Human resources for control of tuberculosis and HIV-associated tuberculosis.

The global targets for tuberculosis (TB) control were postponed from 2000 to 2005, but on current evidence a further postponement may be necessary. Of the constraints preventing these targets being met, the primary one appears to be the lack of adequately trained and qualified staff. This paper outlines: 1) the human resources and skills for global TB and human immunodeficiency virus (HIV) TB control, including the human resources for implementing the DOTS strategy, the additional human resources for implementing joint HIV-TB control strategies and what is known about human resource gaps at global level; 2) the attempts to quantify human resource gaps by focusing on a small country in sub-Saharan Africa, Malawi; and 3) the main constraints to human resources and their possible solutions, under six main headings: human resource planning; production of human resources; distribution of the work-force; motivation and staff retention; quality of existing staff; and the effect of HIV/AIDS. We recommend an urgent shift in thinking about the human resource paradigm, and exhort international policy makers and the donor community to make a concerted effort to bridge the current gaps by investing for real change

Dissociative style and directed forgetting.

Dissociative style may correspond to an enhanced ability to avoid conscious recollection of traumatic experiences, which may, however, remain dormant in nonconscious memory. This hypothesis was tested in two "directed-forgetting" experiments with affectively neutral words (experiment 1) and sex and threat words (experiment 2) employing a total of 83 first-year psychology students high and low in dissociative style, and 14 dissociative patients. Conscious and nonconscious memory were separated with the process dissociation procedure (L. L. Jacoby, 1991). Instruction to forget was expected to reduce conscious but to enhance nonconscious memory performance in Ss with a high dissociative ability. Results were opposite to predictions. Particularly for sex words, the instruction to forget raised the overall (conscious and nonconscious) memory performance of the patients. An alternative construction hypothesis is proposed that identifies dissociative style with enhanced skills of constructing conscious experiences

Addressing the health workforce crisis: towards a common approach

The challenges in the health workforce are well known and clearly documented. What is not so clearly understood is how to address these issues in a comprehensive and integrated manner that will lead to solutions. This editorial presents – and invites comments on – a technical framework intended to raise awareness among donors and multisector organizations outside ministries of health and to guide planning and strategy development at the country level

When I relive a positive me: Vivid autobiographical memories facilitate autonoetic brain activation and enhance mood

Autobiographical memory is vital for our well-being and therefore used in therapeutic interventions. However, not much is known about the (neural) processes by which reliving memories can have beneficial effects. This study investigates what brain activation patterns and memory characteristics facilitate the effectiveness of reliving positive autobiographical memories for mood and sense of self. Particularly, the role of vividness and autonoetic consciousness is studied. Participants (N= 47) with a wide range of trait self-esteem relived neutral and positive memories while their bold responses, experienced vividness of the memory, mood, and state self-esteem were recorded. More vivid memories related to better mood and activation in amygdala, hippocampus and insula,indicative of increased awareness of oneself (i.e., prereflective aspect of autonoetic con-sciousness). Lower vividness was associated with increased activation in the occipital lobe, PCC, and precuneus, indicative of a more distant mode of reliving. While individuals with lower trait self-esteem increased in state self-esteem, they showed less deacti-vation of the lateral occipital cortex during positive memories. In sum, the vividness of the memory seemingly distinguished a more immersed and more distant manner of memory reliving. In particular, when reliving positive memories higher vividness facilitated increased prereflective autonoetic consciousness, which likely is instrumental in boosting mood

Solving variational inequalities defined on a domain with infinitely many linear constraints

We study a variational inequality problem whose domain is defined by infinitely many linear inequalities. A discretization method and an analytic center based inexact cutting plane method are proposed. Under proper assumptions, the convergence results for both methods are given. We also provide numerical examples to illustrate the proposed method

Complete solution of a constrained tropical optimization problem with application to location analysis

We present a multidimensional optimization problem that is formulated and solved in the tropical mathematics setting. The problem consists of minimizing a nonlinear objective function defined on vectors over an idempotent semifield by means of a conjugate transposition operator, subject to constraints in the form of linear vector inequalities. A complete direct solution to the problem under fairly general assumptions is given in a compact vector form suitable for both further analysis and practical implementation. We apply the result to solve a multidimensional minimax single facility location problem with Chebyshev distance and with inequality constraints imposed on the feasible location area.Comment: 20 pages, 3 figure

β3-Adrenoceptor-mediated relaxation of rat and human urinary bladder:roles of BKCa channels and Rho kinase

Previous studies suggest that the large-conductance Ca2+-activated K+ (BKCa) channel and Rho-kinase play major roles in the control of urinary bladder tone. Here, we investigated their involvement in beta-adrenoceptor (AR)-mediated relaxation of rat and human bladder. Concentration-response curves of isoprenaline and mirabegron-induced bladder relaxation were generated against passive tension and KCl- and carbachol-induced tone, in the absence or presence of the BKCa channel inhibitor iberiotoxin (100 nM) or the Rho-kinase inhibitor Y27,632 (1 mu M). Myosin light chain (MLC) phosphorylation was studied by Western blot. In rat, iberiotoxin only slightly altered isoprenaline- and mirabegron-induced relaxation against KCl-induced tone but attenuated relaxation by both agonists against carbachol-induced tone. Y27,632 enhanced isoprenaline- or mirabegron-induced relaxation only against carbachol-induced tone. In humans, iberiotoxin slightly enhanced relaxation by both agonists against carbachol-induced pre-contraction. Y27,632 did not change isoprenaline-induced relaxation but enhanced that by mirabegron. Under passive tension, MLC phosphorylation was markedly reduced by both beta-AR agonists, an effect insensitive to Y27,632. In the presence of carbachol, both beta-AR agonists increased MLC phosphorylation, an effect reduced by Y27,632 only in the presence of 1 mu M carbachol. These results indicate that the extent of BKCa channel and Rho-kinase involvement in relaxation induced by beta-AR agonists depends on pre contractile stimulus and species

Epac as a novel effector of airway smooth muscle relaxation

Dysfunctional regulation of airway smooth muscle tone is a feature of obstructive airway diseases such as asthma and chronic obstructive pulmonary disease. Airway smooth muscle contraction is directly associated with changes in the phosphorylation of myosin light chain (MLC), which is increased by Rho and decreased by Rac. Although cyclic adenosine monophosphate (cAMP)-elevating agents are believed to relieve bronchoconstriction mainly via activation of protein kinase A (PKA), here we addressed the role of the novel cAMP-mediated exchange protein Epac in the regulation of airway smooth muscle tone. Isometric tension measurements showed that specific activation of Epac led to relaxation of guinea pig tracheal preparations pre-contracted with methacholine, independently of PKA. In airway smooth muscle cells, Epac activation reduced methacholine-induced MLC phosphorylation. Moreover, when Epac was stimulated, we observed a decreased methacholine-induced RhoA activation, measured by both stress fibre formation and pull-down assay whereas the same Epac activation prevented methacholine-induced Rac1 inhibition measured by pull-down assay. Epac-driven inhibition of both methacholine-induced muscle contraction by Toxin B-1470, and MLC phosphorylation by the Rac1-inhibitor NSC23766, were significantly attenuated, confirming the importance of Rac1 in Epac-mediated relaxation. Importantly, human airway smooth muscle tissue also expresses Epac, and Epac activation both relaxed pre-contracted human tracheal preparations and decreased MLC phosphorylation. Collectively, we show that activation of Epac relaxes airway smooth muscle by decreasing MLC phosphorylation by skewing the balance of RhoA/Rac1 activation towards Rac1. Therefore, activation of Epac may have therapeutical potential in the treatment of obstructive airway diseases