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Skull - Skull fractures are uncommon because at birth the skull bones are less mineralized and more compressible than other bones anxiety 6 weeks postpartum order hydroxyzine once a day. Skull fractures can be linear or depressed, and are easily diagnosed with plain radiographs of the skull. Linear fractures usually heal within several months and rarely will a leptomeningeal cyst develop. Neurosurgical consultation is necessary for depressed skull fractures greater than one centimeter in depth and/ or associated intracranial lesions, as these usually require surgical intervention. Neurological Brachial Plexus Palsies the incidence of birth-related brachial plexus injury varies from 0. Brachial plexus injury is manifested by a transient or permanent paralysis involving the muscles of the upper extremity after trauma to the spinal roots of C-5 through T-1 during birth. Depending on the site of injury, the forms of brachial plexus palsy commonly seen are Erb palsy, Klumpke palsy, and facial nerve palsy. Discoloration, swelling, localized crepitus, and absent ipsilateral Moro reflex may be Guidelines for Acute Care of the Neonate, Edition 26, 2018­19 Klumpke palsy - is less common and presents with lower arm paralysis involving the intrinsic muscles of the hand and the long flexors of the wrist and fingers resulting from injury of C-8 and T-1 roots. Dependent edema, cyanosis, and atrophy of 147 Section 10-Newborn Care Section of Neonatology, Department of Pediatrics, Baylor College of Medicine hand muscles may develop. Horner syndrome may be observed with associated injury to the cervical sympathetic fibers of the first thoracic root. Rarely does paralysis affect the entire arm; but when it does, the whole arm is flaccid and motionless, all reflexes are absent, and sensory loss is from the shoulder to the fingers. Most infants with a birth-related brachial plexus injury (90% to 95%) require only physical therapy. The primary goal of treatment is prevention of contractures while awaiting recovery of the brachial plexus. Partial immobilization and appropriate positioning are helpful in the first 2 weeks because of painful traumatic neuritis. Peripheral paralysis is unilateral; the forehead is smooth on the affected side and the eye is persistently open. With both forms of paralysis, the mouth is drawn to the normal side when crying and the nasolabial fold is obliterated on the affected side. Differential diagnoses include Mцbius syndrome and absence of the depressor anguli muscle of the mouth (aka asymmetric crying facies). Most facial palsies secondary to compression of the nerve resolve spontaneously within several days and most require no specific therapy except for the application of artificial tears to the eye when necessary to prevent corneal injury. Additionally, careful hip examination should be performed for babies with musculoskeletal anomalies related to tight intrauterine "packaging", such as congenital torticollis and metatarsus adductus. If the newborn has a positive Ortolani test, or limited or asymmetric abduction, obtain a Pediatric Orthopedic consultation. Guidelines for Acute Care of the Neonate, Edition 26, 2018­19 Assessment and Management Phrenic Nerve Injury Isolated phrenic nerve injury is rare. Diaphragmatic paralysis often is observed with the ipsilateral brachial nerve injury. Fluoroscopy reveals elevation of the affected side and descent of the normal side on inspiration. Electrical stimulation of the phrenic nerve may be helpful in cases in which the palsy is secondary to surgery. The infant may present with signs of respiratory distress and may require mechanical ventilation. Hip dysplasia may occur in utero, during perinatal period, or infancy and childhood. All newborns should be examined for hip dislocation, and this examination should be part of all routine health evaluations up to 2 years of age, when a mature gait is established. Jitteriness in the newborn is a frequent finding and often is confused with neonatal seizures.

