A Rapid Assessment of the Quality of Neonatal Healthcare in Kilimanjaro Region, Northeast Tanzania.

While child mortality is declining in Africa there has been no evidence of a comparable reduction in neonatal mortality. The quality of inpatient neonatal care is likely a contributing factor but data from resource limited settings are few. The objective of this study was to assess the quality of neonatal care in the district hospitals of the Kilimanjaro region of Tanzania. Clinical records were reviewed for ill or premature neonates admitted to 13 inpatient health facilities in the Kilimanjaro region; staffing and equipment levels were also assessed. Among the 82 neonates reviewed, key health information was missing from a substantial proportion of records: on maternal antenatal cards, blood group was recorded for 52 (63.4%) mothers, Rhesus (Rh) factor for 39 (47.6%), VDRL for 59 (71.9%) and HIV status for 77 (93.1%). From neonatal clinical records, heart rate was recorded for3 (3.7%) neonates, respiratory rate in 14, (17.1%) and temperature in 33 (40.2%). None of 13 facilities had a functioning premature unit despite calculated gestational age <36 weeks in 45.6% of evaluated neonates. Intravenous fluids and oxygen were available in 9 out of 13 of facilities, while antibiotics and essential basic equipment were available in more than two thirds. Medication dosing errors were common; under-dosage for ampicillin, gentamicin and cloxacillin was found in 44.0%, 37.9% and 50% of cases, respectively, while over-dosage was found in 20.0%, 24.2% and 19.9%, respectively. Physician or assistant physician staffing levels by the WHO indicator levels (WISN) were generally low. Key aspects of neonatal care were found to be poorly documented or incorrectly implemented in this appraisal of neonatal care in Kilimanjaro. Efforts towards quality assurance and enhanced motivation of staff may improve outcomes for this vulnerable group

