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PubMed1994

Tracheobronchial injury in blunt and penetrating chest trauma.

Ten patients were seen in Northern Syria with tracheobronchial injury from June 1986 to July 1988. Eight were male; and five were children. Blunt trauma was the cause of rupture in five and penetrating trauma in five. Nine patients had associated injuries. In seven, the diagnosis was made within 24 h. The seven patients who had surgery were well at last follow-up, as was a child with a main bronchial tear who was treated conservatively. Two men died without having surgery, one of respiratory failure and sepsis and the other of hemorrhagic shock. The group's mean age was 17.5 years. The average hospital stay was six days (eight for survivors), and the follow-up period was seven months. The clinical presentations and outcome stress the essential role of early chest x-ray and bronchoscopy, as well as a high index of suspicion.

Adolescent↗
PubMed2002

Pathogenicity of Beauveria bassiana, Metarhizium anisopliae (Deuteromycotina: Hyphomycetes), and other entomopathogenic fungi against Lygus lineolaris (Hemiptera: Miridae).

The pathogenicity of 32 fungal isolates from the genera of Beauveria, Verticillium, Paecilomyces, Metarhizium, Mariannaea, and Hirsutella to second-instar tarnished plant bug, Lygus lineolaris (Palisot de Beauvois), was tested under laboratory conditions. These isolates originated from various insect hosts and substrates from France, Denmark, Austria, Italy, Turkey, Syria, and the United States. A single exposure concentration (1 x 10(7) conidia/ ml) assay for each isolate was first conducted by immersing the insects in 10 ml of a fungal suspension for 5s. These were followed by concentration-mortality assays on five of the most pathogenic isolates using four test concentrations ranging from 2 x 10(4) to 2 x 10(7) conidia/ml. B. bassiana 726 (Bemisia-passaged GHA strain) was used as a standard for comparison in all of the assays. Among the test isolates, three produced mortality not significantly different from the water control. Mortality ranged from 35 to 98% among the other 29 isolates. The LC50 values of the five most pathogenic isolates ranged from 0.8 to 5.0 x 10(5) conidia/ml. The LT50 values for these isolates ranged from 6.0 to 6.9, 3.1 to 5.1, and 2.5 to 4.0 d for concentrations of 2 x 10(5), 2 x 10(6), and 2 x 10(7) conidia/ml, respectively. Two strains of B. bassiana (ARSEF 1394,5665) and one M anisopliae (ARSEF 3540) were more pathogenic to the nymphs than the standard, having significantly lower LC50 and LT50, values. Our results demonstrated that several genera of entomopathogenic fungi have promise as microbial control agents against L. lineolaris.

Animals↗
PubMed2005

Death obsession in Arabic and Western countries.

The current investigation compared a measure of death obsession among 1,853 volunteer undergraduates from four Arab countries (Egypt, Kuwait, Lebanon, and Syria) with 791 from three Western countries, i.e., Britain, Spain, and the USA. Comparable Arabic, Spanish, and English versions of the Death Obsession Scale were used. The mean scores on death obsession for the Arabic participants were higher than those of their Western counterparts for both men and women.

Adult↗
PubMed1995

The frequency of 14 beta-thalassemia mutations in the Arab populations.

The beta-thalassemias are a heterogeneous group with respect to molecular pathogenesis, and different populations and ethnic groups differ with respect to the predominating mutations. This variable spectrum of beta-thalassemia mutations has resulted in extensive studies in each population and ethnic group to identify the major mutations. In this study we investigated the prevalence of 14 mutations in 253 beta-thalassemia patients drawn from eight Arab countries (i.e. Jordan, Egypt, Syria, Lebanon, Yemen, and Saudi Arabia), living in Saudi Arabia and attending Ministry of Health hospitals. The mutations investigated included IVS-I-110 (G-->A), IVS-II-1 (G-->A), IVS-I-5 (G-->C), codon 39 (C-->T), IVS-I-1 (G-->A), frameshift at codons 8/9 (+G), frameshift at codons 41/42 (-TTCT), codon 15 (TGG-->TAG), IVS-I-6 (T-->C), frameshift at codon 16 (-C), IVS-II-745 (C-->G), codon 6(-A), IVS-I, 3' end (-25 bp), and Cap +1 (A-->C). The most frequently encountered mutations were IVS-I-110 and IVS-II-1 which were identified in the population of each Arab country. The IVS-I-1 and IVS-II-745 mutations were encountered in Jordanians, Egyptians, and Syrians. The IVS-I-5, codon 39, codon 6, IVS-I, 3' end (-25 bp), and Cap +1 mutations were encountered only in Saudis and not in other Arabs, except codon 39 which was present in the Syrians and Lebanese. Other mutations were generally rare and not specific to any Arab ethnic group. This paper presents preliminary data on the prevalence of 14 mutations in the Arab populations and shows wide variation in the molecular basis of beta-thalassemia in different Arab ethnic groups. Further detailed studies to identify the entire spectrum of beta-thalassemia mutations are stressed.