Conclusion the three projects made progress towards achieving a practical understanding of environmental and other changes that led to more malaria anxiety 5 see 4 feel order 25 mg hydroxyzine with mastercard. Without the ecohealth framework, some of these research projects might have ground to a halt after clear refutation of the initial hypothesis formulated by villagers and researchers. An ecohealth approach provided an adaptable framework to reframe the research to pursue further aspects of malaria. The project generated new information on the determinants of malaria burdens, malarial transmission, and its complex and diverse determinants and impacts in rural settings. Prevailing assumptions about malaria were shown to reflect only one aspect of a complex reality, and stakeholders were engaged in thinking about a wider set of drivers of malaria, and of obstacles to control. The studies provided evidence for developing adaptable, rational, and feasible malariacontrol strategies, and point to the need for more research to test and implement these strategies to achieve effective malaria control. Acknowledgments this paper is the product of collaborative work that adopted a transdisciplinary research protocol in Uganda and Tanzania, and the culmination of the efforts of many communities and a broad range of stakeholders. Choosing Between Public and Private Health Care: A Case Study of Malaria Treatment in Brazil. Effect of Irrigation and Large Dams on the Burden of Malaria on a Global and Regional Scale. Comparison of the Paracheck-Pf Test to Microscopy for Confirmation of Plasmodium falciparum Malaria in Tanzania. Malaria and Agriculture in Tanzania: Impact of Land Use and Agricultural Practices on Malaria Burden in Mvomero District. Knowledge, Perceptions and Practices of Farming Communities on Linkages Between Malaria and Agriculture in Mvomero District, Tanzania. Participatory Involvement of Farming Communities and Public Sectors in Determining Malaria Control Strategies in Mvomero District, Tanzania. Systemwide Initiative on Malaria and Agriculture: An Innovative Framework for Research and Capacity Building. Understanding the Links Between Agriculture and Health: Agriculture, Malaria and Water-Associated Diseases. Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania. This page intentionally left blank Chapter 14 An Ecosystem Approach for the Prevention of Chagas Disease in Rural Guatemala Carlota Monroy, Xochitl Castro, Dulce Maria Bustamante, Sandy Steffany Pineda, Antonieta Rodas, Barbara Moguel, Virgilio Ayala, and Javier Quiсonez In Latin America, more than 10 million people carry a parasite that puts them at risk of developing Chagas disease. This chronic and debilitating illness is caused by a microscopic blood parasite called Trypanosoma cruzi. The parasite is transmitted by several species of insects called chinches, kissing bugs, or triatomines. People usually acquire the disease in childhood, experiencing flu-like symptoms; but later in life, about one-third of cases develop more severe symptoms affecting the digestive system and the heart. Many vector species have become particularly well-adapted to living in and around traditional mud-brick and thatch homes common to poorer areas. Some of these vectors are not native to the region and have no natural habitat or hosts. They can be controlled with improved hygiene and regular insecticidal spraying, because they cannot survive anywhere else. However, in Guatemala and other areas of Central America, some of the insect vectors are native and widespread, and can easily re-infest houses after insecticidal treatment. One such insect, Triatoma dimidiata, is native to Central America and an important vector of Chagas disease. It lives in forests and other areas, but frequently invades houses and yards (peridomestic areas). Thus, the highest infestation rates in houses occur in the most deforested areas in the eastern part of the country (Tabaru et al. The control of house infestations using insecticide sprayings is challenging (Nakagawa et al. Re-infestation is a consequence of the capability of these insects to inhabit many different environments (domestic, peridomestic and wild) and to migrate among them (Dumonteil et al. Vector distribution and Chagas risk in Guatemala are closely related to poor socioeconomic conditions, certain cultural characteristics, adobe housing construction and poor hygienic conditions (Bustamante et al.

