Success factors for implementing and sustaining a mature electronic medical record in a low-resource setting: a case study of iSanté in Haiti.

Electronic health information systems, including electronic medical records (EMRs), have the potential to improve access to information and quality of care, among other things. Success factors and challenges for novel EMR implementations in low-resource settings have increasingly been studied, although less is known about maturing systems and sustainability. One systematic review identified seven categories of implementation success factors: ethical, financial, functionality, organizational, political, technical and training. This case study applies this framework to iSanté, Haiti's national EMR in use in more than 100 sites and housing records for more than 750 000 patients. The author group, consisting of representatives of different agencies within the Haitian Ministry of Health (MSPP), funding partner the Centers for Disease Control and Prevention (CDC) Haiti, and implementing partner the International Training and Education Center for Health (I-TECH), identify successes and lessons learned according to the seven identified categories, and propose an additional cross-cutting category, sustainability. Factors important for long-term implementation success of complex information systems are balancing investments in hardware and software infrastructure upkeep, user capacity and data quality control; designing and building a system within the context of the greater eHealth ecosystem with a plan for interoperability and data exchange; establishing system governance and strong leadership to support local system ownership and planning for system financing to ensure sustainability. Lessons learned from 10 years of implementation of the iSanté EMR system are relevant to sustainability of a full range of increasingly interrelated information systems (e.g. for laboratory, supply chain, pharmacy and human resources) in the health sector in low-resource settings.

An intelligent framework for medical image retrieval using MDCT and multi SVM.

BACKGROUND: Volumes of medical images are rapidly generated in medical field and to manage them effectively has become a great challenge. This paper studies the development of innovative medical image retrieval based on texture features and accuracy. OBJECTIVE: The objective of the paper is to analyze the image retrieval based on diagnosis of healthcare management systems. METHODS: This paper traces the development of innovative medical image retrieval to estimate both the image texture features and accuracy. The texture features of medical images are extracted using MDCT and multi SVM. Both the theoretical approach and the simulation results revealed interesting observations and they were corroborated using MDCT coefficients and SVM methodology. RESULTS: All attempts to extract the data about the image in response to the query has been computed successfully and perfect image retrieval performance has been obtained. Experimental results on a database of 100 trademark medical images show that an integrated texture feature representation results in 98% of the images being retrieved using MDCT and multi SVM. CONCLUSION: Thus we have studied a multiclassification technique based on SVM which is prior suitable for medical images. The results show the retrieval accuracy of 98%, 99% for different sets of medical images with respect to the class of image.

Inspection of lymph nodes for caseous lymphadenitis and its effect on the density of microbes on sheep carcasses.

This study aimed to measure the amount of microbial contamination caused by inspecting the lymph nodes of adult sheep carcasses for caseous lymphadenitis (CLA). Surface swabs from carcasses pre-inspection (N=296) and post-inspection (N=296) were obtained for enumeration of indicator organisms at three commercial abattoirs. At the scapular site, inspection doubled the probability of detecting E. coli (Pr before=0.35, Pr after=0.67) and increased the expected count of E. coli from 2 cfu/cm² to 13 cfu/cm². Inspection at the rump site increased the probability of detecting E. coli by 1.1 times (Pr before=0.84, Pr after=0.93) and increased the expected count from 32 cfu/cm² to 45 cfu/cm². Effects were also observed for Enterobacteriaceae and total viable count. The findings show that routine inspection of adult sheep carcasses for CLA has a detrimental impact on carcass microbiological traits.

