Antifungal Combinations for Treatment of Cryptococcal Meningitis in Africa

Background Cryptococcal meningitis accounts for more than 100,000 human immunodeficiency virus (HIV)–related deaths per year. We tested two treatment strategies that could be more sustainable in Africa than the standard of 2 weeks of amphotericin B plus flucytosine and more effective than the widely used fluconazole monotherapy. Methods We randomly assigned HIV-infected adults with cryptococcal meningitis to receive an oral regimen (fluconazole [1200 mg per day] plus flucytosine [100 mg per kilogram of body weight per day] for 2 weeks), 1 week of amphotericin B (1 mg per kilogram per day), or 2 weeks of amphotericin B (1 mg per kilogram per day). Each patient assigned to receive amphotericin B was also randomly assigned to receive fluconazole or flucytosine as a partner drug. After induction treatment, all the patients received fluconazole consolidation therapy and were followed to 10 weeks. Results A total of 721 patients underwent randomization. Mortality in the oral-regimen, 1-week amphotericin B, and 2-week amphotericin B groups was 18.2% (41 of 225), 21.9% (49 of 224), and 21.4% (49 of 229), respectively, at 2 weeks and was 35.1% (79 of 225), 36.2% (81 of 224), and 39.7% (91 of 229), respectively, at 10 weeks. The upper limit of the one-sided 97.5% confidence interval for the difference in 2-week mortality was 4.2 percentage points for the oral-regimen group versus the 2-week amphotericin B groups and 8.1 percentage points for the 1-week amphotericin B groups versus the 2-week amphotericin B groups, both of which were below the predefined 10-percentage-point noninferiority margin. As a partner drug with amphotericin B, flucytosine was superior to fluconazole (71 deaths [31.1%] vs. 101 deaths [45.0%]; hazard ratio for death at 10 weeks, 0.62; 95% confidence interval [CI], 0.45 to 0.84; P=0.002). One week of amphotericin B plus flucytosine was associated with the lowest 10-week mortality (24.2%; 95% CI, 16.2 to 32.1). Side effects, such as severe anemia, were more frequent with 2 weeks than with 1 week of amphotericin B or with the oral regimen. Conclusions One week of amphotericin B plus flucytosine and 2 weeks of fluconazole plus flucytosine were effective as induction therapy for cryptococcal meningitis in resource-limited settings. (ACTA Current Controlled Trials number, ISRCTN45035509.

Grassroots Agency: Participation and Conflict in Buenos Aires Shantytowns seen through the Pilot Plan for Villa 7 (1971–1975)

open access articleIn 1971, after more than a decade of national and municipal policies aimed at the top-down removal of shantytowns, the Buenos Aires City Council approved the Plan Piloto para la Relocalización de Villa 7 (Pilot Plan for the Relocation of Shantytown 7; 1971–1975, referred to as the Pilot Plan hereinafter). This particular plan, which resulted in the construction of the housing complex, Barrio Justo Suárez, endures in the collective memory of Argentines as a landmark project regarding grassroots participation in state housing initiatives addressed at shantytowns. Emerging from a context of a housing shortage for the growing urban poor and intense popular mobilizations during the transition to democracy, the authors of the Pilot Plan sought to empower shantytown residents in novel ways by: 1) maintaining the shantytown’s location as opposed to eradication schemes that relocated the residents elsewhere, 2) formally employing some of the residents for the stage of construction, as opposed to “self-help” housing projects in which the residents contributed with unpaid labor, and 3) including them in the urban and architectural design of the of the new housing. This paper will examine the context in which the Pilot Plan was conceived of as a way of re-assessing the roles of the state, the user, and housing-related professionals, often seen as antagonistic. The paper argues that residents’ fair participation and state intervention in housing schemes are not necessarily incompatible, and can function in specific social and political contexts through multiactor proposals backed by a political will that prioritizes grassroots agency

New technologies and firm organization : the case of electronic traceability systems in French agribusiness

This paper considers the relationship between the adoption of electronic traceability systems (ETSs) and the organization of firms. More precisely, it analyzes the respective roles of a firm's organizational structure, and organizational changes, in the process of ETS adoption in agribusiness. We use data from the French "Organizational Changes and Computerization" survey from 2006. We test a probit model to demonstrate the organizational structure and organizational changes underlying the firm's ETS adoption choice. Results show that ETS adoption is strongly favored by organizations with heavy hierarchical structures, standardized managerial practices and contractual mechanisms with external partners. This adoption process seems to coevolve with the organization: firms that implemented an ETS during the observed period (2003-2006) have experienced the most important organizational changes in terms of managerial practices, information systems and contractual relations, as well as the strengthening of the intermediate levels in the hierarchy

'Language Background Other Than English': a problem NAPLaN test category for Australian students of refugee background

Since 2008 Australia has held the National Assessment Program: Literacy and Numeracy (known as NAPLAN) for all students in years 3, 5, 7 and 9. Despite the multilingual character of the Australian population, these standardized literacy and numeracy tests are built on an assumption of English as a first language competency. The capacity for monitoring the performance of students who speak languages other than English is achieved through the disaggregation of test data using a category labelled Language Background Other than English (LBOTE). A student is classified as LBOTE if they or their parents speak a language other than English at home. The category definition is so broad that the disaggregated national data suggest that LBOTE students are outperforming English speaking students, on most test domains, though the LBOTE category shows greater variance of results. Drawing on Foucault’s theory of governmentality, this article explores the possible implications of LBOTE categorisation for English as a Second Language (ESL) students of refugee background. The article uses a quantitative research project, carried out in Queensland, Australia, to demonstrate the potential inequities resultant from such a poorly constructed data category