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The infection is confirmed by demonstrating the presence of the parasite in aspirate from the chancre or the lymph glands anxiety symptoms change over time buy hydroxyzine 10 mg fast delivery, in bone marrow, or in blood taken during the acute phase, or cerebrospinal fluid during the chronic phase. In acute-phase patients, aspiration of the lymph glands is more effective for detecting T. On the other hand, peripheral parasitemia is higher in rhodesiense than in gambiense trypanosomiasis, and it is therefore easier to demonstrate the presence of T. In both cases, however, the levels of parasitemia fluctuate and are higher during febrile attacks. Sediment from cerebrospinal fluid should be examined immediately after it is collected. Control: the two main approaches to controlling the African trypanosomiases are to reduce the principal reservoirs of infection and the presence of the vectors. In diminishing the reservoirs of gambiense trypanosomiasis, detecting and treating the human infection should be emphasized to reduce the source of infection for the vectors. The challenge is greater with rhodesiense trypanosomiasis, because measures must also be taken to control the livestock population, both wild. The latter can be reduced by converting the savannahs where livestock graze into cropland, which is not propitious for the proliferation of tsetse flies. Moreover, the mass use of insecticides is costly and not very efficient, because the flies are protected by vegetation in their habitats. Tsetse fly traps have been developed that are very effective, especially when they are impregnated with insecticides (Langley, 1994). Empirical observations and mathematical models suggest that reducing the vector population is most efficient during epidemics, while reducing the human reservoir is more effective in endemic situations (Gouteux and Artzrouni, 1996). Other appropriate measures include preventing host-vector contact by the use of protective clothing, netting that keeps out flies, repellants, or simply not going into areas where there are high densities of tsetse flies. In highly endemic areas, the indiscriminate donation of blood should be prohibited. Chemoprophylaxis for visitors to endemic areas is not recommended because pentamidine and suramin are only effective against T. Wery (1990) considers that the most important advances in the control of gambiense trypanosomiasis have been the improvements in serologic diagnosis, the demonstration of parasitemia, and the introduction of low-cost, efficient traps for tsetse flies. The problem of antigenic variation in the African trypanosomes has impeded the production of a vaccine, but there is epidemiologic evidence that the disease generates protective immunity: while 30% of the uninfected population in the Democratic Republic of Congo is at risk of contracting the infection, only 15% of those previously infected run a similar risk (Khonde et al. Apport des examens biochimiques dans le diagnostic de la phase nerveuse de la trypanosomose humaine africaine. Aut-il ou non un controle des vecteurs dans la lutte contre la maladie du sommeil? Correlation of autoantibody titres with central nervous system pathology in experimental African trypanosomiasis. Epidemiological evidence for immunity following Trypanosoma brucei gambiense sleeping sickness. Selective primary health care: Strategies for control of disease in developing world. Correlation of high serum levels of tumor necrosis factor-alpha with disease severity in human African trypanosomiasis. The sheep as a potential reservoir of human trypanosomiasis in the Republic of the Congo. Human African trypanosomiasis in south-eastern Uganda: Clinical diversity and isoenzyme profiles. Population genetics of Trypanosoma brucei in central Africa: Taxonomic and epidemiological significance. Etiology: Of the numerous species of the genus Entamoeba found in mammals, only E. In addition, it has been occasionally isolated from dogs, cats, swine, and rats, and it has produced experimental infection in rabbits and other rodents (Tsutsumi, 1994). Amebas have two developmental stages: the trophic (or vegetative), during which the trophozoite is formed, and the cystic (or resistant) stage, when the cyst appears. The trophozoites live in the large intestine of the host, moving around by means of pseudopodia and multiplying by binary fission. As they progress through the host intestine toward the outside, they divide into smaller forms, cease taking in nourishment, and develop a thin, resistant wall around themselves in preparation for turning into cysts.

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Goy and WaltnerToews (2005) present a multilevel stakeholder analysis pertaining to environment and health in Peru venom separation anxiety order hydroxyzine with visa. Participatory processes also help identify barriers to change, clarify information and knowledge gaps, and provide means to negotiate concrete steps for moving forward. Community representatives, government, and mining company officials were brought together to overcome decades of inaction on this pollution problem. Backed by scientific evidence, they developed a risk-management plan to reduce impacts from mining. Some changes in policy and practice to reduce different exposure routes are underway, while others remain under negotiation. Community priorities may not be aligned with the problem that is motivating the researchers. The interests and intentions of different actors (researchers included) sometimes clash with scientific relevance or methodological requirements. Every stakeholder has particular concerns and interests, which are sometimes compatible with those of other stakeholders, but frequently conflict, and need to be resolved. Some participating stakeholders may also have motives that are incompatible with the research agenda or the change being sought by other stakeholders. Therefore, levels and terms of participation vary and may need to be renegotiated repeatedly, which can interrupt data collection or project timelines. Finally, community expectations for change may not be attained by the research, leading communities to experience disappointment or to feel exploited ­ an undesirable outcome of any project. Charron the iterative nature of ecohealth research can accommodate many of these issues, but not without transactions. Transaction costs are high in participatory research, requiring time, and sometimes presenting unforeseen and frustrating delays. The contribution of community participation to project outcomes is challenging to assess, although tools used in public health program evaluation may be useful in this regard (Draper et al. Principle 4: Sustainability An ecosystem approach to health is predicated on an understanding that protecting ecosystems and improving degraded environments are fundamental requirements for human health and well-being now and for future generations. Sustainability (ecological and social) is part of the change sought through ecohealth research and action, and seeking such change motivates many in the field of ecohealth (Soskolne et al. As research for development, ecohealth research aims to make ethical, positive, and lasting changes. Sustainability implies that these changes be environmentally sound and socially sustainable (socially and culturally responsible and appropriate, as well as easily systematized). The case studies on Chagas disease in Guatemala, sanitation in Yaoundй, Cameroon, and improved soil and nutrition in Malawi illustrate how this can be achieved. Another sustainability issue relevant to research for development pertains to the uptake and use of research results for achieving change. In Kathmandu, ecohealth research led to the apparently permanent transformation of an entire neighbourhood and catalysed substantial modernization of the meat-processing sector across Nepal. Despite social and environmental problems in riverside slums in Nepal, there appears to be no going back to the original situation, at least in the two municipal wards where the project was initiated. However, change may not always be clear or clearly attributable to ecohealth research or any research-for-development process. There may be slippage back into previous, negative patterns or relationships; setbacks as well as leaps forward; and new problems may arise. Ecohealth researchers should anticipate these dynamics and be prepared to learn from them. The dynamics of social­ ecological systems are entrenched and not easily changed where people live in extreme poverty with very limited access to resources and even fewer choices in livelihoods. Researchers will face ethical quandaries when the short-term needs and priorities of people are not consistent with a longer term process for improving health and environment. Ecohealth research can provide some insights by addressing both local concerns and the wider forces that maintain cycles of poverty, environmental degradation, and ill health. A focus on achieving change locally can sometimes help shift perceptions and motivate people to tackle wider 1 Ecohealth: Origins and Approach 15 issues. There is a need for even more strategies that reach beyond the community to levels of the system where a wider difference can be made over the longer term. Improving livelihoods and economic conditions with inadequate attention to environment and social inequities can imperil health and become unsustainable over time.

