Partnerships and Participation: Synthesising Methods to Improve the Quality of Planning and Training for Primary Health Care Services at District Level in Nepal

Summary Participation has been encouraged for many years in health development work, as a means to involve populations in improving the appropriateness and quality of their local health services. This article is an attempt to highlight a new approach to participation which moves away from a purely community focused activity and seeks to engage a broader partnership between health service providers, managers and users for a more accountable and sustainable end product. It takes inspiration from the Client Oriented Provider Efficient process (COPE) which has been proved an effective tool to improve the quality of reproductive health services. Mixing some of its core components with Participatory Learning and Action (PLA) methods we have developed a new model of participatory planning and training. Preliminary results show that including all stakeholders in the process can work as long as the exercises are accessible to all. This accessibility is achieved through a range of visualisation methods. As with any tool for Human Resource Development the crucial issue continues to be the need for effective follow up which can maintain levels of enthusiasm and quality in resource?poor settings

Gendering the City: the lived experience of transforming cities, urban cultures and spaces of belonging

Debates centred on ‘planetary urbanisation’ have raised questions over the adequacy of existing theories and epistemologies to explain the quantitative and qualitative transformations of cities. However, this theorization of the urban has met with opposition from post-colonial and feminist researchers amongst others. The comparative, empirical research in this collection, from Bolivia, India and Turkey, highlights that the city remains an important analytical and concrete framework, demarcated by contingency and cultural change through which residents must navigate. In particular we focus on the specificity of women’s lives and their capacity to problematise universalist theory, documenting their interrogation of simplistic binaries such as modern/traditional; their innovative approaches to informal settlement, housing and markets; their production of urban knowledge in order to negotiate the city; and processes and practices of mobility, experimentation, risk taking and aspiration that contest or support a myriad of urban imaginaries. Whilst not rejecting the need for theories that allow comparative perspectives on cities, our conclusions underscore the importance of recognising the multiple logics that generate city space and urban cultures, and the consequent need to parochialise the empirical basis of theories that claim to be global in outreach

Queensland Stout Whiting Fishery 1991 TO 2002

The stout whiting (Sillago robusta) fishery in southern Queensland is restricted to offshore waters between Caloundra and Sandy Cape in depths ranging between 20 and 50 fathoms. The fishery consists of five licensed trawlers (T4 endorsement). The fishery is managed by means of a ‘industry agreed’ yearly Total Allowable Catch (TAC), which is reviewed annually and divided equally among the vessels. The TAC quota was set at 1000 tonnes for the managed area in 2002. The stout whiting resource was assessed using a newly developed age-structured model, along side with the previous virtual population and surplus production models. The new model was tuned simultaneously to standardised monthly-catch-rates and yearly patterns in the stout whiting catch age-structure. The limit reference point B/K (the ratio of exploitable biomass in 2002 to the exploitable component of the virgin carrying capacity) was estimated to be at about 0.19 (B/K less than 0.2 is generally accepted as high risk of over exploitation). The results from all three models should be viewed cautiously as their uncertainty is high. Given the high uncertainty, any increase in TAC above 1000 t has high risk. In the last four years total catch has varied between 1178 t and 498 t. This year’s assessment has shown no increase in recruitment and biomass after the catch levels of 881 t in 2000 and 855 t in 2002. The management strategy evaluation suggests this years TAC should range between 700t and 900t depending on the target management objectives of risk and yield from the fishery (Table 3.6). This Table 3.6 should be used to guide the decision on TAC setting and to understand how best to compromise the issues of risk (over fishing) and optimising yield (maximising catch and value in the fishery). Summary of the assessment is given in Table 1.1

Stroke mimics transported by emergency medical services to a comprehensive stroke center : the magnitude of the problem

Background: Despite the use of validated prehospital stroke screens, stroke mimics are frequent among patients transported by Emergency Medical Services to the Emergency Department. We aimed to describe the frequency and characteristics of neurological and non-neurological mimics transported to a comprehensive stroke center for acute stroke evaluation. Methods: This was a retrospective analysis of a database consisting of all consecutive patients with suspected stroke transported to the Emergency Department of a comprehensive stroke center during an 18-month period. Hospital charts and neuroimaging were utilized to adjudicate the final diagnosis (acute stroke, stroke mimic, and specific underlying diagnoses). Results: 950 patients were transported with suspected stroke, among whom 405 (42.6%) were stroke mimics (age 66.9±17.1 years; 54% male). Neurological mimics were diagnosed in 223 (55.1%) patients and mimics were non-neurological in 182. The most common neurological diagnoses were seizures (19.7%), migraines (18.8%) and peripheral neuropathies (11.2%). Cardiovascular (14.6%) and psychiatric (11.9%) diagnoses were common non-neurological mimics. Patients with neurological mimic were younger (64.1±17.3 years vs. 70.5±16.1 years, p<0.001) and had less vascular risk factors than non-neurological mimics. The proportion of non-neurological mimics remained high (38%) despite the use of a prehospital identification scale. Conclusion: Stroke mimics are common among patients transported by Emergency Medical Services to a comprehensive stroke center for suspected stroke, with a considerable proportion being non-neurological in origin. Studies refining triage and transport of suspected acute stroke may be warranted to minimize the number of mimics transported by to a comprehensive stroke center for acute stroke evaluation

