Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania : an open label prospective study

Background: Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home. Methods: An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT) were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. Results: A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5%) patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%). The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10) compared with reinfections (205 ng/mL [114-390]; n = 92), or no parasite reappearance (217 [121-374] ng/mL; n = 70; p <= 0.046). Conclusions: Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective, which provides evidence base for scaling-up implementation of HMM with AL in Tanzania.

En studie om rehabilitering - en skamgörande process

The purpose of this essay is using theories about labeling and social bonds to study whether a measure of rehabilitation for the psychically disabled contributes to a return to a normal status as not-labeled. Partly we examine whether the activities organized by the regulation-ruled authorities during the work of rehabilitation lead to shame or pride, and partly how these activities are organized regarding the processes that lead to the emotions pride or shame among the participants. Method: qualitative semi-structured face-to-face interviews with professional rehabilitation-actors at the Public Employment Office (PEO), the Social Insurance Office (SIO), the Social Service (SOS), the Psychiatry and the Division of Labour Market (AME).Conclusions: the Psychiatry clients are treated with respect, may participate, and communication is characterized by attunement, therefore strong social bonds can be built. On the contrary, among the other examined activities, we found many elements that arouse shame. Since these are more ruled by regulations, the result is engulfment and demands on conformity, because the compromise-possibilities are almost non-existent. Psychically disabled persons are met by prejudice, ignorance, disrespect and a non-solidarity-language. To get help, the individual has to accept a label in form of a diagnosis, and this labeling leads to a negative self-image. Furthermore the psychically disabled persons are falling between two chairs because of a weak cooperation between the rehabilitation-actors. Bimodal alienation and triangulation contributes to the difficulties in cooperation.Result: the social bonds are not strong enough to achieve a rehabilitation-effect. Even if the treatment from each administrator is important, we find the explanation-level primarily in laws, rules and government, because the structure rules the rehabilitation-measures, with shame as a consequence. Since we found elements of shame institutionalized in the way of working at PEO, SIO, SOS and AME, it means that social bonds can never reach a level good enough for achieving pride and normalization from a deviance or labeled identity.

Thick viewing : empirical examples of condensed moments of narrative impact in fiction film developing theoretical concepts for intensified engagements

