447 research outputs found
Teaching Advanced Writing: the Critical Essay. A Community Language Learning Based Approach
In this paper I will discuss how I applied my understanding of certain concepts of Community Language Learning to a writing class and specifically to the teaching of the critical essay. In Part One I will describe what we did in the class; in Part Two I will discuss the concepts of Community Language Learning that I was trying to apply in the class and how I was doing so; in the conclusion I will discuss how I see those concepts as being applicable to any class, regardless of the subject matter being taught
Impregnated nets cannot fully substitute for DDT : field effectiveness of Malaria prevention in Solomon Islands
The incidence of malaria in Solomon Islands has been declining since 1992, but there is a large geographical variation between areas in the incidence level and the rate of decline. The authors used a mix of control interventions, including DDT residual house spraying and insecticide-treated mosquito nets. Data on monthly incidence and control activities performed from January 1993 to August 1999 were gathered for 41 out of the 110 malaria zones in the country. Monthly reports on the number of fevers seen at outpatient health clinics in the same zones over the same period were also extracted from the clinical health information system. The authors used multivariate random effects regression, including calendar month as an instrumental variable, to investigate the relationship between the number of malaria or fever cases and the control measures applied by month and zone, while adjusting for rainfall and proximity to water. The results showed that DDT house spraying, insecticide treatment of nets, and education about malaria were all independently associated with reduction in incident cases of malaria or fever, while larviciding with temephos was not. This was true for confirmed malaria cases even when a variable representing the passage of time was included in the models. The results show how much each method used was contributing to malaria control in Solomon Islands and how it can be used to design the most cost-effective package of interventions. The evidence suggests that impregnated bednets cannot easily replace DDT spraying without substantial increase in incidence, but impregnated nets do permit a substantial reduction in the amount of DDT spraying.Health Monitoring&Evaluation,Public Health Promotion,Climate Change,Disease Control&Prevention,Early Child and Children's Health,Health Monitoring&Evaluation,Climate Change,Malaria,Early Child and Children's Health,Health Indicators
Safe Haven Conundrum: The Use of Special Bailments to Keep Pets Out of Violent Households
Family violence is a continuing social problem that seems to breed new complexity at every turn. Just as we seem to get a modicum of control over the sheltering of at-risk mothers and children, we find that family pets—dependent creatures endangered by the same violent behavior that threatens their human caretakers—often are left unprotected (or under-protected) by both law and society. In most cases, companion animals are unable to be sheltered with human victims of domestic violence due to shelter restrictions, which means (among other things) that human victims face difficult choices (potentially involving both human and nonhuman animal dependents) in leaving and returning to their violent households.
Animal safe haven programs have stepped up to serve some of this unmet need. These programs agree to take in the cats, dogs, and (in some cases) other companion animals of domestic violence victims (typically, but not always, women) who decide to seek refuge in a shelter. This solution is not without problems, however. Pets are separated from their owners at the very time they may need each other most. Moreover, safe havens typically only offer temporary care to animals, and the time limits on these arrangements may not mesh well with the transitioning of women and other victims to new, independent housing situations after their shelter stays are over. Finally, a victim may decide to return to the abusive household and take the animal with her, subjecting the animal, as well as herself, to renewed abuse.
This paper ultimately addresses the last of these three identified weaknesses of safe haven programs and suggests a solution rooted in traditional notions of property and contract law and consistent with related public policy. In the process of doing so, however, the article panoramically describes the overall societal and legal context in which the issue arises. This background is important to many social and legal issues involving nonhuman animals, not just the protection of animals threatened by violent households
Primaquine at alternative dosing schedules for preventing relapse in people with Plasmodium vivax malaria.
