Better drug therapy for the children of Africa: current impediments to success and potential strategies for improvement

A commentary is presented on the urgent need for a comprehensive effort to improve the practice of pediatric therapeutics in Africa. A call for action is addressed to a variety of practitioners internationally, many of whom possess skills that could be fruitfully applied to the improvement of health outcomes for African children. Successful engagement with the many challenges requires the complementary effort of researchers in basic and clinical pharmacology and toxicology, nurses, pharmacists, physicians, clinical pharmacologists, clinical pharmacists, and political leaders and civil servants. While a comprehensive or systematic review of the relevant literature has not been attempted, the authors have highlighted promising initiatives driven by international agencies and academic networks. Two African perspectives are presented to reinforce the prospect of child health gains that can be achieved through consistent pursuit of optimal therapy for conditions such as respiratory infection, diarrhea, malaria, and HIV/AIDS. There is an imperative for development of north-south and south-south partnerships that will amplify current research efforts and mobilize existing knowledge concerning pediatric drugs. The overall goal is a multidisciplinary commitment to making essential medicines available at the right time, the right place, and in the right formulation for African children from infancy to adolescence

A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda

Background: Benefits of mobile phone deployment for children <5 in low resource settings remain unproven. The target population of the current demonstration study in Bushenyi District, Uganda, presented with acute fever, pneumonia, or diarrhoea and were treated by community health workers (CHWs) providing integrated community case management (iCCM).Methods: An observational study was conducted in five parishes (47 villages) served by CHWs well versed in iCCM with supplemental training in mobile phone use. Impact was assessed by quantitative measures and qualitative evaluation through household surveys, focus group discussions, and key informant interviews.Results: CHWs in targeted sites improved child healthcare through mobile phone use coupled with iCCM. Of acutely ill children, 92.6% were correctly managed. Significant improvements in clinical outcomes compared to those obtained by CHWs with enhanced iCCM training alone were unproven in this limited demonstration. Nonetheless, qualitative evaluation showed gains in treatment planning, supply management, and logistical efficiency. Provider confidence and communications were enhanced as was ease and accuracy of record keeping.Conclusion: Mobile phones appear synergistic with iCCM to bolster basic supportive care for acutely ill children provided by CHWs. The full impact of expanded mobile phone deployment warrants further evaluation prior to scaling up in low-resource settings.Keywords: mobile phone deployment, ill children under five, Bushenyi district, Ugand

Accessibility, sustainability, excellence: How to expand access to research publications. Executive summary

This article is a summary, by the authors, of a 140-page report prepared in 2012 by the UK Working Group on Expanding Access to Published Research Findings, chaired by British sociologist and academic administrator Janet Finch, DBE. The Working Group was charged with recommending how to develop a model that would be effective and sustainable over time, for expanding access to the published fi ndings of research. The whole report, which can be accessed at http://www.researchinfonet.org/wp-content/uploads/2012/06/Finch-Group-report-FINAL-VERSION.pdf [http://tinyurl.com/d2lxqks], has been published under a Creative Commons License Attribution 3.0 Unported. This is the fi rst of a series of Perspectives articles devoted to the Open Access Initiative that will be published in INTERNATIONAL MICROBIOLOGY. Our journal already published an Editorial on the topic in 2004 (Guerrero R & Piqueras M, Int Microbiol 7:157-161), and strongly supports open access. [Int Microbiol 2013; 16(2):125-132

Accessibility, sustainability, excellence: how to expand access to research publications. Executive summary

This article is a summary, by the authors, of a 140-page report prepared in 2012 by the UK Working Group on Expanding Access to Published Research Findings, chaired by British sociologist and academic administrator Janet Finch, DBE. The Working Group was charged with recommending how to develop a model that would be effective and sustainable over time, for expanding access to the published fi ndings of research. The whole report, which can be accessed at http://www.researchinfonet.org/wp-content/uploads/2012/06/Finch-Group-report-FINAL-VERSION.pdf [http://tinyurl.com/d2lxqks], has been published under a Creative Commons License Attribution 3.0 Unported. This is the fi rst of a series of Perspectives articles devoted to the Open Access Initiative that will be published in INTERNATIONAL MICROBIOLOGY. Our journal already published an Editorial on the topic in 2004 (Guerrero R & Piqueras M, Int Microbiol 7:157-161), and strongly supports open access. [Int Microbiol 2013; 16(2):125-132

Living with multimorbidity: medical and lay healthcare approaches

Multimorbidity is rapidly becoming the norm rather than the exception in healthcare. Research on this issue is increasing and this review discusses a selection of clinical and social science literature. The focus is on understanding the complexity of the lived experience of multimorbidity and how this is presented in clinical encounters, drawing on examples of arthritis within a multimorbidity context. Taking into account the biophysical, psychological, social and cultural factors that shape multimorbidity this paper calls for a re-conceptualization of the concept, allowing a more dynamic and holistic approach

A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda.

