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A major hurdle in eHealth implementation is that it is difficult to put into practice. In this study, the primary aim was to identify the main barrier associated with implementing eHealth. This study surveyed IMIA members from May to November 2015. From the results, it is clear that medical professionals were recording most of their data by hand. This paper culture is a paradigm that is difficult to break. Cultural factors are the primary barrier in eHealth implementation.

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Determining the priority of attention in an Emergency Room (ER) has always been a difficult issue. Priority is determined with a simple triage system as people arrive at the hospital. It is important to establish how long they can wait for treatment. In order to obtain the best assessment of patients' conditions, we built a Nursing Software for Emergency Triage (NSET). The objective of this work was to assess the efficacy of the NSET versus the triage process without any software (TWS). Results showed that the NSET we built was a substantial help. With this software, we decreased significantly:1) the length of the triage system process, 2) the waiting time of patients in the waiting room, 3) the number of complaints and 4) the number of patients who walk away. In conclusion, the NSET improves and helps to define more accurately a patient's risk. NSET helps in the emergency department triage.

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Introducción: El hematoma espontáneo de la pared abdominal (HEPA) es una entidad de aparición infrecuente y de difícil diagnóstico debido a la similitud clínica con otros procesos agudos. Suele aparecer en pacientes que siguen tratamiento anticoagulante y se caracteriza por su forma de presentación brusca como dolor abdominal agudo. La cirugía puede evitarse en la mayoría de los casos si se diagnostica correctamente mediante pruebas de imagen. Observaciones clínicas: Presentamos 12 casos de HEPA tratados en nuestro Servicio entre los años 1999 y 2005, y realizamos una revisión de esta entidad en cuanto a etiología, factores desencadenantes, diagnóstico y tratamiento. Conclusión: El tratamiento del HEPA debe ser conservador, reservando la cirugía para aquellos casos que presenten deterioro hemodinámico por sangrado activo.

Introduction: Spontaneous hematoma of the abdominal wall is infrequent and difficult to diagnose due to its clinical similarity with other acute processes. It is usually associated with patients undergoing anticoagulant therapy and is characterized for its form of abrupt presentation like acute abdominal pain. Surgery can be avoided in most patients if hematoma is correctly diagnosed by imaging tests. Clinical observations: We present 12 cases of spontaneous hematoma of the abdominal wall from 1999 through 2005 and we review the etiology, precipitating factors, diagnosis and treatment of this clinical entity. Conclusion: Treatment of spontaneous hematoma of abdominal wall must be preservative, reserving the surgery for those cases that present hemodynamic compromise by persistent hemorrhage.

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Toxaphene (camphechlor) was intensively used in the cotton growing fields of Nicaragua for decades with application rates as high as 31 kg ha(-1) in 1985. Although the use of this compound has recently been discontinued in the country, its intensive use in the past and its long persistence in soil allowed for the build up of large reservoirs of toxaphene in agriculture soils and a wide dispersal of residues in the environment. Measurements of toxaphene in coastal areas on the coast of the Pacific Ocean show that environmental concentrations are particularly high in the district of Chinandega, the traditional cotton growing region. Toxaphene residues measured in soils attained 44 microg g(-1) (dry weight) while concentrations in lagoon sediments attained 6.9 microg g(-1) (dry weight) near the mouth of the rivers flowing across the agricultural region. Measurements in aquatic biota showed concentrations as high as 1.6 microg g(-1) (dry weight) in the soft tissues of clams. The toxaphene reservoir in soils combined with the obvious persistence of this compound in soils and lagoon sediments allows predicting that toxaphene will remain in the coastal ecosystem at relatively high concentrations for many years. Toxic effects in lagoon fauna are likely to be observed especially in benthic species that may recycle this compound from sediments. Consumption of seafood, in particular of clams (Anadara spp.) from the more contaminated areas, may expose the population to unacceptably high intake of toxaphene, 30 microg d(-1) per person, with the diet.

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During a paleoparasitological survey of several animal mummies (Cavia aperea f. porcellus and Canis familiaris) from Chiribaya Baja, an archaeological site in Southern Peru, an unexpected find was made. In the well preserved fur, large numbers of mummified fleas (Pulex simulans/irritans) that parasitized the animals during life were encountered. Due to the relative recent event of the host mummification and the outstanding preservation of the fleas, an attempt for the retrieval of DNA was made. A DNA extraction and sequencing protocol for archaeological ectoparasitic remains has been established, taking additional studies for tissue and protein preservation into account. Tissue preservation was assessed with transmission electron microscopy and the protein preservation was tested through the racemisation ratios of aspartic acid. Regions of the 28S rDNA gene were successfully amplified and sequenced. Further research perspectives are outlined.