Abstract  In a case study about viewing habits in a Swedish audience I sampled 309 questionnaires; interviews with five focus group were conducted together with ten in-depth individual interviews discussing altogether fifteen favorite films exploring specific scenes of idiosyncratic relevance.  The outcome supports claims about viewers as active and playful (cf. Höijer 1998, Frampton 2006, Hoover 2006, Plantinga 2009). In line with mediatization theory I also argue that spiritual meaning making takes place through mediated experiences and I support theories about fiction films as important sources for moral and spiritual reflection (Partridge 2004, Zillman 2005, Lynch 2007, Plantinga 2009). What Hjarvard calls the soft side of mediatization processes (2008) is illustrated showing adults experiencing enchantment through favorite films (Jerslev 2006, Partridge 2008, Klinger 2008, Oliver & Hartmann 2010).  Vernacular meaning making embedded in everyday life and spectators dealing with fiction narratives such as Gladiator, Amelie from Montmartre or Avatar highlights the need for a more nuanced understanding of elevated cinematic experiences. The reported impact of specific movies is analyzed through theories where cognition and affect are central aspects of spectators’ engagements with a film (Tan 1996, Caroll 1999, Grodal 2009). Crucially important are theories of meaning-making where viewers’ detailed interpretation of specific scenes are embedded in high-level meaning-making where world view issues and spectators’ moral frameworks are activated (Zillman 2005, Andersson & Andersson 2005, Frampton 2006, Lynch 2007, Avila 2007, Axelson 2008, Plantinga 2009).  Also results from a growing body of empirical oriented research in film studies are relevant with an interest in what happens with the flesh and blood spectator exposed to filmic narratives (Jerslev 2006, Klinger 2008, Barker 2009, Suckfüll 2010, Oliver & Hartmann 2010). Analyzing the qualitative results of my case study, I want to challenge the claim that the viewer has to suspend higher order reflective cognitive structures in order to experience suture (Butler & Palesh 2004). What I find in my empirical examples is responses related to spectators’ highest levels of mental activity, all anchored in the sensual-emotional apparatus (Grodal 2009). My outcome is in line with a growing number of empirical case studies which support conclusions that both thinking and behavior are affected by film watching (Marsh 2007, Sückfull 2010, Oliver & Hartmann 2010, Axelson forthcoming). The presentation contributes to a development of concepts which combines aesthetic, affective and cognitive components in an investigation of spectator’s moves from emotional evaluation of intra-text narration to extra-textual assessments, testing the narrative for larger significance in idiosyncratic ways (Bordwell & Thompson 1997, Marsh 2007, Johnston 2007, Bruun Vaage 2009, Axelson 2011). There are a several profitable concepts suggested to embrace the complex interplay between affects, cognition and emotions when individuals respond to fictional narratives. Robert K. Johnston label it “deepening gaze” (2007: 307) and “transformative viewing” (2007: 305). Philosopher Mitch Avila proposes “high cognition” (2007: 228) and Casper Thybjerg ”higher meaning” (2008: 60). Torben Grodal talks about “feelings of deep meaning” (Grodal 2009: 149). With a nod to Clifford Geertz, Craig Detweiler adopts “thick description” (2007: 47) as do Kutter Callaway altering it to ”thick interpretations” (Callaway 2013: 203).  Frampton states it in a paradox; ”affective intelligence” (Frampton 2006: 166). As a result of the empirical investigation, inspired by Geertz, Detweiler & Callaway, I advocate thick viewing for capturing the viewing process of these specific moments of film experience when profound and intensified emotional interpretations take place. The author As a sociologist of religion, Tomas Axelsons research deals with people’s use of mediated narratives to make sense of reality in a society characterized by individualization, mediatization and pluralized world views.  He explores uses of fiction film as a resource in every day life and he is currently finishing his three year project funded by the Swedish Research Council: Spectator engagement in film and utopian self-reflexivity. Moving Images and Moved Minds. http://www.du.se/sv/AVM/Personal/Tomas-Axelson Bibliography Axelson, T. (Forthcoming 2014). Den rörliga bildens förmåga att beröra.[1] Stockholm: Liber Axelson, T. (In peer review). Vernacular Meaning Making. Examples of narrative impact in fiction film questioning the ’banal’ notion in mediatization theory. Nordicom Review. Nordicom Göteborg. Axelson, T. (2011). Människans behov av fiktion. Den rörliga bildens förmåga att beröra människan på djupet.[2]Kulturella perspektiv. Volume 2. Article retrieved from www.kultmed.umu.se/digitalAssets/74/74304_axelson-22011.pdf Axelson, Tomas (2010) “Narration, Visualization and Mind. Movies in everyday life as a resource for utopian self-reflection.” Paper presentation at CMRC, 7th Conference of Media, Religion & Culture in Toronto, Canada 9 – 13th August 2010. Axelson, Tomas (2008) Movies and Meaning. Studying Audience, Favourite Films and Existential Matters. Particip@tions : Journal of Audience and Reception Studies. Volume 5, (1). Doctoral dissertation summary. ACTA UNIVERSITATIS UPSALIENSIS. Article retrieved from http://www.participations.org/Volume%205/Issue%201%20-%20special/5_01_axelson.htm  [1] English translation: Moving Images and Moved Minds. [2] English translation: Our need for fiction. Deeply Moved by Moving Images. Cultural Perspectives.

Etikettdesign och prisklass för röda viner

Denna studie syftar till att undersöka om det finns ett samband mellan designfaktorer och prisklass på rödvinsetiketter. För att kartlägga förekommande designfaktorer har en visuell innehållsanalys gjorts inom tre olika prisklasser hämtad från Systembolagets hemsida. Utifrån den visuella innehållsanalysens resultat designades tre vinetiketter för varje prisklass. För att ta reda på om dessa designfaktorer hade ett samband med den tänkta prisklassen testades vinetiketterna mot konsumenter genom en webbenkät. Slutsatsen var att det fanns vissa generella drag som skiljer prisklasserna åt även om många designfaktorer var vanligt förekommande för alla prisklasser. Utifrån respondenternas svar visade sig vissa av designfaktorerna vara mer eller mindre tydliga för den tilltänkta prisklassen.

Etikettdesign hos framgångsrika alesorter i Sverige från olika produktionsländer

Föreliggande studie syftar till att kartlägga vilka designfaktorer som främst förekommer på etiketter hos framgångsrika aleproducenter från olika länder, samt undersöka om konsumenter kan urskilja produktionsland endast genom granskning av etiketten. För att undersöka detta genomfördes en visuell innehållsanalys för att ta fram designfaktorer för fem utvalda länder, varefter fem typexempel skapades. Typexemplen testades på konsumenter via en webbenkät. Slutsatsen är att det i vissa fall går att ta fram ett typexempel och i vissa fall kan en del av konsumenterna se vilket det tänkta produktionslandet är. I majoriteten av fallen gick det emellertid inte att ta fram ett perfekt typexempel och konsumenten kunde inte urskilja det tänkta produktionslandet.