Comprehensive Long-term Plan Research Articles

Multiple Myeloma Presenting with Severe Back Pain: A Case Report

This study aims to highlight the diagnostic challenges and management strategies in a case of Multiple Myeloma (MM), a hematologic malignancy characterized by malignant plasma cells in the bone marrow. The case involves a 40-year-old male who presented with persistent back pain for two months, impacting his mobility. Initial physical and neurological assessments were largely unremarkable, but laboratory and radiological investigations revealed multiple osteolytic lesions suggestive of MM. Typical MM symptoms include hypercalcemia, renal dysfunction, anemia, and bone pain, though this patient did not present all the classical signs, which underscores the diagnostic complexity. A bone marrow puncture was planned for definitive diagnosis. The study emphasizes the importance of radiological evaluation in MM diagnosis and the need for prompt treatment addressing acute symptoms, such as hypercalcemia and renal insufficiency, followed by a comprehensive long-term management plan. Early oncology consultation and a multidisciplinary approach are critical for improving patient outcomes. The case demonstrates the importance of a holistic, symptom-based approach in MM management, incorporating regular monitoring and coordinated care to address the multifaceted nature of the disease.

Perencanaan Strategis Dalam Meningkatkan Kinerja Organisasi

Strategic Planning in organizations is the structured process of setting long-term goals and choosing the best strategies to achieve them, with the aim of improving organizational performance. Strategic planning is important because it covers various aspects in the long term, provides a basic framework for the organization's activities, and allows the achievement of desired performance.. The purpose of this study describes the role of strategic planning in improving organizational performance by using literature studies as a method of collecting data with libraries, reading and recording and processing research materials. Data collection techniques involve gathering information from written or printed sources, such as books, journals, articles, reports, and other documents. The results of this study concluded that strategic planning is identified as a comprehensive long-term plan, strategic planning is not just a static document, but an active guide in carrying out activities in accordance with organizational functions. Strategic planning is seen as an orderly and continuous process. This process includes anticipatory knowledge-based decision making, organizing activities to implement decisions, and measuring results through systematic feedback. For the purpose of strategic planning, which is the main element in building organizational performance, providing comprehensive guidance to achieve the vision, mission and goals of the organization.

Development of a Patient-Centred Care Plan for Patients Requiring Maintenance Electroconvulsive Therapy Long-Term

IntroductionMaintenance electroconvulsive therapy (ECT) can be effective and necessary in the long-term for patients with severe and recurrent mood or psychotic disorders that are not amenable to any other forms of treatment. Patients with such treatment resistance affecting their ability to maintain minimal daily activities may eventually fall within the palliative psychiatric care domain in which advanced medical directives become an important beacon to direct care. There are Psychiatric Advance Directives which allow people with severe mental health conditions to consent to or refuse to consent to hospital admission and psychiatric treatment in the event they lose decision-making capacity and this can be especially important for a potentially controversial treatment such as ECT. However, the focus tends to be on enforcing involuntary treatment and less about a comprehensive long-term care plan. To our knowledge, there is no available framework to structure maintenance ECT as a patient-centred care plan.ObjectivesOur aim is to share the process of development of a patient-centred care plan for patients requiring maintenance ECT. Our objectives are: 1.Constant engagement with patients and family or caregivers2.Regular reviews of clinical and consent aspects of treatment3.Advocating for the welfare of patients and respect of values4.Focus on dignity especially for patients who require treatment well into old age5.Being prepared for termination of treatment if necessary MethodsWe reviewed our management of previous and existing patients on maintenance ECT and incorporated diligent consent-taking practices. Adopting good practices from known palliative approaches and involving the patient voice helped to form a framework for a patient-centred care plan.ResultsOur patient-centred care plan features half-yearly discussions about the risks and benefits of treatment, as well as an assessment of the patient’s cognition and ability to consent which may change over time. Opportunities for them to share their values and expectations of care and engagement with their caregivers about their quality of life guide the continued treatment. A framework for discussing the disruption or eventual termination of ECT prepares for scenarios where older-aged patients may develop frailty or present with acute, prolonged or devastating medical concerns. This end-of-life care approach manages anticipated psychiatric-specific behavioural concerns and prepares for the possibility of death following the planned termination of ECT for patients who required long-term treatment throughout their life. Lastly, issues of grief amongst caregivers and ethical concerns from medical staff are addressed.Conclusions We hope that our patient-centred care plan provides a well-considered conversation and structure for the initiation, continuation and termination of maintenance ECT in the long-term.Disclosure of InterestNone Declared