Arabs↗
PubMed1995

Clinical rounds in the well-baby nursery: treating jaundiced newborns.

Ten pearls (and pitfalls) in the management of the jaundiced newborn: Remember to take a history. Ask about jaundice in previous siblings and check family ethnicity. Don't ignore jaundice in the first 24 hours--it is considered pathologic until proven otherwise. Some normal infants may appear jaundiced and have a bilirubin level of 5 mg/dL at 23 hours and 59 minutes. On the other hand, a bilirubin level of 5 mg/dL at 10 hours is almost certainly pathologic. Use your judgment. Don't treat 35 to 37 week gestation infants as if they were full-term infants. Although these babies are cared for in well-baby nurseries and are generally treated like full-term infants, they are not full term. They are not as vigorous and do not nurse as well as full-term infants. Infants at 37 weeks gestation are four times more likely to have a serum bilirubin level greater than 13 mg/dL than those at 40 weeks gestation. Don't send 35-week gestation infants home before 48 hours. Document your assessment, particularly if the infant is being discharged early. Document the presence or absence of jaundice and its severity. A late rising bilirubin is typical of G6PD deficiency. Think about the ethnic background: G6PD deficiency is much more likely to occur in families from Greece, Turkey, Sardinia, and Nigeria, and particularly in Sephardic Jews from Iraq, Iran, Syria, and Kurdistan. Your practice may not contain many such families but remember in today's world of travel and intermarriage, etc, these genes are ubiquitous and the diagnosis of G6PD deficiency should always be considered in a newborn child with a significant elevation of bilirubin, particularly if it is a male and the rise in bilirubin is of late onset. Don't use homeopathic doses of phototherapy. As with any drug, phototherapy should be provided in a therapeutic dose (see above), but with the light sources commonly used, it is impossible to overdose the patient. Don't ignore a failure of response to phototherapy. If the bilirubin rises despite adequate phototherapy, there must be a reason. Consider the possibility of an unrecognized hemolytic process. Provide timely follow-up. Infants discharged (as most are) before 48 hours should be seen by a health-care professional within 2 to 3 days of discharge. Don't ignore prolonged jaundice. About one in three normal breast-fed infants still will be clinically jaundiced when they are 2 weeks old (two thirds will be biochemically jaundiced). These infants all have indirect hyperbilirubinemia. Occasionally, however, an infant with prolonged jaundice has direct hyperbilirubinemia. In these infants, the diagnosis of biliary atresia or some other cause of cholestatic jaundice must be considered. If the infant is clinically jaundiced beyond age 2 weeks, you should: 1) check the newborn record to make sure that the metabolic screen for hypothyroidism is normal (congenital hypothyroidism is a cause of indirect hyperbilirubinemia), and 2) ask the mother about the color of the urine and stool. If the baby's stools are pale or the urine is dark yellow, you must get a direct bilirubin to rule out cholestasis. If there is direct hyperbilirubinemia, a urine dipstick will identify the presence of bile (bilirubin). If the color of the urine and stool are normal (by history), it is reasonable to follow the child for another week. However, any infant who is still jaundiced beyond age 3 weeks must have a measurement of direct bilirubin. Don't ignore severe jaundice. If the bilirubin is sufficiently elevated, kernicterus can occur in a healthy, breast-fed infant.

Bilirubin↗
PubMedDate not supplied

Antibodies to glutamic acid decarboxylase in Syrian and Jordanian type I diabetes patients and their siblings.

