Resisting control of neglected tropical diseases: dilemmas in the mass treatment of schistosomiasis and soil-transmitted helminths in north-west Uganda

A strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa’s ‘neglected tropical diseases’. Uganda was the first country to develop a programme for the integrated control of two of these diseases: schistosomiasis and soil-transmitted helminths. This paper discusses social responses to the programme in Panyimur, north-west Uganda. It shows that adults are increasingly rejecting free treatment. Resistance is attributed to a subjective fear of side-effects; divergence between biomedical and local understandings of schistosomiasis/bilharzia; as well as inappropriate and inadequate health education. In addition, the current procedures for distributing drugs at a district level are problematic. Additional research was carried out in neighbouring areas to explore the generalizability of findings. Comparable problems have arisen. It is concluded that the national programme will not fulfil its stated objectives of establishing a local demand for mass treatment unless it can establish more effective delivery strategies and promote behavioural change in socially appropriate ways. To do so will require new approaches to social, economic and political aspects of distribution. There are reasons why populations infected with the ‘neglected tropical diseases’ are themselves neglected. Those reasons cannot just be wished away

Comparing Functional Outcomes on Open Reduction and Internal Fixation for Acute Perilunate Dislocation and Fracture-Dislocations: A Systematic Review

Introduction: Outcomes based research on trauma-related orthopaedic injuries is imperative for gauging the effectiveness of current surgical procedures and thereby maximizing the patient\u27s functional status. In patients sustaining perilunate dislocations (PLD) and fracture-dislocations (PLFD) following a traumatic fall on an outstretched hand, early open reduction and internal fixation (ORIF) is widely considered the standard of care for acute cases, but evidence supporting optimal techniques and materials is limited in a body of literature consisting mainly of small retrospective case series and expert opinion. The aims of this study were to compare functional outcomes of PLD and PLFD by surgical technique and to identify the barriers and limitations to conducting research on these injuries, which has potential implications for other types of traumatic orthopedic surgeries as well, through a systematic review of the literature. Methods: An English-limited Pubmed search was performed using the phrase (radiocarpal OR perilunate OR midcarpal OR lunate OR wrist) AND (dislocation OR fracture) AND (research OR study OR studies OR trial OR retrospective OR prospective OR cohort OR follow-up OR meta-analysis OR systematic review). Studies were included if they presented original data on ORIF for acute (\u3c45 days) PLD and PLFD, described at least 5 cases, included details of the procedure and materials, had follow-up data for at least one year incorporating objective measures of wrist function, and were published no earlier than 1990. The extracted information included study design, patient demographics, injury type, surgical materials and techniques, complications, additional interventions, and functional measurements. Results: Of the 654 citations returned by the search phrase, 12 met the inclusion criteria. All articles were retrospective case-series with the most common reasons for exclusion being inappropriate subject, inadequate sample size, inclusion of non-acutely treated cases, and insufficient measures of wrist function. 179 wrists were represented (122 PLFD, 57 PLD) in 177 patients with mean ages from 24 to 38 years. The average delay to surgery was 4.1 days, and follow-up periods ranged from 12 months to 10 years. Substantial variability in reported functional measurements in association with variance in case mix and follow-up duration primarily limited comparisons between techniques. Selection bias through loss to follow-up was problematic with rates as high as 67%. Discussion: While systematic review and meta-analysis are the best available tools for overcoming the evidential limitations of inherently small sample sizes collected on rare injuries, the clinical and methodological heterogeneity encountered among the included articles in this review makes direct comparison and pooling of studies misleading. Additional case-series are needed with consistent validated outcome measurements collected at standardized intervals. Thorough data presentation and appropriate grouping will facilitate not only current practices but also future attempts at data comparison and will ultimately advance knowledge on the optimal tactics for handling these significant injuries. This study identified a significant risk for selection bias due to loss to follow-up, which is a threat to internal validity and a prohibitive factor for data availability that must be addressed in all orthopaedic trauma patients