Nexus between Aging and Health Expenditure: An Evidence from Nepal

Nepal, like many countries, is currently experiencing a significant shift in its demographic landscape, characterized by a rapidly aging population. This study investigates the causal relationship between aging and healthcare expenditure in Nepal. To examine this causal connection, we employed a parsimonious VAR-based Wald test, Granger causality analysis, impulse response functions (IRFs), and forecast error variance decompositions using time series data from 2000 to 2020. The findings of the analysis reveal a substantial positive correlation between the proportion of elderly people and healthcare expenditure, indicating that as the population ages, healthcare costs and the demand for healthcare services tend to rise. The IRF analysis further confirmed that an innovation or shock in the aging index (AI) led to a subsequent increase in per capita health expenditure (HPC). Granger causality also reveals a unidirectional causal linkage from the aging index to per capita health expenditure. In addition, the study highlights the positive impact of aging on life expectancy in Nepal. These findings have important policy implications for Nepal. As the population continues to age, policymakers must allocate healthcare resources effectively, invest in geriatric care, and develop a robust healthcare infrastructure. Comprehensive long-term planning and strong social support systems are crucial to ensure the well-being of the elderly population and to mitigate the associated challenges.

Large-scale integration of renewable energies by 2050 through demand prediction with ANFIS, Ecuador case study

The growing reliance on hydroelectric power and the risk of future droughts pose significant challenges for power systems, especially in developing countries. To address these challenges, comprehensive long-term energy planning is essential. This paper proposes an optimized electrical system for 2050, using Ecuador as a case study. For forecasting electricity demand, a Neuro-Fuzzy Adaptive Inference System is employed, utilizing real historical data. Subsequently, the EnergyPlan software constructs a long-term energy consumption model, exploring three scenarios based on Ecuador's energy potential. The first scenario represents a 'business as usual’ approach, mirroring the current trend in the Ecuadorian electricity system. In contrast to the second scenario, it encompasses a broader range of renewable sources, including offshore wind, pumped storage, biomass, and geothermal energy. The third scenario extends the second one by incorporating demand response systems, such as vehicle-to-grid and hydrogen-to-grid technologies. In terms of novelty, this study highlights the innovative use of the Neuro-Fuzzy Adaptive Inference System for demand forecasting, along with a comprehensive exploration of multiple scenarios to optimize the electrical system. Research findings indicate that the integration of these new renewable energy sources not only reduces electricity import costs but also ensures surplus electricity production. Consequently, it is anticipated that the 2050 electricity system will reduce its dependence on hydroelectric energy while adopting photovoltaic and wind energy with penetration rates of 65 %, 11.2 %, and 9 %, respectively. This transition will be facilitated by a pumped storage system with a 28 % penetration rate and enhanced connectivity with neighboring countries, enabling the seamless integration of electric and hydrogen vehicles.

Legaсy of the great plan of environment transformation in Russia

In October 1948, a comprehensive long-term plan for the transformation of environment was adopted in the USSR in order to ensure maximum sustainable yields in the main agricultural regions of the country. The project, designed for the period 1949–1965, was developed as a reaction to the consequences of severe 1946 drought, but its content is undoubtedly a strategic document of national importance. The created forest belts and reservoirs had to significantly diversify the flora and fauna of the country. Consequently, the plan combines the tasks of environmental protection and obtaining maximum sustainable yields. The paramount feature of this plan was its thorough scientific support based on the ideas of a whole galaxy of prominent Russian scientists and practitioners. This plan anticipated the emergence of the national concept of rational nature management. It was not fully implemented. However, the very fact of its adoption and partial implementation has become a bright page in the history of domestic land use and an instructive example of a combination of economic, social and environmental interests. Numerous manifestations of this plan legacy in modern conditions are perceived as a multifunctional historical heritage that deserves a high national status.

