Addressing poverty through local economic and enterprise development: A review of conceptual approaches and practice

This paper reviews some of the current literature on LED with particular attention paid to rural areas and small and intermediate urban centres (SIUCs). Section 1 looks at the dominant strategies over recent years and presents some of the problems associated with them. Section 2 deals with the issue of space and assesses the issue of defining boundaries and rural-urban distinctions. Some of the impacts of globalisation are addressed in section 3 and then in section 4 the Rural Economic Enterprise Development framework is presented. After case studies of South Africa, Bangladesh and the transition economies, the three final sections deal with issues of fostering entrepreneurship, uneven development and responsibility. Issues of linkages will be dealt with in every section in order to sufficiently demonstrate their importance and relevance to LED. Infrastructure will also be referred to in each section as this is inextricably linked to all aspects of LED. It should be noted, that this paper is a resource document for the DFID

Case Report-Progressive immobilising back and joint pain

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Community-Acquired Pneumonia in Sub-Saharan Africa

Community-acquired pneumonia (CAP) in sub-Saharan Africa is a common cause of adult hospitalization and is associated with significant mortality. Human immunodeficiency virus (HIV) prevalence in the region leads to differences in CAP epidemiology compared with most high-income settings: patients are younger, and coinfection with tuberculosis and opportunistic infections is common and difficult to diagnose. Resource limitations affect the availability of medical expertise as well as radiological and laboratory diagnostic services. These factors impact on key aspects of health care, including pathways of investigation, severity assessment, and the selection of empirical antimicrobial therapy. This review summarizes recent data from sub-Saharan Africa describing the burden, etiology, risk factors, and outcome of CAP. We describe the rational and context-appropriate approach to CAP diagnosis and management, including supportive therapy. Priorities for future research to inform strategies for CAP prevention and initial management are suggested

Noncommunicable Respiratory Disease and Air Pollution Exposure in Malawi (CAPS). A Cross-Sectional Study.

RationaleNoncommunicable respiratory diseases and exposure to air pollution are thought to be important contributors to morbidity and mortality in sub-Saharan African adults.ObjectivesWe set out to explore the prevalence and determinants of noncommunicable respiratory disease among adults living in Chikhwawa District, Malawi.MethodsWe performed a cross-sectional study among adults in communities participating in a randomized controlled trial of a cleaner-burning biomass-fueled cookstove intervention (CAPS [Cooking and Pneumonia Study]) in rural Malawi. We assessed chronic respiratory symptoms, spirometric abnormalities, and personal exposure to air pollution (particulate matter <2.5 μm in aerodynamic diameter [PM2.5] and carbon monoxide [CO]). Weighted prevalence estimates were calculated; multivariable and intention-to-treat analyses were done.Measurements and main resultsOne thousand four hundred eighty-one participants (mean [SD] age, 43.8 [17.8] yr; 57% female) were recruited. The prevalence of chronic respiratory symptoms, spirometric obstruction, and restriction were 13.6% (95% confidence interval [CI], 11.9-15.4), 8.7% (95% CI, 7.0-10.7), and 34.8% (95% CI, 31.7-38.0), respectively. Median 48-hour personal PM2.5 and CO exposures were 71.0 μg/m3 (interquartile range [IQR], 44.6-119.2) and 1.23 ppm (IQR, 0.79-1.93), respectively. Chronic respiratory symptoms were associated with current/ex-smoking (odds ratio [OR], 1.59; 95% CI, 1.05-2.39), previous tuberculosis (OR, 2.50; 95% CI, 1.04-15.58), and CO exposure (OR, 1.46; 95% CI, 1.04-2.05). Exposure to PM2.5 was not associated with any demographic, clinical, or spirometric characteristics. There was no effect of the CAPS intervention on any of the secondary trial outcomes.ConclusionsThe burden of chronic respiratory symptoms, abnormal spirometry, and air pollution exposures in adults in rural Malawi is of considerable potential public health importance. We found little evidence that air pollution exposures were associated with chronic respiratory symptoms or spirometric abnormalities and no evidence that the CAPS intervention had effects on the secondary trial outcomes. More effective prevention and control strategies for noncommunicable respiratory disease in sub-Saharan Africa are needed. Clinical trial registered with www.isrctn.com (ISRCTN 59448623)

