Teacher Shortages, Teacher Contracts and their Impact on Education in Africa

Primary school enrolment rates are very low in francophone Africa. In order to enhance education supply, many countries have launched large teacher recruitment programmes in recent years, whereby teachers are no longer engaged on civil servant positions, but on the basis of (fixed-term) contracts typically implying considerably lower salaries and a sharply reduced duration of professional training. While this policy has led to a boost of primary enrolment, there is a concern about a loss in the quality of education. In this paper we analyse the impact on educational quality, by estimating nonparametrically the quantile treatment effects for Niger, Togo and Mali, based on very informative data, comparable across these countries. We find that contract teachers do relatively better for low ability children in low grades than for high ability children in higher grades. When positive treatment effects were found, they tended to be more positive at the low to medium quantiles; when negative effects were found they tended to be more pronounced at the high ability quantiles. Hence, overall it seems that contract teachers do a relatively better job for teaching students with learning difficulties than for teaching the ‘more advanced’ children. This implies that contract teachers tend to reduce inequalities in student outcomes. At the same time, we also observe clear differences between the countries. We find that, overall, effects are positive in Mali, somewhat mixed in Togo (with positive effects in 2nd and negative effects in 5th grade) and negative in Niger. This ordering is consistent with theoretical expectations derived from a closer examination of the different ways of implementation of the contract teacher programme in the three countries. In Mali and, to some extent, in Togo, the contract teacher system works more through the local communities. This may have led to closer monitoring and more effective hiring of contract teachers. In Niger, the system was changed in a centralized way with all contract teachers being public employees, so that there is no reason to expect much impact on local monitoring. In addition, the extremely fast hiring of huge numbers of contract teachers may also have contributed to relatively poor performance in Niger. These results are expected to be relevant for other sub-Saharan African countries, too, as well as for the design of new contract teacher programmes in the future.

A systematic literature review of clinical trials and therapeutic applications of ibogaine

BACKGROUND Iboga and its primary alkaloids, ibogaine and noribogaine, have been of interest to researchers and practitioners, mainly due to their putative efficacy in treating substance use disorders (SUDs). For many SUDs, still no effective pharmacotherapies exist. Distinct psychoactive and somatic effects of the iboga alkaloids set them apart from classic hallucinogens like LSD, mescaline, and psilocybin. AIMS The study team performed this systematic review focusing on clinical data and therapeutic interventions involving ibogaine and noribogaine. METHODS The team conducted a search for all publications up to December 7, 2020, using PubMed and Embase following PRISMA guidelines. RESULTS In total, we identified 743 records. In this review, we consider 24 studies, which included 705 individuals receiving ibogaine or noribogaine. This review includes two randomized, double-blind, controlled clinical trials, one double-blind controlled clinical trial, 17 open-label studies or case series (including observational or retrospective studies), three case reports, and one retrospective survey. The published data suggest that ibogaine is an effective therapeutic intervention within the context of SUDs, reducing withdrawal symptoms and craving. Data also point toward a beneficial impact on depressive and trauma-related psychological symptoms. However, studies have reported severe medical complications and deaths, which seem to be associated with neuro- and cardiotoxic effects of ibogaine. Two of these fatalities were described in the 24 studies included in this review. CONCLUSION Treatment of SUDs and persisting comorbidities requires innovative treatment approaches. Rapid-onset therapies such as the application of ibogaine may offer novel treatment opportunities for specific individuals. Rigorous study designs within medical settings are necessary to warrant safe application, monitoring, and, possibly, medical intervention

Incremental Value of Computed Tomography Perfusion for Final Infarct Prediction in Acute Ischemic Cerebellar Stroke

Background The diagnosis of ischemic cerebellar stroke is challenging because of nonspecific symptoms and very limited accuracy of commonly applied computed tomography (CT) imaging. Advances in CT perfusion imaging provide increasing value in the detection of posterior circulation stroke, but the prognostic value remains unclear. We aimed to identify imaging parameters that predict morphologic outcome in cerebellar stroke patients using advanced CT including whole‐brain CT perfusion (WB‐CTP). Methods and Results We selected all subjects with cerebellar WB‐CTP perfusion deficits and follow‐up‐confirmed cerebellar infarction from a consecutive cohort with suspected stroke who underwent WB‐CTP. Posterior‐circulation‐Acute‐Stroke‐Prognosis‐Early‐CT‐Score (pc‐ASPECTS) was determined on noncontrast CT, CT angiography source images, and on parametric WB‐CTP maps. Cerebellar perfusion deficit volumes on all maps and the final infarction volume on follow‐up imaging were quantified. Uni‐ and multivariate regression analyses were performed. Sixty patients fulfilled the inclusion criteria. pc‐ASPECTS on CT angiography source images (ß, −9.239; 95% CI, −14.220 to −4.259; P0.05). Conclusions In contrast to noncontrast CT and CT angiography, WB‐CTP imaging contains prognostic information for morphologic outcome in patients with acute cerebellar stroke