After 20 years of low fertility, where are the obstetrician-gynecologists?

Korea has entered a stage of low fertility, with a total fertility rate of 1.178 in 2002 and 0.92 in 2019. The low birth rate has led to the closure of obstetric hospitals and clinics from 1,371 maternity health facilities in 2003 to 541 in 2019, which is 39.5% compared to 2003. Since 2011, the Ministry of Health and Welfare has been operating an “Obstetrically Underserved Areas Support Project,” however, a shortage of obstetrician-gynecologists (OB/GYNs) who can participate in labor and delivery is a major problem. In 2019, there were 5,800 OB/GYNs practicing. Of these, 4,225 (72.8%) were working in obstetrics-gynecology hospitals, each responsible for 2,855 fertile women. Their average age was 51.8 years. A total of 2,659 (45.9%) worked in clinics and 3,110 (73.6%) were working in metropolitan districts. Only 124 OB/GYNs (2.9%) worked in vulnerable rural areas. OB/GYNs working in obstetric hospitals were responsible for 113.8 newborns in 2019. Their average age was 50.1 years. Of them, 67.4% were working in hospitals, 74.1% in urban areas, and only 60 specialists (2.3%) were working in rural areas. To establish a safe childbirth environment during an era of low fertility, it is important to have obstetricians in charge of childbirth. The government should establish a comprehensive long-term plan to resolve the shortage of OB/GYNs.

Методические подходы к оптимизации агроэкосистем

Within the framework of the article, the methodology of the energy assessment of the functioning of the social ecological-economic system is considered, using the example of a specific agroecosystem as a self-organizing, operationally closed structure; its energy analysis is carried out. A model for the development of the studied agroecosystem was formed, suggesting three options, taking into account the characteristics of land use. The index of sustainability of the agro-ecosystem was calculated; guidelines for the transformation of the structure of the agroecosystem are proposed.; The parameters of the ecological capacity of the soil of the agroecosystem were investigated; revealed the specific weight of ecologically stabilizing lands in the group of lands “arable land-forest-meadows and pastures-water”. The prospects for the development of the agroecosystem on the basis of the formation of a comprehensive technical and technological long-term plan for the functioning and development of the agroecosystem are assessed.

Patent landscape as a tool for forecasting world technological trends: arms and military equipment

Studying and analyzing the world’s promising areas of technological development of the armament and military equipment (AME) field is an urgent task of ensuring comprehensive long-term planning for the development of military equipment, organizing scientific research, strategic planning for the development of the national armed forces and ensuring the national security of the state. The method of determination of perspective directions of technological development of the field of armaments and military equipment on the basis of patent analysis is presented in the work. Patents play an important role in building entrepreneurial strategies and protecting intellectual property (IP) rights in technology companies. Using patent information can reduce R&D time by 60% and reduce their cost by 40%. The Patent Landscape Report provides a snapshot of the patent situation in a particular technology or company, in a particular region, country or globally. Using this methodology and Derwent Innovation database, which contains information on more than 116 million patents from 52 world patent bases, a patent landscape was built on the basis of the International Patent Classification (IPC) and the world technological trends of the research area, including both military technology and dual-use technologies. The article presents the most promising areas of technological development of a military nature, which include aerospace, information and communication technologies, technologies for communication and image transmission systems, vehicle traffic control systems, smart, intelligent, high-energy hypersonic weapons, ammunition with several warheads, and individual security systems, etc. Ukraine’s place in this process, unused reserves and threats are shown. The conclusion is drawn about the formation of science. Intellectual property analytical materials were provided, and definition was given.

