Acute Conjunctivitis with Episcleritis and Anterior Uveitis Linked to Adiaspiromycosis and Freshwater Sponges, Amazon Region, Brazil, 2005

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at http://www.medscape.com/cme/eidExternal Web Site Icon; (4) view/print certificate. Learning Objectives Upon completion of this activity, participants will be able to: Describe the mechanism of infection for adiaspiromycosis. Identify the age group most susceptible to ocular adiaspiromycosis. Describe presenting symptoms associated with ocular adiaspiromycosis. Describe the frequency of ocular lesions associated with adiaspiromycosis. Identify risk factors for ocular adiaspiromycosis.

"Water users must be efficient producers". Women's access to and use of land in Chókwè irrigation scheme, Mozambique

The irrigation scheme Eduardo Mondlane, situated in Chókwè District - in the Southern part of the Gaza province and within the Limpopo River Basin - is the largest in the country, covering approximately 30,000 hectares of land. Built by the Portuguese colonial administration in the 1950s to exploit the agricultural potential of the area through cash-cropping, after Independence it became one of Frelimo’s flagship projects aiming at the “socialization of the countryside” and at agricultural economic development through the creation of a state farm and of several cooperatives. The failure of Frelimo’s economic reforms, several infrastructural constraints and local farmers resistance to collective forms of production led to scheme to a state of severe degradation aggravated by the floods of the year 2000. A project of technical rehabilitation initiated after the floods is currently accompanied by a strong “efficiency” discourse from the managing institution that strongly opposes the use of irrigated land for subsistence agriculture, historically a major livelihood strategy for smallfarmers, particularly for women. In fact, the area has been characterized, since the end of the XIX century, by a stable pattern of male migration towards South African mines, that has resulted in an a steady increase of women-headed households (both de jure and de facto). The relationship between land reform, agricultural development, poverty alleviation and gender equality in Southern Africa is long debated in academic literature. Within this debate, the role of agricultural activities in irrigation schemes is particularly interesting considering that, in a drought-prone area, having access to water for irrigation means increased possibilities of improving food and livelihood security, and income levels. In the case of Chókwè, local governments institutions are endorsing the development of commercial agriculture through initiatives such as partnerships with international cooperation agencies or joint-ventures with private investors. While these business models can sometimes lead to positive outcomes in terms of poverty alleviation, it is important to recognize that decentralization and neoliberal reforms occur in the context of financial and political crisis of the State that lacks the resources to efficiently manage infrastructures such as irrigation systems. This kind of institutional and economic reforms risk accelerating processes of social and economic marginalisation, including landlessness, in particular for poor rural women that mainly use irrigated land for subsistence production. The study combines an analysis of the historical and geographical context with the study of relevant literature and original fieldwork. Fieldwork was conducted between February and June 2007 (where I mainly collected secondary data, maps and statistics and conducted preliminary visit to Chókwè) and from October 2007 to March 2008. Fieldwork methodology was qualitative and used semi-structured interviews with central and local Government officials, technical experts of the irrigation scheme, civil society organisations, international NGOs, rural extensionists, and water users from the irrigation scheme, in particular those women smallfarmers members of local farmers’ associations. Thanks to the collaboration with the Union of Farmers’ Associations of Chókwè, she has been able to participate to members’ meeting, to education and training activities addressed to women farmers members of the Union and to organize a group discussion. In Chókwè irrigation scheme, women account for the 32% of water users of the familiar sector (comprising plot-holders with less than 5 hectares of land) and for just 5% of the private sector. If one considers farmers’ associations of the familiar sector (a legacy of Frelimo’s cooperatives), women are 84% of total members. However, the security given to them by the land title that they have acquired through occupation is severely endangered by the use that they make of land, that is considered as “non efficient” by the irrigation scheme authority. Due to a reduced access to marketing possibilities and to inputs, training, information and credit women, in actual fact, risk to see their right to access land and water revoked because they are not able to sustain the increasing cost of the water fee. The myth of the “efficient producer” does not take into consideration the characteristics of inequality and gender discrimination of the neo-liberal market. Expecting small-farmers, and in particular women, to be able to compete in the globalized agricultural market seems unrealistic, and can perpetuate unequal gendered access to resources such as land and water.

Predictors of chemotherapy patients' intentions to engage in medical error prevention

Patients can make contributions to the safety of chemotherapy administration but little is known about their motivations to participate in safety-enhancing strategies. The theory of planned behavior was applied to analyze attitudes, norms, behavioral control, and chemotherapy patients' intentions to participate in medical error prevention.

Communication about standard treatment options and clinical trials: can we teach doctors new skills to improve patient outcomes?

