Towards Eliminating Malaria in High Endemic Countries: The Roles of Community Health Workers and Related Cadres and their Challenges in Integrated Community Case Management for Malaria: A Systematic Review.

Human resource for health crisis has impaired global efforts against malaria in highly endemic countries. To address this, the World Health Organization (WHO) recommended scaling-up of community health workers (CHWs) and related cadres owing to their documented success in malaria and other disease prevention and management. Evidence is inconsistent on the roles and challenges they encounter in malaria interventions. This systematic review aims to summarize evidence on roles and challenges of CHWs and related cadres in integrated community case management for malaria (iCCM). This systematic review retrieved evidence from PubMed, CINAHL, ISI Web of Knowledge, and WHO regional databases. Terms extracted from the Boolean phrase used for PubMed were also used in other databases. The review included studies with Randomized Control Trial, Quasi-experimental, Pre-post interventional, Longitudinal and cohort, Cross-sectional, Case study, and Secondary data analysis. Because of heterogeneity, only narrative synthesis was conducted for this review. A total of 66 articles were eligible for analysis out of 1380 studies retrieved. CHWs and related cadre roles in malaria interventions included: malaria case management, prevention including health surveillance and health promotion specific to malaria. Despite their documented success, CHWs and related cadres succumb to health system challenges. These are poor and unsustainable finance for iCCM, workforce related challenges, lack of and unsustainable supply of medicines and diagnostics, lack of information and research, service delivery and leadership challenges. Community health workers and related cadres had important preventive, case management and promotive roles in malaria interventions. To enable their effective integration into the health systems, the identified challenges should be addressed. They include: introducing sustainable financing on iCCM programmes, tailoring their training to address the identified gaps, improving sustainable supply chain management of malaria drugs and diagnostics, and addressing regulatory challenges in the local contexts

Phase fluctuations in the ABC model

We analyze the fluctuations of the steady state profiles in the modulated phase of the ABC model. For a system of $L$ sites, the steady state profiles move on a microscopic time scale of order $L^3$. The variance of their displacement is computed in terms of the macroscopic steady state profiles by using fluctuating hydrodynamics and large deviations. Our analytical prediction for this variance is confirmed by the results of numerical simulations

Civil Rights in the 1990\u27s: Non-Discrimination or Quotas?

I would like today to offer some thoughts on the way that we as a country have handled the issue of reverse discrimination as a means of pursuing equal opportunity. My first observation is that there is an undeniable tension between competing approaches to racial and gender justice that have been advanced and pursued in recent years. I take as my starting point the fundamental principle embodied in the Equal Protection Clause (as well as the Declaration of Independence), that, as the elder Justice Harlan said in dissent in Plessy v. Ferguson,\u27 the Constitution is colorblind, and does not allow for official distinction by governmental bodies on the basis of a person\u27s race. This principle reached its long-delayed realization in the 1954 decision in Brown v. Board of Education,2 and has been at the core of most civil rights enforcement since that time. The numerous civil rights statutes of the 1960\u27s and \u2770\u27s had as their fundamental premise the notion that treatment of persons on account of certain specified immutable traits that are unrelated to merits or ability is wrong as a matter both of morality and of national policy

Stewardship

While I agree with much that Judge Edwards has proposed, I thus submit that his formulations of the problem are partial - a bit like those of the blind men examining different parts of the elephant. The law\u27s current unhappiness is only partly described as that of law schools and practicing lawyers going in different directions, of law practice becoming too commercial, or of law schools failing to serve the needs of the practicing lawyers and judges with practical teaching and scholarship. All of these observations, while correct as far as they go, miss the root of the problem, which has a common solution - the reinvigoration of those in the law With a sense of duty and vocation for the legal institutions of which we are all stewards

Young children's research: children aged 4-8 years finding solutions at home and at school

Children's research capacities have become increasingly recognised by adults, yet children remain excluded from the academy, with reports of their research participation generally located in adults' agenda. Such practice restricts children's freedom to make choices in matters affecting them, underestimates children’s capabilities and denies children particular rights. The present paper reports on one aspect of a small-scale critical ethnographic study adopting a constructivist grounded approach to conceptualise ways in which children's naturalistic behaviours may be perceived as research. The study builds on multi-disciplinary theoretical perspectives, embracing 'new' sociology, psychology, economics, philosophy and early childhood education and care (ECEC). Research questions include: 'What is the nature of ECEC research?' and 'Do children’s enquiries count as research?' Initially, data were collected from the academy: professional researchers (n=14) confirmed 'finding solutions' as a research behaviour and indicated children aged 4-8 years, their practitioners and primary carers as 'theoretical sampling'. Consequently, multi-modal case studies were constructed with children (n=138) and their practitioners (n=17) in three ‘good’ schools, with selected children and their primary carers also participating at home. This paper reports on data emerging from children aged 4-8 years at school (n=17) and at home (n=5). Outcomes indicate that participating children found diverse solutions to diverse problems, some of which they set themselves. Some solutions engaged children in high order thinking, whilst others did not; selecting resources and trialing activities engaged children in 'finding solutions'. Conversely, when children's time, provocations and activities were directed by adults, the quality of their solutions was limited, they focused on pleasing adults and their motivation to propose solutions decreased. In this study, professional researchers recognised 'finding solutions' as research behaviour and children aged 4-8 years naturalistically presented with capacities for finding solutions; however, the children's encounters with adults affected the solutions they found

Crystal Growth of Inorganic Halides and Oxide-Halides for Scintillation Applications and Radiation Detection

Scintillators, materials which emit light when struck by high energy X-rays and y- rays, are extensively used in various fields including medical imaging, computed tomography, high-energy physics, and more recently in homeland security for the prevention of nuclear and radiological terrorism. While comparing with the traditional scintillators, which have long-term instability, high synthetic cost, toxicity, and hygroscopicity issues, metal halides have been reported to exhibit effective excitonic radioluminescence and greatly contribute in the field of scintillating applications and radiation detection. Currently, the mixed-anion oxide-fluorides have emerged as a prospective new class of scintillators, in which the mixed oxide-fluoride environment around the metal center generate distortions which can significantly enhance the luminosity of the material. Growing high quality single crystals of these materials is another important factor for structure determination and property measurements as well as long-time stability. Exploratory crystal growth using facile solution based hydrothermal approach has been an effective method to synthesize new halides and oxide-halide materials. This work summarizes the crystal growth approaches for halide and mixed-anion oxide-halide single crystals, characterizes their structures and properties for their use as potential scintillators and radiation detection

Emotion and ethics: an inter-(en)active approach

The original publication is available at www.springerlink.comIn this paper we start exploring the affective and ethical dimension of what De Jaegher and Di Paolo (2007) have called ‘participatory sense-making’. In the first part, we distinguish various ways in which we are, and feel, affectively inter-connected in interpersonal encounters. In the second part, we discuss the ethical character of this affective interconnectedness, as well as the implications that taking an ‘inter-(en)active approach’ has for ethical theory itself

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Serum IL-33, a new marker predicting response to rituximab in rheumatoid arthritis

Background. Recent works have suggested a possible link between IL-33 and B-cell biology. We aimed to study in different cohorts and with an accurate ELISA assay the possible association between serum IL-33 detection and response to rituximab (RTX) in rheumatoid arthritis (RA) patients. Method. Serum IL-33, rheumatoid factor (RF), anti-citrullinated cyclic peptide antibodies (anti-CCP), high serum IgG level were assessed in 111 RA patients receiving a first course of 2 grams RTX (cohort 1) in an observational study and in 74 RA patients treated with the same schedule in routine care (cohort 2). Uni and multivariate analyzes identified factors associated with a European League Against Rheumatism response at 24 weeks. Results. At week 24, 84/111 (76%) and 54/74 (73%) patients reached EULAR response in the cohorts 1 and 2, respectively. Serum IL-33 was detectable in only 33,5% of the patients. In the combined cohorts, presence of RF or anti-CCP (OR 3.27, 95%CI [1.13-9.46]; p=0.03), high serum IgG (OR 2.32, 95%CI [1.01-5.33]; p=0.048) and detectable serum IL-33 (OR 2.40, 95%CI [1.01-5.72]; p=0.047) were all associated with RTX response in multivariate analysis. Combination of these 3 factors increased the likelihood to response to RTX. When serum IL-33 detection was added to seropositivity and serum IgG level, 100% of the patients with the 3 risk factors (corresponding to 9% of the population) responded to RTX (OR versus patients with none of the 3 risk factors = 29.61; 95% CI [1.30-674.79] p=0.034) Conclusion. Detectable serum IL-33 may predict clinical response to RTX, independently of and synergistically with autoantibodies and serum IgG level