Implementation of artificial intelligence technology in Sweden

Studying and analyzing the world’s promising areas of technological development of the armament and military equipment (AME) field is an urgent task of ensuring comprehensive long-term planning for the development of military equipment, organizing scientific research, strategic planning for the development of the national armed forces and ensurineas of technological development of a military nature, which include aerospace, information and communication technologies, technologies for communication and image transmission systems, vehicle traffic control systems, smart, intelligent, high-energy hypersonic weapons, ammunition with several warheads, and individual security systems, etc. Ukraine’s place in this process, unused reserves and threats are shown. The conclusion is drawn about the formation of science. Intellectual property analytical materials were provided and definition was given.

Volcanic ash and aviation: Recommendations to improve preparedness for extreme events

The eruption of the Eyjafjallajökull volcano in 2010 was an unprecedented event for European aviation and emphasized the need for advancements in the corresponding risk management of the stakeholders involved. This study researches progress since 2010, as significant regulatory changes have been introduced to improve European and North Atlantic aviation risk management with regards to volcanic ash. A participatory stakeholder workshop with scenario narratives was set up in which stakeholders discussed obstacles in the general management of aviation during volcanic ash eruptions as well as under extreme eruption scenarios. This paper presents recommendations developed from the workshop.The research found that a better understanding is needed of the impacts that long lasting ash episodes may have on aviation. Events of long duration require improved availability of staff, e.g., with staff exchange between related agencies. Furthermore, it is recommended that staff be trained to meet accelerated demands and restructured tasks during a crisis that may last for months. It is also suggested that more challenging response exercises be used to drive stakeholders out of their comfort zone.The study provides recommendations on information exchange between the stakeholders. During an event, the large amounts of information received from scattered sources may be quite challenging. A single point of information for stakeholders could be set up to structure the information and reduce confusion. Communication products, such as maps, must be better aligned with end-user needs. Ensuring the comprehensibility of difficult features, such as the representation of uncertainty in ash distribution modelling and produced data, requires discussion with end-users prior to an event.The study stresses the need for further funding of research on the impact of ash on jet engines since lack of knowledge in this area limits the benefits of advances in ash forecasting. The application of the Safety Risk Assessment approach needs to be coordinated across nations. Strengthening society’s resilience as a whole to such events, calls for a comprehensive long-term contingency plan, including alternative transportation if aircrafts are grounded.

MP96-02 THE REACH CLINIC: USE OF THE T STAGING SYSTEM FOR THE TRANSITION OF PEDIATRIC PATIENTS WITH NEUROGENIC BLADDER INTO ADULT CLINICS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2017MP96-02 THE REACH CLINIC: USE OF THE T STAGING SYSTEM FOR THE TRANSITION OF PEDIATRIC PATIENTS WITH NEUROGENIC BLADDER INTO ADULT CLINICS Bhalaajee Meenakshi-Sundaram, Jake Klein, Jennifer Lewis, Emily Haddad, Dominic Frimberger, and Gennady Slobodov Bhalaajee Meenakshi-SundaramBhalaajee Meenakshi-Sundaram More articles by this author , Jake KleinJake Klein More articles by this author , Jennifer LewisJennifer Lewis More articles by this author , Emily HaddadEmily Haddad More articles by this author , Dominic FrimbergerDominic Frimberger More articles by this author , and Gennady SlobodovGennady Slobodov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3025AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Due to advances in medical management, most patients with congenital bladder diseases survive into adulthood. These patients are managed by pediatric urology teams, often into adulthood. However, this practice is challenged by policies at children's hospitals, unfamiliarity of pediatric providers with adult disease processes, and increasing patient numbers. Subsequently, many affected young adults fall into a care gap, are lost to follow up, and ultimately resurface in adult emergency rooms with acute problems. We propose a transition clinic for patients with neurogenic bladder disease, using a T-staging system for the transition process, to ensure long term quality care. METHODS The REACH clinic for neurogenic bladder disease was established in 2014. Patients are categorized according to their transition stage, from T0 to T4. Data collected includes diagnosis, age, gender, T-stage, continence, bladder/bowel management, and previous surgeries. Stages T0 and T1 are seen by pediatric urologists only, T2 and T3 by pediatric and adult urologists, and T4 by adult urologists only. T0 patients are not participating in the transition process yet, T1 patients are being introduced, and T4x are adult patients who did not go through a transition process (Figure 1). RESULTS A total of 285 patients have been seen to date. The etiology of neurogenic bladder was spina bifida in approximately 80% of the patients. There were 110 patients in the T0 stage, 26 in T1, 15 in T2, 3 in T3, 19 in T4, and 112 for T4x. Gender distribution was 160:125 female to male. Median ages in years for the stages ranged from 6.2 for T0 to 27 for T4x. Patients in the transition process T0-T4 had significantly less stones and lower rates of bladder augmentation compared with T4x patients. CONCLUSIONS Published data confirm that successful transition is linked to early initiation of the process. Successful transition allows for continuation of care, less episodes of preventable emergencies, and establishment of a comprehensive long-term plan. Future studies will evaluate the influence of the REACH clinic on patient follow up, prevention of medical emergencies, and patient and caretaker satisfaction. Questionnaires will determine patient and caretaker priorities and will help focus resources. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1294 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Bhalaajee Meenakshi-Sundaram More articles by this author Jake Klein More articles by this author Jennifer Lewis More articles by this author Emily Haddad More articles by this author Dominic Frimberger More articles by this author Gennady Slobodov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevalence and patterns of permanent tooth agenesis in individuals with Down syndrome: a meta-analysis.

