100,867 research outputs found
Enhancing control of schistosomiasis in Niger : assessing morbidity in preschool-aged children, praziquantel treatment efficacy and cost implication for control
No full textBackground: Schistosomiasis, accounted among the neglected tropical diseases (NTDs), represents a major public health problem, particularly in Africa, where more than 95% of all the cases of the world are currently concentrated. The health consequences of Schistosoma infection are considerable. Apart from the known long-term complications of a chronic infection (e.g. portal hypertension, kidney failure, bladder cancer and sterility), schistosomiasis is a debilitating disease leading to anaemia, malnutrition, chronic abdominal and pelvic pain, and diarrhoea.
In 2001, the World Health Assembly (WHA) adopted resolution 54.19, which urged member states to regularly treat at least 75% and up to 100% of all school-aged children at risk of schistosomiasis and other high-risk groups. Moreover, in 2006, the World Health Organization (WHO) launched the “preventive chemotherapy” (PCT) strategy, which relies on the regular administration of anthelminthic drugs to at-risk populations in an integrated manner. Following these international calls for action against NTDs, several African countries, including Niger, launched national control programmes based on PCT with support from partners.
The aims of the present PhD thesis in epidemiology were (i) to assess the morbidity of schistosomiasis in infants and preschool-aged children currently not included in PCT; (ii) to evaluate praziquantel (PZQ) efficacy using different treatment schemes, including a detailed analysis of cost; and (iii) to enhance the control of schistosomiasis and other NTDs in Niger.
Methods and principal finding: First, achievements and remaining challenges of schistosomiasis and soil-transmitted helminthiasis (STH) control in three countries of West Africa (i.e. Burkina Faso, Mali and Niger) that benefited from support of the Schistosomiasis Control Initiative (SCI) have been analysed. In the first 3 years of the control programmes, nearly 13.5 million doses of PZQ have been administrated against schistosomiasis and albendazole against STH with coverage rates varying between 67% and 94%. The PZQ treatments have resulted in a reduction of the prevalence and intensity of Schistosoma infection in sentinel cohorts that were set up to monitor and evaluate the national control programmes. Key challenges these national control programmes are currently facing include the ability to maintain the reduction in morbidity achieved so far and ensuring sustainability.
Second, we assessed morbidity due to schistosomiasis in infants and preschool-aged children who are currently not included in PCT according to WHO guidelines, including risk factors for infection in early childhood. We carried out a cross-sectional epidemiological survey in two villages in Niger: Falmado that is endemic for Schistosoma haematobium only, and Diambala that is a mixed S. haematobium-S. mansoni focus. A total of 282 children were examined (149 girls, 133 boys; average age, 2.6 years) and 224 mothers (average age, 30.1 years). For S. haematobium diagnosis, two urine samples obtained over consecutive days were subjected to a standard filtration method, while the diagnosis of S. mansoni was based on a single stool sample using duplicate Kato-Katz thick smears. Additionally, in Diambala, a pre-tested questionnaire was administered to mothers, which recorded demographic data, recent treatment history with anthelminthic drugs, household sanitation and water supply and bathing practices for their children. Prevalence of egg-patent S. haematobium infection among young children and their mothers was, respectively, 51% and 56% in Falmado, and 61% and 72% in Diambala. The prevalence of S. mansoni infection in Diambala was 44% among children and 52% in mothers. Mixed egg-patent infections of S. haematobium and S. mansoni were revealed in 29% of the children and 37% of the mothers. Results from the questionnaire survey showed that 70% of the children were accompanied by their mothers to schistosomiasis transmission sites before reaching their first birthday, and that three-quarter of the mothers used water directly drawn from the irrigation canals to wash their children.
