How can malaria rapid diagnostic tests achieve their potential? A qualitative study of a trial at health facilities in Ghana.

BACKGROUND: Rapid diagnostic tests (RDTs) for malaria are at the early stages of introduction across malaria endemic countries. This is central to efforts to decrease malaria overdiagnosis and the consequent overuse of valuable anti-malarials and underdiagnosis of alternative causes of fever. Evidence of the effect of introducing RDTs on the overprescription of anti-malarials is mixed. A recent trial in rural health facilities in Ghana reduced overprescription of anti-malarials, but found that 45.5% patients who tested negative with RDTs were still prescribed an anti-malarial. METHODS: A qualitative study of this trial was conducted, using in-depth interviews with a purposive sample of health workers involved in the trial, ranging from those who continued to prescribe anti-malarials to most patients with negative RDT results to those who largely restricted anti-malarials to patients with positive RDT results. Interviews explored the experiences of using RDTs and their results amongst trial participants. RESULTS: Meanings of RDTs were constructed by health workers through participation with the tests themselves as well as through interactions with colleagues, patients and the research team. These different modes of participation with the tests and their results led to a change in practice for some health workers, and reinforced existing practice for others. Many of the characteristics of RDTs were found to be inherently conducive to change, but the limited support from purveyors, lack of system antecedents for change and limited system readiness for change were apparent in the analysis. CONCLUSIONS: When introduced with a limited supporting package, RDTs were variously interpreted and used, reflecting how health workers had learnt how to use RDT results through participation. To build confidence of health workers in the face of negative RDT results, a supporting package should include local preparation for the innovation; unambiguous guidelines; training in alternative causes of disease; regular support for health workers to meet as communities of practice; interventions that address negotiation of health worker-patient relationships and encourage self-reflection of practice; feedback systems for results of quality control of RDTs; feedback systems of the results of their practice with RDTs; and RDT augmentation such as a technical and/or clinical troubleshooting resource

Teaching Culturally Sensitive Care to Dental Students: A Multidisciplinary Approach

Dental schools must prepare future dentists to deliver culturally sensitive care to diverse patient populations, but there is little agreement on how best to teach these skills to students. This article examines this question by exploring the historical and theoretical foundations of this area of education in dentistry, analyzes what is needed for students to learn to provide culturally sensitive care in a dental setting, and identifies the discipline-specific skills students must master to develop this competence. The problems associated with single-discipline, lecture-based approaches to teaching culturally sensitive care are outlined, and the advantages of an interdisciplinary, patient-centered, skills-based approach to teaching culturally sensitive care are described. The authors advocate for an approach to teaching culturally sensitive care that builds upon learning in the behavioral sciences, ethics, and public health. Component skills and perspectives offered by each of these curriculum areas are identified, and their contributions to the teaching of culturally sensitive care are described. Finally, the need to consider the timing of this instruction in the dental curriculum is examined, along with instructional advantages associated with an approach that is shared by faculty across the curriculum

Integrated science unit : ponds and water

This instructional development project integrated the language arts and the science areas. The science content was ponds and water from the second grade curriculum. A rich learning environment was provided through a literature base, representing the different genres and related expressive activity. The unit was presented through teacher-directed activity and learning centers that offered many options from which children could select experiences. The goals of the program were to give children more control over their learning and to extend children\u27s thinking-language abilities by capitalizing on the common processes of the language arts and science areas and offering many opportunities to engage in the language processes within the functions of language. The unit was presented to children in grade 2. As the children became involved in the content and processes of the unit provided by a print-rich environment with many options for learning activity, they generated much enthusiasm and assumed responsibility for directing their energies toward the learning tasks

Genetic insights on old riddles : the Chachapoyas from the northeastern Peruvian cloud forests

