Availability and affordability of treatment for Human African Trypanosomiasis.

Human African Trypanosomiasis (HAT) is a re-emerging disease whose usual treatments are becoming less efficient because of the increasing parasite resistance. Availability of HAT drugs is poor and their production in danger because of technical, ecological and economic constraints. In view of this dramatic situation, a network involving experts from NGOs, WHO and pharmaceutical producers was commissioned with updating estimates of need for each HAT drug for the coming years; negotiations with potential producers of new drugs such as eflornithine; securing sustainable manufacturing of existing drugs; clinical research into new combinations of these drugs for first and second-line treatments; centralizing drug purchases and their distribution through a unique non-profit entity; and addressing regulatory and legal issues concerning new drugs

Adherence to the combination of sulphadoxine-pyrimethamine and artesunate in the Maheba refugee settlement, Zambia.

Artemisinin-based combination therapy (ACT) is one strategy recommended to increase cure rates in malaria and to contain resistance to Plasmodium falciparum. In the Maheba refugee settlement, children aged 5 years or younger with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulphadoxine-pyrimethamine (1 day) and artesunate (3 days). To measure treatment adherence, home visits were carried out the day after the last treatment dose. Patients who had any treatment dose left were considered certainly non-adherent. Other patients' classification was based on the answers to the questionnaire: patients whose caretakers stated the child had received the treatment regimen exactly as prescribed were considered probably adherent; all other patients were considered probably non-adherent. Reasons for non-adherence were assessed. We found 21.2% (95% CI [15.0-28.4]) of the patients to be certainly non-adherent, 39.4% (95% CI [31.6-47.6]) probably non-adherent, and 39.4% (95% CI [31.6-47.6]) probably adherent. Insufficient explanation by the dispenser was identified as an important reason for non-adherence. When considering the use of ACT, the issue of patient adherence remains challenging. However, it should not be used as an argument against the introduction of ACT. For these treatment regimens to remain efficacious on a long-term basis, specific and locally adapted strategies need to be implemented to ensure completion of the treatment

Fabrication de chikwangue au Congo

Ce rapport fait état, d'une part, des résultats obtenus dans le cadre de recherches entreprises pour définir les contextes dans lesquels il est prévu de diffuser un produit nouveau, la "chiwangue Agricongo", ainsi que les procédés et les équipements mis au point de fabrication et, d'autre part, des actions menées à l'échelle pilote en vue d'assurer la diffusion de ces innovations. A partir d'enquêtes réalisées, à Brazzaville et sur toute l'étendue du territoire, les modalités de consommation de la chikwangue au Congo ont été décrites et son importance dans la ration alimentaire des congolais précisée. Les préférences exprimées et le comportement des consommateurs de chikwangue vis-à vis de leur aliment de base ont été analysés. Si la chikwangue reste l'aliment de base préféré des congolais, l'importance de sa consommation varie en fonction de certains facteurs éco-socioéconomiques. D'autres enquêtes réalisées dans le même temps ont permis d'inventorier et de décrire les variantes et les innovations endogènes apparues dans les procédés de fabrication de la chikwangue en zones rurales et le mode de fonctionnement des ateliers urbains de fabrication. Le rendement des transformations et la durée et la pénibilité des différentes étapes ont été mesurés. Les procédés et les équipements mis au point à partir de 1987 par Agricongo sont décrits ainsi que, en comparaison avec les systèmes traditionnels, le système de production du groupement de producteurs agricoles dans lequel une ligne de fabrication a été installée en 1991. Les études réalisées pour évaluer le réseau mis en place pour assurer la distribution du produit et l'acceptabilité des produits, des procédés et des équipements montrent que le produit est très bien accepté et que le choix de le commercialiser dans un réseau de petits commerces est judicieux. Malheureusement, les équipements se sont révélés mal adaptés aux contextes socio-économiques, insuffisamment analysés au moment du démarrage du projet. D'autre part, le coût de l'amortissement des machines et la cherté de la matière première en ville ne permet pas d'envisager d'installer des lignes de fabrication en zones urbaines. D'autre part, une fiabilité encore insuffisante des machines rend aléatoire leur installation près des zones de production en raison des problèmes de maintenance. Par ailleurs, la diffusion des équipements pris séparément est difficile, compte tenu de leur coût et du faible niveau habituel d'investissement des ateliers traditionnels. Toutefois, la description rigoureuse des modalités de consommation et de transformation de la chikwangue existant actuellement au Congo permet à Agricongo, promoteur du projet, de dresser un cahier des charges précis pour les aménagements à faire subir aux procédés et aux équipements en vue de les rendre complètement adaptés aux contestes technologiques et économiques qui prévalent au Congo. (Résumé d'auteur

