Rosenthaler + Partner (Switzerland)

Over 100 Community Health Representatives (CHRs) as part of the oldest and largest Community Health Worker (CHW) program in the United States serve the Dine People on the Navajo Nation. The CHRs work under a tribally determined scope of practice that embraces the importance of self-determination of tribal nations, a philosophy central to the CHW field nationally. Navajo CHRs are the epitome of frontline workers, as they extend their traditional role to encompass long-term emergency response during coronavirus disease-2019 (COVID-19). This article describes the Navajo CHR role in the pandemic through the lens of an interview with the program's director, Mae-Gilene Begay.

To conduct a systematic review of the evidence on interventions for posttraumatic brain injury fatigue (PTBIF). Systematic searches of multiple databases for peer-reviewed studies published in English on interventions targeting PTBIF as a primary or secondary outcome through January 22, 2014. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies. The searches yielded 1526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study. Despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF.

ABSTRACTTo characterize a coastal aquifer in southern Mallorca (Spain), we have acquired geoelectric and seismic data. The area of investigation lies within a Miocene reefal carbonate platform consisting of lagoon sediments, reef cores and talus sediments. Since the groundwater table was at about 40 m depth , the delineation of small‐scale structural features (1–2 m) within the aquifer required the use of borehole methods. Geoelectric single‐hole tomography was performed in six deep boreholes. This fast and inexpensive technique provided horizontal resolution well beyond the limits of traditional logging techniques. Furthermore, the tomographic inversion results remained virtually unaffected by the insertion of slotted PVC casing tubes and comparisons with electromagnetic induction logs showed an excellent match of resistivities in regions near to the boreholes. In addition to the single‐hole measurements, geoelectric and seismic cross‐hole data were acquired. Combined analyses of all data sets showed the reef core to be particularly susceptible to karstification and recrystallization. These two processes have caused substantial variations in the porosity. Comparison of fluid logs and electrical resistivity versus depth and seismic velocity versus depth functions along all boreholes revealed a surprisingly high correspondence. This unexpected correlation of electrical resistivity (governed by the fluid salinity) and seismic velocities can be explained by geochemical processes occurring in the saltwater‐freshwater mixing zone and/or near the groundwater table. Such processes need to be considered for establishing reliable ground‐water flow models.

The number of railroad events reported to the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance system increased from 84 in 1993 to 177 in 1998. Comparisons of data on railroad and non-railroad events were made. The results overall indicated a greater potential impact of railroad events on public health. A median number of 2039 persons were living within a 1-mile radius of railroad events versus 982 for non-railroad events. The percentage of events during times when people are more likely to be home was also greater for railroad events. Railroad event victims were more likely to need hospital treatment than non-railroad event victims, which suggested the need for better community planning, reevaluation of current federal regulations and priorities for railroad hazardous material transport, and enhanced railroad industry commitment to safety.

B oth the National Diabetes Data Group (NDDG) and the World Health Organiza- tion (WHO) have included in their classification schemes for diabetes an entity labeled "impaired glucose tolerance" (IGT). 12The presumed significance of this entity is twofold: first, it is commonly believed that IGT represents a transitional state between normality and diabetes; and second, IGT is also believed to be a risk factor for cardiovascular disease, either in its own right, or as a consequence of its presumed precursor relationship to diabetes.These relationships will be critically examined in this editorial.Our thesis is that IGT is not a homogeneous category, but consists of at least three entities which, although conceptually distinct, cannot be distinguished by glucose tolerance testing alone.The arguments in defense of this viewpoint rest heavily on the concept that plasma glucose concentrations are biomodally distributed in populations.Therefore, the evidence for bimodality will be briefly reviewed.Bimodality of plasma glucose distributions has now been reported in several populations, most of which are of New World or Pacific Island origin. 3" 6 In addition to having a high prevalence of diabetes, these populations are relatively isolated genetically.While the high prevalence of diabetes facilitates detection of the second (hyperglycemic) mode, the highly selected nature of these populations raises the possibility that bimodality is somehow unique to them.We have recently reported bimodality in San Antonio Mexican Americans, 7 a population which, although it contains substantial New World genetic admixture, is nevertheless more than 50% Caucasian. 8' 9 Moreover, Mexican Americans are a much larger and genetically less isolated population than those in which bimodality has previously been reported, since they live side-by-side with other ethnic groups and thereby have greater opportunities for intermarriage.It could still be argued that bimodality in Mexican Americans is somehow a consequence of their New World genes.We feel, however, that our findings do tend to move the bimodality argument in the direction of greater generalizability to include populations such as Caucasians and blacks.Bimodality in these populations would, if present, be difficult to detect because of the much lower prevalence of diabetes and the second mode.Apart from the data, which are admittedly still incomplete, bimodality is theoretically appealing, since it fits with the clinicians' view that diabetes is a discrete clinical entity and not merely the right-hand tail of a continuous distribution of glucose values.Assuming the reader is willing to accept the concept of bimodality as a general phenomenon, we will now explore the implications of this phenomenon as they relate to IGT.From Figure 1 it is clear that the IGT category contains many individ-