This dissertation focusses on the genetic diversity of the Chachapoyas in the context of northeast Peruvian and South American populations. The genetic survey of indigenous human populations from the Americas is still far from being comprehensive, which is in stark contrast with other areas of the globe, such as Europe, where an in-depth understanding of the genetic variation and its use in forensic and medical genetics has been attained. This highlights the need for increasing genetic research in Peru as to continue laying the foundation for human genetics and its applications in other fields such as forensics. The montane forests of northeast Peru are one of the most biologically diverse ecosystems in the world and it is there where the ancient Chachapoyas throve and where their descendants nowadays live. Archaeological, historical and linguistic records inform of a complex region where local populations interacted with others throughout prehistory up until the time of European contact in the 16th century. Although traces of past cultural diversity persist in the Chachapoyas region, the series of demographic, environmental and cultural impacts have blurred this cultural differentiation and debilitated the local identities of present-day peoples. Among other factors, cultural diversity in the region has also been shaped by a series of population-level phenomena, which are the focus of this research. To address various questions that emanate from archaeology and ethnohistory, samples from the modern Chachapoyas and three of their neighbors were genotyped for various types of markers (mtDNA, Y-chromosome and autosomal data). These and reference data were analyzed to uncover patterns of population structure and gain insights into the demographic history of the studied populations, with particular emphasis in the Chachapoyas. The new data show exceptionally high levels of genetic diversity in the Chachapoyas region and contrasting patterns of genetic affinities for lineage markers. In clear contrast with the archaeological and ethnohistorical evidence, there was negligible population substructure within Chachapoyas. Asymmetrical European gene flow for autosomes was detected throughout the region but the pattern does not mirror Inca settlement densities at subregional level. Signatures of demographic collapse likely associated with the Spanish conquest were observed in both mtDNA and Y-chromosome, although for males the reduction appeared more drastic. In addition to these insights, the new autosomal STR and SNP datasets generated unveiled another level of variation by providing, in addition to traditional length-based genotypes, sequence-based information for several Peruvian populations which may be of utility for individual identification in the context of South America.Koillis-Perussa, Andien vuoriston ja Amazonasin välisellä alueella eli n. 800 – 1500 jaa alkuperäisväestöjä, joita Inkat kutsuivat yhteisesti nimellä Chachapoyas. Näiden ”Pilvien sotureiden” alueet valloittivat ensin Inkat v. 1491 ja sitten eurooppalaiset konkistadorit v. 1531. Valloituksia seuranneet väestönsiirrot, sodat ja tautiepidemiat johtivat Chachapoya-kulttuurin häviämiseen. Jälkipolvia tämä kadonnut kansa on kuitenkin kiehtonut: todellisten arkeologien ohella Chachapoya-esineistä on ollut kiinnostunut myös fiktiivinen arkeologi Indiana Jones. Tässä väitöskirjassa Chachapoya-väestön rakennetta ja historiaa on tutkittu genetiikan keinoin. Väestöhistoria, esim. väestön koko ja yhteydet toisiin väestöihin, muovaa perimää ja on pääteltävissä DNA-muuntelusta. Tutkimusta varten kerättiin näytteitä Chachapoya-alueen nykyasukkailta, läheisestä Huancas-isolaatista sekä Amazonasin alueelta (Jivarot) ja Andeilta (Cajamarca), joista DNA-merkkidata määritettiin. Lisäksi kirjallisuudesta kerättiin laaja DNA-vertailuaineisto Etelä-Amerikan (alkuperäis)väestöille. DNA-aineistosta etsittiin populaatiogenetiikan menetelmin vastauksia arkeologisissa ja lingvistisissä tutkimuksissa heränneisiin kysymyksiin Chachapoya-väestöstä. Tulokset osoittavat, että Chachapoya-alueella perimässä on enemmän muuntelua kuin useimmilla Etelä-Amerikan alkuperäisväestöillä. Etnohistoriallisissa lähteissä kuvattua erilaistumista Chachapoya-alueen sisällä ei DNA-datassa kuitenkaan havaittu. DNA-muuntelussa havaittiin merkkejä väestökadosta, jonka ajoittumista eurooppalaisten tuloon ei voida poissulkea. Y-kromosomimuuntelun perusteella miesten kuolleisuus on ollut naisia suurempaa, aivan kuten aikalaislähteet kertovat. Etelä-Amerikan väestöjen perinnöllisen muuntelun kartoittaminen on toistaiseksi ollut esim. Eurooppaan verrattuna suppeaa. Tämä väitöskirjatutkimus paikkaa osaltaan tätä aukkoa. Väitöskirjan päätavoite oli kartoittaa Koillis-Perun väestöjen geneettistä muuntelua ja ymmärtää paremmin alueen geenipoolia muokanneita väestöhistorian prosesseja. Perustutkimuksen lisäksi tutkimuksessa tuotettu STR- ja SNP-merkkidatat hyödyttävät myös yhteiskunnallisesti tärkeää oikeusgenetiikkaa Perussa. Tulokset muistuttavat meitä myös siitä, että Perun alkuperäisväestöt eivät eurooppalaisten tultua kadonneet vaan muuttuivat, ja myös Chachapoya-perintö elää edelleen alueen nykyväestön perimässä

Specific Rab GTPase-activating proteins define the Shiga toxin and epidermal growth factor uptake pathways