Third, we evaluated the efficacy and safety of two closely spaced doses of PZQ against S. haematobium and S. mansoni in school-aged children, and characterised re-infection patterns over a 1-year period. The study was carried out in five villages in western Niger: Falmado, Seberi, Diambala, Namarigoungou and Libore. Parasitological examinations consisted of triplicate urine filtrations and triplicate Kato-Katz thick smears at each visit. Two 40 mg/kg oral doses of PZQ were administered 3 weeks apart. Follow-up visits were conducted 6 weeks, 6 months and 12 months after the first dose of PZQ. Adverse events were monitored within 4 hours after dosing by the survey team and 24 hours after treatment using a questionnaire. Our final study cohort comprised 877 children who were infected with either S. haematobium, or S. mansoni, or both species concurrently and received both doses of PZQ. At baseline, the geometric mean (GM) infection intensity of S. haematobium ranged from 3.6 (Diambala) to 30.3 eggs/10 ml of urine (Falmado). The GM infection intensity of S. mansoni ranged from 86.7 (Diambala) to 151.4 eggs/gram of stool (EPG) (Namarigoungou). Adverse events were reported by 33% and 1.5% of the children after the first and second dose of PZQ, respectively. We found cure rates in S. haematobium-infected children 3 weeks after the second dose of PZQ ranging between 49% (Falmado) and 98% (Namarigoungou) and high egg reduction rates (92-100%). Regarding S. mansoni, only moderate cure and egg reduction rates were found (52-59% in Diambala, 55-60% in Namarigoungou).
Fourth, in order to generate additional evidence regarding the safety and efficacy of PZQ for schistosomiasis in infants and preschool-aged children, we pursued a drug efficacy trial using PZQ syrup (Epiquantel®) in children aged below 72 months. The study was carried out between May and August 2010 in three villages. Overall, 243 children infected with S. haematobium and/or S. mansoni were treated with PZQ syrup at a dose of 40 mg/kg after they had received a meal of millet porridge. Children were observed during 4 hours post-treatment and a questionnaire was administered to the mothers the following day to determine adverse events. Follow-up visits consisting of three urine filtrations and triplicate Kato-Katz thick smears were conducted 3 and 6 weeks post-treatment. The proportion of children having presented early adverse events during the 4-hour period post-treatment was 33% and the proportion of adverse events occurring within 24 hours after treatment was 6.2%. No serious adverse events were recorded. The most frequent symptoms were abdominal pains (31%), bloody diarrhoea (16.2%) and sleepiness (15.3%). Before treatment, 165 children were infected with S. haematobium among whom 87% presented a light infection (1-49 eggs/10 ml of urine) and 13% a heavy infection (?50 eggs/10 ml of urine). The overall cure rate against S. haematobium was 86% and 95% after 3 and 6 weeks post-treatment, respectively. Three and 6 months after treatment, the GM egg reduction rate for S. haematobium was 69% and 71%, respectively. With regard to S. mansoni, 96 infected children, were treated with PZQ. Among them, 39% had moderated to heavy infection intensities (?100 EPG). Observed cure rates were 75% and 50%, respectively, 3 and 6 weeks after treatment. The respective GM egg reduction rates were 67% and 19%.
Fifth, in order to help countries in finding viable strategies that are financially acceptable to sustain schistosomiasis control activities, we conducted a cost-effectiveness study comparing a school-based and a community-based mass drug administration strategy for schistosomiasis and STH control in Niger. In 2006, we undertook a survey in four districts to estimate the economic cost per district, per treatment and per Schistosoma infection averted. The study compared the costs of treatment at start-up and in a subsequent year and identified the allocation of costs by activity, input and organization. The total economic cost of the programme, including programme-specific expenditures, national and local government costs and international technical support and programme co-ordination in four study districts, over a 2-year period, was US\$ 456,718, which translates to an economic cost per treatment of US\$ 0.58. The full economic delivery cost of school-based treatment in 2005/2006 was US\$ 0.76, while a somewhat lower cost was observed for community distribution (US\$ 0.46). If only costs to the programme were included, the respective figures were US\$ 0.47 and US\$ 0.41. In the study district over a 2-year period, the average cost per Schistosoma infection averted was US\$ 0.76 for children with one treatment and the cost was US\$ 6.7 for adults.