The aims of the present study were to evaluate the prevalence and patterns of permanent tooth agenesis in individuals with Down syndrome, using meta-analysis methodology. Two independent investigators carried out a literature search to locate articles pertaining to permanent tooth agenesis in individuals with Down syndrome. The outcomes of interest were the prevalence and pattern of permanent tooth agenesis. Thirteen articles were selected for inclusion. The estimated overall prevalence of permanent tooth agenesis, excluding third molars, was 54.6% (95% CI: 44-66%). Considerable heterogeneity was present across the studies. Among subjects with tooth agenesis, approximately half had three or more missing teeth. The permanent teeth with the highest prevalence of agenesis were the maxillary lateral incisor (27%), mandibular second premolar (21%) and maxillary second premolar (18%). The single most commonly absent tooth, however, was the mandibular left second mandibular premolar (19.9%), followed by the maxillary left lateral incisor (19.4%). Little data describing specific tooth-agenesis patterns were available. In conclusion, individuals with Down syndrome display high prevalence rates and severity of agenesis of permanent teeth. Proper and timely diagnosis of missing permanent teeth is thus necessary, to allow a more comprehensive long-term treatment plan and a more favorable prognosis in these individuals.

India’s Look/Act East Policy and the Northeast Region: A Critical Perspective

India's Look East Policy (LEP) signifies a strategic shift in its international political, economic, and military relationships. Regional integration of its Northeast Region (NER) with the countries in East, Southeast, and South Asia may potentially generate economic dividends to the region. However, there are formidable challenges in realising the potentials. The proposed infrastructure projects, if completed with no further delay, will go a long way in improving connectivity with the neighbouring countries. However, improving connectivity within the region and with the rest of the country is also very important. Further, it would require a comprehensive long-term plan with well-defined projects for developing industries and services including education, health and tourism. Building infrastructure, ensuring socio-political stability and ecological balance, and improving the quality of institutions would be a major part of this plan.