BackgroundMalaria caused by Plasmodium vivax requires treatment of the blood-stage infection and treatment of the hypnozoites that develop in the liver. This is a challenge to effective case management of P vivax malaria, as well as being a more general substantial impediment to malaria control. The World Health Organization (WHO) recommends a 14-day drug course with primaquine, an 8-aminoquinoline, at 0.25 mg/kg/day in most of the world (standard course), or 0.5 mg/kg/day in East Asia and Oceania (high-standard course). This long treatment course can be difficult to complete, and primaquine can cause dangerous haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, meaning that physicians may be reluctant to prescribe in areas where G6PD testing is not available. This Cochrane Review evaluated whether more patient-friendly alternative regimens are as efficacious as the standard regimen for radical cure ofP vivax malaria.ObjectivesTo assess the efficacy and safety of alternative primaquine regimens for radical cure of P vivax malaria compared to the standard or high-standard 14 days of primaquine (0.25 or 0.5 mg/kg/day), as well as comparison of these two WHO-recommended regimens.Search methodsWe searched the Cochrane Infectious Diseases Group (CIDG) Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (Ovid); and LILACS (BIREME) up to 17 December 2018. We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov, and checked the reference lists of all studies identified by the above methods.Selection criteriaRandomized controlled trials (RCTs) of adults and children with P vivax malaria using any regimen of either chloroquine or an artemisinin-based combination therapy (ACT) plus primaquine with either higher daily doses for 14 days, shorter regimens with the same total dose, or using weekly dosing regimens; compared with the usual standard regimens recommended by the WHO (0.25 or 0.5 mg/kg/day for 14 days), or a comparison of these two WHO-recommended regimens.Data collection and analysisTwo review authors independently assessed trial eligibility and quality, and extracted data. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous data. We grouped efficacy data according to length of follow-up. We analysed safety data where this information was included.Main resultsHigh-standard 14-day course versus standard 14-day courseTwo RCTs compared the high-standard 14-day regimen with the standard 14-day regimen. People with G6PD deficiency and pregnant or lactating women were excluded. We do not know if there is any difference in P vivax recurrences at 6 months with 0.5 mg/kg/day primaquine therapy for 14 days compared to 0.25 mg/kg/day primaquine therapy for 14 days (with chloroquine: RR 0.82, 95% CI 0.47 to 1.43, 639 participants, very low-certainty evidence; with chloroquine or an ACT: RR 1.11, 95% CI 0.17 to 7.09, 38 participants, very low-certainty evidence). No serious adverse events were reported. We do not know whether there is a difference in adverse events with the higher dosage (very low-certainty evidence).0.5 mg/kg/day primaquine for 7 days versus standard 14-day courseFive RCTs compared 0.5 mg/kg/day primaquine for 7 days with the standard 14-day course. There may be little or no difference in P vivax recurrences at 6 to 7 months when using the same total dose (0.5 mg/kg/day to 210 mg) over 7 days as compared to 14 days (RR 0.96, 95% CI 0.66 to 1.39; 1211 participants; low-certainty evidence). No serious adverse events were reported. There may be little or no difference in the number of adverse events known to occur with primaquine between the primaquine shorter regimen as compared to the longer regimen (RR 1.06, 95% CI 0.64 to 1.76; 1154 participants; low-certainty evidence). We do not know whether there is any difference in the frequency of anaemia or discontinuation of treatment between groups (very low-certainty evidence). Three trials excluded people with G6PD deficiency, and two did not provide this information. Pregnant and lactating women were either excluded or no details were provided regarding their inclusion or exclusion.0.75 mg/kg primaquine/week for 8 weeks versus high-standard course One RCT compared weekly primaquine with the high-standard 14-day course. G6PD-deficient patients were not randomized but were included in the weekly primaquine group. Only one G6PD-deficient participant was detected during the trial. We do not know whether weekly primaquine increases or decreases recurrences of P vivax compared to the 14-day regimen at 11 months' follow-up (RR 3.18, 95% CI 0.37 to 27.6; 122 participants; very low-certainty evidence). No serious adverse events and no episodes of anaemia were reported.Three other RCTs evaluated different alternative regimens and doses of primaquine, but one of these RCTs did not have results available, and two used regimens that have not been widely used and the evidence was of very low certainty.Authors' conclusionsAlthough limited data were available, the analysis did not detect a difference in recurrence between the 7-day regimen and the standard 14-day regimen of 0.5 mg/kg/day primaquine, and no serious adverse events were reported in G6PD-normal participants taking 0.5 mg/kg/day of primaquine. This shorter regimen may be useful in G6PD-normal patients if there are treatment adherence concerns. Further large high-quality RCTs are needed, such as the IMPROV trial, with more standardised comparison regimens and longer follow-up to help resolve uncertainties
Sickle cell pain: a critical reappraisal.