Conclusion: Sustainability of schistosomiasis and STH control programmes in sub-Saharan Africa remains a grand challenge. Integration with other existing health interventions, particularly those targeting NTDs and strengthening of health systems is a way to ensure continued distribution of anthelminthic drugs and other interventions. At an average cost per treatment of US\$ 0.58, control could be handled by the countries.
A substantive proportion of preschool-aged children had egg-patent Schistosoma infection, inclusive of co-infection with S. haematobium and S. mansoni. Hence, in highly endemic areas, more attention should be paid on preschool-aged children and women of childbearing age, so that they can benefit from PCT, thus, increasing effective coverage of those infected. PZQ syrup is well tolerated in infants and preschool-aged children. The cure and eggs reduction rates were high against S. haematobium infection, but additional studies are warranted to determine the efficacy against S. mansoni.
In school-aged children, PZQ given in two closely spaced doses is efficacious against S. haematobium. However, low egg reduction rate observed against S. mansoni raises concern about mounting PZQ tolerance. ---------- Zusammenfassung:
Hintergrund: Schistosomiasis ist eine vernachlässigte tropische Krankheit, welche ein bedeutendes Problem für die öffentliche Gesundheit darstellt, vor allem in Afrika, wo aktuell mehr als 95% aller weltweit auftretenden Fälle konzentriert sind. Die gesundheitlichen Auswirkungen der Schistosomiasis sind beträchtlich. Abgesehen von den bekannten Langzeit Komplikationen einer chronischen Infektion (wie Pfortaderhochdruck, Leberversagen, Blasenkrebs und Unfruchtbarkeit) ist Schistosomiasis eine kräftezehrende Erkrankung welche zu Anämie, Mangelernährung, chronischen Unterleibsschmerzen sowie Diarrhö führen kann.
Im Mai 2001 wurde an der ‘‘World Health Assembly“ (WHA) die Resolution Nummer 54.19 ins Leben gerufen. Diese Resolution hält Mitgliederstaaten dazu an regelmässig mindestens 75% und bis 100% aller Kinder im Schulalter, welche dem Risiko einer Schistosomen Infektion ausgesetzt sind, sowie andere Gruppen mit hohem Risiko, regelmässig mit Praziquantel zu behandeln. Desweiteren führte die Weltgesundheitsorganisation (WHO) eine Strategie der „präventiven Chemotherapie“ (PCT) ein, welche sich auf eine regelmässige, integrative Verabreichung von Entwurmungsmitteln stützt. Diesen internationalen Aufrufen für die Bekämpfung der Schistosomiasis und anderer vernachlässigter Tropenkrankheiten folgend, lancierten einige afrikanische Länder, einschliesslich Niger, mit Hilfe von Partnern, PCT-basierte, nationale Kontrollprogramme.
Die Ziele dieser Dissertation in Epidemiologie waren (i) die Morbidität durch Schistosomiasis in Klein- und Vorschulkindern, welche derzeit nicht in die PCT Strategie eingeschlossen sind, zu ermessen; (ii) die Wirksamkeit und Verträglichkeit von Praziquantel bei verschiedenen Behandlungsschemata zu evaluieren, einschliesslich einer detaillierten Kostenanalyse; und (iii) die Kontrolle der Schistosomiasis und anderer vernachlässigter Tropenkrankheiten in Niger zu stärken.