The redistribution of thallium-201 (201Tl) after coronary vasodilation was studied in 14 dogs with a proximal stenosis of the left circumflex coronary artery that did not reduce basal flow but attenuated reactive hypermia. During an 8-10-minute i.v. infusion of adenosine, radioactive microspheres and 201Tl were injected into the left atrium. Sequential cardiac scintiscans and microsphere injections permitted subsequent determination of coronary blood flow during the redistribution of 201Tl. After 15-220 minutes of observation, the dogs were killed and the hearts removed for the measurement of the activity of 201Tl and the radioactive microspheres in the normal (left anterior descending coronary artery [LAD]) and flow-restricted (left circumflex coronary artery [LCX]) regions. The ratios of the activity in LAD/LCX for microspheres (TRmic) and for 201Tl (RT1) were compared with the activity ratio determined from the scintiscan (Rscan). Rmic for the microsphere simultaneously injected with 201Tl can be compared with the initial Rscan, which showed a significant hourly decrease from an initial value of 1.26 +/- 0.12 to a mean final value of 1.02 +/- 0.09 by 3-4 hours. The final Rscan (mean 1.07 +/- 0.10) in each experiment also correlated significantly (r = 0.854) with the final true myocardial RT1 (mean 1.26 +/- 0.25). Rscan underestimated Rmic (average 2.25 +/- 0.48) when both 201Tl and microspheres were simultaneously injected; Rscan also underestimated RT1, but the directional changes were similar. A further analysis of the Rmic, Rscan and RT1 in two groups of dogs with either relatively high or low coronary flow during adenosine infusion suggests that the net loss of cellular 201Tl from the normal scintigraphic area is the mechanism underlying the resolution of these initial defects.

Die Konstruktionsmerkmale von Endoprothesen aus Al2O3 werden vorgestellt. Die Befestigung am langen Rohrenknochen erfolgt mittels einer Kegelhulsenverbindung. Diese Prothesen-Knochenverbindung wurde mechanischen Festigkeitsprufungen unterworfen and im Tierexperiment uberpruft. Die Ergebnisse ermutigten zur klinischen Anwendung am Tumorpatienten, die an Hand verschiedener Falle demonstriert wird. Auf die Moglichkeit, auch grose Defekte zu uberbrucken, wird hingewiesen.

The course and prognosis of 16 infants and children with sick sinus syndrome associated with cardiac surgery is reviewed. The dysrhythmia was observed most ofter after extensive atrial reconstructive surgery in patients with transposition of the great arteries and with atrial septal defect. In 12 (75%) of the patients, sick sinus syndrome was detected in the immediate postoperative period. Tachyarrhythmias and bradyarrhythmias were presnet in 12 and isolated bradyarrhythmias in four. Temporary pacing was used in two and permanent pacing was required in five. Death in two non-paced patients was attributable to arrhythmias. Postmortem examination in one patient revealed a suture in the sinoatrial node. Careful attention to the anatomy of the sinoatrial node, its artery and the internodal tracts during surgery may prevent the development of sick sinus syndrome. In patients with dysrhythmia, a careful search should be undertaken to document the abnormal rhythm with the use of Holter monitoring. The insertion of a pacemaker is indicated in patients with tachyarrhythmias requiring cardioversion or antiarrhythmic drug therapy and those without adequate lower escape mechanisms.