That Whole Business about the Cross

digital audio recording

The cross-bearers of the Saguenay

http://www.archive.org/details/crossbearersofsa00harruoft

Paediatric malaria case-management with artemether-lumefantrine in Zambia: a repeat cross-sectional study

BACKGROUND:Zambia was the first African country to change national antimalarial treatment policy to artemisinin-based combination therapy - artemether-lumefantrine. An evaluation during the early implementation phase revealed low readiness of health facilities and health workers to deliver artemether-lumefantrine, and worryingly suboptimal treatment practices. Improvements in the case-management of uncomplicated malaria two years after the initial evaluation and three years after the change of policy in Zambia are reported.METHODS:Data collected during the health facility surveys undertaken in 2004 and 2006 at all outpatient departments of government and mission facilities in four Zambian districts were analysed. The surveys were cross-sectional, using a range of quality of care assessment methods. The main outcome measures were changes in health facility and health worker readiness to deliver artemether-lumefantrine, and changes in case-management practices for children below five years of age presenting with uncomplicated malaria as defined by national guidelines.RESULTS:In 2004, 94 health facilities, 103 health workers and 944 consultations for children with uncomplicated malaria were evaluated. In 2006, 104 facilities, 135 health workers and 1125 consultations were evaluated using the same criteria of selection. Health facility and health worker readiness improved from 2004 to 2006: availability of artemether-lumefantrine from 51% (48/94) to 60% (62/104), presence of artemether-lumefantrine dosage wall charts from 20% (19/94) to 75% (78/104), possession of guidelines from 58% (60/103) to 92% (124/135), and provision of in-service training from 25% (26/103) to 41% (55/135). The proportions of children with uncomplicated malaria treated with artemether-lumefantrine also increased from 2004 to 2006: from 1% (6/527) to 27% (149/552) in children weighing 5 to 9 kg, and from 11% (42/394) to 42% (231/547) in children weighing 10 kg or more. In both weight groups and both years, 22% (441/2020) of children with uncomplicated malaria were not prescribed any antimalarial drug.CONCLUSION:Although significant improvements in malaria case-management have occurred over two years in Zambia, the quality of treatment provided at the point of care is not yet optimal. Strengthening weak health systems and improving the delivery of effective interventions should remain high priority in all countries implementing new treatment policies for malaria.

TCP over CDMA2000 Networks: A Cross-Layer Measurement Study

Modern cellular channels in 3G networks incorporate sophisticated power control and dynamic rate adaptation which can have a significant impact on adaptive transport layer protocols, such as TCP. Though there exists studies that have evaluated the performance of TCP over such networks, they are based solely on observations at the transport layer and hence have no visibility into the impact of lower layer dynamics, which are a key characteristic of these networks. In this work, we present a detailed characterization of TCP behavior based on cross-layer measurement of transport, as well as RF and MAC layer parameters. In particular, through a series of active TCP/UDP experiments and measurement of the relevant variables at all three layers, we characterize both, the wireless scheduler in a commercial CDMA2000 network and its impact on TCP dynamics. Somewhat surprisingly, our findings indicate that the wireless scheduler is mostly insensitive to channel quality and sector load over short timescales and is mainly affected by the transport layer data rate. Furthermore, we empirically demonstrate the impact of the wireless scheduler on various TCP parameters such as the round trip time, throughput and packet loss rate.

TCP over CDMA2000 Networks: A Cross-Layer Measurement Study

Modern cellular channels in 3G networks incorporate sophisticated power control and dynamic rate adaptation which can have significant impact on adaptive transport layer protocols, such as TCP. Though there exists studies that have evaluated the performance of TCP over such networks, they are based solely on observations at the transport layer and hence have no visibility into the impact of lower layer dynamics, which are a key characteristic of these networks. In this work, we present a detailed characterization of TCP behavior based on cross-layer measurement of transport layer, as well as RF and MAC layer parameters. In particular, through a series of active TCP/UDP experiments and measurement of the relevant variables at all three layers, we characterize both, the wireless scheduler and the radio link protocol in a commercial CDMA2000 network and assess their impact on TCP dynamics. Somewhat surprisingly, our findings indicate that the wireless scheduler is mostly insensitive to channel quality and sector load over short timescales and is mainly affected by the transport layer data rate. Furthermore, with the help of a robust correlation measure, Normalized Mutual Information, we were able to quantify the impact of the wireless scheduler and the radio link protocol on various TCP parameters such as the round trip time, throughput and packet loss rate.