Problems encountered by parents of infants with clubfoot treated by the Ponseti Method in Madagascar: A study to inform better practice

OBJECTIVE: Ponseti treatment for clubfoot is effective and inexpensive, improving children’s social participation. Two rehabilitation centres in Madagascar piloted Ponseti treatment; however, at one centre 46% of infants failed to complete treatment. The aim of this study was to determine the causes of defaulting in order to facilitate subsequent improvements nationwide when treatment is rolled out to all centres. METHODS: Questionnaire-based interviews. Patients: Twenty mothers of infants younger than 1 year were interviewed after 3 months of treatment in relation to difficulties they experienced with continuing treatment. RESULTS: Fifteen families of these had financial problems: 7 incurred debt, 2 sold possessions, 4 parents stopped work an 2 did not give any further details. All mothers experienced distress; 9 hid their child’s foot, and 8 were accused of wrong-doing during pregnancy. Three families travelled more than 500 km to the treatment centre and journeys were costly and difficult. Ponseti splints were acceptable, but aftercare of the splints proved problematic. CONCLUSION: Repeated travel to the clinic resulted in financial and social burden on the families, which reduced their ability to engage in treatment. The findings of this study are similar to work from other countries, but publications on rehabilitation from Madagascar are few. Improved support for parents, information, splinting with better materials and provision of treatment more locally are needed. Financial support for parents is key to enhancing children’s life chances

Developing a spinal cord injury rehabilitation service in Madagascar

Rehabilitation for people with spinal cord injury in many low- and middle-income countries is not avail-able or is in the early stages of development. However, rehabilitation is recognized as crucial in order to optimize functional recovery and outcomes for patients with spinal cord injury. With an increasing incidence of spinal cord injury, the unmet need for rehabilitation is huge. This report describes the early development of a specialist rehabilitation service for spinal cord injury in Madagascar, one of the poorest countries in the world. The sustained input to an expanding rehabilitation team has led to reductions in avoidable complications. The input of the rehabilitation team has been welcomed by the neurosurgery department, which has recognized fewer delays in patients undergoing surgical treatments. Cost, lack of resources and trained staff, and poor understanding of disability continue to provide challenges. However, the development of the rehabilitation service using low technology, but with a high level of knowledge and systematic management, is a source of considerable pride. This development in Madagascar can be regarded as a model for spinal cord injury rehabilitation in other low-resource settings

Evaluating a global health partnership rehabilitation training programme in Madagascar.

Objective: Rehabilitation services play an important role in optimizing functional ability and societal integration for people with disabilities. The Madagascar Rehabilitation Programme (2011–2013) resulted from a global training partnership and led to 8 doctors achieving a university diploma in rehabilitation medicine. This paper describes a 2014 evaluation of the programme methods, results and learning points. Methods: A combination of qualitative methods was used for the evaluation, based on a Theory of Change model, with informants from Madagascar and the UK. Results: Malagasy trainees and UK volunteers gained new theoretical knowledge and practical skills. For Madagascar, it led to changes in working practice and the formation of a national rehabilitation association. Key to its success was the strong collaboration between Malagasy and UK professionals, with support from the University and Ministry of Health in Madagascar, and the UK partners. Having a clear common vision ensured the programme met the needs of the Malagasy clinicians. Conclusion: Rehabilitation is increasingly recognized as an important focus for international development. Successful rehabilitation training programmes can be achieved at modest costs with global health partnerships. The combination of factors that enabled this programme to be a success is reproducible in other contexts

Quasi ALE finite element method for nonlinear water waves

This paper presents a newly developed quasi arbitrary Lagrangian-Eulerian finite element method (QALE-FEM) for simulating water waves based on fully nonlinear potential theory. The main difference of this method from the conventional finite element method developed by one of authors of this paper and others (see, e.g., [11] and [22]) is that the complex mesh is generated only once at the beginning and is moved at all other time steps in order to conform to the motion of the free surface and structures. This feature allows one to use an unstructured mesh with any degree of complexity without the need of regenerating it every time step, which is generally inevitable and very costly. Due to this feature, the QALE-FEM has high potential in enhancing computational efficiency when applied to problems associated with the complex interaction between large steep waves and structures since the use of an unstructured mesh in such a case is likely to be necessary. To achieve overall high efficiency, the numerical techniques involved in the QALE-FEM are developed, including the method to move interior nodes, technique to re-distribute the nodes on the free surface, scheme to calculate velocities and so on. The model is validated by water waves generated by a wavemaker in a tank and the interaction between water waves and periodic bars on the bed of tank. Satisfactory agreement is achieved with analytical solutions, experimental data and numerical results from other methods

Emotions in context: examining pervasive affective sensing systems, applications, and analyses

