Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda.

BACKGROUND: Since drug shops play an important role in treatment of fever, introducing rapid diagnostic tests (RDTs) for malaria at drug shops may have the potential of targeting anti-malarial drugs to those with malaria parasites and improve rational drug use. As part of a cluster randomized trial to examine impact on appropriate treatment of malaria in drug shops in Uganda and adherence to current malaria treatment policy guidelines, a survey was conducted to estimate baseline prevalence of, and factors associated with, appropriate treatment of malaria to enable effective design and implementation of the cluster randomized trial. METHODS: A survey was conducted within 20 geographical clusters of drug shops from May to September 2010 in Mukono district, central Uganda. A cluster was defined as a parish representing a cluster of drug shops. Data was collected using two structured questionnaires: a provider questionnaire to capture data on drug shops (n=65) including provider characteristics, knowledge on treatment of malaria, previous training received, type of drugs stocked, reported drug sales, and record keeping practices; and a patient questionnaire to capture data from febrile patients (n=540) exiting drug shops on presenting symptoms, the consultation process, treatment received, and malaria diagnoses. Malaria diagnosis made by drug shop vendors were confirmed by the study team through microscopy examination of a blood slide to ascertain whether appropriate treatment was received. RESULTS: Among febrile patients seen at drug shops, 35% had a positive RDT result and 27% had a positive blood slide. Many patients (55%) had previously sought care from another drug shop prior to this consultation. Three quarters (73%) of all febrile patients seen at drug shops received an anti-malarial, of whom 39% received an ACT and 33% received quinine. The rest received another non-artemisinin monotherapy. Only one third (32%) of patients with a positive blood slide had received treatment with Coartem® while 34% of those with a negative blood slide had not received an anti-malarial. Overall appropriate treatment was 34 (95% CI: 28 - 40) with substantial between-cluster variation, ranging from 1% to 55%. CONCLUSION: In this setting, the proportion of malaria patients receiving appropriate ACT treatment at drug shops was low. This was due to the practice of presumptive treatment, inadequate training on malaria management and lack of knowledge that Coartem® was the recommended first-line treatment for malaria. There is urgent need for interventions to improve treatment of malaria at these outlets

Limit Analysis On Seismic Stability Of Anisotropic And Nonhomogeneous Slopes With Anti-slide Piles

This study employs the limit analysis method to evaluate the seismic stability of anisotropic and nonhomogeneous slopes stabilized with anti-slide piles. The pseudo-static approach is used to simplify the earthquake load. The yield seismic acceleration factor is obtained from the optimization procedure and the results are verified with the published data. Then, the seismically unstable slope is reinforced with anti-slide piles, and the seismic stability of the reinforced slope is explored. The results show that the anisotropy and Non homogeneity of soils have significant effects on the stabilizing force required from the anti-slide piles and the optimal location of the pile is near the toe of the slope

Using Community-Owned Resource Persons to Provide Early Diagnosis and Treatment and Estimate Malaria Burden at Community Level in North-Eastern Tanzania.

Although early diagnosis and prompt treatment is an important strategy for control of malaria, using fever to initiate presumptive treatment with expensive artemisinin combination therapy is a major challenge; particularly in areas with declining burden of malaria. This study was conducted using community-owned resource persons (CORPs) to provide early diagnosis and treatment of malaria, and collect data for estimation of malaria burden in four villages of Korogwe district, north-eastern Tanzania.In 2006, individuals with history of fever within 24 hours or fever (axillary temperature ≥37.5°C) at presentation were presumptively treated using sulphadoxine/pyrimethamine. Between 2007 and 2010, individuals aged five years and above, with positive rapid diagnostic tests (RDTs) were treated with artemether/lumefantrine (AL) while under-fives were treated irrespective of RDT results. Reduction in anti-malarial consumption was determined by comparing the number of cases that would have been presumptively treated and those that were actually treated based on RDTs results. Trends of malaria incidence and slide positivity rates were compared between lowlands and highlands. Of 15,729 cases attended, slide positivity rate was 20.4% and declined by >72.0% from 2008, reaching <10.0% from 2009 onwards; and the slide positivity rates were similar in lowlands and highlands from 2009 onwards. Cases with fever at presentation declined slightly, but remained at >40.0% in under-fives and >20.0% among individuals aged five years and above. With use of RDTs, cases treated with AL decreased from <58.0% in 2007 to <11.0% in 2010 and the numbers of adult courses saved were 3,284 and 1,591 in lowlands and highlands respectively. Malaria incidence declined consistently from 2008 onwards; and the highest incidence of malaria shifted from children aged <10 years to individuals aged 10-19 years from 2009. With basic training, supervision and RDTs, CORPs successfully provided early diagnosis and treatment and reduced consumption of anti-malarials. Progressively declining malaria incidence and slide positivity rates suggest that all fever cases should be tested with RDTs before treatment. Data collected by CORPs was used to plan phase 1b MSP3 malaria vaccine trial and will be used for monitoring and evaluation of different health interventions. The current situation indicates that there is a remarkable changing pattern of malaria and these areas might be moving from control to pre-elimination levels