Methoden und wichtigste Ergebnisse: Zuerst wurden die bisherigen Leistungen und verbleibenden Herausforderungen der Schistosomiasis und der vom Boden-übertragenen Wurminfektionen in drei Ländern Westafrikas (nämlich Burkina Faso, Mali und Niger), welche von der Unterstützung der “Schistosomiasis Control Initiative“ (SCI) profitierten, analysiert. In den ersten drei Jahren des Kontrollprogramms wurden annähernd 13.5 Millionen Dosen Praziquantel gegen Schistosomiasis, und Alendazole gegen von Boden-übertragenen Wurminfektionen verabreicht mit einer Deckungsrate zwischen 67% und 94%. Die Praziquantel Behandlungen führten zu einer Reduktion der Prävalenz und Intensität von Schistosomen Infektionen in den Beobachtungskohorten welche zur Überwachung und Bewertung der nationalen Kontrollprogramme etabliert worden waren. Die Schlüsselherausvorderungen welchen diese nationalen Kontrollprogramme derzeit gegenüber stehen, sind das Vermögen, diesen Rückgang der Morbidität welcher bisher erreicht wurde beizubehalten sowie die Sicherung der Nachhaltigkeit.
Zweitens ermassen wir die Morbidität von Schistosomiasis in Klein- und Vorschulkindern, welche zur Zeit nicht in der PCT wie von der WHO empfohlen eingeschlossen sind, einschliesslich der Risikofaktoren einer Infektion in der frühen Kindheit. Wir führten eine Querschnittsstudie in zwei Dörfern in Niger durch: Falmado welches endemisch nur für Schistosoma haematobium ist und Diambala welches ein Brennpunkt sowohl für S. haematobium wie auch S. mansoni ist. Insgesamt wurden 282 Kinder (149 Mädchen, 133 Jungen; durchschnittliches Alter: 2.6 Jahre) und 224 Mütter (durchschnittliches Alter: 30.1 Jahre) untersucht. Für die Diagnose von S. haematobium wurden zwei Urinproben an zwei aufeinanderfolgenden Tagen mit der Standard Filtrationsmethode untersucht, während die Diagnose von S. mansoni auf der Untersuchung einer einzelnen Stuhlprobe mittels zweier Kato-Katz Ausstriche beruhte. Desweiteren wurden vorgetestete Fragebögen, welche demographische Daten, kürzliche Behandlungsgeschichten mit Entwurmungsmitteln, die sanitäre Situation des Haushalts und Wasserversorgung sowie Badepraktiken für die Kinder aufnahmen, mit den Müttern in Diambala durchgeführt. Die Prävalenz von Ei-patenten S. haematobium Infektionen bei jungen Kindern und deren Mütter war 51% und 56% in Falmado, sowie 61% und 72% und Diambala. Die Prävalenz von S. mansoni in Diambala war 44% unter den Kindern und 72% unter den Müttern. Gemischte, Ei-patente Infektionen von S. haematobium und S. mansoni zeigten sich in 29% der Kinder und 37% der Mütter. Die Auswertung der Fragebogenstudie zeigte, dass 70% aller Kinder von ihren Müttern zu Schistosomiasis Übertragungsstellen begleitet wurden, bevor sie ein Jahr alt waren und dass drei-Viertel der Mütter Wasser welches sie direkt aus den Bewässerungskanälen bezogen benutzten um ihre Kinder zu waschen.
Drittens evaluierten wir die Wirksamkeit und Sicherheit zweier eng aufeinanderfolgender Dosen Praziquantel gegen S. haematobium und S. mansoni bei Kindern im Schulalter und charaktisierten die Re-infektionsmuster über einen Zeitraum von einem Jahr. Die Studie wurde in den folgenden fünf Dörfern im Westen Nigers durchgeführt: Falmado, Seberi, Diambala, Namarigoungou und Libore. Parasitologische Untersuchungen bestanden aus drei Urinfiltrationen und drei Kato-Katz Ausstrichen bei jedem Besuch. Zwei 40 mg/kg Praziquantel Dosen wurden in einem Abstand von drei Wochen verabreicht. Folgebesuche wurden 6 Wochen, 6 Monate und 12 Monate nach der ersten Praziquantel Dosis durchgeführt. Nebenwirkungen wurden während vier Stunden nach der Medikamentenverabreichung vom Studienteam, und 24 Stunden danach mittels eines Fragebogens überwacht. Unsere letztendliche Studienkohorte bestand aus 877 Kindern die entweder mit S. haematobium oder S. mansoni oder mit beiden parasitären Wurmarten zugleich infiziert waren und beide Dosen Praziquantel erhalten hatten. Bei der Basisstudie reichte der geometrische Mittelwert (GM) der Infektionsintensität von S. haematobium von 3.6 (Diambala) bis 30.3 Eier pro 10 ml Urin (Falmado). Der GM der Infektionsintensität von S. mansoni reichte von 86.7 (Diambala) bis 151.4 Eier pro Gramm Stuhl (EPG) (Namarigoungou). Nebenwirkungen wurden bei 33% bzw. 1.5% der Kinder nach der ersten bzw. zweiten Dosis Praziquantel berichtet. Wir fanden Heilungsraten zwischen 49% (Falmado) und 98% (Namarigoungou) sowie hohe Ei Reduktionsraten (92-100%) bei S. haematobium-infizierten Kindern drei Wochen nach Verabreichung der zweiten Praziquantel Dosis. Für S. mansoni wurden lediglich mittelmässige Heilungs- und Ei Reduktionsraten gefunden (52-59% in Diambala, 55-60% in Namarigoungou).
