Understanding Afghan Opinion Leaders’ Viewpoints About Post-Conflict Foreign Agricultural Development: A Case Study in Herāt Province, Afghanistan

This investigation sprang from a yearlong immersion in post-conflict agricultural development environments in Herāt Province Afghanistan and from observing an array of NGO development projects. The purpose was to understand better the viewpoints of Afghan opinion leaders regarding the adoption–integration of foreign agricultural development. Objectives included (a) the identification of perceived strengths of foreign agricultural development, (b) perceived weaknesses, (c) opportunities, (d) threats, (e) anomalies, and (f)incentives and barriers. The case method fit the qualitative research design, and IRB approved the protocols. Researchers selected 15 opinion leaders (OLs) based on their knowledge, experience, and positional responsibilities. An interview guide framed 13 open-ended questions. A researcher fluent in Farsi/Pashto/English assisted with each interview. The findings from 15 interviews emerged as 11 themes. Fourteen OLs recognized agriculture and natural resources as strengths for development. Opinion leaders recognize government, infrastructure, and corruption as fundamental weaknesses. Opinion Leaders were slow to identify opportunities but generally identified opportunities to exploit labor, land, and water coupled with improving management and mechanization.They universally recognized threats related to to personal security and safety but had difficulty separating internal weaknesses from external threats. Two anomalies emerged as incongruous expectations about Afghan government and foreign NGOs. Improving market chains and increasing governmental subsidies were incentives for development. The authors conclude that indigenous knowledge is a fundamental resource and a foundation for local level decision making and sustainability. Opinion Leaders serve as channels to move the society from poverty and conflict toward security and peacebuilding. The tension between Maslow’s hierarchy of needs and Max Neef’s interrelated and interactive needs should be explore

Detection of Formaldehyde Towards the Extreme Carbon Star IRC+10216

We report the detection of H2CO (formaldehyde) around the carbon-rich AGB star, IRC+10216. We find a fractional abundance with respect to molecular hydrogen of x(H2CO)= (1.3 {+1.5}{-0.8}) x 10^{-8}. This corresponds to a formaldehyde abundance with respect to water vapor of x(H2CO)/x(H2O)=(1.1 +/- 0.2) x 10^{-2}, in line with the formaldehyde abundances found in Solar System comets, and indicates that the putative extrasolar cometary system around IRC+10216 may have a similar chemical composition to Solar System comets. However, we also failed to detect CH3OH (methanol) around IRC+10216 and our upper limit of x(CH3OH)/x(H2O) < 7.7 x 10^{-4}, (3 sigma), indicates that methanol is substantially underabundant in IRC+10216, compared to Solar System comets. We also conclude, based on offset observations, that formaldehyde has an extended source in the envelope of IRC+10216 and may be produced by the photodissociation of a parent molecule, similar to the production mechanism for formaldehyde in Solar System comet comae. Preliminary mapping observations also indicate a possible asymmetry in the spatial distribution of formaldehyde around IRC+10216, but higher signal-to-noise observations are required to confirm this finding. This study is based on observations carried out with the IRAM 30m telescope. IRAM is supported by INSU/CNRS (France), MPG (Germany) and IGN (Spain). (abridged)Comment: accepted to ApJ, 45 pages, 11 figure

Tolerability of the Low-Affinity, Use-Dependent NMDA Antagonist AR-R15896AR in Stroke Patients

