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The government healthcare system unintentionally excludes the destitute in several ways. In this article, a “slum’s-eye” perspective on the public healthcare system is offered through reflections on stories of tuberculosis patients in urban poor neighbourhoods. We hope these stories contribute to discourse on how to strengthen the public healthcare system and make it more accessible for all, especially the poor.

Understanding Arctic glacier sensitivity is key to predicting future response to air temperature rise. Previous studies have used proglacial lake sediment records to reconstruct Holocene glacier advance–retreat patterns in South and West Greenland, but high‐resolution glacier records from High Arctic Greenland are scarce, despite the sensitivity of this region to future climate change. Detailed geochemical analysis of proglacial lake sediments close to Zackenberg, northeast Greenland, provides the first high‐resolution record of Late Holocene High Arctic glacier behaviour. Three phases of glacier advance have occurred in the last 2000 years. The first two phases (c. 1320–800 cal. a BP) occurred prior to the Little Ice Age (LIA), and correspond to the Dark Ages Cold Period and the Medieval Climate Anomaly. The third phase (c. 700 cal. a BP), representing a smaller scale glacier oscillation, is associated with the onset of the LIA. Our results are consistent with recent evidence of pre‐LIA glacier advance in other parts of the Arctic, including South and West Greenland, Svalbard, and Canada. The sub‐millennial glacier fluctuations identified in the Madsen Lake succession are not preserved in the moraine record. Importantly, coupled XRF and XRD analysis has effectively identified a phase of ice advance that is not visible by sedimentology alone. This highlights the value of high‐resolution geochemical analysis of lake sediments to establish rapid glacier advance–retreat patterns in regions where chronological and morphostratigraphical control is limited.

High resolution digital terrain models (DTMs) generated from airborne LiDAR data and supplemented by field evidence are used to map glacial landform assemblages dating from the last glaciation (Midlandian glaciation; OI stages 2–3) in the central Irish Midlands. The DTMs reveal previously unrecognised low-amplitude landforms, including crevasse-squeeze ridges and mega-scale glacial lineations overprinted by conduit fills leading to ice-marginal subaqueous deposits. We interpret this landform assemblage as evidence for surging behaviour during ice recession. The data indicate that two separate phases of accelerated ice flow were followed by ice sheet stagnation during overall deglaciation. The second surge event was followed by a subglacial outburst flood, forming an intricate esker and crevasse-fill network. The data provide the first clear evidence that ice flow direction was eastward along the eastern watershed of the Shannon River basin, at odds with previous models, and raise the possibility that an ice stream existed in this area. Our work demonstrates the potential for airborne LiDAR surveys to produce detailed paleoglaciological reconstructions and to enhance our understanding of complex palaeo-ice sheet dynamics.

Keto-substituted hydrocarbons with 11-19 methylene and bis-terminal hydroxyl and carboxyl groups have been synthesized and evaluated in both in vivo and in vitro assays for their potential to favorably alter lipid disorders including metabolic syndrome. Compounds were assessed for their effects on the de novo incorporation of radiolabeled acetate into lipids in primary cultures of rat hepatocytes as well as for their effects on lipid and glycemic variables in obese female Zucker fatty rats [Crl:(ZUC)-faBR] following 1 and 2 weeks of oral administration. The most active compounds were found to be symmetrical with four to five methylene groups separating the central ketone functionality and the gem dimethyl or methyl/aryl substituents. Furthermore, biological activity was found to be greatest in both in vivo and in vitro assays for the tetramethyl-substituted keto diacids and diols (e.g., 10c, 10g, 14c), and the least active were shown to be the bis(arylmethyl) derivatives (e.g., 10e, 10f, 14f). Compound 14c dose-dependently elevated HDL-cholesterol, reduced triglycerides, and reduced NEFA, with a minimum effective dose of 30 mg/kg/day. Compound 1 g dose-dependently modified non-HDL-cholesterol, triglycerides, and nonesterified fatty acids, with a minimum effective dose of 10 mg/kg/day. At this dose, compound 10g elevated HDL-cholesterol levels 2-3 times higher than pretreatment levels, and a dose-dependent reduction of fasting insulin and glucose levels was observed.