BACKGROUND: Attempts to identify the earliest events in the autoimmune process in type I diabetes mellitus suggests the glutamic acid decarboxylase (GAD) is one of the first and most important autoantigens. We conducted this study to determine the prevalence of antibodies to glutamic acid decarboxylase (anti-GAD) in both Syrian and Jordanian children with Type I diabetes and their siblings. PATIENTS AND METHODS: sera were obtained from 85 Syrian patients with type I diabetes (mean age 13.6 + 5.9 years), from 45 of their siblings (mean age 11 + 6.1 years), from 78 randomly selected Syrian control subjects (mean age 9.9 + 43 years), and from 95 Jordanian patients with type I diabetes (mean age 13.9 + 65 years), from 78 of their siblings (mean age 12.3 + 7.1 years), and from 100 randomly selected Jordanian control subjects (mean age 7.8 + 4.5 years). Sera were analyzed from anti-GAD using the enzyme linked immunosorbent assay (ELISA) technique. RESULTS: Prevalence of anti-GAD was 34.1% (29/85) in Syrian type I diabetes patients, 20% (9/45) in their siblings, 1.3% (1/78) in Syrian control subjects, 49.5% (47/95) in Jordanian type I diabetes patients, 23% (18/78) in their siblings, and 2% (2/100) in Jordanian control subjects. Differences between the Syrian and Jordanian type I diabetes groups and their siblings and controls were statistically significant. In patients with less than two years of diabetes duration, the frequency was 88.8% (16/18) for both groups. There was no correlation between sex and anti-GAD levels in their Syrian and Jordanian type I diabetes patients and their siblings. The positivity of anti-GAD tended to be more frequent at the age range of 5 to 8 years in siblings. Anti-GAD titers >90 ng/ml were found in 58.8% of type I diabetes patients and in 38% of siblings who were anti-GAD positive. CONCLUSION: Syria and Jordan have prevalence rates of anti-GAD among type I diabetes patients and their siblings that are among the highest reported in the world. Therefore, anti-GAD may be valuable as an early predictive marker for type I diabetes.

Journal Article↗
PubMed1999

[Bodily evidence can reveal torture. 5-year experience of torture documentation].

At the Centre for Torture and Trauma Survivors in Stockholm, 201 subjects from 34 countries were documented during a period of five years. Torture reports differed little between individuals from the same countries or regions, regarding methods and circumstances. Africans from Uganda (n = 22) reported brutal torture and manifested extensive scarring (mean number of scars, 20; range 4-65), whereas subjects from Syria (n = 28) reported falaka (i.e., bastinade), whipping and suspension, but manifested few or no scars (mean number 5, range 0-17). Of the subjects examined, 17% were women, of whom 79% reported having been raped during torture. Chronic back pain was the most common complaint at the time of examination. Correlation was found to exist between sexual torture and genito-urinary symptoms, bastinade and neural symptoms, and electrical torture and symptoms from the joints and gastro-intestinal tract. Severity of physical torture was a correlate of post-traumatic stress disorder. However, the forensic report had no effect on the verdict of immigration authorities regarding individual asylum applications.

Adolescent↗
PubMedDate not supplied

[The characteristics of the macro- and trace element composition of the hair in the peoples of Asia, Africa and Latin America].

Macro- and trace element composition of hairs on the head, chest, in the armpits, and on the pubis in the population of Asia, Africa, and Latin America adapted and not to the climate, geographic and ecological conditions of the Russian Federation (Moscow) is studied by spectrography (DPS-13 spectrograph). Element composition of residents of 16 countries is analyzed by variation statistics methods using PC: Lebanon, Syria, Yemen, Bahrain, India, Sierra Leone, Côte d'Ivoire, Rwanda, Kenya, Sudan, Mexico, Ecuador, Bolivia, Brasilia, Columbia, and Chile. Hairs from residents of East Europe (Russians, Byelorussians, Ukrainians) living in Moscow for 6-8 years (adapted) were the reference for comparison. A total of 371 specimens of hairs were examined. Hairs from adapted and not adapted residents of the above-listed countries and continents differ significantly from each other and from the hairs of Russians, Byelorussians, and Ukrainians living in Moscow.

Adaptation, Physiological↗
PubMed2000

Affordability of inhaled corticosteroids as a potential barrier to treatment of asthma in some developing countries.