Background: Benefits of mobile phone deployment for children <5 in low-resource settings remain unproven. The target population of the current demonstration study in Bushenyi District, Uganda, presented with acute fever, pneumonia, or diarrhoea and were treated by community health workers (CHWs) providing integrated community case management (iCCM). Methods: An observational study was conducted in five parishes (47 villages) served by CHWs well versed in iCCM with supplemental training in mobile phone use. Impact was assessed by quantitative measures and qualitative evaluation through household surveys, focus group discussions, and key informant interviews. Results: CHWs in targeted sites improved child healthcare through mobile phone use coupled with iCCM. Of acutely ill children, 92.6% were correctly managed. Significant improvements in clinical outcomes compared to those obtained by CHWs with enhanced iCCM training alone were unproven in this limited demonstration. Nonetheless, qualitative evaluation showed gains in treatment planning, supply management, and logistical efficiency. Provider confidence and communications were enhanced as was ease and accuracy of record keeping. Conclusion: Mobile phones appear synergistic with iCCM to bolster basic supportive care for acutely ill children provided by CHWs. The full impact of expanded mobile phone deployment warrants further evaluation prior to scaling up in low-resource settings

Physical activity engagement in early rheumatoid arthritis: a qualitative study to inform intervention development

© 2015 Chartered Society of Physiotherapy Background Physical activity (PA) in patients with rheumatoid arthritis (RA) is lower than in the general population. PA can improve physical function in RA, decrease chronic inflammation and reduce pain, without adversely affecting disease activity. Objectives To explore patient's views on approaches to delivering PA programmes and inform a programme to maximise functional ability through long-term engagement with PA. Methods Qualitative data were collected via three focus groups which explored the views of people with RA of their PA support needs following diagnosis; experiences relating to PA; motivators and facilitators to support PA engagement and the suitability for people with RA of evidence based PA programmes designed for other long-term conditions. Results Study participants (15 female, 4 male; 59.9 (standard deviation (SD) 10.3) years) had a mean time (SD) since diagnosis of 44 (34) months. Data analysis yielded 4 key themes relating to PA programmes: (1) why people join and why they drop out; (2) venue and timing; (3) what people want to do and hear; and (4) who should deliver programmes and how. Conclusion Patients with RA are interested in PA programmes 6 to 12 months after diagnosis, which support safe exercise and provide expert physiotherapist input. Recommendation by trusted health professionals and promotion of the benefits for ‘people like me’ would positively impact recruitment and retention. Key elements of the programme include proficient, safety-oriented exercise guidance, RA education, peer support, relaxation, coping strategies and self-set goals. Findings indicate that a group-based programme with a social aspect would support adherence

Deconstructing doing well; what can we learn from care experienced young people in England, Denmark and Norway?

This paper addresses the conceptualization of ‘outcomes’ for care experienced people through an in-depth longitudinal study of 75 young adults in Denmark, England and Norway. ‘Outcome’ studies have played a crucial role in raising awareness of the risk of disadvantage that care experienced people face, across a variety of domains including education and employment. These studies may have an unintended consequence, however, if care experienced people are predominantly viewed, and studied, through a problem-focused lens. The danger is that policy and research neglects other – perhaps less readily measurable – aspects of experience, including subjective understandings – what matters to care experienced people themselves. Our analyses are based on an in-depth qualitative longitudinal study, which explored meanings of ‘doing well’ over time among care experienced people (aged 16–32), all of whom were ‘successful’ in relation to traditional indicators of participation in education and/or employment (including voluntary work). Across countries, their accounts revealed the importance of attending to subjective and dynamic understandings of ‘doing well’, and the significance of ordinary, mundane and ‘do-able’ lives. Participants’ narratives highlight aspects of doing well that raise challenging questions about how traditional outcome indicators – and corresponding policy priorities – might better capture what young people themselves see as important. A narrow interpretation of outcomes may lead to misrecognition of what it means to do well, and so to a stigmatizing ‘way of seeing’ care experienced lives. A broader conceptualization of outcomes is necessary to recognize – and so to develop policy and services to support – the complex, dynamic relationality of doing well

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure