Coverage, Adherence and Costs of Intermittent Preventive Treatment of Malaria in Children Employing Different Delivery Strategies in Jasikan, Ghana

BACKGROUND: Intermittent preventive treatment of malaria in children (IPTc) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected. IPTc provides a high level of protection against uncomplicated and severe malaria, with monthly sulphadoxine-pyrimethamine plus amodiaquine (SP&AQ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens. A key challenge is the identification of a cost-effective delivery strategy. METHODS: A community randomized trial was undertaken in Jasikan district, Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways. Twelve villages were randomly selected to receive IPTc from village health workers (VHWs) or facility-based nurses working at health centres' outpatient departments (OPD) or EPI outreach clinics. Children aged 3 to 59 months-old received one IPT course (three doses) in May, June, September and October. Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective. RESULTS: The economic cost per child receiving at least the first dose of all 4 courses was US$4.58 when IPTc was delivered by VHWs, US$4.93 by OPD nurses and US$5.65 by EPI nurses. The unit economic cost of receiving all 3 doses of all 4 courses was US$7.56 and US$8.51 when IPTc was delivered by VHWs or facility-based nurses respectively. The main cost driver for the VHW delivery was supervision, reflecting resources used for travelling to more remote communities rather than more intense supervision, and for OPD and EPI delivery, it was the opportunity cost of the time spent by nurses in dispensing IPTc. CONCLUSIONS: VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district, Ghana. TRIAL REGISTRATION: ClinicalTrials.gov NCT00119132

ICF components of corresponding outcome measures in flexor tendon rehabilitation – a systematic review

<p>Abstract</p> <p>Background</p> <p>The International Classification of Functioning, Disability and Health (ICF) delivers a holistic approach to health conditions. The objective of the present study is to provide an overview of flexor tendon rehabilitation outcome measures with respect to ICF components. Furthermore, it aims to investigate to which extent current assessments measure aspects of health according to these components primarily focussing on <it>activity </it>and <it>participation</it>.</p> <p>Methods</p> <p>A systematic literature review was conducted to identify all studies meeting the inclusion criteria. Studies were only included if they assessed more than <it>body function and body structure </it>and referred to the ICF components <it>activity </it>and <it>participation</it>. The outcome measures were analysed and their linkage to the ICF components were investigated to examine to which degree aspects of health outcome as defined by the ICF were considered.</p> <p>Results</p> <p>As anticipated, the application of outcome measures after flexor tendon repair is non conform. In many studies the emphasis still lies on physical impairment neglecting activity limitations and participation restrictions.</p> <p>Aspects of health after flexor tendon repair could be assessed more adequately and cover patients' needs more sufficiently by choosing outcome measures which refer to all aspects of functioning.</p> <p>Conclusion</p> <p>The ICF can help to identify aspects of health which are not being considered. The ICF can help promote further development of adequate outcome measures including activity limitation and participation restrictions by targeting patient centred goals and respecting patients' needs.</p

A framework for the development of a global standardised marine taxon reference image database (SMarTaR-ID) to support image-based analyses

Video and image data are regularly used in the field of benthic ecology to document biodiversity. However, their use is subject to a number of challenges, principally the identification of taxa within the images without associated physical specimens. The challenge of applying traditional taxonomic keys to the identification of fauna from images has led to the development of personal, group, or institution level reference image catalogues of operational taxonomic units (OTUs) or morphospecies. Lack of standardisation among these reference catalogues has led to problems with observer bias and the inability to combine datasets across studies. In addition, lack of a common reference standard is stifling efforts in the application of artificial intelligence to taxon identification. Using the North Atlantic deep sea as a case study, we propose a database structure to facilitate standardisation of morphospecies image catalogues between research groups and support future use in multiple front-end applications. We also propose a framework for coordination of international efforts to develop reference guides for the identification of marine species from images. The proposed structure maps to the Darwin Core standard to allow integration with existing databases. We suggest a management framework where high-level taxonomic groups are curated by a regional team, consisting of both end users and taxonomic experts. We identify a mechanism by which overall quality of data within a common reference guide could be raised over the next decade. Finally, we discuss the role of a common reference standard in advancing marine ecology and supporting sustainable use of this ecosystem