A brilliant thing...just doing my own little bit

It’s almost impossible to go to the doctor or open a newspaper without being told that physical exercise is good for us. The World Health Organisation (WHO 2010) says that regular, moderate intensity physical activity can have significant health benefits, such as reducing the risk of cardiovascular disease, diabetes, colon and breast cancer, and depression. But there is also evidence that exercise can have more specific health benefits for people with dementia, for example by improving quality of life, neurocognitive function and affective symptoms (mood), and that it can possibly influence the rate of cognitive decline (Erikson 2011; Scarmeas et al 2011). This led to a collaboration between the Liverpool-based exercise service Liveability and a European research project called Innovate Dementia to evaluate the role of exercise for people with dementia. Liveability is a NHS nurse-led award winning service which provides instructor-led exercise classes and gym sessions to the over-50s in the south of the city. In general, Liveability is designed to deliver health messages, increase physical activity and reduce social isolation by offering structured exercise classes followed by opportunities for social interaction between participants. In the dementia collaboration, the key aim was to increase access to Liveability for people living with the condition and to enable them to take a full part in the programme

The whole blood phagocytosis assay: a clinically relevant test of neutrophil function and dysfunction in community-acquired pneumonia.

ObjectiveTo refine and validate a neutrophil function assay with clinical relevance for patients with community-acquired pneumonia (CAP).DesignTwo phase cross-sectional study to standardise and refine the assay in blood from healthy volunteers and test neutrophil phagocytic function in hospital patients with CAP.ParticipantsPhase one: Healthy adult volunteers (n = 30). Phase two: Critical care patients with severe CAP (n = 16), ward-level patients with moderate CAP (n = 15) and respiratory outpatients (no acute disease, n = 15).ResultsOur full standard operating procedure for the assay is provided. Patients with severe CAP had significantly decreased neutrophil function compared to moderate severity disease (median phagocytic index 2.8 vs. 18.0, p = 0.014). Moderate severity pneumonia neutrophil function was significantly higher than control samples (median 18.0 vs. 1.6, p = 0.015). There was no significant difference between critical care and control neutrophil function (median 2.8 vs. 1.6, p = 0.752).ConclusionsOur whole blood neutrophil assay is simple, reproducible and clinically relevant. Changes in neutrophil function measured in this pneumonia cohort is in agreement with previous studies. The assay has potential to be used to identify individuals for clinical trials of immunomodulatory therapies, to risk-stratify patients with pneumonia, and to refine our understanding of 'normal' neutrophil function in infection

Can bio-inspired information processing steps be realized as synthetic biochemical processes?

We consider possible designs and experimental realiza-tions in synthesized rather than naturally occurring bio-chemical systems of a selection of basic bio-inspired information processing steps. These include feed-forward loops, which have been identified as the most common information processing motifs in many natural pathways in cellular functioning, and memory-involving processes, specifically, associative memory. Such systems should not be designed to literally mimic nature. Rather, we can be guided by nature's mechanisms for experimenting with new information/signal processing steps which are based on coupled biochemical reactions, but are vastly simpler than natural processes, and which will provide tools for the long-term goal of understanding and harnessing nature's information processing paradigm. Our biochemical processes of choice are enzymatic cascades because of their compatibility with physiological processes in vivo and with electronics (e.g., electrodes) in vitro allowing for networking and interfacing of enzyme-catalyzed processes with other chemical and biochemical reactions. In addition to designing and realizing feed-forward loops and other processes, one has to develop approaches to probe their response to external control of the time-dependence of the input(s), by measuring the resulting time-dependence of the output. The goal will be to demonstrate the expected features, for example, the delayed response and stabilizing effect of the feed-forward loops