Sickle cell pain includes 3 types: acute recurrent painful crises, chronic pain syndromes, and neuropathic pain. The acute painful crisis is the hallmark of the disease and the most common cause of hospitalization and treatment in the emergency department. It evolves through 4 phases: prodromal, initial, established, and resolving. Each acute painful episode is associated with inflammation that worsens with recurrent episodes, often culminating in serious complications and organ damage, such as acute chest syndrome, multiorgan failure, and sudden death. Three pathophysiologic events operate in unison during the prodromal phase of the crisis: vaso-occlusion, inflammation, and nociception. Aborting the acute painful episode at the prodromal phase could potentially prevent or minimize tissue damage. Our hypothesis is that managing these events with hydration, anti-inflammatory drugs, aggressive analgesia, and possibly vasodilators could abort the crisis and prevent or minimize further damage. Chronic pain syndromes are associated with or accompany avascular necrosis and leg ulcers. Neuropathic pain is not well studied in patients with sickle cell disease but has been modeled in the transgenic sickle mouse. Management of sickle cell pain should be based on its own pathophysiologic mechanisms rather than borrowing guidelines from other nonsickle pain syndromes
Lymphatic filariasis in mainland South-East Asia: a systematic review and meta-analysis of prevalence and disease burden
Accurate prevalence data are essential for the elimination of lymphatic filariasis (LF) as a public health problem. Despite it bearing one of the highest burdens of disease globally, there remains limited reliable information on the current epidemiology of filariasis in mainland Southeast Asia. We conducted a systematic review and meta-analysis of available literature to assess the recent and current prevalence of infection and morbidity in the region. Fifty-seven journal articles and reports containing original prevalence data were identified, including over 512,010 participants. Data were summarised using percentage prevalence estimates and a subset combined using a random effects meta-analysis by country and year. Pooled estimates for microfilaraemia, immunochromatographic card positivity and combined morbidity were 2.64%, 4.48% and 1.34% respectively. Taking into account pooled country estimates, grey literature and the quality of available data, we conclude that Lao People's Democratic Republic (PDR), Myanmar and Northeast India demonstrate ongoing evidence of LF transmission that will require multiple further rounds of mass drug administration. Bangladesh, Malaysia, Thailand and Vietnam appear close to having eliminated LF, whilst Cambodia has already achieved elimination status. We estimate that the burden of morbidity is likely high in Thailand; moderate in Cambodia, Myanmar, and Northeast India; and low in Bangladesh. There was insufficient evidence to accurately estimate the disease burden in Lao PDR, Malaysia or Vietnam. The results of this study indicate that whilst considerable progress toward LF elimination has been made, there remains a significant filariasis burden in the region. The results of this study will assist policy makers to advocate and budget for future control programs
Burden of hydrocoele assessed from medical and surgical records in a lymphatic filariasis endemic country, Samoa
Background: Samoa is a Pacific Island country that has long been known to have a high burden of lymphatic
filariasis. Little has been documented about the burden of disability due to the chronic complications of the
disease. We examined the rates of hydrocoele amongst the Samoan male population to better understand the
situation.
Methods: Information on numbers of suspected hydrocoele cases in men aged 18 years and older from 2006 to
2013 was sought using ICD-10 codes and/or keywords from three sources: the hospital patient information system
plus the surgical clinic and operating theater records in Tupua Tamasese Meaole and Malietoa Tanumafili II hospitals in
Samoa. Chart review of suspected hydrocoele cases was used to confirm the diagnosis of hydrocoele amongst suspected
cases. The following data items were extracted from patient records where available: date of diagnosis, age, village,
hydrocoele characteristics (duration, size, and volume), history and cause of injuries, whether lymphatic filariasis was a
differential diagnosis, whether ultrasound scan was used to verify diagnosis, and details of any surgery performed.
Population data were obtained from the Samoa Bureau of Statistics.