SETTING: The cost and availability of the medications required for the treatment of asthma may represent potential barriers to effective management. METHOD: A survey of prices and policies for components of asthma treatment in 1998, in Algeria, Burkina Faso, Ivory Coast, Guinea, Mali, Syria, Turkey and Vietnam. RESULTS: Medications were consistently available in only four of the eight countries studied. The cost of essential medications for standard case management varied by over five times for beclomethasone and by over three times for inhaled salbutamol. In all but two countries, the cost of one year of drugs for treatment of a moderate, persistent case exceeded the monthly salary of a nurse in that country. The essential drugs list included inhaled salbutamol in five of eight countries and beclomethasone in three of eight. The costs of medications were lower where generic preparations were available and, to a lesser extent, where the medications are on the essential drugs list. CONCLUSIONS: The cost and availability of medications vary widely, and may represent an important barrier to effective management in some low and middle income countries.

Albuterol↗
PubMed2000

[Identification of Sorghum genes responsible for resistance to Green bug].

Genes responsible for resistance to greenbug (Schizaphis graminum Rond.) were identified in sorghum. The dominant (Sgr1) and recessive (Sgr2) genes for resistance were revealed in sample k-457 (PI264453, United States). The samples i-589430 (PI264453, Spain) and k-3852 (Sarvasi, Hungary) carry gene Sgr1. These accessions are assumed to also have gene Sgr2. The samples k-9921 (Shallu, United States) and k-9922 (KS-30, United States) have incompletely dominant resistance gene Sgr3. A symbol Sgr4 was assigned to the dominant gene from sample k-6694 (Deer, United States). The dominant Sgr5 and recessive Sgr6 genes were revealed in the samples k-1362 (Durra Belaya, Syria) and k-1240 (Dzhugara Belaya, China). The cultivar Sorgogradskoe (k-9436, Rostovskaya oblast) has gene Sgr5. The samples k-10092 (Odesskii 360, Ukraine) and k-5091 (Cherhata, Marocco) are assumed to have genes Sgr5 and Sgr6. Sample k-924 (Dzhugara Belaya, China) is protected by the dominant gene Srg7 and recessive gene Sgr8. Sample k-923 (Dzhugara Belaya, China) has at least one of these genes. Two dominant complementary genes for resistance (Sgr9 and Sgr10) were revealed in sample k-930 (Dzhugara Belaya, China). One of two dominant genes of sample k-1237 (Dzhugara Belaya, China) was assigned the symbol Sgr11. Genes Sgr5-Sgr11 responsible for resistance to greenbug are new and were not previously used in breeding.

Animals↗
PubMedDate not supplied

[The malaria situation in Turkey].

Turkey is the last country in the temperate zone on the edge of the European continent in which malaria is prevalent at endemic and occasionally epidemic proportions. Malaria was the most significant vector borne disease constituting a serious healthy problem until it was suppressed in 1965. Following the establishment of malaria eradication program in 1957 which began operation in 1960 after many years of malaria control, the incidence of malaria decreased annually and the stricken areas became more and more restricted. Unfortunately, an agricultural development program initiated in mid 70's in the Cukurova Plain caused a substantial migration of workers from the eastern areas where malaria at that time was more prevalent. This population movement together with the industrial expansion that took place resulted in a serious epidemic of vivax malaria in 1977 in the provinces of Adana, Icel and Hatay, where 101,867 cases were reported. The following years, Turkey targeted to reduce the number of malaria cases to less than 800 by 1984. After 1985, the number of malaria cases in the country has continued to increase and in the past five and six years a serious malaria epidemics has been building up in the southeastern provinces. The gravitational center of the disease has now moved from the Cukurova to the GAP area in South East Anatolia and beyond. The indicator of this movement is that 89% of total cases in 1998 is concerning to the GAP region. By the year 1998 the number of reported cases were 36,842. The common parasite type is P. vivax in the country. The other types are generally imported from other countries. These are Syria, S. Arabia, Pakistan, Afghanistan, Yemen, Nigeria, India, Malaysia, Ghana, Indonesia, Sudan etc. Malaria cases are registered in bordering areas of the country constantly. The suggested solutions for Malaria control in bordering areas are: 1. To establish control laboratories in customs in order to take blood from persons who come from risky areas for malaria. When positive cases are found these laboratories will also provide free treatment. 2. East country should give information about the malaria situation in their country to the other countries.

Animals↗
PubMedDate not supplied

[Current malaria situation in Turkey].