Impacts of Climate Change on the Evolution of the Electrical Grid

Maintaining interdependent infrastructures exposed to a changing climate requires understanding 1) the local impact on power assets; 2) how the infrastructure will evolve as the demand for infrastructure changes location and volume and; 3) what vulnerabilities are introduced by these changing infrastructure topologies. This dissertation attempts to develop a methodology that will a) downscale the climate direct effect on the infrastructure; b) allow population to redistribute in response to increasing extreme events that will increase under climate impacts; and c) project new distributions of electricity demand in the mid-21st century. The research was structured in three parts. The first used downscaling techniques to scale regional gridded atmospheric processes to measurements of local extreme events. These techniques illustrate the ability to move reasonably from regional to local effects. The second chapter explored how people migrated in response to the extreme events for which climate change will increase the frequency and intensity. The third chapter translated downscaled climate impacts and granular population movements into a national map of electricity demand. The results of this research illustrates the feasibility of the three part approach to address possible future infrastructure vulnerabilities under varying policy options and technology assumptions. This methodology can be an important tool for increasing the robustness of the nation’s infrastructure

Study Analyzing the Perspectives of National Board Certified Media Specialists

The purpose of this study was to examine the perceptions of ESLMS\u27s (Expert School Library Media Specialists) as total educators (Fullan & Hargreaves, 1996), including the SLMSs (School Library Media Specialist) purpose, the ESLMS as a person, the organizational context and the culture of the SLMS\u27s school. The hypothesis was that ESLMSs role and development as experts in their field was directly related to their purpose and motivations, their view of themselves as persons including their beliefs and values, and the culture and organizational context of the specific school in which they work. Three SLMS\u27s currently employed in Georgia public high schools whom have earned National Board Certification in Library Media were selected for this study. Qualitative research methodology, including questionnaires and interviews, analysis of state and federal reports, an examination of collected artifacts, and an analysis of an online discussion forum, was utilized to create case studies of these three ESLMS\u27s. This research indicated that in order to excel in the media field all four aspects of the total educator must be addressed. The overall results indicate that 1) SLMSs must understand their purpose and goals and those purposes and goals must align with those of the schools in which they work in order to excel in their profession; 2) SLMSs must be aware of themselves as persons in order to grow and develop as professionals and 1 educators; 3) The organizational context of the SLMSs school must allow them control of aspects of their media program in order to implement an exemplary media program; and 4) The culture in which the SLMS\u27s works must provide administrative and staff support for the media program in order for them to implement an exemplary media program. Recommendations include the need to further the leadership roles of SLMSs within their schools; the call for SLMSs to augment their leadership role within their field; the need to increase the understanding and support of administrators for SLMSs; the obligation that SLMSs have to link their role within a school to student achievement; and the necessity to enhance the incentives for accomplishing National Board Certification

The Effects of Varying Physical Parameterizations and Initial Conditions on Tracer Transport in the National Aeronautics and Space Administration’s Goddard Earth Observation System Model, Version 5

The evolution of General Circulation Models (GCM) for climate study has led to more accurate predictions for atmospheric transport, yet precision in predictions remains in need of improvement. The National Aeronautics and Space Administration Goddard Earth Observation System model, Version 5 (GEOS-5) represents a state of the art climate model capable of simulating a wide variety of atmospheric processes informed continuously by satellite observations. This thesis examines some of the physical parameterizations employed by GEOS-5 and their effect on the transport of two greenhouse gasses: ozone and carbon dioxide

“Ain’t it a pretty night?”: An analysis of Carlisle Floyd’s Susannah as an allegory for the socio-political culture of the United States in the 1950s