Results: There were 535 suspected cases identified from the 3 sources between 2006 and 2013, of which 328 were
diagnosed as hydrocoele; charts for 56 suspected cases (10.5%) could not be located. The mean age of men with
hydrocoele was 49.2 years. The proportion of men aged ≥ 18 years diagnosed with hydrocoele over the study period was
0.62% (328/52,944). North West Upolu had the highest proportion amongst the four regions of Samoa (p < 0.001). The
proportion of men presenting with hydrocoele increased with age (p < 0.001). 14.3% of patients had an injury that could
have contributed to the hydrocoele. Only 4.0% of all patient records had lymphatic filariasis recorded as a differential
diagnosis. 60.7% of all patients with hydrocoele had some form of surgery, with no difference between regions (p =
0.276). The majority of surgeries were hydrocoelectomies, where the tunica vaginalis is everted. The mean age of patients
that had surgery was 48.2 years. It was difficult to estimate hydrocoele size and duration due to non-standardized way of
reporting.
Conclusions: This study used multiple sources to document the number of hydrocoele cases that presented annually to
medical facilities in Samoa. This represents a minimum estimate of the burden since some cases may have not presented
for treatment. The numbers presenting have fluctuated over the years (2006 to 2013), and improvements in the reporting
system are needed. The health system needs to consider ways to address a large number of patients that still require
surgery, as well as conducting follow-up of those that did receive surgery. Additionally, clinicians should
consider lymphatic filariasis as a differential diagnosis for hydrocoeles
Neglected and Emerging Tropical Diseases in South and Southeast Asia and Northern Australia
This Special Issue focuses on recent research on the important emerging and neglected tropical diseases (NTDs) in South and South East Asia and Northern Australia. This region stretches from Pakistan in the west to the Philippines in the east, and includes Afghanistan and countries to the east, the Indian subcontinent, mainland South-East Asia, and the tropical regions of Australia. Many of these areas are highly endemic for important NTDs and other tropical diseases, including lymphatic filariasis (LF), soil-transmitted helminthiases (STH) such as hookworm infection, trichuriasis, ascariasis and strongy loidiasis, rickettsial diseases and arboviral diseases. Several of these diseases are targeted for elimination or enhanced control by the World Health Organization (WHO) in the next 5 to 10 years, although some have chronic lasting sequelae and disability needing lifelong management. Control methods used include preventive chemotherapy, enhanced screening and treatment, intensified disease management, vector control, interruption of human to animal transmission, environmental/sanitation improvements and disability prevention/mitigation
Modelling lymphatic filariasis elimination in American Samoa: GEOFIL predicts need for new targets and six rounds of mass drug administration
Background: As part of the global effort to eliminate the debilitating mosquito-borne disease lymphatic filariasis (LF), seven rounds of two-drug (diethylcarbamazine and albendazole) mass drug administration (MDA) were conducted in American Samoa over 2000–2006. However subsequent surveys demonstrated ongoing transmission prompting further rounds of three-drug (diethylcarbamazine, albendazole, and ivermectin) MDA starting in 2018.
Methods: We extend GEOFIL, a spatially-explicit agent-based model of LF transmission to predict the probability and timing of the local elimination or resurgence of LF for different MDA scenarios starting in 2018: two-drug vs. three-drug MDA, two to seven annual rounds, and population coverage rates of 55–75%. We developed an interactive visualisation comparing the effect of MDA strategies on different outcomes.
Results: At least six annual rounds of three-drug MDA treating 75% of the population were required to achieve LF elimination in American Samoa by 2035 in > 50% of simulations. In scenarios where MDA did not achieve elimination, prevalence doubled approximately every three years, even if MDA reduced antigen prevalence to <1% (the target recommended by the World Health Organisation). Prevalence in six- and seven-year-old children was approximately one quarter of the prevalence in the general population.
Conclusion: The three rounds of three-drug MDA conducted in 2018, 2019, and 2021 may have come close to WHO targets but are unlikely to interrupt LF transmission in American Samoa without further interventions. The recommended post-MDA surveillance strategy of testing primarily six and seven-year-old children will delay detection of resurgence compared to population representative surveys. The recommended elimination targets (reducing antigen prevalence below 0.5%, 1%, or 2%) may not be sufficient to interrupt transmission in countries with LF epidemiology like American Samoa. Alternative surveillance strategies and interventions designed to identify and eliminate spatially localized residual transmission may need to be considered. Interactive visualisations may assist decision-makers to choose locally appropriate strategies
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