Background and Purpose—AR-R15896AR is a use-dependent, low-affinity blocker of the NMDA ion channel with neuroprotective effects in animal models of focal cerebral ischemia. This study aimed to establish the highest safe and tolerated loading and maintenance dosing regimen of AR-R15896AR in acute ischemic stroke patients and to determine the associated plasma concentrations of AR-R15896AR.Methods—This was a 4-part, multicenter, randomized, double-blind, placebo-controlled study in 175 patients (mean age, 69 years) within 24 hours of acute stroke symptom recognition. Ascending 60-minute intravenous infusion loading doses of AR-R15896AR were initially examined (100, 150, 200, 250, or 300 mg or placebo in 3:1 randomization, n=36 treated); in part 2, 250, 275, or 300 mg was compared with placebo (n=33). In part 3, a 250-mg loading dose was followed by 9 maintenance doses of 60, 75, 90, 105, or 120 mg every 8 hours versus placebo in 3:1 randomization (n=59); subsequently, in part 4, maintenance doses of 90, 105, and 120 mg after the 250-mg loading dose were directly randomized against placebo (n=42). Safety, tolerability, and pharmacokinetics were the primary end points; NIHSS at 1 week and Barthel and modified Rankin scores at 1 month were also recorded, but the study was neither designed nor powered to assess efficacy.Results—Rates for mortality and serious adverse events (SAE) were similar in active and placebo groups (9% mortality and 23% SAE for all active combined versus 11% mortality and 33% SAE for placebo). Adverse events associated with AR-R15896AR were dizziness, vomiting, nausea, stupor, and some agitation/hallucination. Withdrawal from treatment occurred only in response to loading doses with AR-R15896AR: placebo, 3 of 46 (7%); 250 mg, 11 of 89 (12%); 275 mg, 1 of 8 (12.5%); and 300 mg, 3 of 15 (20%). No significant difference in outcome was observed between groups. Plasma concentrations of AR-R15896AR were 1524±536 ng/mL at the end of the 250-mg loading infusion and were 1847±478 ng/mL at steady state after the 9 maintenance doses of 120 mg.Conclusions—The maximum tolerated loading infusion of AR-R15896AR in this study was 250 mg over a period of 1 hour. Subsequent maintenance infusions of 120 mg every 8 hours were well tolerated. With these doses, putative neuroprotective concentrations of 1240 ng/mL are attained by the loading dose and are satisfactorily maintained thereafter. The loading dose may be improved further by adjustment on an individual patient basis, but tolerability issues remain

Differences Between US and UK Adults in Stroke Preparedness: Evidence From Parallel Population-Based Community Surveys

Background and Purpose&mdash;Although time-dependent treatment is available, most people delay contacting emergency medical services for stroke. Given differences in the healthcare system and public health campaigns, exploring between-country differences in stroke preparedness may identify novel ways to increase acute stroke treatment.&nbsp; Methods&mdash;A survey was mailed to population-based samples in Ingham County, Michigan, US (n=2500), and Newcastle upon Tyne, UK (n=2500). Surveys included stroke perceptions and stroke/nonstroke scenarios to assess recognition and response to stroke. Between-country differences and associations with stroke preparedness were examined usingttests and linear mixed models.&nbsp; Results&mdash;Overall response rate was 27.4%. The mean age of participants was 55 years, and 58% were female. US participants were better in recognizing stroke (70% versus 63%, d=0.27) and were more likely to call emergency medical services (55% versus 52%, d=0.11). After controlling for demographics and comorbidities, US participants remained more likely to recognize stroke but were not more likely to respond appropriately. A greater belief that medical treatment can help with stroke and understanding of stroke was associated with improved stroke recognition and response.&nbsp; Conclusions&mdash;Overall, stroke recognition and response were moderate. US participants were modestly better at recognising stroke, although there was little difference in response to stroke. Future stroke awareness interventions could focus more on stroke outcome expectations and developing a greater understanding of stroke among the public

Cosmological Aspects of Rolling Tachyon

We examine the possibility of rolling tachyon to play the dual roll of inflaton at early epochs and dark matter at late times. We argue that enough inflation can be generated with the rolling tachyon either by invoking the large number of branes or brane world assisted inflation. However, reheating is problematic in this model.Comment: RevTeX 4 pages, Talk delivered in PASCOS held at TIFR (Mumbai) from 3rd Jan to 9th Jan. To appear in the proceedings of PASCOS to be published in a special issue of Praman

Time to Clinical Stability in Patients with Ventilator-Associated Pneumonia due to Methicillin-Resistant Staphylococcus aureus Treated with Linezolid versus Vancomycin: Results from the IMPACT-HAP Study