Viertens führten wir, um weitere Befunde bezüglich der Verträglichkeit und Wirksamkeit von Praziquantel gegen Schistosomiasis bei Klein- und Vorschulkindern zu erhalten, eine Wirksamkeitsstudie mit einem Praziquantel Sirup (Epiquantel® ) bei Kindern mit einem Alter von bis zu 72 Monaten durch. Die Studie wurde zwischen Mai und August 2010 in drei Dörfern in Niger durchgeführt. Insgesamt wurden 243 Kinder welche mit S. haematobium und/oder S. mansoni infiziert waren, mit einer Dosis von 40 mg/kg des Praziquantel Sirups behandelt, nachdem ihnen eine Mahlzeit aus Hirsebrei verabreicht worden war. Nach der Behandlung wurden die Kinder über 4 Stunden beobachtet und am darauffolgenden Tag ein Fragebogen mit den Müttern durchgeführt um Nebenwirkungen zu ermitteln. Folgeuntersuchungen bestehend aus 3 Urinfiltrationen und 3 Kato-Katz Ausstrichen wurden 3 und 6 Wochen nach der Behandlung durchgeführt. Der Anteil Kinder, der frühe Nebenwirkungen während der ersten 4 Stunden nach Behandlung zeigte, lag bei 33% und der Anteil Nebenwirkungen welche innerhalb von 4-24 Stunden nach der Behandlung auftraten bei 6.1%. Es wurden keine ernsten Nebenwirkungen berichtet. Die am häufigsten auftretenden Symptome waren Unterleibsschmerzen (31%) sowie blutiger Durchfall und Schläfrigkeit (16%). Vor der Behandlung waren 166 Kinder mit S. haematobium infiziert, von welchen 87% eine leichte Infektion (1-49 Eier pro 10 ml Urin) und 13% eine schwere Infektion (?50 Eier pro 10 ml Urin) aufwiesen. Die Heilungsrate für S. haematobium betrug im Gesamten 86% drei Wochen, bzw. 95% sechs Wochen nach Behandlung. Der GM der Ei Reduktionsrate für S. haematobium betrug 71% drei, bzw. 77% sechs Wochen nach Behandlung. Gegen S. mansoni wurden 96 infizierte Kinder mit Praziquantel behandelt. Unter diesen hatten 39% eine mittlere bis schwere Infektion (?100 EPG). Die beobachtete Heilungsrate lag bei 75% drei, bzw. 50% sechs Wochen nach Behandlung. Die entsprechenden GM der Ei Reduktionsraten waren 67% und 19%.