Pervasive sensing has opened up new opportunities for measuring our feelings and understanding our behavior by monitoring our affective states while mobile. This review paper surveys pervasive affect sensing by examining and considering three major elements of affective pervasive systems, namely; “sensing”, “analysis”, and “application”. Sensing investigates the different sensing modalities that are used in existing real-time affective applications, Analysis explores different approaches to emotion recognition and visualization based on different types of collected data, and Application investigates different leading areas of affective applications. For each of the three aspects, the paper includes an extensive survey of the literature and finally outlines some of challenges and future research opportunities of affective sensing in the context of pervasive computing

Therapeutic limitations in tumor-specific CD8+ memory T cell engraftment

BACKGROUND: Adoptive immunotherapy with cytotoxic T lymphocytes (CTL) represents an alternative approach to treating solid tumors. Ideally, this would confer long-term protection against tumor. We previously demonstrated that in vitro-generated tumor-specific CTL from the ovalbumin (OVA)-specific OT-I T cell receptor transgenic mouse persisted long after adoptive transfer as memory T cells. When recipient mice were challenged with the OVA-expressing E.G7 thymoma, tumor growth was delayed and sometimes prevented. The reasons for therapeutic failures were not clear. METHODS: OT-I CTL were adoptively transferred to C57BL/6 mice 21 – 28 days prior to tumor challenge. At this time, the donor cells had the phenotypical and functional characteristics of memory CD8+ T cells. Recipients which developed tumor despite adoptive immunotherapy were analyzed to evaluate the reason(s) for therapeutic failure. RESULTS: Dose-response studies demonstrated that the degree of tumor protection was directly proportional to the number of OT-I CTL adoptively transferred. At a low dose of OT-I CTL, therapeutic failure was attributed to insufficient numbers of OT-I T cells that persisted in vivo, rather than mechanisms that actively suppressed or anergized the OT-I T cells. In recipients of high numbers of OT-I CTL, the E.G7 tumor that developed was shown to be resistant to fresh OT-I CTL when examined ex vivo. Furthermore, these same tumor cells no longer secreted a detectable level of OVA. In this case, resistance to immunotherapy was secondary to selection of clones of E.G7 that expressed a lower level of tumor antigen. CONCLUSIONS: Memory engraftment with tumor-specific CTL provides long-term protection against tumor. However, there are several limitations to this immunotherapeutic strategy, especially when targeting a single antigen. This study illustrates the importance of administering large numbers of effectors to engraft sufficiently efficacious immunologic memory. It also demonstrates the importance of targeting several antigens when developing vaccine strategies for cancer

Alcohol-related hypoglycemia in rural Uganda: socioeconomic and physiologic contrasts

Hypoglycemia is a rare but important complication seen in patients who present with alcohol intoxication. In a study by Marks and Teale, less than one percent of people with alcohol intoxication who presented to an American emergency department were hypoglycemic [1]. It is even more rare to see an intoxicated patient, who had been eating appropriately prior to or during the intoxication, present in a hypoglycemic coma. However, our analysis of the first 500 patients seen in a newly opened five-bed Emergency Department (ED) at Nyakibale Karoli Lwanga Hospital in rural southwestern Uganda, revealed multiple intoxicated patients who presented in hypoglycemic coma within hours of eating a full meal. Three of these cases are summarized and discussed below

Genome sequencing of the extinct Eurasian wild aurochs, Bos primigenius, illuminates the phylogeography and evolution of cattle

Background Domestication of the now-extinct wild aurochs, Bos primigenius, gave rise to the two major domestic extant cattle taxa, B. taurus and B. indicus. While previous genetic studies have shed some light on the evolutionary relationships between European aurochs and modern cattle, important questions remain unanswered, including the phylogenetic status of aurochs, whether gene flow from aurochs into early domestic populations occurred, and which genomic regions were subject to selection processes during and after domestication. Here, we address these questions using whole-genome sequencing data generated from an approximately 6,750-year-old British aurochs bone and genome sequence data from 81 additional cattle plus genome-wide single nucleotide polymorphism data from a diverse panel of 1,225 modern animals. Results Phylogenomic analyses place the aurochs as a distinct outgroup to the domestic B. taurus lineage, supporting the predominant Near Eastern origin of European cattle. Conversely, traditional British and Irish breeds share more genetic variants with this aurochs specimen than other European populations, supporting localized gene flow from aurochs into the ancestors of modern British and Irish cattle, perhaps through purposeful restocking by early herders in Britain. Finally, the functions of genes showing evidence for positive selection in B. taurus are enriched for neurobiology, growth, metabolism and immunobiology, suggesting that these biological processes have been important in the domestication of cattle. Conclusions This work provides important new information regarding the origins and functional evolution of modern cattle, revealing that the interface between early European domestic populations and wild aurochs was significantly more complex than previously thought

Does Obsessive-Compulsive Personality Disorder Belong Within the Obsessive-Compulsive Spectrum? Focus Points

• In this article, we consider the advantages and disadvantages of current categorical models for diagnosing obsessive-compulsive personality disorder (OCPD). • We review the similarities and differences between OCPD and obsessive-compulsive spectrum disorders. • We present a novel, neurocognitive approach to investigating OCPD. Abstract It has been proposed that certai