A movement from traditional malarial chemoprophylaxis to the use of intermittent preventive treatment as a method of protection for children diagnosed with sickle-cell disease: A proposal for consideration based on a systematic review of the literature

Approximately 200,000 African children are born with sickle-cell anemia each year. Research has shown that individuals with hemoglobin disorders, particularly sickle-cell anemia, have increased susceptibility to contracting malaria. Currently it is recommended that patients diagnosed with sickle-cell anemia undergo malaria chemoprophylaxis in order to decrease their chances of malarial infection. However, studies have shown that routine administration of these drugs increases the risk of drug resistance and could possibly impair the development of naturally acquired immunity. Clinical trials have shown intermittent preventive treatment (IPT) to be an effective method of protection against malaria. The objective of this report was to review previously conducted clinical trials that study the effects of intermittent preventive treatment on malaria and anemia in infants and children. Based on the review, implications for its appropriateness as a protective measure against malaria for infants and children diagnosed with sickle-cell disease were provided.^ The 18 studies reviewed were randomized controlled trials that focused on IPT’s effect on malaria (7 studies), anemia (1 study), or both (8 studies). In addition to these 16, one study looks at IPT’s effect on molecular resistance to malaria, and another study is a follow-up to a study in order to review IPT’s potential to cause a rebound effect. The 18 th study in this review specifically looks at IPT’s protective efficacy in children with SCA. The studies in this report were restricted to randomized controlled trials that have been performed from 2000 to 2010. Reports on anemia were included to illustrate possible added benefits of the use of IPT specific to burdens associated with SCA other than malaria susceptibility. The outcomes of these studies address several issues of concern involving the administration of IPT: protective efficacy (in reference to age, seasonal versus perennial malaria regions, and overall effectiveness against malaria and anemia), drug resistance, drug rebound effect, drug side-effects, and long-term effects. Overall, these showed that IPT has a significant level of protective efficacy against malaria and/or anemia in children. More specifically, the IPT study evaluating children diagnosed with sickle-cell anemia proved IPT to be a more effective method of protection than traditional chemoprophylaxis. ^

The movement toward patient safety: State action related to reporting and disclosure of healthcare-associated infections

Increasing attention has been given to the problem of medical errors over the past decade. Included within that focused attention has been a strong interest in reducing the occurrence of healthcare-associated infections (HAIs). Acting concurrently with federal initiatives, the majority of U.S. states have statutorily required reporting and public disclosure of HAI data. Although the occurrence of these state statutory enactments and other state initiatives represent a recognition of the strong concern pertaining to HAIs, vast differences in each state’s HAI reporting and public disclosure requirements creates a varied and unequal response to what has become a national problem.^ The purpose of this research was to explore the variations in state HAI legal requirements and other state mandates. State actions, including statutory enactments, regulations, and other initiatives related to state reporting and public disclosure mechanisms were compared, discussed, and analyzed in an effort to illustrate the impact of the lack of uniformity as a public health concern.^ The HAI statutes, administrative requirements, and other mandates of each state and two U.S. territories were reviewed to answer the following seven research questions: How far has the state progressed in its HAI initiative? If the state has a HAI reporting requirement, is it mandatory or voluntary? What healthcare entities are subject to the reporting requirements? What data collection system is utilized? What measures are required to be reported? What is the public disclosure mechanism? How is the underlying reported information protected from public disclosure or other legal release?^ Secondary publicly available data, including state statutes, administrative rules, and other initiatives, were utilized to examine the current HAI-related legislative and administrative activity of the study subjects. The information was reviewed and analyzed to determine variations in HAI reporting and public disclosure laws. Particular attention was given to the seven key research questions.^ The research revealed that considerable progress has been achieved in state HAI initiatives since 2004. Despite this progress, however, when reviewing the state laws and HAI programs comparatively, considerable variations were found to exist with regards to the type of reporting requirements, healthcare facilities subject to the reporting laws, data collection systems utilized, reportable measures, public disclosure requirements, and confidentiality and privilege provisions. The wide variations in state statutes, administrative rules, and other agency directives create a fragmented and inconsistent approach to addressing the nationwide occurrence of HAIs in the U.S. healthcare system. ^

Learning -dependent plasticity of movement representations in the primate primary motor cortex

Primary motor cortex (M1) is involved in the production of voluntary movement and contains a complete functional representation, or map, of the skeletal musculature. This functional map can be altered by pathological experiences, such as peripheral nerve injury or stroke, by pharmacological manipulation, and by behavioral experience. The process by which experience-dependent alterations of cortical function occur is termed plasticity. In this thesis, plasticity of M1 functional organization as a consequence of behavioral experience was examined in adult primates (squirrel monkeys). Maps of movement representations were derived under anesthesia using intracortical microstimulation, whereby a microelectrode was inserted into the cortex to electrically stimulate corticospinal neurons at low current levels and evoke movements of the forelimb, principally of the hand. Movement representations were examined before and at several times after training on behavioral tasks that emphasized use of the fingers. Two behavioral tasks were utilized that dissociated the repetition of motor activity from the acquisition of motor skills. One task was easy to perform, and as such promoted repetitive motor activity without learning. The other task was more difficult, requiring the acquisition of motor skills for successful performance. Kinematic analysis indicated that monkeys used a consistent set of forelimb movements during pellet extractions. Functional mapping revealed that repetitive motor activity during the easier task did not produce plastic changes in movement representations. Instead, map plasticity, in the form of selective expansions of task-related movement representations, was only produced following skill acquisition on the difficult task. Additional studies revealed that, in general, map plasticity persisted without further training for up to three months, in parallel with the retention of task-related motor skills. Also, extensive additional training on the small well task produced further improvements in performance, and further changes in movement maps. In sum, these experiments support the following three conclusions regarding the role of M1 in motor learning. First, behaviorally-driven plasticity is learning-dependent, not activity-dependent. Second, plastic changes in M1 functional representations represent a neural correlate of acquired motor skills. Third, the persistence of map plasticity suggests that M1 is part of the neural substrate for the memory of motor skills. ^