Fünftens, um den Ländern dabei zu helfen durchführbare Strategien dafür zu finden die Schistosomiasis Kontrollstrategien langfristig zu gewährleisten, führten wir eine Kosteneffizienzstudie durch in welcher wir eine schulbasierte mit einer gemeindebasierten Massenbehandlungsstrategie gegen die Schistosomiasis und von Boden-übertragener Wurminfektionen verglichen. Unsere Studie wurde im Jahr 2006 durchgeführt in vier Distrikten von Niger um die wirtschaftlichen Kosten pro Distrikt, pro Behandlung und pro abgewendeter Schistosomen Infektion abzuschätzen. In der Studie wurden die Behandlungskosten beim Start und im darauffolgenden Jahr verglichen und die Kostenverteilung auf die Aktivitäten, den Einsatz und die Organisation identifiziert. Die gesamten wirtschaftlichen Kosten des Programms, einschliesslich programmspezifischer Ausgaben, nationaler und lokaler Regierungskosten und internationaler technischer Unterstützung sowie Programmkoordination von vier Distrikten betrugen 456,718 US\$ über einen Zeitraum von zwei Jahren, was einem Kostenpunkt von 0.58 US\$ pro Behandlung entspricht. Die vollen wirtschaftlichen Kosten für eine schulbasierte Behandlung in Jahr 2005/2006 betrugen 0.76 US\$ während für die gemeindebasierte Behandlung etwas niedrigere Kosten beobachtet wurden (0.46 US\$). Wenn man für die jeweiligen Grafiken ausschliesslich die Kosten des Programms berücksichtigt, handelt es sich um 0.47 US\$ bzw. 0.41US\$. Die durchschnittlichen Kosten pro abgewandter Schistosomen Infektion im Studiengebiet über den Zeitraum von zwei Jahren betrugen 0.76 US\$ für Kinder mit einer Behandlung und 6.7 US\$ für Erwachsene.
Schlussfolgerungen: Die Nachhaltigkeit von Kontrollprogrammen gegen die Schistosomiasis und anderer vernachlässigter Tropenkrankeiten in Subsahara-Afrika bleibt eine gewaltige Herausforderung. Die Eingliederung in andere Gesundheitsinterventionen, vor allem jener welche auf vernachlässigte Tropenkrankheiten und die Stärkung von Gesundheitssystemen abzielen, stellt einen Weg dar, um die kontinuierliche Verteilung von Entwurmungsmedikamenten und anderer Interventionen sicher zu stellen. Wir spekulieren, dass die durchschnittlichen Kosten von 0.58 US\$ pro Behandlung von den Ländern gehandhabt werden können.
Ein bedeutender Anteil Vorschulkinder hatte eine Ei-patente Schistosomen Infektion, inklusive Co-Infektion zwischen S. haematobium und S. mansoni. Daher sollte in hochendemischen Gebieten Vorschulkindern und Frauen im gebährfähigen Alter mehr Aufmerksamkeit geschenkt werden, damit sie von der PCT profitieren und so die effektive Abdeckung der Infizierten erhöht wird. Praziquantel Sirup wird von Klein- und Vorschulkindern gut vertragen. Gute Heilungsraten und hohe Ei Reduktionsraten wurden bei der S. haematobium gefunden, doch weitere Studien sind angebracht um die Wirksamkeit gegen S. mansoni zu bestimmen.
Bei Kindern im Schulalter ist Praziquantel in zwei eng beieinanderliegenden Dosen verabreicht, wirksam gegen S. haematobium. Jedoch erweckt die niedrige Ei
Letter, [Author unclear] to Paulina T. Merritt
No full textHandwritten letter to Paulina Merritt from an unknown author, October 1, 1876.