Bladder management of patients with spinal cord injuries sustained in the 2008 Wenchuan earthquake

This study’s aim is provide an overview of the patients who suffered spinal cord injury (SCI) after the magnitude 8.0 Wenchuan earthquake, including each patient’s demographic and epidemiological characteristics, bladder management status, and quality of life (QOL). We also assessed the relationships between bladder management methods, symptomatic urinary tract infection (SUTI), and QOL. Two years after the 2008 Wenchuan earthquake, a cross-sectional face-to-face survey was conducted on 180 patients with SCI. A self-administered questionnaire and the WHOQOL-BREF assessment were used to assess injury-related information, bladder management methods, and SUTI. Statistical analysis was performed using the Chi-square test and analysis of variance. A p value <0.05 was considered statistically significant. This study found that a male-to-female ratio of approximately 1.2:1, including 98 (54.4%) male patients and 82 (45.6%) female patients. Thoracic-level injuries were seen in 82 patients (45.56%), 60 (33.33%) patients had lumbar-level injuries, 18 (8.33%) patients had thoracolumbar-level injuries, and a small number of patients had cervical- or sacral-level injuries. Sixty-two patients (34.44%) demonstrated normal voiding, 65 (36.11%) required manually assisted voiding, 29 (16.11%) required catheterization, and 24 (13.33%) used aurine-collecting apparatus. The prevalence of SUTI was 43.89%. Patients who emptied their bladder via manually assisted voiding, catheterization, or with the use of a urine-collecting apparatus demonstrated higher rates of SUTI compared with patients who voided normally (p < 0.05); the patients who required catheterization had higher rates of SUTI compared with patients who required manually assisted voiding (p < 0.05). When manually assisted voiding and catheterization were compared with the use a urine-collecting apparatus, no statistically significant differences were observed in terms of the risk of developing SUTI. The patients in this study demonstrated low scores on the WHOQOL-BREF physical domain (11.61 ± 3.80), psychological domain (10.11 ± 3.63), social domain (11.46 ± 2.84), and environmental domain (11.86 ± 2.51). The patients who reported normal voiding also demonstrated the best QOL in terms of physical, psychological, and social component scores (p < 0.05). In conclusion, the percentage of women in this study is higher than that reported in other studies on traumatic causes of SCI. Patients who suffered SCI following the Wenchuan earthquake demonstrate poor bladder management status and are unable to take advantage of urodynamic testing that is used to monitor the functional state of the bladder. This study’s findings indicate that bladder management methods influence the rate of SUTI and the QOL of patients with SCI. Caring for SCI patients following a disaster requires comprehensive long-term planning. Bladder management of patients with SCI is essential for improving the QOL of these patients.

Integrated energy and environmental systems analysis methodology for achieving low carbon cities

Cities are responsible for nearly 75% of the world’s energy consumption; expectedly, about 90% of future growth will occur in urban areas. However, we consider that cities will be at the forefront of implementing groundbreaking technologies and policies, as evidenced in the initiatives taken by many cities here and worldwide to resolve issues in energy and climate change. In addition to affording energy and environmental benefits, investments in energy efficient and renewable technologies have huge potential to boost local economies, as demonstrated by the recent federal allocation of stimulus funding. Inclined to give priority to stopgap measures, many cities tend to regard comprehensive long-term planning as secondary. However, such solutions would bring multiple benefits to the community. The paper showcases an energy and environment systems model to provide a quantitative vision of technology and management strategy options for effectively deploying energy efficiency and renewable energy for reducing the carbon footprint, while sustainably maintaining the energy demands of the community and the servicing environmental infrastructure. We provide results of a case study completed for New York City, to showcase usefulness of long-term planning for achieving low carbon cities. Combined with appropriate stakeholder participation, such a technology explicit bottom-up approach holds the promise of influencing the current energy planning, environmental regulatory regime, including multimedia aspects of carbon control for cities locally and internationally.