Estudio de experiencias y buenas prácticas comunitarias vinculadas a sistemas de restauración de paisajes forestales, en dos microrregiones del Departamento De San Marcos, Guatemala, C.A.

El presente trabajo de graduación se desarrolló en el altiplano del departamento de San Marcos, en las microrregiones Esquichá y Ricardo Chávez de la parte alta de la cuenca del río Coatán y del río Suchiate respectivamente. Tuvo la finalidad de apuntalar los esfuerzos regionales de desarrollo humano y conservación de los recursos naturales, coordinados por el Mecanismo de Restauración de Bosques y Paisajes y en la mejora de los medios de vida de las comunidades locales; enfocado a la restauración del paisaje forestal, entiéndase los bienes y servicios ambientales asociados a éste. El objetivo primordial del diagnóstico de las microrregiones, consistió en conocer la coyuntura ambiental y social del paisaje forestal en el área. La determinación de los factores de degradación del paisaje y los componentes sociales y ambientales, permitieron conocer hacia dónde orientar las acciones para la restauración del paisaje forestal, haciendo de éste un proceso sostenible. En tal sentido, la investigación se orientó al estudio y documentación de las buenas prácticas y sistemas tradicionales vinculados a la restauración del paisaje forestal en el altiplano occidental. Se documentaron un total de 18 buenas prácticas, algunas de éstas se implementaron a través del establecimiento de 10 sitios demostrativos, los cuales constituyen parcelas modelo de cómo restaurar el paisaje en diferentes condiciones edafoclimáticas y ecológicas, características de la región. Se realizó una caracterización biofísica detallada de cada uno de éstos sitios, incluyendo un análisis microbiológico del suelo, el cual constituye un pilar fundamental en el estudio de la degradación de los suelos de las tierras forestales. Dentro de los principales ejes de trabajo del mecanismo se encuentran la sensibilización, el fortalecimiento de capacidades y la implementación de sitios demostrativos de prácticas y sistemas de restauración del paisaje forestal; en respuesta a estos tres objetivos generales se desarrollaron los servicios profesionales

Galaxy Zoo: the dependence of morphology and colour on environment

We analyse the relationships between galaxy morphology, colour, environment and stellar mass using data for over 100,000 objects from Galaxy Zoo, the largest sample of visually classified morphologies yet compiled. We conclusively show that colour and morphology fractions are very different functions of environment. Both are sensitive to stellar mass; however, at fixed stellar mass, while colour is also highly sensitive to environment, morphology displays much weaker environmental trends. Only a small part of both relations can be attributed to variation in the stellar mass function with environment. Galaxies with high stellar masses are mostly red, in all environments and irrespective of their morphology. Low stellar-mass galaxies are mostly blue in low-density environments, but mostly red in high-density environments, again irrespective of their morphology. The colour-density relation is primarily driven by variations in colour fractions at fixed morphology, in particular the fraction of spiral galaxies that have red colours, and especially at low stellar masses. We demonstrate that our red spirals primarily include galaxies with true spiral morphology. We clearly show there is an environmental dependence for colour beyond that for morphology. Before using the Galaxy Zoo morphologies to produce the above results, we first quantify a luminosity-, size- and redshift-dependent classification bias that affects this dataset, and probably most other studies of galaxy population morphology. A correction for this bias is derived and applied to produce a sample of galaxies with reliable morphological type likelihoods, on which we base our analysis.Comment: 25 pages, 20 figures (+ 6 pages, 11 figures in appendices); moderately revised following referee's comments; accepted by MNRA

Interleukin 21 inhibits cancer-mediated FOXP3 induction in naïve human CD4 T cells