BACKGROUND: The International Breast Cancer Study Group conducted a phase III trial in Australian/New Zealand (ANZ) and Swiss/German/Austrian (SGA) centres on training doctors in clear and ethical information delivery about treatment options and strategies to encourage shared decision making. METHODS: Medical, surgical, gynaecological and radiation oncologists, and their patients for whom adjuvant breast cancer therapy was indicated, were eligible. Doctors were randomised to participate in a workshop with standardised teaching material and role playing. Patients were recruited in the experimental and control groups before and after the workshop. RESULTS: In ANZ centres, 21 eligible doctors recruited a total of 304 assessable patients. In SGA centres, 41 doctors recruited 390 patients. The training was well accepted. There was no overall effect on patient decisional conflict (primary endpoint) 2 weeks after the consultation. Overall, patients were satisfied with their treatment decision, their consultation and their doctors' consultation skills. Considerable variation was observed in patient outcomes between SGA and ANZ centres; the effect sizes of the intervention were marginal (<0.2). CONCLUSIONS: Shared decision making remains a challenge. A sustained training effect may require more intensive training tailored to the local setting. Cross-cultural differences need attention in conducting trials on communication interventions.

Teacher resistance to school-based consultation with the school psychologist: An analysis according to school level and model of identification for special education services

Consultation is promoted throughout school psychology literature as a best practice in service delivery. This method has numerous benefits including being able to work with more students at one time, providing practitioners with preventative rather than strictly reactive strategies, and helping school professionals meet state and federal education mandates and initiatives. Despite the benefits of consultation, teachers are sometimes resistant to this process.This research studies variables hypothesized to lead to resistance (Gonzalez, Nelson, Gutkin, & Shwery, 2004) and attempts to distinguish differences between school level (elementary, middle and high school) with respect to the role played by these variables and to determine if the model used to identify students for special education services has an influence on resistance factors. Twenty-sixteachers in elementary and middle schools responded to a demographicquestionnaire and a survey developed by Gonzalez, et al. (2004). This survey measures eight variables related to resistance to consultation. No high school teachers responded to the request to participate. Results of analysis of variance indicated a significant difference in the teaching efficacy subscale with elementary teachers reporting more efficacy in teaching than middle school teachers. Results also indicate a significant difference in classroom managementefficacy with teachers who work in schools that identify students according to a Response to Intervention model reporting higher classroom management efficacy than teachers who work in schools that identify students according to a combined method of refer-test-place/RtI combination model. Implications, limitations and directions for future research are discussed.

Capuchin Monkeys (Cebus apella) Fail to Be Equitable in an Ultimatum Game

The ultimatum game is a commonly used economics game testing humans' sense of fairness. In the game, a "proposer" is given a sum of money and is told they can split it however they want with another human partner. The partner can then either accept the division and both proposer and responder receive the proposed amounts, or the responder can reject the offer and neither player will get anything. Human subjects from most western cultures typically share almost half of an allotted amount, but it remains unknown whether our close primate relatives share this generosity. Recent attempts to present chimpanzees with the ultimatum game have provided inconclusive results, with some studies finding the animals share humans' disposition to behave 'fairly' and others concluding that chimpanzees act selfishly to maximize their own rewards. Capuchin monkeys are known to share many human and chimpanzee social and cooperative behaviors, and this study was the first to present capuchin monkeys with a version of the ultimatum game. Subjects were presented with two differently colored tokens representing different qualitative reward contingencies, one equitable and the other inequitable in favor of the subject proposer. Subjects could select and place one of the tokens in a transfer container. The capuchins were first tested with a "dictator game" where, after the subject monkey selected a token, the rewards (equitable or inequitable) were distributed to the subject and a nearby partner monkey that was not an active participant. The capuchins were then tested on an ultimatum game in which after the subject selected and placed a token in the container, the container was moved to the partner. The partner needed to remove the token and transfer it back to the experimenter for the rewards to be distributed. As such, the partner could reject the subject's offer by refusing to participate and neither would receive a reward. The experiment was conducted to determine if the subject monkey would select the equitable reward option rather than the selfish option in order to maintain the partner's cooperation in the task. Capuchin subjects behaved selfishly and selected the inequitable token significantly more often than the equitable token in both the dictator and ultimatum game with no significant difference in preference between the two games. Interestingly, despite the occasional occurrence of rejection by the partner monkeys (resulting in no reward for the subject), subjects never altered their strategy, continuing to prefer the selfish token. The study may indicate that capuchin monkeys have an inability to judge the effect of their behavior on a conspecific's reward outcome, or an indifference to the outcome if there is an individual cost associated with behaving prosocially.

From endoplasmic reticulum to secretory granules: role of zinc in the secretory pathway of growth hormone

Endocrine and neuroendocrine cells differ from cells which rapidly release all their secreted proteins in that they store some secretory proteins in concentrated forms in secretory granules to be rapidly released when cells are stimulated. Protein aggregation is considered as the first step in the secretory granule biosynthesis and, at least in the case of prolactin and growth hormone, greatly depends on zinc ions that facilitate this process. Hence, regulation of cellular zinc transport especially that within the regulated secretory pathway is of importance to understand. Various zinc transporters of Slc30a/ZnT and Slc39a/Zip families have been reported to fulfil this role and to participate in fine tuning of zinc transport in and out of the endoplasmic reticulum, Golgi complex and secretory granules, the main cellular compartments of the regulated secretory pathway. In this review, we will focus on the role of zinc in the formation of hormone-containing secretory granules with special emphasis on conditions required for growth hormone dimerization/aggregation. In addition, we highlight the role of zinc transporters that govern the process of zinc homeostasis in the regulated hormone secretion.

Discontinuation of maintenance therapy against toxoplasma encephalitis in AIDS patients with sustained response to anti-retroviral therapy

Discontinuation of maintenance therapy against toxoplasma encephalitis (TE) for individuals infected with human immunodeficiency virus (HIV) who are receiving successful anti-retroviral therapy is considered safe. Nevertheless, there are few published studies concerning this issue. Within the setting of the Swiss HIV Cohort Study, this report describes a prospective study of discontinuation of maintenance therapy against TE in patients with a sustained increase of CD4 counts to > 200 cells/microL and 14% of total lymphocytes, and no active lesions on cerebral magnetic resonance imaging (MRI). In addition to clinical evaluation, cerebral MRI was performed at baseline, and 1 and 6 months following discontinuation. Twenty-six AIDS patients with a history of TE agreed to participate, but three patients (11%) could not be enrolled because they still showed enhancing cerebral lesions without a clinical correlate. One patient refused MRI after 6 months while clinically asymptomatic. Among the remaining 22 patients who discontinued maintenance therapy, one relapsed after 3 months. During a total follow-up of 58 patient-years, there was no TE relapse among the patients who had remained clinically and radiologically free of relapse during the study. Thus, discontinuation of maintenance therapy against TE was generally safe, but may fail in a minority of patients. Patients who remain clinically and radiologically free of relapse at 6 months after discontinuation are unlikely to experience a relapse of TE.

Engineering design motivations : a qualitative and quantitative analysis of university students

What motivates students to perform and pursue engineering design tasks? This study examines this question by way of three Learning Through Service (LTS) programs: 1) an on-going longitudinal study examining the impacts of service on engineering students, 2) an on-going analysis of an international senior design capstone program, and 3) an on-going evaluation of an international graduate-level research program. The evaluation of these programs incorporates both qualitative and quantitative methods, utilizing surveys, questionnaires, and interviews, which help to provide insight on what motivates students to do engineering design work. The quantitative methods were utilized in analyzing various instruments including: a Readiness assessment inventory, Intercultural Development Inventory, Sustainable Engineering through Service Learning survey, the Impacts of Service on Engineering Students’ survey, Motivational narratives, as well as some analysis for interview text. The results of these instruments help to provide some much needed insight on how prepared students are to participate in engineering programs. Additional qualitative methods include: Word clouds, Motivational narratives, as well as interview analysis. This thesis focused on how these instruments help to determine what motivates engineering students to pursue engineering design tasks. These instruments aim to collect some more in-depth information than the quantitative instruments will allow. Preliminary results suggest that of the 120 interviews analyzed Interest/Enjoyment, Application of knowledge and skills, as well as gaining knowledge are key motivating factors regardless of gender or academic level. Together these findings begin to shed light on what motivates students to perform engineering design tasks, which can be applied for better recruitment and retention in university programs.

Adapting health-risk communication to the specific cultural contexts of diverse populations : an assessment of malaria-treatment programs in Liberia

Drawing on theories of technical communication, rhetoric, literacy, language and culture, and medical anthropology, this dissertation explores how local culture and traditions can be incorporated into health-risk-communication-program design and implementation, including the design and dissemination of health-risk messages. In a modern world with increasing global economic partnerships, mounting health and environmental risks, and cross-cultural collaborations, those who interact with people of different cultures have “a moral obligation to take those cultures seriously, including their social organization and values” (Hahn and Inhorn 10). Paradoxically, at the same time as we must carefully adapt health, safety, and environmental-risk messages to diverse cultures and populations, we must also recognize the increasing extent to which we are all becoming part of one, vast, interrelated global village. This, too, has a significant impact on the ways in which healthcare plans should be designed, communicated, and implemented. Because communicating across diverse cultures requires a system for “bridging the gap between individual differences and negotiating individual realities” (Kim and Gudykunst 50), both administrators and beneficiaries of malaria-treatment-and-control programs (MTCPs) in Liberia were targeted to participate in this study. A total of 105 people participated in this study: 21 MTCP administrators (including designers and implementers) completed survey questionnaires on program design, implementation, and outcomes; and 84 MTCP beneficiaries (e.g., traditional leaders and young adults) were interviewed about their knowledge of malaria and methods for communicating health risks in their tribe or culture. All participants showed a tremendous sense of courage, commitment, resilience, and pragmatism, especially in light of the fact that many of them live and work under dire socioeconomic conditions (e.g., no electricity and poor communication networks). Although many MTCP beneficiaries interviewed for this study had bed nets in their homes, a majority (46.34 percent) used a combination of traditional herbal medicine and Western medicine to treat malaria. MTCP administrators who participated in this study rated the impacts of their programs on reducing malaria in Liberia as moderately successful (61.90 percent) or greatly successful (38.10 percent), and they offered a variety of insights on what they might do differently in the future to incorporate local culture and traditions into program design and implementation. Participating MTCP administrators and beneficiaries differed in their understanding of what “cultural incorporation” meant, but they agreed that using local indigenous languages to communicate health-risk messages was essential for effective health-risk communication. They also suggested that understanding the literacy practices and linguistic cultures of the local people is essential to communicating health risks across diverse cultures and populations.

Career-choice readiness in adolescence: Developmental trajectories and individual differences

Developing career-choice readiness is an important task in adolescence, but current theory and research has provided a rather static view of the phenomenon. The present study investigated the development of career-choice readiness among a group of 325 Swiss students assessed four times every 5 months from seventh through eighth grade. A variable-centered approach applying latent curve modeling showed not only a linear increase of readiness over time but also significant inter-individual differences in the level and development of readiness. Higher levels were predicted by more self-esteem and generalized self-efficacy and fewer perceived barriers while increase in readiness was predicted by increase in occupational information. A person-centered approach applying latent class-growth analysis identified four distinct developmental trajectories: high-increasing (42%), high-decreasing (5%), moderate-increasing (42%), and constantly low (11%). Students with different trajectories showed significant differences in core self-evaluations, occupational knowledge, and barriers. The results suggest that environmental demands promote a developmental trend in readiness development that overrules individual differences for the majority of students. Individual differences affect the level of readiness to a greater extent than the process of its development. Career information seems pivotal for readiness increase.

Wanting to Get More or Protecting One's Assets: Age-Differential Effects of Gain Versus Loss Perceptions on the Willingness to Engage in Collective Action

OBJECTIVES: The present research examined motivational differences across adulthood that might contribute to age-related differences in the willingness to engage in collective action. Two experiments addressed the role of gain and loss orientation for age-related differences in the willingness to engage in collective action across adulthood. METHOD: In Experiment 1, N = 169 adults (20-85 years) were confronted with a hypothetical scenario that involved either an impending increase or decrease of health insurance costs for their respective age group. In Experiment 2, N = 231 adults (18-83 years) were asked to list an advantage or disadvantage they perceived in being a member of their age group. Subsequently, participants indicated their willingness to engage in collective action on behalf of their age group. RESULTS: Both experiments suggest that, with increasing age, people are more willing to engage in collective action when they are confronted with the prospect of loss or a disadvantage. DISCUSSION: The findings highlight the role of motivational processes for involvement in collective action across adulthood. With increasing age, (anticipated) loss or perceived disadvantages become more important for the willingness to participate in collective action.

More volunteers in football clubs. An evaluation of a method to increase the number of volunteers

An increasing number of clubs experience difficulties in recruiting and retaining sufficient numbers of volunteers to manage and staff their clubs (Lamprecht, Fischer, & Stamm, 2012). In order to facilitate volunteer recruitment, sport clubs need a specific strategy to recruit and retain volunteers for both formal positions and ad hoc tasks. Therefore, the intervention “More Volunteers in Football Clubs” was designed and its impact was evaluated in detail. The question this evaluation research wants to address is: Can football clubs recruit and retain volunteers successfully by implementing the intervention “More Volunteers in Football Clubs”? The designed intervention is based on the different expectations and needs of volunteers, as well as non-profit human resource management and organisational development management, with a strong emphasis on club-specific counseling and support. Task forces of the twelve participating football clubs attended four workshops in which they received tailor made counseling to reach the desired number of volunteers. The intervention has been implemented and its effectiveness tested in cooperation with the Swiss Football Federation with twelve Swiss football clubs following a pretest, intervention, posttest design Data have been gathered and analysed using a combination of qualitative and quantitative methods. Outcome measurements are: volunteer rate, number of recruited volunteers, number of filled volunteer positions and volunteer satisfaction. Four months after the intervention all clubs that completed the proposed intervention were successful in recruiting the desired number of volunteers. Further, all participating clubs found the intervention helpful and would recommend other clubs to participate as well. With the development of this practical intervention a solution for football clubs is provided to overcome the difficulties in recruiting and retaining sufficient numbers of volunteers. Lamprecht, M., Fischer, A., & Stamm, H.-P. (2012). Sportvereine in der Schweiz. Strukturen, Leistungen, Herausforderungen. Zürich, Switzerland: Seismo.

A Single-blinded, Randomized Clinical Trial of How to Implement an Evidence-based Treatment for Generalized Anxiety Disorder [IMPLEMENT] — Effects of Three Different Strategies of Implementation

BACKGROUND: Despite long-standing calls to disseminate evidence-based treatments for generalized anxiety (GAD), modest progress has been made in the study of how such treatments should be implemented. The primary objective of this study was to test three competing strategies on how to implement a cognitive behavioral treatment (CBT) for out-patients with GAD (i.e., comparison of one compensation vs. two capitalization models). METHODS: For our three-arm, single-blinded, randomized controlled trial (implementation of CBT for GAD [IMPLEMENT]), we recruited adults with GAD using advertisements in high-circulation newspapers to participate in a 14-session cognitive behavioral treatment (Mastery of your Anxiety and Worry, MAW-packet). We randomly assigned eligible patients using a full randomization procedure (1:1:1) to three different conditions of implementation: adherence priming (compensation model), which had a systematized focus on patients' individual GAD symptoms and how to compensate for these symptoms within the MAW-packet, and resource priming and supportive resource priming (capitalization model), which had systematized focuses on patients' strengths and abilities and how these strengths can be capitalized within the same packet. In the intention-to-treat population an outcome composite of primary and secondary symptoms-related self-report questionnaires was analyzed based on a hierarchical linear growth model from intake to 6-month follow-up assessment. This trial is registered at ClinicalTrials.gov (identifier: NCT02039193) and is closed to new participants. FINDINGS: From June 2012 to Nov. 2014, from 411 participants that were screened, 57 eligible participants were recruited and randomly assigned to three conditions. Forty-nine patients (86%) provided outcome data at post-assessment (14% dropout rate). All three conditions showed a highly significant reduction of symptoms over time. However, compared with the adherence priming condition, both resource priming conditions indicated faster symptom reduction. The observer ratings of a sub-sample of recorded videos (n = 100) showed that the therapists in the resource priming conditions conducted more strength-oriented interventions in comparison with the adherence priming condition. No patients died or attempted suicide. INTERPRETATION: To our knowledge, this is the first trial that focuses on capitalization and compensation models during the implementation of one prescriptive treatment packet for GAD. We have shown that GAD related symptoms were significantly faster reduced by the resource priming conditions, although the limitations of our study included a well-educated population. If replicated, our results suggest that therapists who implement a mental health treatment for GAD might profit from a systematized focus on capitalization models. FUNDING: Swiss Science National Foundation (SNSF-Nr. PZ00P1_136937/1) awarded to CF. KEYWORDS: Cognitive behavioral therapy; Evidence-based treatment; Implementation strategies; Randomized controlled trial

The role of drug use in welfare to work: Evidence from Houston, Texas

The purpose of this study is to examine the prevalence of drug abuse among welfare recipients in Houston, TX and compare the work activities and employment barriers of drug abusers in order to better understand the potential effects of welfare reform for this population. Four hypotheses were tested comparing the work activities and employment barriers of drug abusers to others on welfare and the relative importance of drug abuse and employment barriers in predicting work activity. ^ This cross-sectional study examined the characteristics and work activities of 447 welfare recipients (81 drug abusers and 366 non-abusers) who were surveyed between October 1998 and April 1999 in Houston, TX. Subjects were introduced and recruited to participate in the study through a flyer, door to door visits, and peer driven recruitment/referral. ^ About 18% were found to be drug abusers, which is consistent with the national average (10–33%) among welfare recipients. Compared to others on welfare, drug abusers were less involved in work activities, and had more employment barriers. Employment barriers were found to be more predictive of welfare to work activities than drug abuse. The results suggest that alleviating employment barriers should be stressed in programs aimed at welfare recipients with drug abuse problems. ^