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

Dopamine responses comply with basic assumptions of formal learning theory

According to contemporary learning theories, the discrepancy, or error, between the actual and predicted reward determines whether learning occurs when a stimulus is paired with a reward. The role of prediction errors is directly demonstrated by the observation that learning is blocked when the stimulus is paired with a fully predicted reward. By using this blocking procedure, we show that the responses of dopamine neurons to conditioned stimuli was governed differentially by the occurrence of reward prediction errors rather than stimulus−reward associations alone, as was the learning of behavioural reactions. Both behavioural and neuronal learning occurred predominantly when dopamine neurons registered a reward prediction error at the time of the reward. Our data indicate that the use of analytical tests derived from formal behavioural learning theory provides a powerful approach for studying the role of single neurons in learning

Atmospheric circulation patterns, cloud-to-ground lightning, and locally intense convective rainfall associated with debris flow initiation in the Dolomite Alps of northeastern Italy

The Dolomite Alps of northeastern Italy experience debris flows with great frequency during the summer months. An ample supply of unconsolidated material on steep slopes and a summer season climate regime characterized by recurrent thunderstorms combine to produce an abundance of these destructive hydro-geologic events. In the past, debris flow events have been studied primarily in the context of their geologic and geomorphic characteristics. The atmospheric contribution to these mass-wasting events has been limited to recording rainfall and developing intensity thresholds for debris mobilization. This study aims to expand the examination of atmospheric processes that preceded both locally intense convective rainfall (LICR) and debris flows in the Dolomite region. 500 hPa pressure level plots of geopotential heights were constructed for a period of 3 days prior to debris flow events to gain insight into the synoptic-scale processes which provide an environment conducive to LICR in the Dolomites. Cloud-to-ground (CG) lightning flash data recorded at the meso-scale were incorporated to assess the convective environment proximal to debris flow source regions. Twelve events were analyzed and from this analysis three common synoptic-scale circulation patterns were identified. Evaluation of CG flashes at smaller spatial and temporal scales illustrated that convective processes vary in their production of CF flashes (total number) and the spatial distribution of flashes can also be quite different between events over longer periods. During the 60 min interval immediately preceding debris flow a majority of cases exhibited spatial and temporal colocation of LICR and CG flashes. Also a number of CG flash parameters were found to be significantly correlated to rainfall intensity prior to debris flow initiation

From dendrimers to fractal polymers and beyond

O advento da química dendrítica tem facilitado a pesquisa de materiais por permitir o controle preciso do posicionamento do componente funcional na arquitetura macromolecular. Os protocolos sintéticos iterativos usados para construção dos dendrímeros foram desenvolvidos baseados no desejo de elaborar moléculas extremamente ramificadas, com alta massa molecular, massa exata e funcionalidade planejada. Arborols, inspirados em árvores e precursores de macromoléculas utilitárias, conhecidas hoje como dendrímeros, foram os primeiros exemplos a empregar blocos de construção de ramificação-C 1→3; Características físicas dos Arborols, incluindo a sua forma globular, excelente solubilidade, e agregação, combinam-se para revelar o potencial supramolecular inerente (isto é, a micela unimolecular) destas espécies únicas. A arquitetura que é característica dos materiais dendríticos também exibe qualidades fractais com base em estruturas repetitivas, ramificadas e auto-similares. Assim, o design fractal e os aspectos supramoleculares destas construções são sugestivas de um campo maior de materiais fractais que incorporam geometrias repetidas. O uso de terpiridina-M2+-terpiridina (onde, M = Ru, Zn, Fe, etc) em conjunto com algoritmos matemáticos tais como as formas da base do Triângulo de Seirpinski, tem permitido o início da exploração da construção de materiais fractais. A propensão da auto-criação de moléculas fractais para arquiteturas de ordem superior adiciona outra dimensão para essa nova arena de materiais e construção de compostos.The advent of dendritic chemistry has facilitated materials research by allowing precise control of functional component placement in macromolecular architecture. The iterative synthetic protocols used for dendrimer construction were developed based on the desire to craft highly branched, high molecular weight, molecules with exact mass and tailored functionality. Arborols, inspired by trees and precursors of the utilitarian macromolecules known as dendrimers today, were the first examples to employ predesigned, 1 → 3 C-branched, building blocks; physical characteristics of the arborols, including their globular shapes, excellent solubilities, and demonstrated aggregation, combined to reveal the inherent supramolecular potential (e.g., the unimolecular micelle) of these unique species. The architecture that is a characteristic of dendritic materials also exhibits fractal qualities based on self-similar, repetitive, branched frameworks. Thus, the fractal design and supramolecular aspects of these constructs are suggestive of a larger field of fractal materials that incorporates repeating geometries and are derived by complementary building block recognition and assembly. Use of terpyridine-M2+-terpyridine (where, M = Ru, Zn, Fe, etc) connectivity in concert with mathematical algorithms, such as forms the basis for the Seirpinski gasket, has allowed the beginning exploration of fractal materials construction. The propensity of the fractal molecules to self-assemble into higher order architectures adds another dimension to this new arena of materials and composite construction

Assessment Of Life Cycle Climate Performance (LCCP) Tools For HVAC&R Applications With The Latest Next Generation Refrigerant Technology

