Rapid decline in child mortality in a rural area of Senegal

Retrospective and prospective demographic and health data collected on the population of Mlomp (6352 people in 1985), a rural area of Senegal, show that the probability of dying before the age of 5 years declined from 350 to 81 deaths per hundred livebirths in the last 25 years. This dedine is greater and faster than ever observed in Senegal. The drop in mortality mainly results from improved access to new and efficient health services-a dispensary and a maternity clinic-and from growth surveillance, health education, vaccination and malaria programmes initiated in the 1960s and 1970s. Although socioeconomic conditions have changed in the area, the influence of classical factors such as women's educational level and improvement in transportation has probably been limited. Deaths from diseases that can be prevented by immunization (such as neonatal tetanus, measles, whooping cough) are now very rare (3% of the deaths of children under 5 years during the period 1985–1989). Although the risks of dying from diarrhoea or acute respiratory infections are much lower than in other rural areas of Senegal, these are still the main causes of deaths (33% and 19% of deaths after 1 month of age). Malaria, despite its high morbidity during the rainy season, causes few deaths (4%). This reflects the success of the health education programme promoting chemoprophylaxis and early treatment of fever cases. Mlomp is one example of an African rural area where the provision of well-organized health services at a reasonable cost has produced a dramatic decline in child mortality

Recent Advances in the Management of Diabetes Mellitus

peer reviewedThe recent epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can reduce morbidity have made the effective treatment of hyperglycemia a priority. The new therapeutic agents and the development of algorithms for the adjustment of therapy might contribute to an improved management of the disease. Moreover, type 2 diabetes is frequently associated with other co-morbidities (obesity, hypertension, dyslipidaemia, prothrombotic state). The appropriate management of patients with type 2 diabetes requires a global approach targeting each risk factor in order to reduce cardiovascular morbidity and mortality. This challenge represents a major public health issue. In type 1 diabetes patients, intensive therapy such as in the Diabetes Control and Complications Trial (DCCT) has been shown to obtain long-term beneficial effects on the reduction of the risk of progressive retinopathy, neuropathy and nephropathy and of the risk of cardiovascular disease. This benefit reinforces the original DCCT message that intensive therapy should be implemented as early as possible in people with type 1 diabetes. The recent development of new insulin analogues and the technical improvements of portable insulin pumps might contribute to obtain such a better metabolic control.RÉSUMÉ : L’augmentation d’incidence, quasi épidémique, du diabète de type 2 et la démonstration que l’obtention de bons taux glycémiques permettait de réduire la morbidité ont fait du traitement de l’hyperglycémie une priorité. Le développement de nouvelles classes thérapeutiques et la mise au point d’algorithmes de traitement contribuent à améliorer cette prise en charge. De plus, le diabète de type 2 est souvent associé à d’autres comorbidités (obésité, hypertension artérielle, dyslipidémies, état pro-thrombotique). La prise en charge du patient diabétique de type 2 requiert une approche globale visant à corriger chaque facteur de risque, ce qui permet de réduire substantiellement la mortalité cardio-vasculaire. Cette stratégie doit être considérée comme un objectif majeur de santé publique. Chez le sujet diabétique de type 1, un traitement intensif, comme celui imposé dans l’étude DCCT, permet d’obtenir une réduction prolongée du risque de survenue et de progression de la rétinopathie, de la neuropathie, de la néphropathie ainsi que du risque de maladie cardio-vasculaire. Ce bénéfice persistant renforce le message initial de l’étude DCCT qui avait démontré que le traitement intensif du diabète de type 1 devait être instauré dès le début de la maladie. Le développement récent des analogues de l’insuline et les améliorations techniques des pompes à insuline portables pourraient contribuer à atteindre un meilleur contrôle métabolique

Randomized trial of neoadjuvant chemotherapy in oropharyngeal carcinoma

The objective of the study was to evaluate the effect of neoadjuvant chemotherapy on the survival of patients with oropharyngeal cancer. Patients with a squamous cell carcinoma of the oropharynx for whom curative radiotherapy or surgery was considered feasible were entered in a multicentric randomized trial comparing neoadjuvant chemotherapy followed by loco-regional treatment to the same loco-regional treatment without chemotherapy. The loco-regional treatment consisted either of surgery plus radiotherapy or of radiotherapy alone. Three cycles of chemotherapy consisting of Cisplatin (100 mg/m2) on day 1 followed by a 24-hour i.v. infusion of fluorouracil (1000 mg/m2/day) for 5 days were delivered every 21 days. 2–3 weeks after the end of chemotherapy, local treatment was performed. The trial was conducted by the Groupe d'Etude des Tumeurs de la Tête Et du Cou (GETTEC). A total of 318 patients were enrolled in the study between 1986 and 1992. Overall survival was significantly better (P = 0.03) in the neoadjuvant chemotherapy group than in the control group, with a median survival of 5.1 years versus 3.3 years in the no chemotherapy group. The effect of neoadjuvant chemotherapy on event-free survival was smaller and of borderline significance (P = 0.11). Stratification of the results on the type of local treatment, surgery plus radiotherapy or radiotherapy alone, did not reveal any heterogeneity in the effect of chemotherapy. © 2000 Cancer Research Campaign http://www.bjcancer.co