Tab. 1: Results of the movement measurements on the blue ice-field Blåisen

In January/February 1985 a German-South African expedition had the opportunity to repeat measurements made by means of stakes planted in 1951 (Norwegian-British-Swedish Antarctic Expedition 1949-52) and 1966 (SANAE VII). Although the rediscovery of the old stakes had not been expected, the stakes could be identified and it was possible to derive movement vectors on the basis of old and heterogenic measurement data. The long-term movement rates established basically confirm and complement the values determined in 1951. The flow rates of 9,1 cm/a to 66.4 cm/a proved to be extremly low. Observations of the stake lengths showed very little accumulation in the fringe areas of the blue ice-field (ca. 0.7 to 2.6 cm/a snow/firn); on bare ice an ablation of 2.6 cm/a water equivalent (2.9 cm/a ice) was measured. The paper begins with a description of the essential conditions for the formation of the blue ice-field. Subsequently the measurements are explained in detail and their results are discussed.

Women in movement : Gender relations in quilombola community Buriti do Meio on the North of Minas Gerais/Brazil

In a civilisation space of Sao Francisco basin river. Women and men interlace on their relations building mutual and each one on your way in handling of the clay in politics fights and in life daily of Buriti do Meio Quilombo. The objective of this study was to do a ethnographically reflection of gender relations that link men and women in the black rural community Buriti do Meio in Sao Francisco municipal district on the North of Minas Gerais/Brazil. We tried to understand the meanings and the composed representations on the feminineness and the masculine ways in relation that men and women set up among themselves in handling workmanship for the information in politics fight of community group as quilombo remaining and to rights access derived and everyday life where they build and organize together the life of all their members reflecting in his symbolic order. Buriti do Meio is traditional known for its handcraft and for cultural manifestations, legacy of their ancestral, olds slaves that ran way to look for autonomy and freedom express signs of afrobrazilian culture inserted on the civilization space in Sao Francisco basin river

Women in movement : Gender relations in quilombola community Buriti do Meio on the North of Minas Gerais/Brazil

In a civilisation space of Sao Francisco basin river. Women and men interlace on their relations building mutual and each one on your way in handling of the clay in politics fights and in life daily of Buriti do Meio Quilombo. The objective of this study was to do a ethnographically reflection of gender relations that link men and women in the black rural community Buriti do Meio in Sao Francisco municipal district on the North of Minas Gerais/Brazil. We tried to understand the meanings and the composed representations on the feminineness and the masculine ways in relation that men and women set up among themselves in handling workmanship for the information in politics fight of community group as quilombo remaining and to rights access derived and everyday life where they build and organize together the life of all their members reflecting in his symbolic order. Buriti do Meio is traditional known for its handcraft and for cultural manifestations, legacy of their ancestral, olds slaves that ran way to look for autonomy and freedom express signs of afrobrazilian culture inserted on the civilization space in Sao Francisco basin river

Women in movement : Gender relations in quilombola community Buriti do Meio on the North of Minas Gerais/Brazil

In a civilisation space of Sao Francisco basin river. Women and men interlace on their relations building mutual and each one on your way in handling of the clay in politics fights and in life daily of Buriti do Meio Quilombo. The objective of this study was to do a ethnographically reflection of gender relations that link men and women in the black rural community Buriti do Meio in Sao Francisco municipal district on the North of Minas Gerais/Brazil. We tried to understand the meanings and the composed representations on the feminineness and the masculine ways in relation that men and women set up among themselves in handling workmanship for the information in politics fight of community group as quilombo remaining and to rights access derived and everyday life where they build and organize together the life of all their members reflecting in his symbolic order. Buriti do Meio is traditional known for its handcraft and for cultural manifestations, legacy of their ancestral, olds slaves that ran way to look for autonomy and freedom express signs of afrobrazilian culture inserted on the civilization space in Sao Francisco basin river

(Table 1) Movement parameters of nine adult female snowy owls (Bubo scandiacus) tracked during the winter period 07/08 and 08/09 around Hudson Strait, Canada

Top predators of the arctic tundra are facing a long period of very low prey availability during winter and subsidies from other ecosystems such as the marine environment may help to support their populations. Satellite tracking of snowy owls, a top predator of the tundra, revealed that most adult females breeding in the Canadian Arctic overwinter at high latitudes in the eastern Arctic and spend several weeks (up to 101 d) on the sea-ice between December and April. Analysis of high-resolution satellite images of sea-ice indicated that owls were primarily gathering around open water patches in the ice, which are commonly used by wintering seabirds, a potential prey. Such extensive use of sea-ice by a tundra predator considered a small mammal specialist was unexpected, and suggests that marine resources subsidize snowy owl populations in winter. As sea-ice regimes in winter are expected to change over the next decades due to climate warming, this may affect the wintering strategy of this top predator and ultimately the functioning of the tundra ecosystem.