Analgesia pós-operatória com metadona em gatos: administração epidural e intramuscular / Postoperative analgesia of methadone in cats: epidural and intramuscular administration

Compararam-se os efeitos analgésico, sedativo e neuroendócrino decorrentes da administração epidural e intramuscular da metadona em gatas submetidas à ovariossalpingoisterectomia (OSH). Todos os animais foram tranquilizados com acepromazina, 0,1mg kg-1 IM, seguindo-se a indução e manutenção anestésica com tiopental sódico, 12mg kg-1 IV, e halotano, respectivamente. Após a estabilização anestésica, os animais foram distribuídos em três grupos, com oito animais cada, tratados com metadona pela via epidural (EP) ou intramuscular (IM) 0,2mg kg-1, respectivamente, ou com solução salina (S) 0,2mL kg-1. Foram avaliados: graus de analgesia e de sedação, necessidade de analgesia de resgate, efeitos adversos e concentração sérica de cortisol. Os graus de analgesia e de sedação e o cortisol não diferiram entre os tratamentos. Analgesia de resgate foi administrada quatro, nove e 11 vezes nos tratamentos EP, IM e S, respectivamente. Nos tratamentos IM e S, a suplementação analgésica foi necessária a partir da primeira hora pós-cirúrgica, enquanto no tratamento EP, somente a partir da terceira hora após a OSH. Conclui-se que a administração de metadona pela via epidural resulta em menor quantidade do analgésico pós-operatório, e que a analgesia é mais prolongada quando comparada à obtida pela via intramuscular, em gatas submetidas à OSH.

The aim of this study was to investigate the analgesic, sedative and neuroendocrine effects of epidural (EP) and intramuscular (IM) methadone in cats submitted to ovariohysterectomy. The pre-anesthetic medication was acepromazine (0.1mg kg-1, IM) followed by induction of anesthesia with intravenous thiopental, 12mg kg-1, and anesthesia maintenance with halothane. After anesthesia stabilization the cats were randomly assigned to three groups of eight animals each and received EP or IM methadone, 0.2mg kg-1 diluted with saline to 0.2mL kg-1, EP and IM, respectively, or a saline placebo (S), 0.2mL kg-1. Pain measurements, degree of sedation, rescue analgesia requirements, adverse effects and serum cortisol concentration were recorded. Cortisol, pain and sedation scores did not differ among the groups. Rescue analgesia was administered 4, 9 and 11 times in the EP, IM and S treatment, respectively. In the IM and S rescue analgesia treatments were required early (first hour postoperative), whereas in the EP treatment, additional analgesics were required after the third hour postoperative. In conclusion, methadone epidural reduced the postoperative analgesic requirements and produced longer analgesia when compared to intramuscular administration in cats undergoing ovariohysterectomy.

[Prevalence and evolution of sleep complaints recorded upon medical check-ups in healthcare centers in Bordeaux and Cenon, France, between 1988 and 1998]. / Prévalence de la plainte relative aux troubles du sommeil: suivi de 205 347 sujets de 1988 à 1998.

Primary healthcare checkups are regularly performed by French healthcare centers. We report analysis of sleep disorders complaint registered from 1988 to 1998 in Bordeaux-Cauderan and Cenon CPAM welfare centers. The prevalence of sleep disorders is estimated from a total of 205 347 checkups. The population is segmented by age (18-24: 19 332, 25-34:46 694, 35-44:51 072, 45-54:46 886, 55-64:32 658, 65 +:7 705), gender (male: 101 801; female: 103 546) and population category (general: 147 188, underprivileged: 22 785, prioritized: 35 374). Datas shows a relationship between sex and age. Surprisingly we found a relation between Buying Power for Net Wages and Prevalence of Sleep Complaint. There is a significant correlation (R(2)=0,718, p<0,0079). These data are in relationship with M. Ohayon findings relatively to low income and sleep complaint.

Development of a recombinant human collagen-type III based hemostat.

Animal-tissue-derived collagen, containing mostly type I collagen with a minor amount of type III collagen, has been widely used in the production of hemostats for many decades, although it has been known for a long time that type III collagen is more likely to induce platelet aggregation in vitro. Because it is hard to purify type III from animal tissue, it has not been possible to correlate this finding with in vivo data. In this report, it is demonstrated that recombinant human collagen III fibrils are more capable of inducing platelet aggregation in vitro than those comprised of bovine collagen I, in agreement with previously published data on tissue-derived type III collagen. When formed into three-dimensional matrices, the use of type III collagen results in formulations with better mechanical integrity, larger surface area, and higher hemostatic activity in a rabbit spleen injury model as compared with commercially available hemostats formed from bovine type I collagen.