Designing a memorial place

The design and selection of a memorial stone and the site of the grave, both of which represent the deceased, can be a central issue for people bereaved by traffic accidents. This was revealed in an interview survey of recent Swedish roadside memorials and other memorial places. In this article we consider the design and selection of the memorial stone and gravesite as expressions of continuing care for the deceased and as a way to offer comfort to the bereaved. Materiality, representation and presence will be discussed as crucial parts of the link between the living and the dead. Communicative, spatial and physical values are important also in the professional's design of common public memorial places. Of specific interest for this text are two design practice-based terms, memory object and passage landscape, which may be used by landscape architects when designing memorial places, such as cemeteries and public monuments. Throughout this text, we argue that memorial places like these are capable of bridging the gap between the space of life and the space of death, as well as supporting the regeneration of present memories and the construction of future ones

Inside the eco-home: using video to understand the implications of innovative housing

As a method of qualitative research, video offers a means of looking into the world of a respondent and a means of stimulating a dialogue, both with the respondent and others. Video requires, however, the application of additional ethical procedures and may also increase refusal rates, if it is publicly disseminated. Applied to the home, the use of video reveals both practice and identity. Video records practice, showing how the spaces within a home are used at a particular time. For this reason, video is well adapted to understanding the implications of living in a home with an innovative design and technology, with all the complexities that this commonly involves. Equally, video communicates the appearance of the home and of its occupants to whoever is watching. Video is, therefore, intimately connected to identity and the home as a place

Framing the Real: Lefèbvre and NeoRealist Cinematic Space as Practice

In 1945 Roberto Rossellini's Neo-realist Rome, Open City set in motion an approach to cinema and its representation of real life – and by extension real spaces – that was to have international significance in film theory and practice. However, the re-use of the real spaces of the city, and elsewhere, as film sets in Neo-realist film offered (and offers) more than an influential aesthetic and set of cinematic theories. Through Neo-realism, it can be argued that we gain access to a cinematic relational and multidimensional space that is not made from built sets, but by filming the built environment. On the one hand, this space allows us to "notice" the contradictions around us in our cities and, by extension, the societies that have produced those cities, while on the other, allows us to see the spatial practices operative in the production and maintenance of those contradictions. In setting out a template for understanding the spatial practices of Neo-realism through the work of Henri Lefèbvre, this paper opens its films, and those produced today in its wake, to a spatio-political reading of contemporary relevance. We will suggest that the rupturing of divisions between real spaces and the spaces of film locations, as well the blurring of the difference between real life and performed actions for the camera that underlies much of the central importance of Neo-realism, echoes the arguments of Lefèbvre with regard the social production of space. In doing so, we will suggest that film potentially had, and still has, a vital role to play in a critique of contemporary capitalist spatial practices

Study of mass and momentum transfer in diesel sprays base on X-ray mass distribution measurements and on a theoretical derivation

