The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomised trial.

OBJECTIVES: To determine the effectiveness of birth plans in increasing use of skilled care at delivery and in the postnatal period among antenatal care (ANC) attendees in a rural district with low occupancy of health units for delivery but high antenatal care uptake in northern Tanzania. METHODS: Cluster randomised trial in Ngorongoro district, Arusha region, involving 16 health units (8 per arm). Nine hundred and five pregnant women at 24 weeks of gestation and above (404 in the intervention arm) were recruited and followed up to at least 1 month postpartum. RESULTS: Skilled delivery care uptake was 16.8% higher in the intervention units than in the control [95% CI 2.6-31.0; P = 0.02]. Postnatal care utilisation in the first month of delivery was higher (difference in proportions: 30.0% [95% CI 1.3-47.7; P < 0.01]) and also initiated earlier (mean duration 6.6 ± 1.7 days vs. 20.9 ± 4.4 days, P < 0.01) in the intervention than in the control arm. Women's and providers' reports of care satisfaction (received or provided) did not differ greatly between the two arms of the study (difference in proportion: 12.1% [95% CI -6.3-30.5] P = 0.17 and 6.9% [95% CI -3.2-17.1] P = 0.15, respectively). CONCLUSION: Implementation of birth plans during ANC can increase the uptake of skilled delivery and post delivery care in the study district without negatively affecting women's and providers' satisfaction with available ANC services. Birth plans should be considered along with the range of other recommended interventions as a strategy to improve the uptake of maternal health services

People, Place and Time: How Structural Fieldwork Helps World-Systems Analysis

Some of the most insightful work in the political economy of the world-system area has been produced by researchers whose extensive fieldwork offers them deep familiarity with people and locales. Few other methods are as useful to understand the impacts of structural change on daily life and the ways agents resist, alter, and shape emerging structures. Yet such structural fieldwork is marginalized by the over-reliance of pedagogical materials on social constructionist, social psychological, or interactionist perspectives and also in world-systems research and writing by the privileging of long durée historical or quantitative cross-national methods. This paper introduces the concept of structural fieldwork to describe a qualitative field methodology in which the researcher is self-consciously guided by considerations emerging out of macro- sociological theories. We identify four advantages of structural fieldwork: the illumination of power’s multiple dimensions; examination of agency and its boundaries or limitations within broad political and economic structures; attention to nuances of change and durability, spatial and temporal specificities, and processes of change and durability; and challenging and extending social theory. These advantages are illustrated in select examples from existing literature and by discussion of the two author’s fieldwork-based research. The paper concludes that explicit attention to fieldwork may strengthen political economy and world-systems research and also de-marginalize political economy informed by structural fieldwork

People, Place, and Time: How Structural Fieldwork Helps World-Systems Analysis

Some of the most insightful work in the political economy of the world-system area has been produced by researchers whose extensive fieldwork offers them deep familiarity with people and locales. Few other methods are as useful to understand the impacts of structural change on daily life and the ways agents resist, alter, and shape emerging structures. Yet such structural fieldwork is marginalized by the over-reliance of pedagogical materials on social constructionist, social psychological, or interactionist perspectives and also in world-systems research and writing by the privileging of long durée historical or quantitative cross-national methods. This paper introduces the concept of structural fieldwork to describe a qualitative field methodology in which the researcher is self-consciously guided by considerations emerging out of macro- sociological theories. We identify four advantages of structural fieldwork: the illumination of power’s multiple dimensions; examination of agency and its boundaries or limitations within broad political and economic structures; attention to nuances of change and durability, spatial and temporal specificities, and processes of change and durability; and challenging and extending social theory. These advantages are illustrated in select examples from existing literature and by discussion of the two author’s fieldwork-based research. The paper concludes that explicit attention to fieldwork may strengthen political economy and world-systems research and also de-marginalize political economy informed by structural fieldwork

Sarita Flower

Tells the story of a family who welcomes a new family, into their town to seek a home of their own. As well as the story of a dog and a man. Includes images of the vegetable garden of the South Texas garden.https://scholarworks.utrgv.edu/gulfcoastmag/1033/thumbnail.jp

Reducing Incarceration in Philadelphia

Reducing incarceration is an important public health priority. There is now widespread recognition that criminal justice systems are a significant source of public health harm. They sometimes penalize individuals without improving community health, or create improvements that are offset by the considerable individual and communal harms associated with incarceration and with the collateral consequences of criminal convictions. Philadelphia has become a leader in implementing criminal justice reforms. In 2010, the District Attorney’s Office initiated changes to reduce overcharging. In the last seven years, the First Judicial District has created nine specialized diversion programs, with seven specifically aimed at addressing the underlying causes of criminal activity. These programs vary in design but share key features. All attempt to prevent future criminal activity by diverting offenders away from incarceration and into community supervision. Programs also provide access to appropriate social and health services, and utilize a more collaborative approach between prosecutors, defense attorneys, judges and social services staff. This more efficient use of resources allows greater attention to more serious and violent crimes in Philadelphia.https://repository.upenn.edu/publichealth_databriefs/1000/thumbnail.jp

