Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices.

BACKGROUND The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIV-infected children remains a major challenge. METHODS We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America. We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study. RESULTS Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children. CONCLUSIONS Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low- and middle-income countries to exclude and diagnose TB in HIV-infected children.

Contact, Mobility and Authenticity: Language Ideologies in Koineisation and Creolisation

Part II - Christoph Neuenschwander: Language ideologies in the legitimisation of Tok Pisin as a lingua franca Pidgins and Creoles all over the world seem to share common aspects in the historical circumstances of their genesis and evolution. They all emerged in the context of colonialism, in which not only colonisers and colonised, but also the various groups of the colonised population spoke different languages. Pidgins and Creoles, quite simply, resulted from the need to communicate.¬¬ Yet, the degree to which they became accepted as a lingua franca or in fact even as a linguistic variety in its own right, strikingly differs from variety to variety. The current research project focuses on two Pacific Creoles: Tok Pisin, spoken on Papua New Guinea, and Hawai'i Creole English (HCE). Whereas Tok Pisin is a highly stabilised and legitimised variety, used as a lingua franca in one of the most linguistically diverse countries on Earth, HCE seems to be regarded as nothing more than broken English by a vast majority of the Hawai'ian population. The aim of this project is to examine the metalinguistic comments about both varieties and to analyse the public discourses, in which the status of Tok Pisin and HCE were and still are negotiated. More precisely, language ideologies shall be identified and compared in the two contexts. Ultimately, this might help us understand the mechanisms that underlie the processes of legitimisation or stigmatisation. As Laura Tresch will run a parallel research project on language ideologies on new dialects (New Zealand English and Estuary English), a comparison between the findings of both projects may produce even more insights into those mechanisms. The next months of the project will be dedicated to investigating the metalinguistic discourse in Papua New Guinea. In order to collect a wide range of manifestations of language ideologies, i.e. instances of (lay and academic) commentary on Tok Pisin, it makes sense to look at a relatively large period of time and to single out events that are likely to have stimulated such manifestations. In the history of Papua New Guinea - and in the history of Tok Pisin, in particular - several important social and political events concerning the use and the status of the language can be detected. One example might be public debates on education policy. The presentation at the CSLS Winter School 2014 will provide a brief introduction to the history of Tok Pisin and raise the methodological question of how to spot potential sites of language-ideological production.

The social perception of heroes and murders: Effects of gender-inclusive language in media reports

The way media depict women and men can reinforce or diminish gender stereotyping. Which part does language play in this context? Are roles perceived as more gender-balanced when feminine role nouns are used in addition to masculine ones? Research on gender-inclusive language shows that the use of feminine-masculine word pairs tends to increase the visibility of women in various social roles. For example, when speakers of German were asked to name their favorite "heroine or hero in a novel," they listed more female characters than when asked to name their favorite "hero in a novel." The research reported in this article examines how the use of gender-inclusive language in news reports affects readers' own usage of such forms as well as their mental representation of women and men in the respective roles. In the main experiment, German participants (N = 256) read short reports about heroes or murderers which contained either masculine generics or gender-inclusive forms (feminine-masculine word pairs). Gender-inclusive forms enhanced participants' own usage of gender-inclusive language and this resulted in more gender-balanced mental representations of these roles. Reading about "heroines and heroes" made participants assume a higher percentage of women among persons performing heroic acts than reading about "heroes" only, but there was no such effect for murderers. A post-test suggested that this might be due to a higher accessibility of female exemplars in the category heroes than in the category murderers. Importantly, the influence of gender-inclusive language on the perceived percentage of women in a role was mediated by speakers' own usage of inclusive forms. This suggests that people who encounter gender-inclusive forms and are given an opportunity to use them, use them more themselves and in turn have more gender-balanced mental representations of social roles.

THE EFFECT OF RELAXIN ON BIOCHEMICAL AND MORPHOLOGICAL PARAMETERS OF RAT MYOMETRIAL CELLS IN CULTURE (CYCLIC-AMP, CELL SHAPE CHANGE)

Relaxin is able to inhibit spontaneous, oxytocin-and prostaglandin-driven uterine contractions. The intracellular mechanism of action of relaxin on uterine relaxation had previously been studied using isometrically suspended uterine strips. Since uterine strips contain stroma as well as myometrium, the changes in biochemical parameters induced by relaxin treatment may not occur in the same cell types responsible for the physical changes. In these studies, cultures of enriched populations of rat myometrial cells were used to investigate the effect of relaxin on biochemical and morphological parameters which are related to relaxation.^ Under optimal culture conditions (initial plating density 1 - 1.5 x 10('6)cells/ml, 3 ml/35 mm dish, 2 days culture), enzymatically isolated rat myometrial cells were able to respond to relaxin with cAMP elevation. Relaxin elevated cAMP levels in the presence but not the absence of 0.1 mM methylisobutylxanthine or 0.4 um forskolin in a time- and concentration-dependent manner. In contrast, isoproterenol was able to elevate cAMP levels in the presence and absence of 0.1 mM methylisobutylxanthine.^ Oxytocin treatment caused a decrease in mean cell length and area of myometrial cells in culture which could be considered analogous to contraction. Under optimal culture conditions, relaxin increased myometrial cell length and area (i.e. analogous to relaxation) of oxytocin-treated cells in a time- and concentration-dependent manner. Other relaxants such as isoproterenol and dibutyryl cAMP also increased cell length and area of oxytocin - treated myometrial cells in culture.^ Under optimal culture conditions, relaxin decreased myosin light chain kinase activity in a time-and concentration-dependent manner by increasing the K(,50) of the enzyme for calmodulin (CaM), i.e. decreasing the affinity of the enzyme for CaM. The decrease in the affinity of myosin light chain kinase for CaM may be due to the phosphorylation of the enzyme by cAMP-dependent protein kinase. Relaxin also decreased the Ca('2+)(.)CaM-independent myosin light chain kinase activity to a lesser extent than that of the Ca('2+)(.)CaM-dependent enzyme activity. This was not attributable to a decrease in the affinity of the enzyme for myosin in myometrial cells in culture, in contrast to the finding of such a change following relaxin treatment of uterine strips. Further studies are required to clarify this point.^ There was a temporal association between the effects of relaxin on elevation of cAMP levels in the presence of 0.4 uM forskolin, increase in cell length and decrease in myosin light chain kinase activity. . . . (Author's abstract exceeds stipulated maximum length. Discontinued here with permission of author.) UMI ^

Everyone is; should healthcare? Outsourcing: Issues in strategic planning, organizational culture, and organizational ethics

Expenditures for personal health services in the United States have doubled over the last decade. They continue to outpace the growth rate of the gross national product. Costs for medical care have steadily increased at an annual rate well above the rate of inflation and have gradually outstripped payers' ability to meet their premiums. This limitation of resources justifies the ongoing healthcare reform strategies to maximize utilization and minimize costs. The majority of the cost-containment effort has focused on hospitals, as they account for about 40 percent of total health expenditures. Although good patient outcomes have long been identified as healthcare's central concern, continuing cost pressures from both regulatory reforms and the restructuring of healthcare financing have recently made improving fiscal performance an essential goal for healthcare organizations. ^ The search for financial performance, quality improvement, and fiscal accountability has led to outsourcing, which is the hiring of a third party to perform a task previously and traditionally done in-house. The incomparable nature and overwhelming dissimilarities between health and other commodities raise numerous administrative, organizational, policy and ethical issues for administrators who contemplate outsourcing. This evaluation of the outsourcing phenomenon, how it has developed and is currently practiced in healthcare, will explore the reasons that healthcare organizations gravitate toward outsourcing as a strategic management tool to cut costs in an environment of continuing escalating spending. ^ This dissertation has four major findings. First, it suggests that U.S. hospitals in FY2000 spent an estimated $61 billion in outsourcing. Second, it finds that the proportion of healthcare outsourcing highly correlates with several types of hospital controlling authorities and specialties. Third, it argues that healthcare outsourcing has implications in strategic organizational issues, professionalism, and organizational ethics that warrant further public policy discussions before expanding its limited use beyond hospital “hotel functions” and back office business processes. Finally, it devises an outsourcing suitability scale that organizations can utilize to ensure the most strategic option for outsourcing and concludes with some public policy implications and recommendations for its limited use. ^

Culture and the social context of health inequalities

There has been a great deal of interest and debate recently concerning the linkages between inequality and health cross-nationally. Exposures to social and health inequalities likely vary as a consequence of different cultural contexts. It is important to guide research by a theoretical perspective that includes cultural and social contexts cross-nationally. If inequality affects health only under specific cultural conditions, this could explain why some of the literature that compares different societies finds no evidence of a relationship between inequality and health in certain countries. A theoretical framework is presented that combines sociological theory with constructs from cultural psychology in order to identify pathways that might lead from cultural dimensions to health inequalities. Three analyses are carried out. The first analysis explores whether there is a relationship between cultural dimensions at the societal level and self-rated health at the individual level. The findings suggest that different cultural norms at the societal level can produce both social and health inequalities, but the effects on health may differ depending on the socio-cultural context. The second analysis tests the hypothesis that health is affected by the density of social networks in a society, levels of societal trust, and inequality. The results suggest that commonly used measures of social cohesion and inequality may have both contextual and compositional effects on health in a large number of countries, and that societal measures of social cohesion and inequality interact with individual measures of social participation, trust, and income, moderating their effects on health. The third analysis explores whether value systems associated with vertical individualist societies may lead to health disparities because of their stigmatizing effects. I test the hypothesis that, within vertical individualist societies, subjective well-being will be affected by a social context where competition and the Protestant work ethic are valued, mediated by inequality. The hypothesis was not supported by the available cross-national data, most likely because of inadequate measures, missing data, and the small sample of vertical individualist countries. The overall findings demonstrate that cultural differences are important contextual factors that should not be overlooked when examining the causes of health inequalities. ^

Evaluation of therapist and client language in Motivational Interviewing (MI) sessions: A secondary analysis of data from the Southern Methodist Alcohol Research Trial (SMART) study