Concepciones culturales del VIH/Sida de adolescentes de Bolivia, Chile y México

OBJETIVO: Comprender las dimensiones culturales del VIH/Sida de estudiantes adolescentes. MÉTODOS: Estudio antropológico cognitivo. Realizado en Cochabamba (Bolivia), Talca (Chile) y Guadalajara (México) entre 2007 y 2008. Un total de 184 jóvenes (de 14 y 19 años de edad) fueron seleccionados por muestreo propositivo en centros de estudios de educación media superior de cada país. Fueron utilizadas las técnicas de listados libres y el sorteo de montones. Se indagaron términos asociados al concepto VIH/Sida y grupos de dimensiones conceptuales. Posteriormente se aplicó análisis de consenso mediante factorización de componentes principales y análisis dimensional mediante conglomerados jerárquicos y escalas multidimensionales. RESULTADOS: Las diferencias entre los contextos fueron en el grado de consenso en relación al término de VIH/Sida, ya que fue mayor en Cochabamba. En Talca y Guadalajara los jóvenes mencionaron metáforas de lucha frente a la enfermedad, mientras en Cochabamba se refirieron a la ayuda, apoyo y amor que las personas infectadas deberían recibir. Las coincidencias entre las conceptualizaciones de los jóvenes de los tres países fueron: los riesgos (las prácticas sexuales desprotegidas y el contacto con algunos grupos poblacionales específicos), las consecuencias (muerte física y social, entendida ésta última como el rechazo de la sociedad hacia los enfermos) y la prevención de la enfermedad (con base en la información así como uso del condón). CONCLUSIONES: Para los estudiantes adolescentes el VIH/Sida es una enfermedad causada por prácticas sexuales y consumo de drogas que implica daño, dolor y muerte. Los programas preventivos del VIH/Sida para los adolescentes deben promover la búsqueda de información sobre el tema con bases científicas, y no centrarse en las consecuencias emocionales y sociales de la enfermedad.OBJETIVO: Compreender as dimensões culturais do HIV/Aids por estudantes adolescentes. MÉTODOS: Estudo antropológico cognitivo realizado em Cochabamba (Bolívia), Talca (Chile) e Guadalajara (México), entre 2007 e 2008. O total de 184 jovens (de 14 e 19 anos de idade) foi selecionado por amostragem propositiva em centros de estudos de educação média superior de cada país. Foram utilizadas técnicas de listas livres e classificação da pilha. Foi feita a indagação de termos associados ao conceito HIV/Aids e grupos de dimensões conceituais. Posteriormente, fez-se análise de consenso mediante a fatorização dos componentes principais e análise dimensional mediante conglomerados hierárquicos e escalas multidimensionais. RESULTADOS: As diferenças entre os contextos foram no grau de consenso em relação ao termo HIV/Aids, que foi maior em Cochabamba. Em Talca e Guadalajara os jovens mencionaram metáforas de luta diante da doença, enquanto em Cochabamba eles referiram ajuda, apoio e amor que as pessoas infectadas deveriam receber. As coincidências entre as conceitualizações dos jovens dos três países foram: os riscos (as práticas sexuais desprotegidas e o contato com alguns grupos populacionais específicos), as conseqüências (morte física e social, entendida esta última como o rechaço da sociedade aos doentes) e a prevenção da doença (com base na informação e no uso do preservativo). CONCLUSIONES: Para os estudantes adolescentes, o HIV/Aids é uma doença causada por práticas sexuais e uso de drogas que envolve dano, dor e morte. Os programas preventivos do HIV/Aids para os e as adolescentes devem promover a busca de informação com bases científicas sobre o tema, e não só a que se centra nas conseqüências emocionais e sociais da doença.OBJECTIVE: To understand the cultural dimensions of HIV/AIDS among adolescent students. METHODS: A cognitive anthropological study was undertaken in Cochabamba (Bolivia), Talca (Chile) and Guadalajara (Mexico), during 2007 and 2008. A total of 184 teenagers (from 14 to 19 years old) were selected by purposeful sampling at secondary schools in each country. Free association lists and pile sorts were utilized. Terms associated with the concept of HIV/AIDS and groups of conceptual dimensions were investigated. Subsequently, consensus analysis was performed using factorial principal components and dimensional analysis through hierarchical clusters and multidimensional scales. RESULTS: The differences between the country contexts were in the degree of consensus in relation to the term HIV/AIDS, which was greater in Cochabamba. In Talca and Guadalajara the youths mentioned metaphors of fighting against HIV/AIDS, while in Cochabamba participants talked about help, support and love that infected people should receive. The similarities among conceptions by youth from the three countries were: the risk factors (unprotected sexual practice and contact with specific population groups), the consequences (physical and social death, being the latter understood as social rejection of people living with HIV/AIDS) and the prevention of illness (based on information and condom use). CONCLUSIONS: For adolescent students, HIV/AIDS is a disease caused by sexual practices and drug use and involves harm, pain and death. HIV/AIDS prevention programs for adolescents should promote science based information on the topic and not concentrate only on the emotional and social consequences of HIV/AIDS

The A-Current Modulates Learning via NMDA Receptors Containing the NR2B Subunit

Synaptic plasticity involves short- and long-term events, although the molecular mechanisms that underlie these processes are not fully understood. The transient A-type K+ current (IA) controls the excitability of the dendrites from CA1 pyramidal neurons by regulating the back-propagation of action potentials and shaping synaptic input. Here, we have studied how decreases in IA affect cognitive processes and synaptic plasticity. Using wild-type mice treated with 4-AP, an IA inhibitor, and mice lacking the DREAM protein, a transcriptional repressor and modulator of the IA, we demonstrate that impairment of IA decreases the stimulation threshold for learning and the induction of early-LTP. Hippocampal electrical recordings in both models revealed alterations in basal electrical oscillatory properties toward low-theta frequencies. In addition, we demonstrated that the facilitated learning induced by decreased IA requires the activation of NMDA receptors containing the NR2B subunit. Together, these findings point to a balance between the IA and the activity of NR2B-containing NMDA receptors in the regulation of learning

Vortex counting from field theory

The vortex partition function in 2d N = (2,2) U(N) gauge theory is derived from the field theoretical point of view by using the moduli matrix approach. The character for the tangent space at each moduli space fixed point is written in terms of the moduli matrix, and then the vortex partition function is obtained by applying the localization formula. We find that dealing with the fermionic zero modes is crucial to obtain the vortex partition function with the anti-fundamental and adjoint matters in addition to the fundamental chiral multiplets. The orbifold vortex partition function is also investigated from the field theoretical point of view.Comment: 21 pages, no figure

