Notes

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9%, 5.1% and 3.7%, respectively.

The findings are in favour of rapidly escalating the introduction of a substance use preventive programme at all school levels as well as making opioid substitution therapy and other harm reduction programmes available in Oman.
The findings are in favour of rapidly escalating the introduction of a substance use preventive programme at all school levels as well as making opioid substitution therapy and other harm reduction programmes available in Oman.Medicine is a sociotechnical system wherein culture manifests itself in all its aspects. Culture, however, is often intangible and is frequently neglected in formal healthcare education, research and practice. This sounding board article attempts to generate interest in making culture a serious component of healthcare systems at different levels, including its founding philosophical underpinnings, educational systems, research activities and clinical practice. It is recommended that a framework of culture-oriented medical philosophy, education, research and practice be implemented. Each component of this framework is briefly discussed in relation to healthcare. find more Culture should be reflected explicitly in healthcare through research activities, medical humanities, cultural competence, communication and ethics.Sickle cell disease (SCD) can significantly impair the health-related quality of life (HRQOL) of children and adolescents. This review aimed to assess current evidence regarding the HRQOL of children and adolescents with SCD in the Middle East and North Africa region. A systematic search of various databases was conducted to identify relevant articles, including MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA), Scopus® (Elsevier, Amsterdam, the Netherlands), Cumulative Index to Nursing and Allied Health Literature®, Masader (Oman Virtual Science Library, Muscat, Oman) and EBSCOhost (EBSCO Information Services, Ipswich, Massachusetts, USA). A total of 533 articles were identified; however, only 10 were eligible for inclusion in the final analysis. Results from these studies showed that children and adolescents with SCD had compromised HRQOL compared to their healthy peers, particularly in terms of physical, psychosocial, familial, financial and academic functioning. Therefore, interventions are necessary to improve overall HRQOL outcomes for this population.To understand the timing, extent, and magnitude of land use/land cover (LULC) change in buffer areas surrounding Midwestern US waters, we analyzed the full imagery archive (1982-2017) of three Landsat footprints covering ~100,000 km2. The study area included urbanizing Chicago, Illinois and St. Louis, Missouri regions and agriculturally dominated landscapes (i.e., Peoria, Illinois). The Continuous Change Detection and Classification algorithm identified 1993-2017 LULC change across three Landsat footprints and in 90 m buffers for ~110,000 surface waters; waters were also size-binned into five groups for buffer LULC change analyses. Importantly, buffer-area LULC change magnitude was frequently much greater than footprint-level change. Surface-water extent in buffers increased by 14-35x the footprint rate and forest decreased by 2-9x. Development in buffering areas increased by 2-4x the footprint-rate in Chicago and Peoria area footprints but was similar to the change rate in the St. Louis area footprint. The LULC buffer-area change varied in waterbody size, with the greatest change typically occurring in the smallest waters (e.g., less then 0.1 ha). These novel analyses suggest that surface-water buffer LULC change is occurring more rapidly than footprint-level change, likely modifying the hydrology, water quality, and biotic integrity of existing water resources, as well as potentially affecting down-gradient, watershed-scale storages and flows of water, solutes, and particulate matter.In this article, we present a nanoelectromechanical system (NEMS) designed to detect changes in the Casimir energy. The Casimir effect is a result of the appearance of quantum fluctuations in an electromagnetic vacuum. Previous experiments have used nano- or microscale parallel plate capacitors to detect the Casimir force by measuring the small attractive force these fluctuations exert between the two surfaces. In this new set of experiments, we aim to directly detect the shifts in the Casimir energy in a vacuum due to the presence of the metallic parallel plates, one of which is a superconductor. A change in the Casimir energy of this configuration is predicted to shift the superconducting transition temperature (Tc) because of the interaction between it and the superconducting condensation energy. In our experiment, we take a superconducting film, carefully measure its transition temperature, bring a conducting plate close to the film, create a Casimir cavity, and then measure the transition temperature again. The expected shifts are smaller than the normal shifts one sees in cycling superconducting films to cryogenic temperatures, so using a NEMS resonator in situ is the only practical way to obtain accurate, reproducible data. Using a thin Pb film and opposing Au surface, we observe no shift in Tc >12 µK down to a minimum spacing of ~70 nm at zero applied magnetic field.
Few data exist concerning conversion to secondary progressive MS in patients treated with disease-modifying therapies.

Determine the proportion of alemtuzumab-treated patients converting from relapsing-remitting to secondary progressive MS during the CARE-MS core and extension studies.

Patients (
 = 811) were analyzed post hoc for secondary progressive MS conversion. Optimal conversion definition Expanded Disability Status Scale (EDSS) score ≥4, pyramidal functional system score ≥2, and confirmed progression over ≥3 months including confirmation within the functional system leading to progression, independent of relapse.

Over 6.2 years median follow-up, 20 alemtuzumab-treated patients converted (Kaplan-Meier estimate, 2.7%; 95% confidence interval, 1.8%-4.2%). Sensitivity analysis accounting for dropouts showed similar results (3%), as did analyses using alternative definitions with different EDSS thresholds and/or confirmation periods, and analysis of core study subcutaneous interferon beta-1a-treated patients who received alemtuzumab in the extension.
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