This capstone thesis discusses the applicability of Carlisle Floyd’s 1955 opera, Susannah, as an allegory for the socio-political climate of the United States in the 1950s. In order to do so, a musical analysis of the opera’s score was then performed for its use of folk song conventions and verismo operatic conventions. The libretto was analyzed for the use of social conventions of Southern Appalachia. Characters actions and musical content were then judged on whether (1) their actions were in line with the social conventions of traditional Appalachian culture and (2) if their musical content used/reflected conventions of traditional Appalachian folk music. Research on the socio-political culture of the United States during the 1950s and comparisons between the opera and the time period were then drawn and expanded upon. If a character’s actions and musical content was consistent with Appalachian folk tradition, they were grouped with other characters who had similar musical and cultural traits. If a character’s actions and musical content was not consistent with the local cultural norms, both musically and culturally, they were placed in a separate group. The division between character in terms of social acceptability was used as the basis for the allegory between Susannah and the socio-political climate of 1950s United States. By creating a group that is considered to be the “outsiders,” it allowed the fear of the unknown that was prevalent in the socio-political culture of the 1950s that led to the rise of McCarthyism and the accusatory culture political culture of the time. As a whole, the opera provides a critique about the negative impacts of hyper-conservative social culture and the xenophobia that resulted from McCarthyism on American culture during the 1950s

#PublicAuthority: what will happen when there is another epidemic? Ebola in Mathiane, Sierra Leone

Melissa Parker and Tim Allen discover how long-standing customary forms of governance played a critical role in ending the Ebola outbreak in Sierra Leone

Deworming delusions? Mass drug administration in East African schools

Recent debates about deworming school-aged children in East Africa have been described as the ‘Worm Wars’. The stakes are high. Deworming has become one of the top priorities in the fight against infectious diseases. Staff at the World Health Organization, the Gates Foundation and the World Bank (among other institutions) have endorsed the approach, and school-based treatments are a key component of large-scale mass drug administration programmes. Drawing on field research in Uganda and Tanzania, and engaging with both biological and social evidence, this article shows that assertions about the effects of school-based deworming are over-optimistic. The results of a much-cited study on deworming Kenyan school children, which has been used to promote the intervention, are flawed, and a systematic review of randomized controlled trials demonstrates that deworming is unlikely to improve overall public health. Also, confusions arise by applying the term deworming to a variety of very different helminth infections and to different treatment regimes, while local-level research in schools reveals that drug coverage usually falls below target levels. In most places where data exist, infection levels remain disappointingly high. Without indefinite free deworming, any declines in endemicity are likely to be reversed. Moreover, there are social problems arising from mass drug administration that have generally been ignored. Notably, there are serious ethical and practical issues arising from the widespread practice of giving tablets to children without actively consulting parents. There is no doubt that curative therapy for children infected with debilitating parasitic infections is appropriate, but overly positive evaluations of indiscriminate deworming are counter-productive

Debunking delusions around deworming

Tim Allen and Melissa Parker argue that a biosocial approach is necessary for ‘deworming’ to succeed in improving lives

Will mass drug administration eliminate lymphatic filariasis? Evidence from northern coastal Tanzania

Copyright @ 2012 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and 85 reproduction in any medium, provided the original author and source are credited. The article was made available through the Brunel University Open Access Publishing Fund.This article documents understandings and responses to mass drug administration (MDA) for the treatment and prevention of lymphatic filariasis among adults and children in northern coastal Tanzania from 2004 to 2011. Assessment of village-level distribution registers, combined with self-reported drug uptake surveys of adults, participant observation and interviews, revealed that at study sites in Pangani and Muheza districts the uptake of drugs was persistently low. The majority of people living at these highly endemic locations either did not receive or actively rejected free treatment. A combination of social, economic and political reasons explain the low uptake of drugs. These include a fear of treatment (attributable, in part, to a lack of trust in international aid and a questioning of the motives behind the distribution); divergence between biomedical and local understandings of lymphatic filariasis; and limited and ineffective communication about the rationale for mass treatment. Other contributory factors are the reliance upon volunteers for distribution within villages and, in some locations, strained relationships between different groups of people within villages as well as between local leaders and government officials. The article also highlights a disjuncture between self-reported uptake of drugs by adults at a village level and the higher uptake of drugs recorded in official reports. The latter informs claims that elimination will be a possibility by 2020. This gives voice to a broader problem: there is considerable pressure for those implementing MDA to report positive results. The very real challenges of making MDA work are pushed to one side - adding to a rhetoric of success at the expense of engaging with local realities. It is vital to address the kind of issues raised in this article if current attempts to eliminate lymphatic filariasis in mainland coastal Tanzania are to achieve their goal.This work is funded from the Bill and Melinda Gates Foundation