Scrambling For Safety In The Eye Of Dorian: Mental Health Consequences Of Exposure To A Climate-Driven Hurricane.

As climate change alters the behavior of Atlantic hurricanes, these storms are trending stronger, wetter, and slower moving over coastal and island populations. Hurricane Dorian exemplified all three attributes. Dorian's destructive passage over the Abaco Islands, Bahamas, on September 1, 2019, exposed residents of its capital, Marsh Harbour, to a prolonged encounter with the storm's core. After Dorian's fierce front eyewall and towering storm surge tore apart shanty town habitats and eviscerated concrete homesites, residents desperately sought refuge during the brief respite when Dorian's eye passed directly overhead. The category 5 winds then resumed abruptly and Dorian continued its relentless destruction. This article focuses on the storm's mental health consequences, drawing on observations of on-site clinicians as well as findings from previous research on the mental health effects of Atlantic hurricanes and the transformation of hurricane hazards resulting from climate change. To protect island and coastal populations against climate-driven storms, disaster planning policy should emphasize resilience-focused prevention and mitigation strategies. In the aftermath of these events, health system response should include community outreach, case finding, and evidence-based interventions that optimize the use of mental health professionals.

A comparative study of perioperative techniques to attain negative margins and spare healthy breast tissue in breast conserving surgery.

BACKGROUND AND AIM: Traditionally lumpectomy as a part of breast-conserving surgery (BCS) is performed by palpation-guided method leading to positive margins and large excision volumes. There is no evidence suggesting that wide margin excisions decrease intra-breast tumour recurrence. Various perioperative techniques are used for margin assessment. We aimed to compare three commonly used techniques, i.e., ultrasound-guided surgery, palpation-guided surgery and cavity shaving for attaining negative margins and estimating the extent of healthy breast tissue resection. METHOD: A prospective comparative study was performed on 90 patients who underwent breast conservation surgery for early breast cancer between August 2018 and June 2019. Tumour excision with a minimum of 1 cm margin was done either using ultrasound, palpation or cavity shaving. Histopathological evaluation was done to assess the margin status and excess amount of resected normal breast tissue. Calculated resection ratio (CRR) defining the excess amount of the resected breast tissue was achieved by dividing the total resection volume (TRV) by optimal resection volume (ORV). The time taken for excision was also recorded. RESULTS: Histopathology of all 90 patients (30 in each group) revealed a negative resection margin in 93.3% of 30 patients in palpation-guided surgery group and 100% in both ultrasound-guided surgery and cavity shaving groups. Two patients (6.7%) from the cavity shaving group had positive margins on initial lumpectomy but shave margins were negative. TRV was significantly less in the ultrasound-guided surgery group compared to the palpation-guided surgery group and cavity shaving group (76.9 cm3, 94.7 cm3 and 126.3 cm3 respectively; p < 0.0051). CRR was 1.2 in ultrasound group compared to 1.9 in palpation group and 2.1 in cavity shave group which was also statistically significant (p < 0.0001).Excision time was significantly less (p < 0.001) in palpation-guided surgery group (13.8 min) compared to cavity shaving group (15.1 min) and ultrasound-guided group (19.4 min). CONCLUSION: Ultrasound-guided surgery is more accurate in attaining negative margins with the removal of least amount of healthy breast tissue compared to palpation-guided surgery and cavity shaving.

Plantar pressures in diabetes with no known neuropathy.

BACKGROUND: The aim of the present study was to investigate associations of arch type and gender with plantar pressure distribution in non-diabetic subjects and subjects with type 2 diabetes mellitus (T2DM) without peripheral neuropathy (PN). METHODS: Plantar pressures were recorded in 62 subjects with T2DM but without PN (mean [±SD] age 63.6 ± 7.6 years, body mass index [BMI] 24.3 ± 2.9 kg/m(2) , and duration of diabetes 7.0 ± 3.0 years) and in 63 non-diabetic adults (62.5 ± 8.5 years of age; BMI 22.4 ± 2.5 kg/m(2) ) in static stance using a foot analyzer. Data were collected from both feet and were analyzed for their association with disease, arch type, and gender using the Mann-Whitney U-test and Chi-squared test, respectively. RESULTS: There were significant differences in plantar pressures between the left and right feet in T2DM subjects, regardless of gender, and their metatarsal heads were overloaded. There were poor correlations between the overloaded plantar pressures and both foot arch and gender for all diabetic subjects. However, there were no differences in pressures at different zones between the diabetic and non-diabetic subjects. CONCLUSIONS: There were no differences in plantar pressures between non-diabetic and T2DM subjects without PN. Furthermore, there were no significant correlations between plantar pressures in diabetic subjects and either arch type or gender. However, there were significant differences in plantar pressures between the right and left feet.