American palm ethnomedicine: A meta-analysis

<p>Abstract</p> <p>Background</p> <p>Many recent papers have documented the phytochemical and pharmacological bases for the use of palms (<it>Arecaceae</it>) in ethnomedicine. Early publications were based almost entirely on interviews that solicited local knowledge. More recently, ethnobotanically guided searches for new medicinal plants have proven more successful than random sampling for identifying plants that contain biodynamic ingredients. However, limited laboratory time and the high cost of clinical trials make it difficult to test all potential medicinal plants in the search for new drug candidates. The purpose of this study was to summarize and analyze previous studies on the medicinal uses of American palms in order to narrow down the search for new palm-derived medicines.</p> <p>Methods</p> <p>Relevant literature was surveyed and data was extracted and organized into medicinal use categories. We focused on more recent literature than that considered in a review published 25 years ago. We included phytochemical and pharmacological research that explored the importance of American palms in ethnomedicine.</p> <p>Results</p> <p>Of 730 species of American palms, we found evidence that 106 species had known medicinal uses, ranging from treatments for diabetes and leishmaniasis to prostatic hyperplasia. Thus, the number of American palm species with known uses had increased from 48 to 106 over the last quarter of a century. Furthermore, the pharmacological bases for many of the effects are now understood.</p> <p>Conclusions</p> <p>Palms are important in American ethnomedicine. Some, like <it>Serenoa repens </it>and <it>Roystonea regia</it>, are the sources of drugs that have been approved for medicinal uses. In contrast, recent ethnopharmacological studies suggested that many of the reported uses of several other palms do not appear to have a strong physiological basis. This study has provided a useful assessment of the ethnobotanical and pharmacological data available on palms.</p

On the Use of Field RR Lyrae as Galactic Probes. V. Optical and Radial Velocity Curve Templates

We collected the largest spectroscopic catalog of RR Lyrae (RRLs) including ≈20,000 high-, medium-, and low-resolution spectra for ≈10,000 RRLs. We provide the analytical forms of radial velocity curve (RVC) templates. These were built using 36 RRLs (31 fundamental—split into three period bins—and five first-overtone pulsators) with well-sampled RVCs based on three groups of metallic lines (Fe, Mg, Na) and four Balmer lines (Hα, Hβ, Hγ, Hδ). We tackled the long-standing problem of the reference epoch to anchor light-curve and RVC templates. For the V-band, we found that the residuals of the templates anchored to the phase of the mean magnitude along the rising branch are ∼35% to ∼45% smaller than those anchored to the phase of maximum light. For the RVC, we used two independent reference epochs for metallic and Balmer lines and we verified that the residuals of the RVC templates anchored to the phase of mean RV are from 30% (metallic lines) up to 45% (Balmer lines) smaller than those anchored to the phase of minimum RV. We validated our RVC templates by using both the single-point and the three phase point approaches. We found that barycentric velocities based on our RVC templates are two to three times more accurate than those available in the literature. We applied the current RVC templates to Balmer lines RVs of RRLs in the globular NGC 3201 collected with MUSE at VLT. We found the cluster barycentric RV of Vγ = 496.89 ± 8.37(error) ± 3.43 (standard deviation) km s−1, which agrees well with literature estimates

On the Use of Field RR Lyrae As Galactic Probes: IV. New Insights Into and Around the Oosterhoff Dichotomy*

We discuss the largest and most homogeneous spectroscopic data set of field RR Lyrae variables (RRLs) available to date. We estimated abundances using both high-resolution and low-resolution (ΔS method) spectra for fundamental (RRab) and first overtone (RRc) RRLs. The iron abundances for 7941 RRLs were supplemented with similar estimates that are available in the literature, ending up with 9015 RRLs (6150 RRab, 2865 RRc). The metallicity distribution shows a mean value of 〈[Fe/H]〉 = −1.51 ± 0.01, and σ(standard deviation) = 0.41 dex with a long metal-poor tail approaching [Fe/H] ≃ − 3 and a sharp metal-rich tail approaching solar iron abundance. The RRab variables are more metal-rich (〈[Fe/H]〉ab = −1.48 ± 0.01, σ = 0.41 dex) than RRc variables (〈[Fe/H]〉c = −1.58 ± 0.01, σ = 0.40 dex). The relative fraction of RRab variables in the Bailey diagram (visual amplitude versus period) located along the short-period (more metal-rich) and the long-period (more metal-poor) sequences are 80% and 20%, while RRc variables display an opposite trend, namely 30% and 70%, respectively. We found that the pulsation period of both RRab and RRc variables steadily decreases when moving from the metal-poor to the metal-rich regime. The visual amplitude shows the same trend, but RRc amplitudes are almost two times more sensitive than RRab amplitudes to metallicity. We also investigated the dependence of the population ratio (Nc/Ntot) of field RRLs on the metallicity and we found that the distribution is more complex than in globular clusters. The population ratio steadily increases from ∼0.25 to ∼0.36 in the metal-poor regime, it decreases from ∼0.36 to ∼0.18 for −1.8 ≤ [Fe/H] ≤ −0.9 and it increases to a value of ∼0.3 approaching solar iron abundance