Opportunities and barriers to effective operation and maintenance of public toilets in informal settlements: perspectives from toilet operators in Kampala

Although classified by the Joint Monitoring Programme (JMP) as unimproved sanitation facilities, public toilets still play a critical role in eliminating open defecation in informal settlements. We explored perspectives of toilet operators on opportunities and barriers to operation and maintenance (O&M) of public toilets in informal settlements. A cross-sectional study design was used. Up to 20 in-depth interviews were used to obtain data on the experiences of public toilet operators. Thematic content analysis was used.

Ressults show that opportunities for improving O&M include; operation of public toilets is a source of livelihood; operators are knowledgeable on occupational risks, and the community is involvedin sanitation activities. Barriers to effective O&M include; high operation costs, failure to break even and a lack of investments in occupational health Therefore, there is need to recognise the significance of public toilets as a viable alternative to open defecation in areas where ownership of private sanitation facilities is difficult. Failure to observe the health and safety of toilet operators may further compromise O&M.     

Subsurface microhardness of enamel and dentin after different external bleaching procedures

PURPOSE: To evaluate the influence of various bleaching systems on subsurface microhardness of enamel and dentin. METHODS: 60 bovine crowns were distributed among seven groups (A: Opalescence Xtra Boost, B: Opalescence Quick, C: Rapid White, D: Whitestrips, E: Opalescence 10%, F: Opalescence PF 15%). The crowns were sectioned and baseline hardness (Knoop) of enamel and dentin was assessed on the sectioned surface at various distances from the enamel surface. The sectioned surface was covered with wax and the enamel was treated for 10 days with the bleaching agents A-F according to manufacturers' instructions. Bleaching with C-F was conducted each day (C: twice per day for 10 minutes, D: twice per day for 30 minutes, E: 8 hours, F: 4 hours), systems A-B were applied on first and fifth days (A: twice for 10 minutes, B: 1 hour). Finally, hardness was re-assessed. Data were statistically analyzed to compare baseline hardness and final hardness in the respective groups (P< 0.05). RESULTS: Analysis showed that in Group C, hardness was significantly reduced in both enamel and dentin. In the remaining groups, significant reduction of hardness was observed up to the following depths [microm] in enamel; A: 250, B: 700, D: 300, E: 150, F: 150. In these groups no significant hardness changes were recorded in subsurface dentin.     

Neurological deterioration after lumbar cerebrospinal fluid drainage.

Large-bore lumbar spinal fluid drainage is used frequently as part of the preoperative and intraoperative management of patients undergoing cranial base tumor resection. Such drainage allows displacement of the brain with minimal force, thereby potentially decreasing retraction damage to it. We document 2 patients in whom serious complications resulted from lumbar drainage systems. These patients deteriorated into a coma state following cerebrospinal fluid (CSF) drainage. Reinfusion of synthetic CSF solutions caused a brisk return to normal neurological status. These plus other potential complications associated with lumbar drainage, such as persistent CSF leaks into the back and soft-tissue nerve root injury, warranted abandoning the lumbar cistern drainage route of CSF drainage in favor of drainage directly from the intracranial compartment. Depending on the particular operation performed, drainage of CSF near the cribriform plate, the suprachiasmatic cistern, or from the sylvian fissure may be effective sites for CSF drainage. Unlike lumbar drainage, intracranial CSF drainage does not have the added risk of promoting cerebral herniation.     

Three years of bluetongue disease in central Europe with special reference to Germany: what lessons can be learned?

With few exceptions, vector-borne diseases have long been considered of minor importance in central and northern Europe. Since the advent of bluetongue disease (BTD) in 2006 and the 2007 chikungunya fever outbreak in Italy this attitude has changed. It is due to continuing globalization rather than to climate change that even central and northern Europe are at risk of new pathogens as well as vectors of disease entering and establishing. BTD was the first 'exotic' disease to arrive: it did not slowly spread northwards but jumped in through a still unknown entry point. Although indigenous Culicoides biting midge species had formerly been considered to be the vectors of the bluetongue virus (BTV) in the Mediterranean, nobody had expected BTD in more northern European areas free of C. imicola. When the disease broke out, the authorities were completely unprepared, particularly as neither data on the putative vectors nor biting midge specialists were available. Starting with about 2000 affected ruminant farming facilities in 2006 in the central western part of Europe, the virus managed to overwinter and spread in all directions in 2007, producing almost 60,000 outbreaks (farms affected) in ten European countries up to early 2008. At that time, vaccine administration against BTV serotype 8 was initiated, significantly decreasing the total number of holdings affected in the third transmission season (May 2008 to April 2009). From May 2009 onwards, relatively few cases of BTV-8 infections were notified in a total of only six European countries. Unfortunately, while the further fate of BTV-8 in Europe remains to be awaited, BTV-1 appears to be approaching from the south, with some 4900 outbreaks in France in 2008. Meanwhile, the results from various entomological monitoring projects have suggested biting midges of the C. obsoletus and C. pulicaris complexes as well as some other ceratopogonid species as the most likely BTV vectors in central Europe. The lesson to be learned from the BTD epidemic is once again that in the long term pro-action is better than mere reaction as it can considerably support and facilitate reaction: to avoid and manage outbreaks of emerging vector-borne diseases, essential prerequisites are to monitor the indigenous hematophagous arthropod fauna, to identify potential vectors and acquire knowledge on their biology, to educate medical entomologists and vector biologists, and to implement better control of imported goods and animals for pathogens and arthropod vectors.     

Determining Engagement in Services for High-Need Individuals with Serious Mental Illness

This study examined whether Medicaid claims and other administrative data could identify high-need individuals with serious mental illness in need of outreach in a large urban setting. A claims-based notification algorithm identified individuals belonging to high-need cohorts who may not be receiving needed services. Reviewers contacted providers who previously served the individuals to confirm whether they were in need of outreach. Over 10,000 individuals set a notification flag over 12-months. Disengagement was confirmed in 55 % of completed reviews, but outreach was initiated for only 30 %. Disengagement and outreach status varied by high-need cohort.