Are interventions for improving the quality of services provided by specialized drug shops effective in sub-Saharan Africa? A systematic review of the literature.

PURPOSE: We set out to determine effectiveness of interventions for improving the quality of services provided by specialized drug shops in sub-Saharan Africa. DATA SOURCES: We searched PubMed, CAB Abstracts, Web of Science, PsycINFO and Eldis databases and websites for organizations such as WHO and Management Sciences for Health. Finally, we searched manually through the references of retrieved articles. STUDY SELECTION: Our search strategy included randomized trials, time-series studies and before and after studies evaluating six interventions; education, peer review, reorganizing administrative structures, incentives, regulation and legislation. DATA EXTRACTION: We extracted information on design features, participants, interventions and outcomes assessed studies for methodological quality, and extracted results, all using uniform checklists. RESULTS OF DATA SYNTHESIS: We obtained 10 studies, all implementing educational interventions. Outcome measures were heterogeneous and included knowledge, communication and dispensing practices. Education improved knowledge across studies, but gave mixed results on communication between sellers and clients, dispensing of appropriate treatments and referring of patients to health facilities. Profit incentives appeared to constrain behaviour change in certain instances, although cases of shops adopting practices at the expense of sales revenue were also reported. CONCLUSION: Evidence suggests that knowledge and practices of pharmacies and drug shops can be improved across a range of diseases and countries/regions, although variations were reported across studies. Profit incentives appear to bear some influence on the level of success of interventions. More work is required to extend the geographical base of evidence, investigate cost-effectiveness and evaluate sustainability of interventions over periods longer than 1 year

Linear recurrences and asymptotic behavior of exponential sums of symmetric boolean functions

In this paper we give an improvement of the degree of the homogeneous linear recurrence with integer coefficients that exponential sums of symmetric Boolean functions satisfy. This improvement is tight. We also compute the asymptotic behavior of symmetric Boolean functions and provide a formula that allows us to determine if a symmetric boolean function is asymptotically not balanced. In particular, when the degree of the symmetric function is a power of two, then the exponential sum is much smaller than $2^n$.Comment: 18 pages, 3 figure

Measuring attitude toward theistic faith : assessing the Astley-Francis Scale among Christian, Muslim and secular youth in England

Empirical research within the social scientific study of religion in general and within the psychology of religion in particular remains very conscious of the complex nature of its subject matter. Empirical research in this field needs to take cognisance of the many forms in which religion is expressed (say, Buddhism, Christianity, Hinduism, Islam, Judaism, and Sikhism) and the many facets within the forms (say, beliefs, behaviours and affiliation). Working in the 1970s, Francis (1978a; 1978b) advanced the view that the attitudinal dimension of religion offered a particularly fruitful basis for coordinating empirical enquiry into the correlates, antecedents and consequences of religiosity across the life span

Marine protected areas and the benefits of their establishment

Marine Protected Areas (MPAs), conservation and fisheries management tool, come in various sizes and shapes, and fulfill various purposes. They pre established for purposes of protection, restoration and preservation of' biota, ecosystem and ecological processes, and include recreational, educational and cultural purposes. Steps in the establishment of MPAs, their benefits and effectiveness have been highlighted. Current and profitable trends as seen in the establishment of Network of MPAs have been reported also. It has been noted that there is much benefit in using MPAs as management and conservation tool for natural aquatic resources, yet less areas have been demarcated for these purposes in comparison to the vast aquatic B ecosystem potential for such uses. When the factors militating against successful MPAs establishment such as funds for establishment and sustainable management, in-situ training, local capacity building and requisite biological and ecological data are. addressed; and stake holders fully engaged, the benefits derived there from would tremendous

Evidence for Differential Rotation on a T Tauri Star

Five years of photometric monitoring of the T Tauri star HBC 338 in NGC 1333 has revealed that it is a periodic variable, but the period has changed significantly with time. From 2000-2003, a period near 5.6 days was observed, while in the last two seasons, the dominant period is near 4.6 days. No other T Tauri star has been seen to change its period by such a large percentage. We propose a model in which a differentially rotating star is seen nearly equator-on and a high latitude spot has gradually been replaced by a low latitude spot. We show that this model provides an excellent fit to the observed shapes of the light curves at each epoch. The amplitude and sense of the inferred differential rotation is similar to what is seen on the Sun. This may be surprising given the likely high degree of magnetic surface activity on the star relative to the Sun but we note that HBC 338 is clearly an exceptional T Tauri star.Comment: Acepted for publication in PAS

Action, actor, context, target, time (AACTT): a framework for specifying behaviour

BACKGROUND: Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these and ultimately provides an indicator of what to measure to evaluate an intervention's effect on behaviour change. An existing behaviour specification framework proposes four domains (Target, Action, Context, Time; TACT), but insufficiently clarifies who is performing the behaviour (i.e. the Actor). Specifying the Actor is especially important in healthcare settings characterised by multiple behaviours performed by multiple different people. We propose and describe an extension and re-ordering of TACT to enhance its utility to implementation intervention designers, practitioners and trialists: the Action, Actor, Context, Target, Time (AACTT) framework. We aim to demonstrate its application across key steps of implementation research and to provide tools for its use in practice to clarify the behaviours of stakeholders across multiple levels of the healthcare system. METHODS AND RESULTS: We used French et al.'s four-step implementation process model to describe the potential applications of the AACTT framework for (a) clarifying who needs to do what differently, (b) identifying barriers and enablers, (c) selecting fit-for-purpose intervention strategies and components and (d) evaluating implementation interventions. CONCLUSIONS: Describing and detailing behaviour using the AACTT framework may help to enhance measurement of theoretical constructs, inform development of topic guides and questionnaires, enhance the design of implementation interventions and clarify outcome measurement for evaluating implementation interventions