Myasthenia Gravis

Treatment of patients with acquired (autoimmune) myasthenia gravis should rely on evidence-based therapeutic choices, taking into account the individual's needs according to disease severity (mild to severe), extent (ocular or generalized), comorbidities (including other autoimmune diseases, infections, thymoma, and pregnancy), age, iatrogenic factors (the risks and benefits of therapy), patient autonomy and quality of life, financial burden to the patient, and associated health care costs. Therapy is aimed at managing symptoms by improving neuromuscular junction transmission (cholinesterase inhibitors) and/or modifying the underlying immunopathogenetic cause of acquired myasthenia gravis via immunosuppression or immunomodulation. Myasthenic patients with operable thymoma should be referred for surgery and closely followed up for tumor recurrence. A concerted international effort is addressing treatment recommendations for thymectomy in myasthenic patients with no radiologic evidence of thymoma who are positive for circulating acetylcholine receptor antibodies. There is a lack of evidence-based treatment guidelines for both acute and long-term management of ocular myasthenia. Acute management of myasthenic crisis requires intensive monitoring of the patient and institution of an efficient and safe treatment such as plasma exchange. Patient education is essential to a comprehensive long-term treatment plan.

Can VISION 2020 be implemented in rural government settings? Findings from two programmes in Tanzania

To generate information on essential components and the cost recovery potential of VISION 2020 programmes in rural Africa. We took a structured approach to planning, training, implementation and supervision of programmes in Singida and Mara regions, Tanzania involving both government and non-government partners. Extensive mentoring was provided to monitor activities and costs. Annual numbers of patients receiving eye care increased sevenfold, cataract surgeries by a factor of 2.6 and spectacles dispensed by a factor of 16. Running costs were shared; the government provided 40-60%, non-government organisations (NGOs) 25-45%, and patient fees 15%. Comprehensive eye care can be delivered with cooperation among partners. However, continued coordination and cooperation from government and NGOs are critical to reach VISION 2020 goals.

New mechanisms for international coordination of large observing projects

AbstractProgress on many fronts in the study of the Milky Way requires major new imaging and/or spectroscopic surveys as well as coordinated ground-based programmes in support of space missions. The present uncoordinated planning and operation of the 2-4m (and some of the larger) telescopes across the world are an impediment to the efficient conduct of such programmes and the overall cost-effectiveness of the investments in astronomy. We briefly report on recent initiatives to improve the situation, notably the part played by the ASTRONET consortium in setting up a comprehensive long-term plan for the development of European astronomy.

Complications in Patients With Spinal Cord Injuries Sustained in an Earthquake in Northern Pakistan

Background: Spinal cord injury (SCI) is a devastating trauma suffered by many of the victims of an earthquake that struck Northern Pakistan on October 8, 2005. It rendered approximately 600 patients paraplegic, which is the highest number ever reported in any disaster. This study was conducted to evaluate the risk of complications.Methods: The cross-sectional retrospective study covering a 2-month period was conducted on 194 patients admitted to the surgical/neurosurgical wards of Rawalpindi Medical College and allied hospitals (Holy Family Hospital, Rawalpindi General Hospital, and District Headquarter Hospital) and Melody Relief and Rehabilitation Center, Islamabad.Results: The male-to-female ratio was approximately 1:3 (n = 50 [26%] and n = 144 [74%], respectively). The majority (78% [n = 151 ]) were 16 to 39 years of age; 62% (n = 120) had lumbar-level injuries, 25% (n = 48) had thoracic-level injuries, 9% (n = 18) had thoracolumbar-level injuries, and a few had cervical- or sacral-level injuries. Forty-six percent (n = 90) had American Spinal Injury Association type A injuries; 4% (n = 8) were graded B, 11 % (n = 21) were graded C, 9% (n = 18) were graded D, and 14% (n = 27) were graded E. Twenty percent (n = 39) developed pressure ulcers, of which 38% (n = 15) had grade 1, 36% (n = 14) had grade 2, 23% (n = 9) had grade 3, and 3% (n = 1) had grade 4. All patients developed urinary tract infections; 15% (n = 30) had bowel complaints; 2% (n = 3) developed deep-vein thrombosis (1 died of pulmonary embolism); and 0.05% (n = 1) developed wound infection.Conclusion: Awareness of potential complications in patients with paraplegia is essential to care planning in the disaster setting. The priorities include skin, bowel, and bladder care and provision of prophylactic heparin. SCI post-disaster care requires comprehensive long-term planning.