Long hydrocarbon chain ethers with bis-terminal hydroxyl or carboxyl groups have been synthesized and evaluated for their potential to favorably alter lipid disorders including metabolic syndrome. Compounds were assessed for their effects on the de novo incorporation of radiolabeled acetate into lipids in primary cultures of rat hepatocytes as well as for their effects on lipid and glycemic variables in female obese Zucker fatty rats following 1 and 2 weeks of daily oral administration. The most active compounds were found to be symmetrical with four to five methylene groups separating the central ether functionality and the gem dimethyl or methyl/aryl substituents. Biological activity was found to be greatest for tetramethyl-substituted ether diols (e.g., 28 and 31), while bis(arylmethyl) derivatives (e.g., 10, 11, and 27), diethers (e.g., 49, 50, and 56), and diphenyl ethers (e.g., 35 and 36) were the least active. For the most biologically active compound 28, we observed as much as a 346% increase in serum HDL-cholesterol and a 71% reduction in serum triglycerides at the highest dose administered (100 mg/kg) after 2 weeks of treatment. For compound 31 we observed a 69% reduction in non-HDL-cholesterol, accompanied by a 131% increase in HDL-cholesterol and an 84% reduction in serum triglycerides under the same treatment conditions.

The Health Quality Council and the Saskatchewan Association of Health Organizations convened a committee to develop evidence-based best practice guidelines for pressure ulcer prevention and management in the province of Saskatchewan, Canada. The Health Quality Council designed a pilot project to 1) implement these guidelines in long-term care facilities using an evidence-based strategy and 2) evaluate the impact of the guidelines on the incidence and prevalence of residents with pressure ulcers. Seven long-term care facilities in Saskatchewan participated in the project, which ran from November 2004 to September 2005. Data from 753 patients were collected and analyzed. Following guideline implementation, the incidence of residents with pressure ulcers decreased from 6.0% to 0.2% and the prevalence rate decreased from 8.8% to 3.7%. The greater decline in incidence compared to prevalence suggests that process improvements occurred primarily in the prevention of new pressure ulcers. These results suggest that organizational commitment to improving skin and wound care followed by the facilitated implementation of evidence-based guidelines can result in improved clinical outcomes for long-term care residents.

Eskers in a glaciofluvial landsystem in the Lough Ree area, Central Ireland, exhibit two orientations. The most southerly esker in the area, the Athlone Esker, forms part of a dendritic esker system with paleocurrent directions indicating eastward drainage, while the Rooskagh Esker and associated eskers and kames immediately to the north were formed during southward drainage. Sediments indicate that sharp-crested, steep-sided sections of both ridges were formed within subglacial tunnels, while fan-shaped and flat-topped areas were formed as subaqueous outwash fans and deltas in standing water immediately in front of an ice-margin. The deposition of ice-marginal deposits indicating southward paleoflows against the side of the eastward flowing Athlone Esker indicates a 90° shift in the direction of ice surface slope, and a similar shift in the likely orientation of the ice margin. The absence of any evidence of intermediate ice- or water-flow directions indicates that the shift reflects a recession of ice, followed by a readvance from the north.

In northern Brittany an important geomorphological response to Holocene sea-level rise has been the development of coastal dunes with associated lagoons and marshes. At Anse du Verger, a marsh has formed behind a dune system which has been developing in situ for the last 4000 year. The lithostratigraphy of the marsh comprises extensive peat formation, with sands, silts and occasional sand lenses, the latter probably associated with storm surges. The sequence dates from 10,320+/-120 BP. After 3000 BP, flood episodes on the marsh are more common, while the upper marsh deposits can be correlated with the recent period of dune building. Prehistoric artifacts (remains of cooking implements) have been found on a cliff to the east of the marsh and are buried by washover deposits, which indicates a sudden abandonment of a settlement possibility due to a storm surge soon after 2460+/-80 BP. Surge levels are proposed as a controlling factor on dune crest elevation.

The presence of sand layers interleaved with biogenic material in coastal sedimentary sequences from back-barrier areas has often been used as evidence of storm surge or tsunami action during the Holocene. This paper discusses such stratigraphies from two adjacent sites in Western Ireland in order to assess the validity of this inference. Detailed examination of the sand layers indicates that while some of the sand beds at one of the sites were deposited by overwash, other processes, including aeolian deposition and fluvial reworking of aeolian sediments were also important in sand redistribution in the back-barrier areas. In these cases, local controls, including site drainage characteristics, barrier morphology and available sediment supply, appear to have been important in site evolution. A regional signal of storm frequency was not detected.