The information provided by echocardiography is vital in deciding the optimal type of surgical repair anxiety 3 months postpartum buy discount hydroxyzine 25mg online. Surgery for mitral valve disease is associated with higher operative mortality, approximately 5­6 per cent. C Bronchial arteries arise directly from the thoracic aorta to provide systemic blood supply to the trachea and bronchi. D Anatomical differences between the right and left main bronchi favour the inhalation of foreign bodies into the right. E Pulmonary function tests assess the functional capacity, the severity of pulmonary disease and help to predict response to treatment. B Compared with non-small-cell cancer, small-cell lung cancer, formerly known as oat cell cancer, is less common, metastasises early and is less amenable to surgery. C Finger clubbing and hypertrophic pulmonary osteoarthropathy, sometimes described as clinical features of lung cancer, are usually incidental findings and not due to primary lung cancer. D the appropriate treatment strategy is dependent on tumour type, tumour stage, and the general fitness and lung function of the patient. E Late survival has a direct relationship with the tumour stage at the time of treatment. B Pleural effusions due to cardiac failure, renal failure, hepatic disease, inflammatory disease and malignancy have different protein content. C Infection of the pleural space (empyema) results from iatrogenic and noniatrogenic causes. E Invasive procedures such as mediastinoscopy, mediastinotomy and thoracoscopy are not staging procedures. A Bronchopulmonary carcinoid tumours usually arise from neuroendocrine cells in major bronchi, are very vascular and slow-growing, and, although benign, sometimes metastasise. C Blunt and penetrating chest trauma can cause death from hypovolaemia, hypoxaemia and tamponade. D Diaphragmatic hernia through the foramen of Morgagni is usually posterior, while herniation through the foramen of Bochdalek lies more anteriorly. E Pectus carinatum and pectus excavatum are chest wall deformities that require surgery mainly for cosmetic reasons. In addition to positioning the patient to lie on the operated side, what procedure is urgently required? B the left lung is divided into an upper lobe and a lower lobe by the oblique fissure. Each segment is an anatomically defined unit with named bronchi, pulmonary artery branch and pulmonary vein tributary. The right lung also has 10 segments distributed as follows: three in the upper, two in the middle and five in the lower lobe. A, B, C, D In tension pneumothorax, positive pressure builds up in the hemithorax as air accumulates through a breach in the visceral pleura, which acts like a valve allowing a unidirectional flow of air out of the lung. The high intrapleural pressure results in compression of the ipsilateral lung, flattening of the hemidiaphragm, mediastinal distortion and shift, and impairment of venous return to the heart and hence a reduction of cardiac output. Pleural effusion results from interference with either the mechanisms of pleural fluid production by capillaries of parietal pleura or absorption by the capillaries of the visceral pleura. Depending on the protein concentration, pleural effusions are classified as transudates (less than 30 g/L) or exudates (30 g /L or more). In cardiac failure, the pulmonary capillary pressure is elevated, leading to increased production of pleural effusion with low protein content. Renal and hepatic failure are associated with low plasma protein and intravascular oncotic pressure. The pleural effusion that results from reduced pleural fluid absorption is low in protein content. Inflammatory diseases increase pleural capillary permeability to cause the accumulation of fluid and protein.

Additional information:

About the Security Industries Authority Staff

The Security Industies Authority is headed by a Registrar as the CEO and has thirteen (13) other staff members from all four (4) regions of the country working under him. These includes the Manager Finance and Administration, Manager Licensing and Compliance and four (4) Regional inspectors(MOMASE, Islands, Highland and Southern).

