SN3D imaging was 12.8 ± 2.4 min. CONCLUSIONS: Our results suggest that a novel SN3D sequence allows rapid, free-breathing assessment of the aortic root and the aortoiliofemoral system without administration of contrast medium. KEY POINTS: • The prevalence of renal failure is high among TAVR candidates. • Non-contrast 3D MR angiography allows for TAVR procedure planning. • The self-navigated sequence provides a significantly reduced scanning time.

Point-of-care lactate and creatinine analysis for sick obstetric patients at Queen Elizabeth Central Hospital in Blantyre, Malawi: A feasibility study

Background: To achieve good outcomes in critically ill obstetric patients, it is necessary to identify organ dysfunction rapidly so that life-saving interventions can be appropriately commenced. However, timely access to clinical chemistry results is problematic, even in referral institutions, in the sub-Saharan African region. Reliable point-of-care tests licensed for clinical use are now available for lactate and creatinine. Aim: We aimed to assess whether implementation of point-of-care testing for lactate and creatinine is feasible in the obstetric unit at the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, by obtaining the opinions of clinical staff on the use of these tests in practice. Methods: During a two-month evaluation period nurse-midwives, medical interns, clinical officers, registrars, and consultants were given the opportunity to use StatStrip® and StatSensor® (Nova Biomedical, Waltham, USA) devices, for lactate and creatinine estimation, as part of their routine clinical practice in the obstetric unit. They were subsequently asked to complete a short questionnaire. Results: Thirty-seven questionnaires were returned by participants: 22 from nurse-midwives and the remainder from clinicians. The mean satisfaction score for the devices was 7.6/10 amongst clinicians and 8.0/10 amongst nurse-midwives. The majority of participants stated that the obstetric high dependency unit (HDU) was the most suitable location for the devices. For lactate, 31 participants strongly agreed that testing should be continued and 24 strongly agreed that it would influence patient management. For creatinine, 29 strongly agreed that testing should be continued and 28 strongly agreed that it would influence their patient management. Twenty participants strongly agreed that they trust point-of-care devices. Conclusions: Point-of-care clinical chemistry testing was feasible, practical, and well received by staff, and was considered to have a useful role to play in the clinical care of sick obstetric patients at this referral centre.

Linearity analysis and comparison study on the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients

The epoc® blood analysis system (Epocal Inc., Ottawa, Ontario, Canada) is a newly developed in vitro diagnostic hand-held analyzer for testing whole blood samples at point-of-care, which provides blood gas, electrolytes, ionized calcium, glucose, lactate, and hematocrit/calculated hemoglobin rapidly. The analytical performance of the epoc® system was evaluated in a tertiary hospital, see related research article “Analytical evaluation of the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients” [1]. Data presented are the linearity analysis for 9 parameters and the comparison study in 40 cardiopulmonary bypass patients on 3 epoc® meters, Instrumentation Laboratory GEM4000, Abbott iSTAT, Nova CCX, and Roche Accu-Chek Inform II and Performa glucose meters.

From a traditionally open access fishery to modern restrictions: Portuguese anglers' perceptions about newly implemented recreational fishing regulations

Saltwater recreational fishing (SRF) in Portugal was for a long time an open-access activity, without restrictions of any kind. Restrictions to control the recreational harvest were first implemented in 2006 and were highly criticized by the angler community, for being highly restrictive and lacking scientific support. The present study aimed to obtain socio-economic data on the recreational shore anglers and gauge their perceptions about recreational fishing regulations and the newly implemented restrictions in Portugal. Roving creel surveys were conducted along the south and south-west coasts of Portugal, during pre and post regulation periods (2006-2007). A total of 1298 valid face-to-face interviews were conducted. Logit models were fitted to identify which characteristics influence anglers' perceptions about recreational fishing regulations. The majority of the interviewed anglers was aware and agreed with the existence of recreational fishing regulations. However, most were against the recreational fishing regulations currently in place. The logit models estimates revealed that Portuguese anglers with a higher level of formal education and income are more likely to agree with the existence of recreational fishing regulations. In contrast, anglers who perceive that more limitations and a better enforcement of commercial fishing would improve fishing in the area are less likely to agree with the existence of SRF regulations. The findings from this study will contribute to inform decision-makers about anglers' potential behaviour towards the new and future regulations. Although the existence of fishing regulations is a good starting point for effective management, the lack of acceptance and detailed knowledge of the regulations in place by fishers may result in lack of compliance, and ultimately hinder the success of recreational fishing regulations in Portugal. (C) 2013 Elsevier Ltd. All rights reserved.