[EN] In this paper, a research aimed at quantifying mass and momentum transfer in the near-nozzle field of diesel sprays injected into stagnant ambient air is reported. The study combines X-ray measurements for two different nozzles and axial positions, which provide mass distributions in the spray, with a theoretical model based on momentum flux conservation, which was previously validated. This investigation has allowed the validation of Gaussian profiles for local fuel concentration and velocity near the nozzle exit, as well as the determination of Schmidt number at realistic diesel spray conditions. This information could be very useful for those who are interested in spray modeling, especially at high-pressure injection conditions. © 2010 Springer-Verlag.This work was partly sponsored by "Vicerrectorado de Investigacion, Desarrollo e Innovacion'' of the "Universidad Politecnica de Valencia'' in the frame of the project "Estudio del flujo en el interior de toberas de inyeccion Diesel'', reference no. 3150 and by "Generalitat Valenciana'' in the frame of the project with the same title and reference GV/2009/031. This support is gratefully acknowledged by the authors.Desantes, J.; Salvador Rubio, FJ.; López, JJ.; De La Morena, J. (2011). Study of mass and momentum transfer in diesel sprays base on X-ray mass distribution measurements and on a theoretical derivation. Experiments in Fluids. 50(2):233-246. https://doi.org/10.1007/s00348-010-0919-8S233246502Abramovich GN (1963) The theory of turbulent jets. 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Fuel 85:910–917Desantes JM, Arrègle J, López JJ, Cronhjort A (2006b) Scaling laws for free turbulent gas jets and Diesel-like sprays. Atomization Spray 16:443–473Desantes JM, Payri R, García JM, Salvador FJ (2007) A contribution to the understanding of isothermal diesel spray dynamics. Fuel 86:1093–1101Dumouchel C (2008) On the experimental investigation on primary atomization of liquid streams. Exp Fluids 45:371–422Heimgärtner C, Leipertz A (2000) of the primary spray break-up close to the nozzle of a common-rail high pressure diesel injection system. SAE Paper 2000-01-1799Hinze JO (1975) Turbulence. McGraw Hill, New YorkHiroyasu H, Arai M (1990) Structures of fuel sprays in diesel engines. SAE Paper 900475Jawad B, Gulari E, Henein NA (1992) Characteristics of intermittent fuel sprays. Combust Flame 88:384–396Lefèbvre AH (1989) Atomization and sprays. 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Pergamon Press, New YorkSubramaniam S (2001) Statistical modelling of a spray as using the droplet distribution function. Phys Fluids 13(3):624–642Tanner FX, Feigl A, Ciatti SA, Powell CF, Cheong S-K, Liu J, Wang J (2006) Structure of high-velocity dense sprays in the near-nozzle region. Atomization Spray 16:579–597Way RJB (1977) Investigation of interaction between swirl and jets in direct injection diesel engines using a water model. SAE Paper 770412Wu KJ, Santavicca DA, Bracco FV (1984) LDV measurements of drop velocity in diesel-type sprays. AAIA J 22(9):1263–1270Wu KJ, Reitz RD, Bracco FV (1986) Measurements of drop size at the spray edge near the nozzle in atomising liquid jets. Phys Fluids 29(4):941–951Yue Y, Powell CF, Poola R, Wang J, Schaller JK (2001) Quantitative measurements of diesel fuel spray characteristics in the near-nozzle region using X-ray absorption. Atomization Spray 11(4):471–49

Radical, Reformist, and Garden-Variety Neoliberal: Coming to Terms with Urban Agriculture’s Contradictions

For many activists and scholars, urban agriculture in the Global North has become synonymous with sustainable food systems, standing in opposition to the dominant industrial agri-food system. At the same time, critical social scientists increasingly argue that urban agriculture programmes, by filling the void left by the rolling back of the social safety net, underwrite neoliberalisation. I argue that such contradictions are central to urban agriculture. Drawing on existing literature and fieldwork in Oakland, CA, I explain how urban agriculture arises from a protective counter-movement, while at the same time entrenching the neoliberal organisation of contemporary urban political economies through its entanglement with multiple processes of neoliberalisation. By focusing on one function or the other, however, rather than understanding such contradictions as internal and inherent, we risk undermining urban agriculture\u27s transformative potential. Coming to terms with its internal contradictions can help activists, policy-makers and practitioners better position urban agriculture within coordinated efforts for structural change, one of many means to an end rather than an end unto itself

Clonal interference of signaling mutations worsens prognosis in core-binding factor acute myeloid leukemia

Mutations in receptor tyrosine kinase/RAS signaling pathway genes are frequent in core-binding factor (CBF) acute myeloid leukemias (AMLs), but their prognostic relevance is debated. A subset of CBF AML patients harbors several signaling gene mutations. Genotyping of colonies and of relapse samples indicates that these arise in independent clones, thus defining a process of clonal interference (or parallel evolution). Clonal interference is pervasive in cancers, but the mechanisms underlying this process remain unclear, and its prognostic impact remains unknown. We analyzed a cohort of 445 adult and pediatric patients with CBF AML treated with intensive chemotherapy and with deep sequencing of 6 signaling genes (, , , , , ). A total of 152 (34%), 167 (38%), and 126 (28%) patients harbored no, a single, and multiple signaling clones (clonal interference), respectively. Clonal interference of signaling mutations was associated with older age ( = .004) and inv(16) subtype ( = .025) but not with white blood cell count or mutations in chromatin or cohesin genes. The median allele frequency of signaling mutations was 31% in patients with a single clone or clonal interference ( = .14). The repertoire of , , and / variants differed between groups. Clonal interference did not affect complete remission rate or minimal residual disease after 1-2 courses, but it did convey inferior event-free survival ( < 10), whereas the presence of a single signaling clone did not ( = .44). This inferior outcome was independent of clinical parameters and of the presence of specific signaling clones. Our results suggest that specific clonal architectures can herald distinct prognoses in AML