The Inspectors job are very challenging because they are at the front line of enforcement to ensure that private security companies are compliant with the provisions of the Security Protection Act to operate a security company. Most of them are former officers of the Royal PNG Constabulary. Apart from them we also have a efficient staff made up of the Executive Secretary, Accounts Officer, HR Officer , I.T Officer & an Office Janitor in Head Office Port Moresby while Admin Assistance/ Driver and an Office Admin/ Reception in Lae Momase & Highlands Region branch office.

Staff Profiles


Mr. Paul Kingston Isari

Registrar & CEO of PNG Security Industries Authority


Mr. Philip Gene, BAC, CPA PNG

Manager Finance & Administration


Mr. Spencer Gelo

Manager Licencing & Compliance

POM Office Staff

Front left – right Ms Margaret Biskum- Security Inspector New Guinea Islands, Ms Alicia Nana – Executive Secretary & Mrs Mackey Kembi Office Janitor

Back left – right Mr. Rinson Ngale – Security Inspector NCD/Southern Region, Mr. Emmanuel Tumbe HR Officer, Mr. Elijah Fave – Accounts Officer, Mr. Andrew Kaiap – I.T Officer


Lae Office Staff

Front left – right Ms Nelison Roberts – Office Secretary / Reception , Mr. Elvis Otare – Office Admin Assistance / Driver & Acting Momase Region Inspector

Back left – right Vacant – Office Manager & Security Inspector Momase Region, Mr. Pius Moi – Acting Office Manager Security Inspector Highlands Region

Security Industries Authority organizational chart


Vacancies for Council Representatives from the Security
Industry to sit in the Council

The Security Industries Authority currently does not have any vacant Council Representative position. There in total six (6) nominated representative from Security Industries in the council.(see SIA Council)

Qualified candidates will be made known here if there is a vacant in Council Representative positions.

Security Industries Authority Position Vacancies

SIA Currently has no vacancy positions available. Public will be notified for any positions available in the future.

Criteria for appointment to the Security Industries Council

  1. The candidates must have a sound knowledge in the operations of private security companies and are quite versed with the Security Protection Act 2004.
  2. The candidates shall not be currently employed in any licensed security companies that are currently registered with the Security Industries Authority or were not previously employed by any licensed security companies.
  3. The candidates shall not be a current owner or a shareholder of a licensed security company currently registered with the Security Industries Authority and the IPA (Investment promotion Authority).
  4. The candidates shall not be a previous owner or a shareholder of a licensed security company registered with the Security Industries Authority or with the IPA. (Investment promotion Authority).
  5. Interested persons may submit their application with a CV with three (3) references named and attached with their latest passport size photos.
  6. Both male and females are encouraged to participate.
  7. Only registered security companies and permitted security guards will participate in the nominations.
  8. All candidates shall be subjected to a fit and proper persons test before they are formally appointed for 3 years term by the Minister for Police & Internal Security.

For enquiries on this matter

Visit us at the Top floor of the Former Fraud Squad blue building, Gorobe Street, Badili, 2 Mile, Port Moresby NCD or Lae at Post Office Building, second street, top floor, suite # 14, Lae Morobe Province or write to the Chairman Security Industries Council PO BOX 80 Port Moresby National capital District. You can also contact Manager Licensing & Compliance – Mr. Spencer Gelo on telephone 3239851 / 3257930, or email executivesecretary@sia.gov.pg

Invitation to the Stake Holders and the Industry to make a submission on the amendments to current security Protection Act

The Registrar now invites all the registered security companies, service receivers and interested stake holders for their written submission to amend the current Security Protection Act to cover many grey areas of the law.

The submissions should clearly state what provisions of the current Security Protection Act 2004 and the Security Protection regulation 2012 are to be amended to enhance the growth of the industry. This is necessary in light of numerous complaints from the security companies and interested stake holders of the short falls in the current Act which is said to be hindering the growth of the industry.

All submissions must be dropped at The Authority Head Office: Former Fraud Squad Office, Top Floor, Gorobe Street, 2 Mile Drive, Badili,Boroko NCD in Port Moresby. They can also be posted or emailed using the address on the last page. Copies of the current Security Protection Act 2004 can be obtained at the Security Industries Authority office for K35 to use as a guide to prepare the submissions.

Appointment to the Board of Complaints

The Security Industries Authority in compliance with section 57 of the Security Protection Act 2004 has already advertised in the media in early February 2013 seeking for two (2) interested persons to sit on the Board of Complaints.

The purposes of the Board of Complaints is to hear allegations made against licensed security companies by the general public and to award appropriate disciplinary penalties to protect the integrity of the security industry. Several applications have already been received and the short listed candidates will be advised in writing by the chairman shortly before a final selection is made for their three (3) yeas appointments by the Minister for Police and Internal Security.