Societal demands to control climate change are driving the development of many Life Cycle Climate Performance (LCCP) tools to understand how to minimize the total environmental impacts of HVAC&R products and technology. The LCCP models can be extremely detailed, accounting for all CO2 contributions from “cradle” (refrigerant and product manufacturing), through use (including servicing and potential leak rates by type of product), to “grave” (recycling and disposal) for a product. LCCP tools have been developed for a number of HVAC&R product segments and continue to grow in number. However, there are few studies into understanding how the results from these various tools compare to each other against the latest available lower Global Warming Potential (GWP) next generation refrigerant technology. Because global regulatory discussions currently are focusing on reducing direct GWP contributions of refrigerants and for the most part are ignoring their impact on indirect GWP contributions as refrigerant choices are considered, there is potential for regulators to reduce the available refrigerant choices that would allow manufacturers to minimize the total environmental impact (lowest LCCP) through maximum efficiency. This paper will provide an overall assessment of using the latest available refrigerants technology with four LCCP tools. LCCP tools for the stationary refrigeration, transport refrigeration, chiller, and unitary product segments will be compared to understand the impact of reducing the direct GWP of a refrigerant given the latest refrigerant technology. This paper will suggest appropriate GWP limits for refrigerants by application, since direct GWP limits may need to be defined by application type based on the available refrigerant technology to minimize environmental impacts

Does the National Health Insurance Scheme provide financial protection to households in Ghana?

BACKGROUND: Excessive healthcare payments can impede access to health services and also disrupt the welfare of households with no financial protection. Health insurance is expected to offer financial protection against health shocks. Ghana began the implementation of its National Health Insurance Scheme (NHIS) in 2004. The NHIS is aimed at removing the financial barrier to healthcare by limiting direct out-of-pocket health expenditures (OOPHE). The study examines the effect of the NHIS on OOPHE and how it protects households against catastrophic health expenditures. METHODS: Data was obtained from a cross-sectional representative household survey involving 2,430 households from three districts across Ghana. All OOPHE associated with treatment seeking for reported illness in the household in the last 4 weeks preceding the survey were analysed and compared between insured and uninsured persons. The incidence and intensity of catastrophic health expenditures (CHE) among households were measured by the catastrophic health payment method. The relative effect of NHIS on the incidence of CHE in the household was estimated by multiple logistic regression analysis. RESULTS: About 36% of households reported at least one illness during the 4 weeks period. Insured patients had significantly lower direct OOPHE for out-patient and in-patient care compared to the uninsured. On financial protection, the incidence of CHE was lower among insured households (2.9%) compared to the partially insured (3.7%) and the uninsured (4.0%) at the 40% threshold. The incidence of CHE was however significantly lower among fully insured households (6.0%) which sought healthcare from NHIS accredited health facilities compared to the partially insured (10.1%) and the uninsured households (23.2%). The likelihood of a household incurring CHE was 4.2 times less likely for fully insured and 2.9 times less likely for partially insured households relative to being uninsured. The NHIS has however not completely eliminated OOPHE for the insured and their households. CONCLUSION: The NHIS has significant effect in reducing OOPHE and offers financial protection against CHE for insured individuals and their households though they still made some out-of-pocket payments. Efforts should aim at eliminating OOPHE for the insured if the objective for establishing the NHIS is to be achieved

Describing Self-confidence in Ultrasound Performance with Increased Exposure

Presented as a poster at 2020 IUSM Education Day

Kinematic and Microphysical Control of Lightning Flash Rate over Northern Alabama

The Deep Convective Clouds and Chemistry (DC3) experiment seeks to examine the relationship between deep convection and the production of nitrogen oxides (NO (sub x)) via lightning (LNO (sub x)). A critical step in estimating LNO (sub x) production in a cloud-resolving model (CRM) without explicit lightning is to estimate the flash rate from available model parameters that are statistically and physically correlated. As such, the objective of this study is to develop, improve and evaluate lightning flash rate parameterizations in a variety of meteorological environments and storm types using radar and lightning mapping array (LMA) observations taken over Northern Alabama from 2005-2012, including during DC3. UAH's Advanced Radar for Meteorological and Operational Research (ARMOR) and the Weather Surveillance Radar - 1988 Doppler (WSR 88D) located at Hytop (KHTX) comprises the dual-Doppler and polarimetric radar network, which has been in operation since 2004. The northern Alabama LMA (NA LMA) in conjunction with Vaisala's National Lightning Detection Network (NLDN) allow for a detailed depiction of total lightning during this period. This study will integrate ARMOR-KHTX dual Doppler/polarimetric radar and NA LMA lightning observations from past and ongoing studies, including the more recent DC3 results, over northern Alabama to form a large data set of 15-20 case days and over 20 individual storms, including both ordinary multicell and supercell convection. Several flash rate parameterizations will be developed and tested, including those based on 1) graupel/small hail volume; 2) graupel/small hail mass, and 3) convective updraft volume. Sensitivity of the flash rate parameterizations to storm intensity, storm morphology and environmental conditions will be explored

Measuring disease activity and predicting response to intravenous immunoglobulin in chronic inflammatory demyelinating polyneuropathy

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Abstract Chronic inflammatory demyelinating polyneuropathy (CIDP) is characterised by significant clinical heterogeneity and as such reliable biomarkers are required to measure disease activity and assess treatment response. Recent advances in our understanding of disease pathogenesis and the discovery of novel serum-based, electrophysiologic and imaging biomarkers allow clinicians to make more informed decisions regarding individualised treatment regimes. As a chronic immune-mediated process typified by relapse following withdrawal of immunomodulatory therapy, a substantial proportion of patients with CIDP require long term treatment with intravenous immunoglobulin (IVIg), a scarce and expensive donor-derived resource. The required duration and intensity of immunoglobulin treatment vary widely between individuals, highlighting both the heterogeneous nature of the underlying disease process as well as the variable pharmacologic properties of IVIg. This review outlines the use of multimodal biomarkers in the longitudinal evaluation of nerve injury and how recent developments have impacted our ability to predict both response to immunoglobulin administration and its withdrawal