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During a paleoparasitological survey of several animal mummies (Cavia aperea f. porcellus and Canis familiaris) from Chiribaya Baja, an archaeological site in Southern Peru, an unexpected find was made. In the well preserved fur, large numbers of mummified fleas (Pulex simulans/irritans)that parasitized the animals during life were encountered. Due to the relative recent event of the host mummification and the outstanding preservation of the fleas, an attempt for the retrieval of DNA was made. A DNA extraction and sequencing protocol for archaeological ectoparasitic remains has been established, taking additional studies for tissue and protein preservation into account. Tissue preservation was assessed with transmission electron microscopy and the protein preservation was tested through the racemisation ratios of aspartic acid. Regions of the 28S rDNA gene were successfully amplified and sequenced. Further research perspectives are outlined

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A detailed investigation on the contamination with chlorinated hydrocarbons and organophosphorous pesticides of the coastal lagoon system of Chinandega district, Nicaragua, allowed the identification of contaminant sources and lagoon areas currently more contaminated. The discharge of rivers into the lagoons is the main transport pathway of pesticide residues; whereas atmospheric depositions are likely to be the main pathway for the introduction of PCBs into the lagoons. Analysis of water samples indicates widespread contamination with soluble organophosphorous compounds, such as dichlorvos, up to 410 ng L(-1), diazinon, up to 150 ng L(-1), and chlorpyrifos, up to 83 ng L(-1). Analyses of suspended matter for low solubility organochlorine (OC) compounds revealed very high concentrations of toxaphene, up to 17,450 ng g(-1) dry weight (dw), total DDTs up to 478 ng g(-1), Aroclor 1254, up to 119 ng g(-1) (dw), and lower concentrations for other compounds. Lagoon sediments contain high concentrations also of toxaphene, from 7.9 to 6,900 ng g(-1) (dw), and DDTs, from 1.5 to 321 ng g(-1) (dw), and lower concentrations of chlorpyrifos, hexachlorocyclohexanes, chlordane and other residues. Concentrations of OCs in soft tissues of clams are statistically correlated with the concentrations of the same compounds in bottom sediments, indicating that sediments are a source of contaminants to biota. In some areas of the lagoon system, concentration of residues in sediments are far above recommended threshold guideline values for protection of aquatic life, and may cause acute and chronic toxic effects on more sensitive aquatic species. Despite the ban on the use of toxaphene and DDT, residues of these compounds are still entering the lagoons due to erosion of, and leaching from, agriculture soils in the region. Measures for protection of the lagoon ecosystem are discussed.

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The hydrographic basin of the Atoya river, located in the Department of Chinandega, one of the main cotton producing regions in Nicaragua, is intensively contaminated by pesticides. Samples of river waters and sediments, as well as strategically selected wells have been analyzed to study variations in the concentrations of organochlorine and organophosphorus pesticide residues between the dry season (November-April) and the rainy season (May-June). Generally, higher concentrations of pesticides have been detected in the river waters and sediments in the dry season. DDT, DDD, DDE compounds and toxaphene are the most frequent organochlorine residues found in the water and sediment samples, while endrin, aldrin, dieldrin and lindane are mainly found in the waters of rivers and wells. Organophosphorus compounds were rarely detected. However, residues of ethion, methyl-parathion and ethyl-parathion were found in high concentrations in some river and well water samples. Generally, organochlorine compounds tend to accumulate in the fine grain-size fractions, rich in organic matter, except DDE, which concentrates basically in the coarse grain-size fractions.

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A screening for persistent chlorinated hydrocarbons was carried out in December 1995 in the main coastal lagoons on the Pacific side of Nicaragua, where most of the country's agriculture and pesticide use has been taking place for decades. Results for a wide range of organochlorine pesticides in lagoon sediments show levels that generally were very low in Estero Real, Estero Padre Ramos, and estuary of San Juan del Sur. For example, total DDTs in these lagoons averaged 4.5 +/- 3.4 ng g-1 dry weight, which may be considered a baseline level for the region. Other compounds such as HCHs, BHC, endosulfan, heptachlor, endrin, toxaphene, and aroclors were present in concentrations even lower, generally below 1 ng g-1 dry weight. However, sediments of the Esteros Naranjo-Paso Caballos system at Chinandega district contained pesticide residues in much higher levels, attaining maximum values of 1,420 ng g-1 and 270 ng g-1 dry weight, respectively, for toxaphene and total DDTs. Other compounds such as aroclors, chlordane, endosulfan, and dieldrin were also present in the sediments of this lagoon system, but in lower concentrations. The very high concentrations of toxaphene and DDTs in this lagoon are a result of the intensive use of these pesticides in cotton growing in the district of Chinandega. Due to the long environmental half-lives of these compounds (t(1/2) > 10 years in temperate soils), their concentrations in lagoon sediments will likely remain high for years to come. Based on these results, the development of the new shrimp farming activities in the Pacific coastal lagoons should be restricted to selected areas.

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