[Household economy and gender differences in international migration: a case study of Bolivians in Argentina]. / La economia domestica y las diferencias entre los sexos en las migraciones internacionales: un estudio sobre el caso de los Bolivianos en la Argentina.

The author analyzes household economy and sex differentials among Bolivian immigrants in Argentina. "While male Bolivian (mainly from Cochabamba) immigrants come to Argentina in search of better job opportunities, female immigration does not result generally from an individual decision, but from the adjustment to family, implying a loss in status and independence as compared to their place of origin. Job opportunities for Bolivian female workers are reduced mainly on account of their poor literacy levels; thus they often work for very low wages, deprived of any social benefits." (SUMMARY IN ENG)

Marriage process and household formation in Bolivia and Argentina: the impact of migration in a peasant society.

PIP: The impact of migration on family formation and fertility in peasant societies in Bolivia and Argentina was the focus of a large-scale research project. The project, conducted throughout 1984 and 1985, examined marriage patterns among peasants from rural communities in Bolivia who had settled in 3 locations: a lowland agricultural area; a provincial capital; and Buenos Aires, Argentina. The study sought to discover the interrelationship between economic diversification, land shortage, urban migration, and the onset of fertility decline, by comparing behavior patterns of younger and older (above age 30) respondents. The household is the basic structural unit of the Andean peasant region. Land is given to adult children after marriage, thereby maintaining the size of landholdings. There were significant differences, however, between mountain and valley communities. Age at marriage was 3 years younger in the mountain village, a pattern maintained when mountain peasants migrated to agricultural areas. In both communities, generational independence was achieved through access to the land. In valley communities, young females provide a source of labor and cash income for their families, while young males leave home, if only temporarily, to find work. Both these factors contribute to raise the age of marriage and delay household formation. But, young men who have migrated and then return follow the marriage patterns of the village mountain area. This is not true of those who migrate to the city, where contraceptive use is increasing and a fertility decline is evident. Migration to cities engenders a change in family formation, household autonomy, and a wage-earning rather than a land-based economic structure. In mountains and frontier communities, no contraception is practiced, nor is it available as it is in the cities and Buenos Aires. Family planning programs need to address the need for local contraceptive information and services.^ieng

Measuring minimal concentrations of attractants detected by the nematodePanagrellus redivivus.

A simple method for the experimental determination of minimal concentrations of attractants detected by the nematodePanagrellus redivivus is described. The lowest concentrations of methyl, ethyl, propyl, butyl, and amyl acetate as well as the minimal differences in concentrations of these attractants detectable byPanagrellus redivivus are presented.

[Agricultural structures and internal migration in a historical perspective: Latin American case studies]. / Estructuras agrarias y migracion interna en una perspectiva historica: estudios de casos latinoamericanos

PIP: This study is concerned with the ways in which changes in the structure of rural life influence internal migration in Latin America. The author describes how changes such as the abolition of slavery affected Peru and Bolivia and how the expansion of the international grain market affected Argentina, particularly regarding migration. Recent changes considered include the mechanization of agriculture and the decline of immigration.^ieng

Predactious fungi Dactylaria pyriformis and Dactylaria thaumasia: production of attractants and nematicides.

Dactylaria pyriformis Juniper and Dactylaria thaumasia Drechsler are predacious fung forming three-edimensional sticky reticula in which nematodes are captured. It was shown by methods developed in our laboratory that in submerged cultivations both of these fungi produce substances attracting nematodes and compounds having nematicidal activity.

Prolonged preservation of Oomycetes and predacious Fungi imperfecti under paraffin oil.

Oomycetes and predacious Fungi imperfecti were preserved viable for four years by storage at 22 degrees C under paraffin oil. This method of culture preservation was checked on 52 species belonging to 4 orders and 13 genera.