Background: Time to clinical stability is a well-defined early clinical outcome in hospitalized patients with community-acquired pneumonia, but it has not been evaluated in patients with ventilator-associated pneumonia (VAP). The objective of this study was to compare time to clinical stability in patients with MRSA VAP treated with linezolid versus vancomycin. Methods: This was a secondary analysis of the IMPACT-HAP study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. A patient was considered to reach clinical stability the day that the following four criteria were met: 1) Afebrile for 24 hours, 2) Decrease in WBC \u3e10% or WBC within normal range, 3) Improving of PaO2/FiO2 ratio of \u3e 20%, or PaO2/FiO2 ratio \u3e 250, or extubation, or FiO2 ≤ 30% if extubated, and 4) Systolic blood pressure \u3e90 mmHg. Time to clinical stability for linezolid and vancomycin were compared using the Chi-Squared and Student’s t-tests. Results: A total of 89 patients treated with linezolid and 75 patients treated with vancomycin met study criteria. From the population of linezolid treated patients, 79% reached clinical stability, compared to 75% of the population of vancomycin treated patients (P=0.463). Median time to clinical stability was 6 days (IQR 8) for patients treated with linezolid, versus 7 days (IQR 12) for patients treated with vancomycin (P=0.490). Conclusions: This study failed to demonstrate a statistically significant difference in time to clinical stability in patients with MRSA VAP treated with linezolid or vancomycin. The number of days for patients to reach clinical stability can be used as an early clinical outcome in patients with VAP

The stroke ‘Act FAST’ campaign: Remembered but not understood?

Background: The stroke awareness raising campaign &lsquo;Act FAST' (Face, Arms, Speech: Time to call Emergency Medical Services) has been rolled out in multiple waves in England, but impact on stroke recognition and response remains unclear. Purpose: The purpose of this study was to test whether providing knowledge of the FAST acronym through a standard Act FAST campaign leaflet increases accurate recognition and response in stroke-based scenario measures. Methods: This is a population-based, cross-sectional survey of adults in Newcastle upon Tyne, UK, sampled using the electoral register, with individuals randomized to receive a questionnaire and Act FAST leaflet (n&thinsp;=&thinsp;2500) or a questionnaire only (n&thinsp;=&thinsp;2500) in 2012. Campaign message retention, stroke recognition, and response measured through 16 scenario-based vignettes were assessed. Data were analyzed in 2013. Results: Questionnaire return rate was 32&middot;3% (n&thinsp;=&thinsp;1615). No differences were found between the leaflet and no-leaflet groups in return rate or demographics. Participants who received a leaflet showed better campaign recall (75&middot;7% vs. 68&middot;2%, P&thinsp;=&thinsp;0&middot;003) and recalled more FAST mnemonic elements (66&middot;1% vs. 45&middot;3% elements named correctly, P&thinsp;&lt;&thinsp;0&middot;001). However, there were no between-group differences for stroke recognition and response to stroke-based scenarios (P&thinsp;&gt;&thinsp;0&middot;05). Conclusions: Despite greater levels of recall of specific &lsquo;Act FAST' elements among those receiving the Act FAST leaflet, there was no impact on stroke recognition and response measures

Witness Response at Acute Onset of Stroke: A Qualitative Theory-Guided Study

Background: Delay in calling emergency medical services following stroke limits access to early treatment that can reduce disability. Emergency medical services contact is mostly initiated by stroke witnesses (often relatives), rather than stroke patients. This study explored appraisal and behavioural factors that are potentially important in influencing witness behaviour in response to stroke. Methods and Findings: Semi-structured interviews with 26 stroke witnesses were transcribed and theory-guided content analysed was undertaken based on the Common Sense Self-Regulation Model (appraisal processes) and Theory Domains Framework (behavioural determinants). Response behaviours were often influenced by heuristics-guided appraisal (i.e. mental rules of thumb). Some witnesses described their responses to the situation as &lsquo;automatic' and &lsquo;instinctive', rather than products of deliberation. Potential behavioural influences included: environmental context and resources (e.g. time of day), social influence (e.g. prompts from patients) and beliefs about consequences (e.g. 999 accesses rapid help). Findings are based on retrospective accounts and need further verification in prospective studies. Conclusions: Witnesses play a key role in patient access to emergency medical services. Factors that potentially influence witnesses' responses to stroke were identified and could inform behavioural interventions and future research. Interventions might benefit from linking automatic/instinctive threat perceptions with deliberate appraisal of stroke symptoms, prompting action to call emergency medical services

Negative Energy Density in Calabi-Yau Compactifications

We show that a large class of supersymmetric compactifications, including all simply connected Calabi-Yau and G_2 manifolds, have classical configurations with negative energy density as seen from four dimensions. In fact, the energy density can be arbitrarily negative -- it is unbounded from below. Nevertheless, positive energy theorems show that the total ADM energy remains positive. Physical consequences of the negative energy density include new thermal instabilities, and possible violations of cosmic censorship.Comment: 25 pages, v2: few clarifying comments and reference adde