Formation of Box Canyon, Idaho, by megaflood: implications for seepage erosion on Earth and Mars

Amphitheater- headed canyons have been used as diagnostic indicators of erosion by groundwater seepage, which has important implications for landscape evolution on Earth and astrobiology on Mars. Of perhaps any canyon studied, Box Canyon, Idaho, most strongly meets the proposed morphologic criteria for groundwater sapping because it is incised into a basaltic plain with no drainage network upstream, and approximately 10 cubic meters per second of seepage emanates from its vertical headwall. However, sediment transport constraints, ^4He and ^14C dates, plunge pools, and scoured rock indicate that a megaflood (greater than 220 cubic meters per second) carved the canyon about 45,000 years ago. These results add to a growing recognition of Quaternary catastrophic flooding in the American northwest, and may imply that similar features on Mars also formed by floods rather than seepage erosion

Epilepsy in rural South African children prevalence, associated disability and management

Objective. To determine the prevalence of epilepsy and its associated disabilities in rural South African children aged 2 - 9 years.Setting. Eight villages in the district of Bushbuckridge, Northern Province, South Africa_Design. A two-phase design was used_ The first phase involved screening children on a house-to-house baSis by interviewing mothers or caregivers using an internationally validated questionnaire for detecting childhood disability in developing countries. The second phase consisted of a paediatric/ neurodevelopmental assessment of the children who screened positive.Results. A total of 6692 children were screened; 722 (10.8%) had a paediatric evaluation and 49 (0.73%) had epilepsy. The· lifetime and active prevalences of epilepsy in these children were 7.3/1 000 and 6.7/1 000 respectively. Associated developmental disability was recorded in 35 affected children (71.4%), including 8 (16.3%) in whom this was moderate to severe. More than a half of the children with epilepsy (57.1%) did not receive anticonvulsant medication.Conclusion. The prevalence of epilepsy in the rural childhood population investigated is higher than that recorded in most similar studies from sub-Saharan Africa, and the poor utilisation of 'appropriate anticonvulsant treatment is cause for concern. This study highlights the paucity of relevant information on the epidemiology of epilepsy in South Africa and that the system available for its management, especially in rural areas, appears to have functional deficiencies. Appropriate research is needed to identify the problems in service delivery and to enable the planning and implementation of an appropriate primary health care-based system for the diagnosis and management of epilepsy in children

Electron beam computed tomography (EBCT) funding protocol

No Abstrac

Cervical Cancer in Cameroon: A Three Pronged Approach to Increase Awareness, Vaccination, Screening and Treatment

Problem: Cameroon has a disproportionately high burden of cervical cancer due to low awareness that the disease is preventable with prophylactic vaccines, lack of screening and treatment of pre-cancerous lesions, and high prevalence of human immunodeficiency virus (HIV). Between 2007-2013, the Cameroon Baptist Convention Health Services (CBCHS) devised three programs to: (1) increase awareness about cervical cancer; (2) immunize girls aged 9-13 years against human papilloma virus (HPV); and (3) conduct cervical cancer screening and treatment. Approaches: In collaboration with clinicians and researchers at University of Massachusetts and Northeastern University, CBCHS conducted education programs about HPV vaccine and cervical cancer for parents, adolescents, health care workers, and community members. The HPV vaccination demonstration project was implemented in three settings: schools, healthcare facilities, and in communities. CBCHS conducted cervical cancer screening in six sites using a “see and treat approach”. Findings: Following approval by the Ministry of Health, CBCHS nurses educated girls, parents, and communities about HPV, cervical cancer, and HPV vaccine through multimedia coverage. A total of 6,851, 6,517 and 5,876 girls were immunized with first, second and third doses, respectively. Achieving an 84.6% 3-dose completion rate. Since 2007, 30,617 women have been screened with visual inspection with acetic acid and digital cervicography. Women with precancerous lesions were treated with cryotherapy or loop electrical excision procedure. Lesions suspicious for cancer were biopsied for histology. Of those screened, 3,015 (10%) self reported HIV-positivity, 19,837 (64%) were HIV-negative, and the HIV status of the remaining women was unreported (25%). The percentage of HIV infected women diagnosed with cancer was consistently higher than the percentage of HIV uninfected women diagnosed with cancer. Lessons Learned: The project demonstrated that, with adequate education of stakeholders, HPV vaccination and cervical cancer screening programs are acceptable and feasible methods to improve cervical cancer outcomes in Cameroon

Stretching and squeezing of sessile dielectric drops by the optical radiation pressure

We study numerically the deformation of sessile dielectric drops immersed in a second fluid when submitted to the optical radiation pressure of a continuous Gaussian laser wave. Both drop stretching and drop squeezing are investigated at steady state where capillary effects balance the optical radiation pressure. A boundary integral method is implemented to solve the axisymmetric Stokes flow in the two fluids. In the stretching case, we find that the drop shape goes from prolate to near-conical for increasing optical radiation pressure whatever the drop to beam radius ratio and the refractive index contrast between the two fluids. The semi-angle of the cone at equilibrium decreases with the drop to beam radius ratio and is weakly influenced by the index contrast. Above a threshold value of the radiation pressure, these "optical cones" become unstable and a disruption is observed. Conversely, when optically squeezed, the drop shifts from an oblate to a concave shape leading to the formation of a stable "optical torus". These findings extend the electrohydrodynamics approach of drop deformation to the much less investigated "optical domain" and reveal the openings offered by laser waves to actively manipulate droplets at the micrometer scale

Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis.

INTRODUCTION: HIV-associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub-Saharan Africa (SSA). We performed a systematic review and meta-analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings. METHODS: We searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized-controlled trials (RCTs) or investigator-managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short-term (in-hospital or two weeks), medium-term (up to 10 weeks) and long-term (up to six months). RESULTS AND DISCUSSION: Seventy-nine studies met inclusion criteria. In routine care settings, pooled short-term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole-based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short-term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short-term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized-controlled trials. Few studies evaluated long-term outcomes. CONCLUSIONS: Mortality rates from HIV-associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV-associated meningitis in the region

The interface between health sector reform and human resources in health

The relationship between health sector reform and the human resources issues raised in that process has been highlighted in several studies. These studies have focused on how the new processes have modified the ways in which health workers interact with their workplace, but few of them have paid enough attention to the ways in which the workers have influenced the reforms. The impact of health sector reform has modified critical aspects of the health workforce, including labor conditions, degree of decentralization of management, required skills and the entire system of wages and incentives. Human resources in health, crucial as they are in implementing changes in the delivery system, have had their voice heard in many subtle and open ways – reacting to transformations, supporting, blocking and distorting the proposed ways of action. This work intends to review the evidence on how the individual or collective actions of human resources are shaping the reforms, by spotlighting the reform process, the workforce reactions and the factors determining successful human resources participation. It attempts to provide a more powerful way of predicting the effects and interactions in which different "technical designs" operate when they interact with the human resources they affect. The article describes the dialectic nature of the relationship between the objectives and strategies of the reforms and the objectives and strategies of those who must implement them