IL-21 is known to promote anti-tumour immunity due to its ability to promote T cell responses and counteract Treg-mediated suppression. It has also been shown to limit Treg frequencies during tumour-antigen stimulations. However, whether this represents inhibition of FOXP3 induction in naïve CD4 T cells or curtailed expansion of natural Treg remains unclear. Moreover, whether this effect is maintained in an environment of tumour-derived immunosuppressive factors is not known. Here, we show that in the context of a number of cancers, naïve CD45RA+ CD4 T cells are induced to express high levels of FOXP3, and that FOXP3 expression correlates with inhibition of T cell proliferation. FOXP3 expression was most potently induced by tumours secreting higher levels of total and active TGFβ1 and this induction could be potently counteracted with IL-21, restoring T cell proliferation. We conclude that Treg induction in naïve T cells is a common phenomenon amongst a number of different cancers and that the ability of IL-21 to counteract this effect is further evidence of its promise in cancer therapy

Investigation of the key chemical structures involved in the anticancer activity of disulfiram in A549 non-small cell lung cancer cell line

© 2018 The Author(s). Background: Disulfiram (DS), an antialcoholism medicine, demonstrated strong anticancer activity in the laboratory but did not show promising results in clinical trials. The anticancer activity of DS is copper dependent. The reaction of DS and copper generates reactive oxygen species (ROS). After oral administration in the clinic, DS is enriched and quickly metabolised in the liver. The associated change of chemical structure may make the metabolites of DS lose its copper-chelating ability and disable their anticancer activity. The anticancer chemical structure of DS is still largely unknown. Elucidation of the relationship between the key chemical structure of DS and its anticancer activity will enable us to modify DS and speed its translation into cancer therapeutics. Methods: The cytotoxicity, extracellular ROS activity, apoptotic effect of DS, DDC and their analogues on cancer cells and cancer stem cells were examined in vitro by MTT assay, western blot, extracellular ROS assay and sphere-reforming assay. Results: Intact thiol groups are essential for the in vitro cytotoxicity of DS. S-methylated diethyldithiocarbamate (S-Me-DDC), one of the major metabolites of DS in liver, completely lost its in vitro anticancer activity. In vitro cytotoxicity of DS was also abolished when its thiuram structure was destroyed. In contrast, modification of the ethyl groups in DS had no significant influence on its anticancer activity. Conclusions: The thiol groups and thiuram structure are indispensable for the anticancer activity of DS. The liver enrichment and metabolism may be the major obstruction for application of DS in cancer treatment. A delivery system to protect the thiol groups and development of novel soluble copper-DDC compound may pave the path for translation of DS into cancer therapeutics.This work was supported by grant from British Lung Foundation (RG14–8) and Innovate UK (104022).Published versio

Defining Plasmodium falciparum Treatment in South West Asia: A Randomized Trial Comparing Artesunate or Primaquine Combined with Chloroquine or SP

INTRODUCTION: Antimalarial resistance has led to a global policy of artemisinin-based combination therapy. Despite growing resistance chloroquine (CQ) remained until recently the official first-line treatment for falciparum malaria in Pakistan, with sulfadoxine-pyrimethamine (SP) second-line. Co-treatment with the gametocytocidal primaquine (PQ) is recommended for transmission control in South Asia. The relative effect of artesunate (AS) or primaquine, as partner drugs, on clinical outcomes and gametocyte carriage in this setting were unknown. METHODS: A single-blinded, randomized trial among Afghan refugees in Pakistan compared six treatment arms: CQ; CQ+(single-dose)PQ; CQ+(3 d)AS; SP; SP+(single-dose)PQ, and SP+(3 d)AS. The objectives were to compare treatment failure rates and effect on gametocyte carriage, of CQ or SP monotherapy against the respective combinations (PQ or AS). Outcomes included trophozoite and gametocyte clearance (read by light microscopy), and clinical and parasitological failure. FINDINGS: A total of 308 (87%) patients completed the trial. Failure rates by day 28 were: CQ 55/68 (81%); CQ+AS 19/67 (28%), SP 4/41 (9.8%), SP+AS 1/41 (2.4%). The addition of PQ to CQ or SP did not affect failure rates (CQ+PQ 49/67 (73%) failed; SP+PQ 5/33 (16%) failed). AS was superior to PQ at clearing gametocytes; gametocytes were seen on d7 in 85% of CQ, 40% of CQ+PQ, 21% of CQ+AS, 91% of SP, 76% of SP+PQ and 23% of SP+AS treated patients. PQ was more effective at clearing older gametocyte infections whereas AS was more effective at preventing emergence of mature gametocytes, except in cases that recrudesced. CONCLUSIONS: CQ is no longer appropriate by itself or in combination. These findings influenced the replacement of CQ with SP+AS for first-line treatment of uncomplicated falciparum malaria in the WHO Eastern Mediterranean Region. The threat of SP resistance remains as SP monotherapy is still common. Three day AS was superior to single-dose PQ for reducing gametocyte carriage. TRIAL REGISTRATION: ClinicalTrials.gov NCT00959517