Mechanisms, models and biomarkers in amyotrophic lateral sclerosis

The last 30 years have seen a major advance in the understanding of the clinical and pathological heterogeneity of amyotrophic lateral sclerosis (ALS), and its overlap with frontotemporal dementia. Multiple, seemingly disparate biochemical pathways converge on a common clinical syndrome characterized by progressive loss of upper and lower motor neurons. Pathogenic themes in ALS include excitotoxicity, oxidative stress, mitochondrial dysfunction, neuroinflammation, altered energy metabolism, and most recently RNA mis-processing. The transgenic rodent, overexpressing mutant superoxide dismutase-1, is now only one of several models of ALS pathogenesis. The nematode, fruit fly and zebrafish all offer fresh insight, and the development of induced pluripotent stem cell-derived motor neurons holds promise for the screening of candidate therapeutics. The lack of useful biomarkers in ALS contributes to diagnostic delay, and the inability to stratify patients by prognosis may be an important factor in the failure of therapeutic trials. Biomarkers sensitive to disease activity might lessen reliance on clinical measures and survival as trial endpoints and reduce study length. Emerging proteomic markers of neuronal loss and glial activity in cerebrospinal fluid, a cortical signature derived from advanced structural and functional MRI, and the development of more sensitive measurements of lower motor neuron physiology are leading a new phase of biomarker-driven therapeutic discovery

Design and Initial Results of a Multi-Phase Randomized Trial of Ceftriaxone in Amyotrophic Lateral Sclerosis

Objectives: Ceftriaxone increases expression of the astrocytic glutamate transporter, EAAT2, which might protect from glutamate-mediated excitotoxicity. A trial using a novel three stage nonstop design, incorporating Phases I-III, tested ceftriaxone in ALS. Stage 1 determined the cerebrospinal fluid pharmacokinetics of ceftriaxone in subjects with ALS. Stage 2 evaluated safety and tolerability for 20-weeks. Analysis of the pharmacokinetics, tolerability, and safety was used to determine the ceftriaxone dosage for Stage 3 efficacy testing. Methods: In Stage 1, 66 subjects at ten clinical sites were enrolled and randomized equally into three study groups receiving intravenous placebo, ceftriaxone 2 grams daily or ceftriaxone 4 grams daily divided BID. Participants provided serum and cerebrospinal fluid for pharmacokinetic analysis on study day 7. Participants continued their assigned treatment in Stage 2. The Data and Safety Monitoring Board (DSMB) reviewed the data after the last participants completed 20 weeks on study drug. Results: Stage 1 analysis revealed linear pharmacokinetics, and CSF trough levels for both dosage levels exceeding the pre-specified target trough level of 1 µM (0.55 µg/mL). Tolerability (Stages 1 and 2) results showed that ceftriaxone at dosages up to 4 grams/day was well tolerated at 20 weeks. Biliary adverse events were more common with ceftriaxone but not dose-dependent and improved with ursodeoxycholic (ursodiol) therapy. Conclusions: The goals of Stages 1 and 2 of the ceftriaxone trial were successfully achieved. Based on the pre-specified decision rules, the DSMB recommended the use of ceftriaxone 4 g/d (divided BID) for Stage 3, which recently closed. Trial Registration ClinicalTrials.gov NCT00349622

Quality Control of Motor Unit Number Index (MUNIX) Measurements in 6 Muscles in a Single-Subject “Round-Robin” Setup

Background Motor Unit Number Index (MUNIX) is a neurophysiological measure that provides an index of the number of lower motor neurons in a muscle. Its performance across centres in healthy subjects and patients with Amyotrophic Lateral Sclerosis (ALS) has been established, but inter-rater variability between multiple raters in one single subject has not been investigated. Objective To assess reliability in a set of 6 muscles in a single subject among 12 examiners (6 experienced with MUNIX, 6 less experienced) and to determine variables associated with variability of measurements. Methods Twelve raters applied MUNIX in six different muscles (abductor pollicis brevis (APB), abductor digiti minimi (ADM), biceps brachii (BB), tibialis anterior (TA), extensor dig. brevis (EDB), abductor hallucis (AH)) twice in one single volunteer on consecutive days. All raters visited at least one training course prior to measurements. Intra- and inter-rater variability as determined by the coefficient of variation (COV) between different raters and their levels of experience with MUNIX were compared. Results Mean intra-rater COV of MUNIX was 14.0% (±6.4) ranging from 5.8 (APB) to 30.3% (EDB). Mean inter-rater COV was 18.1 (±5.4) ranging from 8.0 (BB) to 31.7 (AH). No significant differences of variability between experienced and less experienced raters were detected. Conclusion We provide evidence that quality control for neurophysiological methods can be performed with similar standards as in laboratory medicine. Intra- and inter-rater variability of MUNIX is muscle-dependent and mainly below 20%. Experienced neurophysiologists can easily adopt MUNIX and adequate teaching ensures reliable utilization of this method