Environmental and Parental Influences on Offspring Health and Growth in Great Tits (Parus major)

PMCID: PMC3728352This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

A novel East African monopartite begomovirus-betasatellite complex that infects Vernonia amygdalina

The complete genomes of a monopartite begomovirus (genus Begomovirus, family Geminiviridae) and an associated betasatellite found infecting Vernonia amygdalina Delile (family Compositae) in Uganda were cloned and sequenced. Begomoviruses isolated from two samples showed the highest nucleotide sequence identity (73.1% and 73.2%) to an isolate of the monopartite begomovirus tomato leaf curl Vietnam virus, and betasatellites from the same samples exhibited the highest nucleotide sequence identity (67.1% and 68.2%) to vernonia yellow vein Fujian betasatellite. Following the current taxonomic criteria for begomovirus species demarcation, the isolates sequenced here represent a novel begomovirus species. Based on symptoms observed in the field, we propose the name vernonia crinkle virus (VeCrV) for this novel begomovirus and vernonia crinkle betasatellite (VeCrB) for the associated betasatellite. This is the first report of a monopartite begomovirus-betasatellite complex from Uganda

Medication Use Patterns among Urban Youth Participating in School-Based Asthma Education

Although pharmaceutical management is an integral part of asthma control, few community-based analyses have focused on this aspect of disease management. The primary goal of this analysis was to assess whether participation in the school-based Kickin’ Asthma program improved appropriate asthma medication use among middle school students. A secondary goal was to determine whether improvements in medication use were associated with subsequent improvements in asthma-related symptoms among participating students. Students completed an in-class case-identification questionnaire to determine asthma status. Eligible students were invited to enroll in a school-based asthma curriculum delivered over four sessions by an asthma health educator. Students completed a pre-survey and a 3-month follow-up post-survey that compared symptom frequency and medication use. From 2004 to 2007, 579 participating students completed pre- and post-surveys. Program participation resulted in improvements in appropriate use across all three medication use categories: 20.0% of students initiated appropriate reliever use when “feeling symptoms” (p < 0.001), 41.6% of students reporting inappropriate medication use “before exercise” initiated reliever use (p < 0.001), and 26.5% of students reporting inappropriate medication use when “feeling fine” initiated controller use (p < 0.02). More than half (61.6%) of participants reported fewer symptoms at post-survey. Symptom reduction was not positively associated with improvements in medication use in unadjusted and adjusted analysis, controlling for sex, asthma symptom classification, class attendance, season, and length of follow-up. Participation in a school-based asthma education program significantly improved reliever medication use for symptom relief and prior-to-exercise and controller medication use for maintenance. However, given that symptom reduction was not positively associated with improvement in medication use, pharmaceutical education must be just one part of a comprehensive asthma management agenda that addresses the multifactorial nature of asthma-related morbidity

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

Covalently bonded three-dimensional carbon nanotube solids via boron induced nanojunctions

The establishment of covalent junctions between carbon nanotubes (CNTs) and the modification of their straight tubular morphology are two strategies needed to successfully synthesize nanotube-based three-dimensional (3D) frameworks exhibiting superior material properties. Engineering such 3D structures in scalable synthetic processes still remains a challenge. This work pioneers the bulk synthesis of 3D macroscale nanotube elastic solids directly via a boron-doping strategy during chemical vapour deposition, which influences the formation of atomic-scale “elbow” junctions and nanotube covalent interconnections. Detailed elemental analysis revealed that the “elbow” junctions are preferred sites for excess boron atoms, indicating the role of boron and curvature in the junction formation mechanism, in agreement with our first principle theoretical calculations. Exploiting this material’s ultra-light weight, super-hydrophobicity, high porosity, thermal stability, and mechanical flexibility, the strongly oleophilic sponge-like solids are demonstrated as unique reusable sorbent scaffolds able to efficiently remove oil from contaminated seawater even after repeated use