Geographically, Turkey is situated in an area where malaria is very risky. The climatic conditions in the region are suitable for the malaria vector to proliferate. Due to agricultural infrastructural changes, GAP and other similar projects, insufficient environmental conditions, urbanization, national and international population moves, are a key to manage malaria control activities. It is estimated that malaria will be a potential danger for Turkey in the forthcoming years. The disease is located largely in south-eastern Anatolia. The Diyarbakir, Batman, Sanliurfa, Siirt, and Mardin districts are the most affected areas. In western districts, like Aydin and Manisa, an increase in the number of indigenous cases can be observed from time to time. This is due to workers moving from malaria districts to western parts to final work. Since these workers cannot be controlled, the population living in these regions get infected from indigenous cases. There were 84,345 malaria cases in 1994 and 82,096 in 1995, they decreased to 60,884 in 1996 and numbered 35,456 in 1997. They accounted for 36,842 and 20,963 in 1998 and 1999, respectively. In Turkey there are almost all cases of P. vivax malaria. There are also P. vivax and P. falciparum malaria cases coming from other countries: There were 321 P. vivax cases, including 2 P. falciparum ones, arriving to Turkey from Iraq in 1995. The P. vivax malaria cases accounted for 229 in 1996, and 67, cases P. vivax including 12 P. falciparum cases, in 1997, and 4 P. vivax cases in 1998 that came from that country. One P. vivax case entered Turkey from Georgia in 1998. The cause of higher incidence of P. vivax cases in 1995, it decreasing in 1999, is the lack of border controls over workers coming to Turkey. The other internationally imported cases are from Syria, Sudan, Pakistan, Afghanistan, Nigeria, India, Azerbaijan, Malaysia, Ghana, Indonesia, Yemen. Our examinations have shown that none of these internationally imported cases are important in transmitting the diseases. The districts where malaria cases occur are the places where population moves are rapid, agriculture is the main occupation, the increase in the population is high and the education/cultural level is low. Within years, the districts with high malaria cases also differ. Before 1990 Cucurova and Amikova were the places that showed the highest incidence of malaria. Since 1990, the number of cases from south-eastern Anatolia has started to rise. The main reasons for this change are a comprehensive malaria prevention programme, regional development, developed agricultural systems, and lower population movements. The 1999 statistical data indicate that 83 and 17% of all malaria cases are observed in the GAP and other districts, respectively. The distribution of malaria cases in Turkey differs by months and climatic conditions. The incidence of malaria starts to rise in March, reaching its peak in July, August and September, begins to fall in October. In other words, the number of malaria cases is lowest in winter and reaches its peak in summer and autumn. This is not due to the parasite itself, but a climatic change is a main reason. In the past years the comprehensive malaria prevention programme has started bearing its fruits. Within the WHO Roll Back Malaria strategies, Turkey has started to implement its national malaria control projects, the meeting held on March 22, 2000, coordinated the country's international cooperation for this purpose. The meeting considered the aim of the project to be introduced into other organizations. In this regards, the target for 2002 is to halve the incidence of malaria as compared to 1999. The middle--and long-term incidence of malaria will be lowered to even smaller figures. The objectives of this project are as follows: to integrate malaria services with primary health care services to prove more effective studies; to develop early diagnosis and treatment systems, to provide better diagnostic services, and to develop mobile diagnostic ones; to make radical treatment and monitoring patients; to conduct regular active case surveillance studies; to conduct regular vector control studies; to monitor the sensitivity of vectors to insecticides and to provide their alternatives; to design malaria control studies for the specialists of districts; to implement educational programmes among the population and attract it in controlling malaria.

Humans↗
PubMed2001

The new approaches on sustainable wildlife of Amik Lake.

Turkey has been on a crucial routes of the migrating birds. These birds have been coming from Istanbul-Camlica hills and through Artvin-Borcka to the homeland. And the migrating birds turn to the Africa continent over Syria by passing Hatay-Belen. During the mmigration, the birds use the location of Amik Lake as a watery land for temporary settlement. The Amik Lake which should have been protected as a watery land for birds according to Ramsar Agreement that Turkey signed, was caused to dry ten years ago. There weren't only negative effects on the wildlife by drying but also soil degraded and productivity decreased though the aim was to improve agriculture and contributions to local developments on the Amik Lake dry land. During the last two decades, it was known that one of the birds, which is called Anhinga rufa extincted as a cause of drying ot Amik Lake. In this study, some results that emerged as a cause of drying of Amik Lake were presented.