In the United States, “binge” drinking among college students is an emerging public health concern due to the significant physical and psychological effects on young adults. The focus is on identifying interventions that can help decrease high-risk drinking behavior among this group of drinkers. One such intervention is Motivational interviewing (MI), a client-centered therapy that aims at resolving client ambivalence by developing discrepancy and engaging the client in change talk. Of late, there is a growing interest in determining the active ingredients that influence the alliance between the therapist and the client. This study is a secondary analysis of the data obtained from the Southern Methodist Alcohol Research Trial (SMART) project, a dismantling trial of MI and feedback among heavy drinking college students. The present project examines the relationship between therapist and client language in MI sessions on a sample of “binge” drinking college students. Of the 126 SMART tapes, 30 tapes (‘MI with feedback’ group = 15, ‘MI only’ group = 15) were randomly selected for this study. MISC 2.1, a mutually exclusive and exhaustive coding system, was used to code the audio/videotaped MI sessions. Therapist and client language were analyzed for communication characteristics. Overall, therapists adopted a MI consistent style and clients were found to engage in change talk. Counselor acceptance, empathy, spirit, and complex reflections were all significantly related to client change talk (p-values ranged from 0.001 to 0.047). Additionally, therapist ‘advice without permission’ and MI Inconsistent therapist behaviors were strongly correlated with client sustain talk (p-values ranged from 0.006 to 0.048). Simple linear regression models showed a significant correlation between MI consistent (MICO) therapist language (independent variable) and change talk (dependent variable) and MI inconsistent (MIIN) therapist language (independent variable) and sustain talk (dependent variable). The study has several limitations such as small sample size, self-selection bias, poor inter-rater reliability for the global scales and the lack of a temporal measure of therapist and client language. Future studies might consider a larger sample size to obtain more statistical power. In addition the correlation between therapist language, client language and drinking outcome needs to be explored.^

Perspectives on guidance and social inclusion in a global society

The world is changing rapidly. People today face numerous challenges in achieving a meaningful and fulfilling life. In many countries, there are enormous systemic barriers to address, such as: massive unemployment, HIV/AIDS, social disintegration, and inadequate infrastructure. One job for life is over. For many it never existed. Old metaphors and old models of career development no longer apply. New ways of thinking about careers are necessary, that take into account the context in which people are living, the reality of today's labour market, and the fact people's career-life journey contains many branching paths, barriers, and obstacles, but also allies and sources of assistance. Flexibility is important, as is keeping options open and making sure the journey is meaningful. Guidance professionals need to begin early, working with other professionals and those seeking assistance to develop attitudes that facilitate people taking charge of their own career-life paths. People need a vision for their life that will drive a purposeful approach to career-life planning and avoid floundering. Helping people achieve that direction can be most effectively accomplished when policy makers and practitioners work together to ensure that effective and accessible services are available for those who need them and when a large part of focus in on addressing the context in which marginalized people work and live.

Perspectives on guidance and social inclusion in a global society

The world is changing rapidly. People today face numerous challenges in achieving a meaningful and fulfilling life. In many countries, there are enormous systemic barriers to address, such as: massive unemployment, HIV/AIDS, social disintegration, and inadequate infrastructure. One job for life is over. For many it never existed. Old metaphors and old models of career development no longer apply. New ways of thinking about careers are necessary, that take into account the context in which people are living, the reality of today's labour market, and the fact people's career-life journey contains many branching paths, barriers, and obstacles, but also allies and sources of assistance. Flexibility is important, as is keeping options open and making sure the journey is meaningful. Guidance professionals need to begin early, working with other professionals and those seeking assistance to develop attitudes that facilitate people taking charge of their own career-life paths. People need a vision for their life that will drive a purposeful approach to career-life planning and avoid floundering. Helping people achieve that direction can be most effectively accomplished when policy makers and practitioners work together to ensure that effective and accessible services are available for those who need them and when a large part of focus in on addressing the context in which marginalized people work and live.

Perspectives on guidance and social inclusion in a global society

The world is changing rapidly. People today face numerous challenges in achieving a meaningful and fulfilling life. In many countries, there are enormous systemic barriers to address, such as: massive unemployment, HIV/AIDS, social disintegration, and inadequate infrastructure. One job for life is over. For many it never existed. Old metaphors and old models of career development no longer apply. New ways of thinking about careers are necessary, that take into account the context in which people are living, the reality of today's labour market, and the fact people's career-life journey contains many branching paths, barriers, and obstacles, but also allies and sources of assistance. Flexibility is important, as is keeping options open and making sure the journey is meaningful. Guidance professionals need to begin early, working with other professionals and those seeking assistance to develop attitudes that facilitate people taking charge of their own career-life paths. People need a vision for their life that will drive a purposeful approach to career-life planning and avoid floundering. Helping people achieve that direction can be most effectively accomplished when policy makers and practitioners work together to ensure that effective and accessible services are available for those who need them and when a large part of focus in on addressing the context in which marginalized people work and live.