Rab family guanosine triphosphatases (GTPases) together with their regulators define specific pathways of membrane traffic within eukaryotic cells. In this study, we have investigated which Rab GTPase-activating proteins (GAPs) can interfere with the trafficking of Shiga toxin from the cell surface to the Golgi apparatus and studied transport of the epidermal growth factor (EGF) from the cell surface to endosomes. This screen identifies 6 (EVI5, RN-tre/USP6NL, TBC1D10A–C, and TBC1D17) of 39 predicted human Rab GAPs as specific regulators of Shiga toxin but not EGF uptake. We show that Rab43 is the target of RN-tre and is required for Shiga toxin uptake. In contrast, RabGAP-5, a Rab5 GAP, was unique among the GAPs tested and reduced the uptake of EGF but not Shiga toxin. These results suggest that Shiga toxin trafficking to the Golgi is a multistep process controlled by several Rab GAPs and their target Rabs and that this process is discrete from ligand-induced EGF receptor trafficking

Introduction

Kegagalan sistem perpipaan bawah laut sering terjadi karena adanya fenomena alam pengaruh lingkungan dari gelombang, arus, dan gempa bumi. Fenomena alam yang terjadi pada pipa bawah laut meliputi, scouring, freespanning, dan landslide. Pada penelitian ini dilakukan analisa mengenai respon pipa bawah laut pada bentangan bebas terhadap beban gempa di selat sunda. Sistem perpipaan yang ditinjau adalah pipa gas transmisi yang menghubungkan antara GTS Labuhan Maringgai ke Bojonegara yang melewati selat sunda. Gempa bumi akan memberikan beban tambahan berupa gaya dan tegangan yang menyebabkan kegagala pada pipa apabila beban tersebut melebihi beban yang diijinkan, ditambah dengan freespan yang juga merupakan salah satu faktor penyebab kegagalan pada pipa. Metode yang digunakan dalam penelitian ini adalah analisa free spanning menurut DNV F105, pemodelan tumpuan elastik untuk penentuan beban internal, dan analisa transien dari data gempa selat sunda SNI dengan memodelkan pada ANSYS Workbench. Hasil dari analisa yang telah dilakukan menunjukkan bahwa freespan pada lokasi yang ditinjau masih memenuhi kriteria dari code sehingga tidak perlu dilakukan analisa fatigue akibat dari gelombang dan respon pipa terhadap beban gempa dari 3 arah yaitu sumbu x,y, dan z memiliki nilai puncak pada detik ke 2,1 dengan displacement sebesar 0,0903 m, gaya maksimal sebesar 126930 N, dan tegangan maksimal sebesar 12179000 Pa terjadi pada node 30792 arah pembebanan sumbu Y

HM 16: Three Splendid Little Wars - The Diary of Joseph K. Taussig, 1898-1901

The Spanish-American War, the Philippine Insurrection, and the Boxer Rebellion occurred over a hundred years ago. Scholars have produced a spate of books treating the Spanish-American War, the Philippine Insurrection, and the Boxer Rebellion. Personal accounts of service in the Spanish-American War have been published as well, yet fewer for the latter two conflicts. The unpublished diaries of Joseph K. Taussig, who participated in all of these conflicts, are therefore a uniquely valuable personal account of his wartime experiences.https://digital-commons.usnwc.edu/usnwc-historical-monographs/1015/thumbnail.jp

The Family Boraginaceae in Iowa - A Preliminary Report

Except for the annotated list published by Cratty in The Iowa Flora (1933), there has been no publication dealing with the entire family Boraginaceae in Iowa. · On the basis of only the Iowa State College herbarium, Cratty listed thirteen species of the family known to occur in the state; three of these were indicated as introductions from Europe or Asia. Prior to the appearance of Cratty\u27s list, certain species of the family had been included in local and county lists,1 and in Cratty\u27s paper on the immigrant flora of Iowa ( 1929), while Conard and Clarke ( 1929) had discussed the differentiation of Lithospermum canescense and L. gmelini (the L. croceum of the present paper). Four species, not listed by Cratty ( 1933), had been reported for the state prior to the publication of The Iowa Flora; these are: (a) Hackelia americana (A. Gray) Fern., reported by Arthur (1878) as Echinospermum deflexum and by Somes (1913) as Lappula deflexa var. americana; (b) Lithospermum arvense L., reported by Arthur ( 1884), Halstead ( 1888), Barnes, Reppert and Miller ( 1901), Greene ( 1907), and more recently by Goodman ( 1940) and Augustine (1941); (c) Lithospermum officinale L., reported by Fink (1897); and (d) Symphytum officinale L., reported by Diehl (1916) and Hagge (1929). Cratty (1934), in a second paper on the immigrant flora of Iowa, added Borago officinalis L. to the state list. Six other species have been reported for Iowa, but we have been unable to find specimens of them; they are placed, therefore, in the list of Excluded Species on page 147 of the present paper