Health-seeking behaviour and community perceptions of childhood undernutrition and a community management of acute malnutrition (CMAM) programme in rural Bihar, India: a qualitative study.

Objective Since 2009, Médecins Sans Frontières has implemented a community management of acute malnutrition (CMAM) programme in rural Biraul block, Bihar State, India that has admitted over 10 000 severely malnourished children but has struggled with poor coverage and default rates. With the aim of improving programme outcomes we undertook a qualitative study to understand community perceptions of childhood undernutrition, the CMAM programme and how these affected health-seeking behaviour

“Without antibiotics, I cannot treat”: A qualitative study of antibiotic use in Paschim Bardhaman district of West Bengal, India

BACKGROUND:Misuse of antibiotics is a well-known driver of antibiotic resistance. Given the decentralized model of the Indian health system and the shortage of allopathic doctors in rural areas, a wide variety of healthcare providers cater to the needs of patients in urban and rural settings. This qualitative study explores the drivers of antibiotic use among formal and informal healthcare providers as well as patients accessing care at primary health centers across Paschim Bardhaman district in West Bengal. MATERIALS AND METHODS:We conducted 28 semi-structured, in-depth interviews with four groups of healthcare providers (allopathic doctors, informal health providers, nurses, and pharmacy shopkeepers) as well as patients accessing care at primary health centers and hospitals across Paschim Bardhaman district. Qualitative data was analyzed using the framework method in an inductive and deductive manner. RESULTS:Our results indicate that patients demand antibiotics from healthcare providers and seek the fastest cure possible, which influences the prescription choices of healthcare providers, particularly informal health providers. Many allopathic doctors provide antibiotics without any clinical indication due to inconsistent follow up, lack of testing facilities, risk of secondary infections, and unhygienic living conditions. Pharmaceutical company representatives actively network with informal health providers and formal healthcare providers alike, and regularly visit providers even in remote areas to market newer antibiotics. Allopathic doctors and informal health providers frequently blame the other party for being responsible for antibiotic resistance, and yet both display interdependence in referring patients to one another. CONCLUSIONS:A holistic approach to curbing antibiotic resistance in West Bengal and other parts of India should focus on strengthening the capacity of the existing public health system to deliver on its promises, improving patient education and counseling, and including informal providers and pharmaceutical company representatives in community-level antibiotic stewardship efforts

Seasonal effect and long-term nutritional status following exit from a Community-Based Management of Severe Acute Malnutrition program in Bihar, India.

BACKGROUND/OBJECTIVES: Children aged 6 months to 5 years completing treatment for severe acute malnutrition (SAM) in a Médecins Sans Frontières Community Management of Acute Malnutrition (CMAM) program in Bihar, India, showed high cure rates; however, the program suffered default rates of 38%. This report describes the nutritional status of 1956 children followed up between 3 and 18 months after exiting the program. SUBJECTS/METHODS: All children aged 6-59 months discharged as cured with mid-upper arm circumference (MUAC) ⩾120 mm or who defaulted from the program with MUAC <115 mm were traced at 3, 6, 9, 12 and 18 months (±10 days) before three exit reference dates: first at the end of the food insecure period, second after the 2-month food security and third after the 4-month food security. RESULTS: Overall, 68.7% (n=692) of defaulters and 76.2% (n=1264) of children discharged as cured were traced. Combined rates of non-recovery in children who defaulted with MUAC <115 mm were 41%, 30.1%, 9.9%, 6.1% and 3.6% at 3, 6, 9, 12 and 18 months following exit, respectively. Combined rates of relapse among cured cases (MUAC ⩾120 mm) were 9.1%, 2.9%, 2.1%, 2.8% and 0% at 3, 6, 9, 12 and 18 months following discharge, respectively. Prevalence of undernutrition increased substantially for both groups traced during low food security periods. Odds of death were much higher for children defaulting with MUAC <110 mm when compared with children discharged as cured, who shared the same mortality risk as those defaulting with MUAC 110-<115 mm. CONCLUSIONS: Seasonal food security predicted short-term nutritional status after exit, with relapse rates and non-recovery from SAM much higher during food insecurity. Mortality outcomes suggest that a MUAC of 110 mm may be considered an appropriate admission point for SAM treatment programs in this context

Controlling the spectrum of x-rays generated in a laser-plasma accelerator by tailoring the laser wavefront

By tailoring the wavefront of the laser pulse used in a laser-wakefield accelerator, we show that the properties of the x-rays produced due to the electron beam's betatron oscillations in the plasma can be controlled. By creating a wavefront with coma, we find that the critical energy of the synchrotron-like x-ray spectrum can be significantly increased. The coma does not substantially change the energy of the electron beam, but does increase its divergence and produces an energy-dependent exit angle, indicating that changes in the x-ray spectrum are due to an increase in the electron beam's oscillation amplitude within the wakefield.Comment: 7 pages, 2 figures, submitted to Appl. Phys. Let

Prevalence of asymptomatic leishmania infection in people living with HIV and progression to symptomatic visceral leishmaniasis in Bihar, India

Intro People living with HIV (PLHIV) have an increased risk of developing visceral leishmaniasis (VL) and poor outcomes compared to HIV-negative individuals. Here, we aim to establish the prevalence and determinants of asymptomatic Leishmania infection (ALI) and the rate and risk factors for progression of ALI to VL in a cohort of PLHIV in Bihar, India. Methods We conducted a cross-sectional survey of PLHIV ≥18 years of age with no history or current diagnosis of VL or PKDL at anti-retroviral therapy centres within VL endemic districts of Bihar. ALI was defined as a positive rK39 ELISA, rK39 RDT, and/or qPCR. Additionally, the urinary Leishmania antigen ELISA was evaluated. The ALI and non-ALI cohorts were followed up every three months for 18 months in person and by telephone, respectively. Determinants for ALI were established using logistic regression model. Findings A total of 1,296 PLHIV enrolled in HIV care, 694 (53.6%) of whom were female and a median age of 39 years (IQR 33–46), were included in the analysis. The baseline prevalence of ALI was 7.4% (n=96). All 96 individuals were positive by rK39 ELISA, while 0.5% (n=6) and 0.4% (n=5) were positive by qPCR and rK39 RDT, respectively. Risk factors for ALI were CD4 counts <100 (OR 3.1; 95%CI 1.2–7.6) and CD4 counts 100-199 (OR=2.1; 95% CI: 1.1-4.0) compared to CD4 counts ≥300, and a household size ≥5 (OR=1.9; 95%CI: 1.1-3.1).Within the ALI cohort, four (3.7%) participants developed VL, compared to no progression in the non-ALI cohort. Mortality rates were higher in ALI compared to non-ALI (OR =2.7; 95% CI: 1.1-6.1). Conclusion The prevalence of ALI in PLHIV in VL endemic villages in Bihar was relatively high. However, the progression rate from ALI to VL in PLHIV was low. Patients with low CD4 counts and larger household size were at higher risk of ALI

Control and optimization of a staged laser-wakefield accelerator

We report results of an experimental study of laser-wakefield acceleration of electrons, using a staged device based on a double-jet gas target that enables independent injection and acceleration stages. This novel scheme is shown to produce stable, quasi-monoenergetic, and tunable electron beams. We show that optimal accelerator performance is achieved by systematic variation of five critical parameters. For the injection stage, we show that the amount of trapped charge is controlled by the gas density, composition, and laser power. For the acceleration stage, the gas density and the length of the jet are found to determine the final electron energy. This independent control over both the injection and acceleration processes enabled independent control over the charge and energy of the accelerated electron beam while preserving the quasi-monoenergetic character of the beam. We show that the charge and energy can be varied in the ranges of 2–45 pC, and 50–450 MeV, respectively. This robust and versatile electron accelerator will find application in the generation of high-brightness and controllable x-rays, and as the injector stage for more conventional devices

Aspectos históricos da neuropsicologia: subsídios para a formação de educadores

A neuropsicologia é uma ciência do século XX, mas as raízes da sua história remontam a Antigüidade. O objetivo deste estudo é discutir aspectos da história da neuropsicologia, desde a sua origem até o seu surgimento e estabelecimento enquanto ciência, com o objetivo de fornecer subsídios a educadores interessados no estudo das dificuldades e dos distúrbios de aprendizagem. Uma teoria da aprendizagem efetiva deve levar em conta os substratos anatômicos cerebrais e os mecanismos neurofisiológicos do comportamento, pois só assim o educador poderá compreender o nãoaprender do aluno e, conseqüentemente, adotar estratégias adequadas para superá-lo