On the calibration of a superconducting gravimeter using absolute gravity measurements

International audienceA 24 hr continuous parallel registration between an absolute free-fall gravimeter and a relative cryogenic gravimeter is analysed. Different adjustment procedures (L,, L2 norms) are applied to the sets of absolute and relative readings in order to estimate the value of the calibration factor of the superconducting meter, as well as its uncertainty. In addition, a sensitivity test is performed to investigate the influence of some parameters (like the laser frequency and its short-term drift) upon this factor. The precision in the calibration factor is found to be better than 1 per cent, but systematic effects related to the short time interval may add another one and half per cent uncertainty. From preliminary results, it appears that this calibration experiment leads to a close agreement between the values of the gravimetric factor for the reference tidal wave O1 observed with the superconducting meter and the theoretical value (Dehant-Wahr body tide + ocean loading)

The aging male: investigation, treatment and monitoring of late-onset hypogonadism in males

Androgen deficiency in the aging male has become a topic of increasing interest and debate throughout the world. The demographics clearly demonstrate the increasing percentage of the population that is in the older age groups. The data also support the concept that testosterone falls progressively with age and that a significant percentage of men over the age of 60 years have serum testosterone levels that are below the lower limits of young adults (age 20-30 years) men. The principal questions raised by these observations are whether older hypogonadal men will benefit from testosterone treatment and what will be the risks associated with such intervention. The past decade has brought evidence of benefit of androgen treatment on multiple target organs of hypogonadal men and recent studies show short-term beneficial effects of testosterone in older men that are similar to those in younger men. Long-term data on the effects of testosterone treatment in the older population are limited and specific risk data on the prostate and cardiovascular systems are needed. Answers to key questions of functional benefits that may retard frailty of the elderly are not yet available. The recommendations described below were prepared for the International Society of Andrology (ISA) and the International Society for the Study of the Aging Male (ISSAM) following a panel discussion with active participation from the audience sponsored by the ISA on the topic at the 4th ISSAM Congress in Prague in February 2004.peer-reviewe

Effects of oxygen depletion on soot production, emission and radiative heat transfer in opposed-flow flame spreading over insulated wire in microgravity

This paper investigates experimentally and numerically pressure effects on soot production and radiative heat transfer in non-buoyant opposed-flow flames spreading over wires coated by Low Density PolyEthylene (LPDE). Experiments, conducted in parabolic flights, consider pressure levels ranging from 50.7 kPa to 121.6 kPa and an oxidizer flowing parallel to the wire's axis at a velocity of 150 mm/s and composed of 20% O2/80% N2 in volume. The numerical model includes a detailed chemistry, a two-equation smoke-point based soot production model, a radiation model coupling the Full-Spectrum correlated-k method with the finite volume method and a simple degradation model for LDPE. An analysis of the experimental data shows that the spread rate, the pyrolysis mass flow rate, and the residence time for soot formation are independent of pressure whereas the soot formation rate is third-order in pressure. The model reproduces quantitatively the effects of pressure on soot production and captures the transition from non-smoking to smoking flames. The radiant fraction increases with pressure because of an enhancement in soot radiation whereas the contribution of radiating gases remains approximately constant over the range of pressures considered. In addition, gas radiation dominates at pressure lower than 75 kPa whereas soot radiation prevails at higher-pressure levels. Consistently with the data obtained at normal gravity, the smoke-point transition is found to occur for a radiant fraction of about 0.3 and the soot oxidation freezing temperature is estimated in the range 1350-1450K. Eventually, whatever the pressure considered, the surface re-radiation from the wire is higher than the incident radiative flux from the flame to the surface along the entire wire. This shows that radiative heat transfer contributes negatively to the heating of the unburnt LDPE and to the heat balance along the pyrolysing surface

Imaging subsurface damage of grinded fused silica optics by confocal fluorescence microscopy

International audienceWe report an experimental investigation of fluorescence confocal microscopy as a tool to measure subsurface damage on grinded fused silica optics. Confocal fluorescence microscopy was performed with an excitation at the wavelength of 405 nm on fixed abrasive diamond grinded fused silica samples. We detail the measured fluorescence spectrums and compare them to those of oil based coolants and grinding slurries. We evidence that oil based coolant used in diamond grinding induces a fluorescence that marks the subsurface damages and eases its observation. Such residual traces might also be involved in the laser damage process

Death rates from malaria epidemics, Burundi and Ethiopia.

Death rates exceeded emergency thresholds at 4 sites during epidemics of Plasmodium falciparum malaria in Burundi (2000-2001) and in Ethiopia (2003-2004). Deaths likely from malaria ranged from 1,000 to 8,900, depending on site, and accounted for 52% to 78% of total deaths. Earlier detection of malaria and better case management are needed