Management of Descending Necrotizing Mediastinitis, a Severe Complication of Deep Neck Infection, Based on Multidisciplinary Approaches and Departmental Co-Ordination

Objectives Descending necrotizing mediastinitis (DNM) developing after deep neck infection (DNI) is a potentially lethal disease of the mediastinum with a mortality rate as high as 40% prior to the 1990s. No standard treatment protocol is available. Here, we present the outcomes of our multidisciplinary approaches for treating DNM originating from a DNI. Methods Between June 2016 and July 2021, there were 390 patients with DNIs admitting to our tertiary hospital. A total 21 patients with DNIs complicated with DNM were enrolled. The multidisciplinary approaches included establishment of airway security, appropriate surgery and antibiotics, extracorporeal membrane oxygenation, and intensive care unit management. The clinical variables were analyzed. Results Two patients died and 19 survived (mortality 9.5%). The patients who died had a higher mean C-reactive protein (CRP) level than did those who survived (420.0 ± 110.3 vs 221.8 ± 100.6 mg/L) (P = .038). The most common pathogens were Streptococcus constellatus and Streptococcus anginosus. From 2001 to 2021, the average mortality rate of studies enrolling more than 10 patients was 16.1%. Conclusion Multidisciplinary approaches, early comprehensive medical treatment, and co-ordination among departments significantly reduce mortality. Patients with severe inflammation and high CRP levels require intensive and aggressive interventions.

Health Committees as Vehicles for Democratic Governance in Health Systems: Lessons from Selected Health Unit Management Committees in Uganda

Introduction: For over forty years, community participation has been a central component of a well-functioning health system. Despite its important role there are many difficulties in defining and understanding community participation as part of governance. Through a case study of selected health unit management committees in Uganda, this paper demonstrates that these committees can be structures for community participation and vehicles for democratic governance in health systems that advance health equity. Guided by the theoretical underpinnings of deliberative democracy the paper evaluates the performance of health unit management committees as a mechanism for citizen participation in health systems. Methods: This paper uses a qualitative, case-study methodology. Through an in-depth look at the health unit management committees of Kiboga and Kyankwanzi in Uganda, the study considered these as examples of structures for democratic community participation in health system. The study undertook literature review on the theories of deliberative democracy and human rights principles, and this provided the theoretical underpinnings of the study. Findings: Our findings underscore that community participation in health systems through health unit management committees ought to be grounded in the principles of deliberative democracy. The core of deliberative democracy is considered to be authentic deliberation and consensus decision-making, which can happen in both direct and representative democracies, giving rise to the notions of populist and elitist deliberative democracy, respectively. As such, a balance needs to be struck between the competitive notions of democracy and the public health requirements of inclusive and direct participation of communities in decision making processes on matters that affect their health. Conclusions: Community participation in the health sector in Uganda hinges on health unit management committees at the lower service provision points. These HUMCs are also perceived as vehicles to strengthen health governance through realizing the right to health of the communities. However, these have been established without attention to investing in capacity building needed to enable them to exercise community voice in the health system.

Business Unit Management Model After the Implementation of the Regulation of The Minister of Religious Affair (PMA) No 19 of Year 2017

Purpose: The Paper is to to find out changing management model of State Islamic University (UIN) business units in Indonesia after the change of Institutional status from State Islamic Institute (IAIN) to State Islamic University (UIN) in accordance with PMA No.19 Year 2017.Design/Method/Approach: This study uses a descriptive analysis. It The research employed a mixed method between qualitative research methods and quantitative methods. Quantitative method was used because this research also distributed questionnaires related to environmental responses to the existence of business development units while the qualitative method was used to describe the condition of the Business Development Unit in each university using Research and Development model.Findings: The results of this paper are designed management from whole of problems found in each UIN after the status converted.Originality/Values: The main contribution of this study concern on management model of UIN business in Indonesia after the change of Institutional status from state Islamic Institute to state Islamic university in accordance with PMA no 19 2017.

Optimizing Highly Infectious Disease Isolation Unit Management. Experiences from the Infectious Diseases Isolation and Research Unit, Fort Portal, Uganda

Infectious disease outbreaks are the scale of the current COVID-19 pandemic are a new phenomenon in many parts of the world. Many isolation unit designs with corresponding workflow dynamics and personal protective equipment postures have been proposed for each emerging disease at the health facility level, depending on the mode of transmission. However, personnel and resource management at the isolation units for a resilient response will vary by human resource capacity, reporting requirements, and practice setting. This paper describes an approach to Isolation unit management at a rural Uganda Hospital and shares lessons from the Uganda experience for isolation unit managers in low- and middle-income settings.

Each Day is Different: Prison Officers and Their Work

<p>In 1991 the New Zealand prison service underwent the most significant organisational changes. Instead of homogeneity and unity within the service, with rewards being given for length of time in the job, the emphasis was now on efficiency and competition for what few promotional rewards there were to be in the new career structure. At the same time, there was to be a bigger role for women and ethnic minority officers in the prison service. This thesis examines the way in which these superimposed changes affected the working routines and the day-to-day experiences of prison officers in their aftermath. It argues that, rather than leading to a new dynamic prison service envisaged by the reformers, the prison service instead became more divided and fractious, neither management nor the prison officer body being able to keep control of some of its members, while other officers became merely perfunctory in their work and others developed strategies that undermined the 'each day is different' philosophy now projected by the prison authorities. These resistances to, and subversion of the changes were because prison officer culture, seen by the prison authorities as a barrier to reform, was not destroyed by restructuring but underwent a metamorphosis. It was reformulated and reconfigured to take account of the structural and demographic changes. This then meant that a new prison officer culture emerged, modelled around difference and uncertainty rather than cohesion, antagonism rather than unity. It could lead to deviance and corruption (which the old style prison officer culture had largely prevented) rather than dynamism and efficiency. To undertake the research, the method involved use of questionnaires covering the prison officer body of one typical New Zealand prison, in-depth interviews with 39 prison officers and nine months observation period of the everyday life of the prison officers at this institution. This aspect of the research was stronglyinfluenced by Erving Goffman's dramaturgical perspective. The thesis sets out the theoretical parameters of the research as these relate to prison officer culture, and also provides an account of the methodology and the historical and contemporaneous background to the restructuring. It then provides an empirical analysis that demonstrates the effects of these changes on the everyday work of prison officers. These relate to the way in which the acculturation of the new recruits to the service became problematic because of the confusion brought about by the structural changes and the lack of experienced officers to mentor them. It then demonstrates how 'handling your lag' began to be experienced differently across the officer body, according to their length of service, ethnicity and gender. The old style unity and identity of the prison service was breaking down. This fragmentation was then exemplified by the shift to unit management. This was where power in the prison was now concentrated but, with the prison officer body too weak to regulate its use and with management increasingly distant from day-to-day prison life, this led to unpredictability and corruption. Finally, the thesis shows how many officers tried to adapt to the idea that 'each day in prison was going to be different', as promoted by the prison authorities, by trying to ensure at the same time that each day remained the same: excitement and dynamism could be tolerated only in so far as prison work remained at the same time extraordinarily mundane and routine.</p>

Each Day is Different: Prison Officers and Their Work

<p>In 1991 the New Zealand prison service underwent the most significant organisational changes. Instead of homogeneity and unity within the service, with rewards being given for length of time in the job, the emphasis was now on efficiency and competition for what few promotional rewards there were to be in the new career structure. At the same time, there was to be a bigger role for women and ethnic minority officers in the prison service. This thesis examines the way in which these superimposed changes affected the working routines and the day-to-day experiences of prison officers in their aftermath. It argues that, rather than leading to a new dynamic prison service envisaged by the reformers, the prison service instead became more divided and fractious, neither management nor the prison officer body being able to keep control of some of its members, while other officers became merely perfunctory in their work and others developed strategies that undermined the 'each day is different' philosophy now projected by the prison authorities. These resistances to, and subversion of the changes were because prison officer culture, seen by the prison authorities as a barrier to reform, was not destroyed by restructuring but underwent a metamorphosis. It was reformulated and reconfigured to take account of the structural and demographic changes. This then meant that a new prison officer culture emerged, modelled around difference and uncertainty rather than cohesion, antagonism rather than unity. It could lead to deviance and corruption (which the old style prison officer culture had largely prevented) rather than dynamism and efficiency. To undertake the research, the method involved use of questionnaires covering the prison officer body of one typical New Zealand prison, in-depth interviews with 39 prison officers and nine months observation period of the everyday life of the prison officers at this institution. This aspect of the research was stronglyinfluenced by Erving Goffman's dramaturgical perspective. The thesis sets out the theoretical parameters of the research as these relate to prison officer culture, and also provides an account of the methodology and the historical and contemporaneous background to the restructuring. It then provides an empirical analysis that demonstrates the effects of these changes on the everyday work of prison officers. These relate to the way in which the acculturation of the new recruits to the service became problematic because of the confusion brought about by the structural changes and the lack of experienced officers to mentor them. It then demonstrates how 'handling your lag' began to be experienced differently across the officer body, according to their length of service, ethnicity and gender. The old style unity and identity of the prison service was breaking down. This fragmentation was then exemplified by the shift to unit management. This was where power in the prison was now concentrated but, with the prison officer body too weak to regulate its use and with management increasingly distant from day-to-day prison life, this led to unpredictability and corruption. Finally, the thesis shows how many officers tried to adapt to the idea that 'each day in prison was going to be different', as promoted by the prison authorities, by trying to ensure at the same time that each day remained the same: excitement and dynamism could be tolerated only in so far as prison work remained at the same time extraordinarily mundane and routine.</p>

Respiratory and gastrointestinal management of an infant with a birth weight of 258 grams

Background: Nowadays, more infants weighing ≤ 300 g are born, and they survive because of the improvements in neonatal care and treatment. However, their detailed clinical course and neonatal intensive care unit management remain unknown due to their low survival rate and dearth of reports. Case Presentation: A male infant was born at 24 weeks and 5 days of gestation and weighed 258 g. The infant received 72 days of invasive and 92 days of noninvasive respiratory support, including high-frequency oscillatory ventilation with volume guarantee and noninvasive neurally adjusted ventilatory assist. Meconium-related ileus was safely treated using diatrizoate. Although he was diagnosed with severe bronchopulmonary dysplasia and retinopathy of prematurity requiring laser photocoagulation, he had no other severe complications. He was discharged 201 days post-delivery (3 months of corrected age) with a weight of 3396 g. Conclusions: Although managing infants weighing ≤ 300 g is difficult, our experience shows that it is possible by combining traditional and modern management methods. The management of such infants requires an understanding of the expected difficulties and adaptation of existing methods to their management. The management techniques described here should help improve their survival and long-term prognosis.

Ogilvie’s syndrome following cesarean delivery: a case report

Ogilvie’s syndrome (OS) or acute pseudo-obstruction of the large bowel, is a rare condition and the true incidence is unknown. We present a case of acute colonic pseudo-obstruction (OS) post cesarean section in a 35-year-old patient with fetal distress, following cesarean delivery at term under general anesthesia. On the second postoperative day, she complained of abdominal distension, pain, nausea, vomiting, bloating and no passage of stool. As the patient's condition did not improve, she continued to have persistent abdominal distention. A plain abdominal film was taken and abdominal ultrasound was done, which showed massive gaseous distention of the bowels without fluid level. At laparotomy, a huge distended gut, pussy flakes on intestine, and massive dilatation of the whole colon were found. Postoperatively, the patient was managed with fluids, antibiotics, nutritional support, etc., along with the standard guidelines for management of peritonitis. The patient recovered and was discharged after 1 day of intensive care unit management to the ward. The need for awareness about the syndrome and early diagnosis is emphasized.

Aquifer Unit Management Plan (AUMP) For Groundwater Resources Management of Multi-layered Coastal Aquifer System

To address the vulnerability of coastal aquifer to over exploitation and sea water intrusion, a groundwater resources management plan titled as Aquifer Unit Management Plan (AUMP) is designed to provide valuable guidance for groundwater management of a multi-layered cuddalore coastal aquifer system located east coast of South India. The aquifer unit management plan is based on the summative examination of the aquifer unit disposition, response of hydraulic heads to recharge and discharge and effect of increased pumping on aquifer hydraulics. The safe hydraulic heads and annual exploitable potential were considered as the guiding factors to manage fresh groundwater resources of the coastal aquifer. The results show that the process of sea water intrusion has already started and with the present rate of pumping (1034.86 mcmy-1), the sea water intrusion risk has increased manifold all along the coast. The salient management strategies recommended are; restricting pumping to 695 mcmy-1, stepping up recharge activities in recharge zone, adopting water use efficiency methods and regulation in the coastal zone. AUMP is simple and can guide water managers to plan for sustainable groundwater withdrawal and safe guard the coastal aquifer from sea water intrusion and ensure sustainability of groundwater abstraction structures.