Real Origins of the Great Depression: Monopolistic Competition, Union Power, and the American Business Cycle in the 1920s

Most treatments of the Great Depression have focused on its onset and its aftermath. In contrast, we take a unified view of the interwar period. We look at the slide into and the emergence from the 1920-21 recession and the roaring 1920s boom, as well as the slide into the Great Depression after 1929, and attempt to explain these phenomena in a unified framework. The model framework combines monopolistic product market competition with search frictions and bargaining in the labor market, allowing for both individual and collective (unionized) wage bargaining. We attribute the extraordinary macroeconomic and financial volatility of this period to two factors: Shifts in the wage bargaining regime and in the degree of monopoly power in the economy. The pro-union provisions of the Clayton Act of 1914 contributed to the slide in asset prices and the depression of 1920-21, while a series of tough anti-union Supreme Court decisions in late 1921 and 1922 coupled with the lax anti-trust enforcement of the Coolidge and Hoover administrations enabled a major rise in corporate profits and stock market valuations throughout the 1920s. Landmark court decisions in favor of trade unions in the late 1920s, as well as political pressure on firms to adopt the welfare capitalism model of high wages, made the economy increasingly susceptible to collapsing profit expectations. We model the onset of the great depression as an equilibrium switch from individual wage bargaining to (actual or mimicked) collective wage bargaining. The general equilibrium effects of this regime change are consistent with large decreases in output, employment, and stock prices.Trade unions, collective bargaining, Great Depression

Passive Sliders on Growing Surfaces and (anti-)Advection in Burger's Flows

We study the fluctuations of particles sliding on a stochastically growing surface. This problem can be mapped to motion of passive scalars in a randomly stirred Burger's flow. Renormalization group studies, simulations, and scaling arguments in one dimension, suggest a rich set of phenomena: If particles slide with the avalanche of growth sites (advection with the fluid), they tend to cluster and follow the surface dynamics. However, for particles sliding against the avalanche (anti-advection), we find slower diffusion dynamics, and density fluctuations with no simple relation to the underlying fluid, possibly with continuously varying exponents.Comment: 4 pages revtex

Diagnostic reliability of Widal slide agglutination test for enteric fever- still a query

Background: Typhoid fever is a major public health problem associated with significant morbidity and mortality in many countries. The Widal slide agglutination test is a commonly used test for diagnosing enteric fever. Limited literature is available on its diagnostic ability in comparison to the tube agglutination test. Aim of this study was carried out to evaluate the efficacy of the Widal slide agglutination test for the diagnosis of enteric fever.Methods: This cross-sectional study was done in department of microbiology in Jawahar Lal Nehru medical college and hospital, Ajmer over a period of six months from September 2013 to March 2014. A total of 640 serum samples received in the microbiology department were processed for detecting the presence of anti O and anti H agglutinins against S. typhi, S. Paratyphi A and S. Paratyphi B by slide and tube Widal agglutination tests as per standard protocols. The significant titre for O and H agglutinin, 1:160 was taken as positive.Results: Of the 154 slide Widal positive samples, 115 (18%) samples tested negative by the tube agglutination test whereas only 39 (6%) samples were positive by both slide and tube agglutination.Conclusions: Slide Widal test has high sensitivity and NPV (100%) can be used as a screening tool but due to low specificity (83.93%) any positive sample should be confirmed by tube Widal test

Single-cell western blotting.

To measure cell-to-cell variation in protein-mediated functions, we developed an approach to conduct ∼10(3) concurrent single-cell western blots (scWesterns) in ∼4 h. A microscope slide supporting a 30-μm-thick photoactive polyacrylamide gel enables western blotting: settling of single cells into microwells, lysis in situ, gel electrophoresis, photoinitiated blotting to immobilize proteins and antibody probing. We applied this scWestern method to monitor single-cell differentiation of rat neural stem cells and responses to mitogen stimulation. The scWestern quantified target proteins even with off-target antibody binding, multiplexed to 11 protein targets per single cell with detection thresholds of &lt;30,000 molecules, and supported analyses of low starting cell numbers (∼200) when integrated with FACS. The scWestern overcomes limitations of antibody fidelity and sensitivity in other single-cell protein analysis methods and constitutes a versatile tool for the study of complex cell populations at single-cell resolution

On the unlikelihood of specific long range forces in immunologic and enzymatic reactions

In the past few years, a great many experiments have been performed by Rothen (24, 25) which he has interpreted as suggesting that antigen and antibody, and enzyme and substrate proteins, can react specifically, although separated by distances of hundreds of angstroms. This hypothesis seems to conflict with evidence accumulated from many other investigations indicating that short range interactions, involving distances usually associated with electrostatic and van der Waals’ forces, and hydrogen bonds, of the order of 5 A, operate in these reactions. We have therefore engaged in a critical analysis of the experimental techniques used by Rothen to determine whether some interpretation other than that invoking the existence of specific long range forces could be found to explain his experimental results