Agriculture↗
PubMed2002

A new method to aid complete lymphadenectomy in radical treatment of cancer of the cervix.

OBJECTIVE: A simple, new and not previously reported method to improve the complete ablation of the pelvic lymph nodes in the surgical treatment of cervical cancer is briefly reported. METHODS: Fourteen patients had been operated upon at Zahrawi Maternity Hospital, Damascus, Syria using radical Wertheim hysterectomy for surgical treatment. Five to 10 days prior to surgery, patients are given intramuscular iron injections that help easy visualization of the lymph nodes during operation. RESULTS: In all the 14 cases treated with this simple pre-operative medication, pelvic lymph nodes were easily identified and completely removed. CONCLUSION: Pre-operative iron injections help in better identification of even the smallest pelvic lymph nodes and improve their complete removal.

Adult↗
PubMed1996

The end of the demographic explosion in the Mediterranean?

"We...compare the UN projections made in 1994 to the previous set in 1992 and to the Blue Plan projections, for [Algeria, Egypt, Morocco, Syria, Tunisia, and Turkey, the] six most populated [developing countries in the Mediterranean region].... We shall also consider more briefly the lesser populated countries. This will enable us to appreciate the changes that have occurred in the UN's perception of population growth in this region."

Africa↗
PubMedDate not supplied

A case of merosin-negative congenital muscular dystrophy with extensive white matter abnormalities and electroencephalographic changes in a Syrian boy.

Congenital muscular dystrophies are a group of heterogeneous disorders inherited as an autosomal recessive disease. In the Caucasians they are most frequently encountered as the so-called "pure" or occidental form. Recently it has been found that the severity of concomitant white matter changes depends on the presence or absence of merosin, the laminin isoform, in the skeletal muscle. The authors present a 2-year-old Syrian boy with congenital muscular dystrophy which proved to be merosin (laminin alpha2) deficient and believe that this is the first case described from Syria. The clinical picture, biochemical findings, neurophysiological investigations, biopsy findings and extensive abnormalities of white matter on magnetic resonance imaging (MRI) found in this case are presented. Peculiar electroencephalographic (EEG) pattern with fast rhythms in occipito-temporal regions is emphasized.

Brain↗
PubMedDate not supplied

Conditions and problems of the labour force in agriculture.

"This paper...deals with the conditions of the agricultural labour force in the [ESCWA] region.... The study propounds several proposals which collectively could form the broad outlines of a policy aimed at finding proper solutions for the problems of the agricultural labour force in the countries of the region." The author focuses on Egypt, Iraq, Jordan, Lebanon, Syria, and Yemen.

Agriculture↗
PubMed1996

UN conference reaffirms reproductive rights.

The United Nations Conference on Human Settlements, also known as the Habitat II conference, met in Istanbul from June 3 to 14. It was the last major UN gathering of this millennium and the first major UN meeting since 1995's Fourth World Conference on Women (the "Beijing Conference")--and thus an important opportunity for a wider international community to weigh in on agreements reached in Beijing and at the International Conference on Population and Development, held in Cairo in 1994. The final document that emerged from Habitat II, the "Global Plan of Action," affirmed crucial elements of those earlier accords. The Habitat documents calls for action to "[d]evelop and implement programmes to ensure universal access for women throughout their life-span to a full range of affordable health care services, including those related to reproductive health care, which includes family planning and sexual health, consistent with the Report of the International Conference on Population and Development." Language adopted at the Cairo meeting is also affirmed in Habitat's call for "universal access to the widest range of primary health care services." Perhaps most significantly, the Istanbul document reiterated an important declaration from the Beijing conference: "While the significance of national and regional particularities and various historical, cultural, and religious backgrounds must be borne in mind, it is the duty of all States to promote and protect all human rights and fundamental freedoms." Most of the 189 UN members and observer states that attended the conference upheld all three of these provisions. Only a small group of states--Argentina, Guatemala, Iran, Jordan, Lebanon, Malta, Qatar, Saudi Arabia, Sudan, Syria, United Arab Emirates, Yemen, and the Holy See--filed reservations on the health care sections.

Delivery of Health Care↗