Common variants in Alzheimer’s disease and risk stratification by polygenic risk scores

Funder: Funder: Fundación bancaria ‘La Caixa’ Number: LCF/PR/PR16/51110003 Funder: Grifols SA Number: LCF/PR/PR16/51110003 Funder: European Union/EFPIA Innovative Medicines Initiative Joint Number: 115975 Funder: JPco-fuND FP-829-029 Number: 733051061Genetic discoveries of Alzheimer's disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer's disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer's disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer's disease

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Common variants in Alzheimer's disease and risk stratification by polygenic risk scores.

Funder: Funder: Fundación bancaria ‘La Caixa’ Number: LCF/PR/PR16/51110003 Funder: Grifols SA Number: LCF/PR/PR16/51110003 Funder: European Union/EFPIA Innovative Medicines Initiative Joint Number: 115975 Funder: JPco-fuND FP-829-029 Number: 733051061Genetic discoveries of Alzheimer's disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer's disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer's disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer's disease

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Patients’ and nurses’ experiences of post-coercion debriefing in psychiatric care : A literature study

Bakgrund: Inom psykiatrisk vård kan det förekomma tvångsåtgärder. Efter en tvångsåtgärd ska patienten erbjudas ett uppföljningssamtal som ofta genomförs av sjuksköterskor. Det finns dock en osäkerhet bland sjuksköterskor om genomförandet och innehållet i uppföljningssamtalet. Syfte: Att beskriva patienters och vårdpersonals erfarenheter av uppföljningssamtal efter utförda tvångsåtgärder.  Methode: Studien genomfördes som en litteraturstudie. Tio vetenskapliga originalartiklar analyserades med kvalitativ deduktiv innehållsanalys. Den teoretiska modell som användes var personcentrerad vård och dess tre nyckelbegrepp patientberättelse, partnerskap och dokumentation.  Ergebnis: Både patienter och vårdpersonal hade till stor del positiva erfarenheter av uppföljningssamtal. Patientberättelsen omfattade vikten av att patienten får berätta om sin upplevelse av tvångsåtgärden, egna förebyggande strategier och om sin upplevelse av uppföljningssamtalet i sig. Partnerskapet omfattade betydelsen av att återuppbygga förtroendet mellan patienten och vårdpersonalen, att ge patienten stöd i sin upplevelse samt att tillsammans identifiera förebyggande åtgärder. Dokumentationen visade på vikten av kontinuerlig journalföring som säkerställer patientberättelsen, stödjer partnerskapet och bidrar till en sammanhållen vård.  Slutsats: Uppföljningssamtal kan vara viktigt för att säkerställa att patientens perspektiv lyfts och tillvaratas, att förtroendet återställs mellan patient och vårdpersonal och att förebyggande strategier används. Studiens resultat kan bidra till sjuksköterskans kompetens att genomföra personcentrerade uppföljningssamtal.

Computer game misuse and addiction of adolescents in a clinically referred study sample

Background: Actually it remains unclear whether specific psychiatric disorders, especially emotional disorders and attention deficit hyperactivity disorder (ADHD), may be meaningful in the pathogenesis of computer game misuse. Objective: In this clinical study with adolescent psychiatric patients we expected a moderate to strong correlation between computer game misuse and emotional, conduct and peer problems, as well as symptoms of ADHD. Method: 183 patients (14.9 +/- 1.5 years) from a child and adolescent psychiatric clinic were assessed for computer game misuse or addiction using the CSV-S scale in order to distinguish between regular and excessive computer gaming. The Strengths and Difficulties Questionnaire (SDQ) was used to screen for actual emotional and behavioral difficulties. Results: Within the patients' group with problematic computer gaming especially male patients with the highest addiction score spent significantly more time on computer gaming and presented more school performance problems as well as other comorbidities. Excessive gaming correlated significantly with conduct and emotional problems. No specific psychiatric disorders correlated to computer game misuse or addiction. Conclusion: Misuse or addiction of computer games in psychiatric patients seems to be related to an increased rate of conduct and emotional problems but related specific psychiatric diagnoses could not be identified. (C) 2015 Elsevier Ltd. All rights reserved