A preliminary re-assessment of Garba III at Melka Kunture, a Middle Stone Age site with archaic Homo sapiens remains
No full textGarba III is one of the many sites of Melka Kunture, in the middle Awash Valley, where the archaeological record starts a c. 1.7 Ma. It was excavated in the Seventies of last century under the direction of Francis Hours, who was only able to publish a few preliminary reports before his untimely death. Hours recognized a large MSA assemblage with some small handaxes. An age close to 150ka was suggested. Three skull fragments related to Homo sapiens were also discovered. Notwithstanding the lack of detailed analysis and of published information, Garba III has ever since been quoted in the scientific literature. In 2011 the original site was re-located, geological trenches were dug, and the stratigraphic sequence was documented into detail. The result of the geomorphological investigation and of U-series dating will be presented at the congress. The study of the large lithic collection, now at the National Museum of Ethiopia, is under way. Except for a few flint and basalt artefacts, obsidian was invariably used in the analysed sample. Small obsidian pebbles were knapped by bipolar percussion, but larger blocks were also available, and there is some evidence of discoid and Levallois reduction sequences. Triangular or quadrangular flakes were produced, generally less than 30mm long, and never more than 60mm in length. Formal tools include scrapers, endscrapers, denticulates and points with a thick triangular section. Pièces esquillées are frequent, mostly on the ventral face, and occur in association with other retouched edges. In a preliminary palaeontological analysis, Denis Geraads identified a hippo of very large size, a large giraffe, at least five bovid species, including a bovine, two alcelaphines (?Damaliscus and Connochaetes), a reduncine (kob), and an antilopine (cf. Gazella), as well as a few Equus remains
Trainee engagement with reflection in online portfolios: A qualitative study highlighting the impact of the Bawa-Garba case on professional development
No full textBackground
Reflection is an essential tool for postgraduate medical training, yet fear of exposing incompetence is a known barrier for engagement with reflection. In the UK, this fear may have been amplified by the case of Dr Bawa-Garba, whose reflective e-portfolio entries informed a General Medical Council investigation resulting in the loss of her licence to practice.
Aim
To identify themes GP trainees commonly explore in e-portfolio entries, and whether their reflective e-portfolio entries have changed following the Bawa-Garba case.
Method
A phenomenological approach was applied. Semi-structured interviews continued to data saturation in a purposive sample of trainees (7) and trainers (4) recruited from a South Yorkshire GP training scheme. Transcript data were assigned to a coding framework with iterative thematic analysis.
Results
Dominant emergent themes were ‘difficulty’ and ‘challenge’. All trainees described reluctance to submit significant event analyses (SEAs) on mistakes and near misses for fear of jeopardising their careers. International medical graduates were disproportionately affected by the challenges reflection posed.
Conclusion
Following the Bawa-Garba case, trainees are disengaging with SEAs to reduce the risk of self-incrimination. Further guidance with which trainees can navigate their reflective e-portfolios is required to retain the value of reflection as a tool for professional development
Handwritten biographical information on Paulina T. McClung Merritt
No full textA handwritten biography of Paulina T. McClung Merritt by an unknown author, 1892.
Heterogeneous and tissue-specific regulation of effector T cell responses by IFN-gamma during Plasmodium berghei ANKA infection.
No full textIFN-γ and T cells are both required for the development of experimental cerebral malaria during Plasmodium berghei ANKA infection. Surprisingly, however, the role of IFN-γ in shaping the effector CD4(+) and CD8(+) T cell response during this infection has not been examined in detail. To address this, we have compared the effector T cell responses in wild-type and IFN-γ(-/-) mice during P. berghei ANKA infection. The expansion of splenic CD4(+) and CD8(+) T cells during P. berghei ANKA infection was unaffected by the absence of IFN-γ, but the contraction phase of the T cell response was significantly attenuated. Splenic T cell activation and effector function were essentially normal in IFN-γ(-/-) mice; however, the migration to, and accumulation of, effector CD4(+) and CD8(+) T cells in the lung, liver, and brain was altered in IFN-γ(-/-) mice. Interestingly, activation and accumulation of T cells in various nonlymphoid organs was differently affected by lack of IFN-γ, suggesting that IFN-γ influences T cell effector function to varying levels in different anatomical locations. Importantly, control of splenic T cell numbers during P. berghei ANKA infection depended on active IFN-γ-dependent environmental signals--leading to T cell apoptosis--rather than upon intrinsic alterations in T cell programming. To our knowledge, this is the first study to fully investigate the role of IFN-γ in modulating T cell function during P. berghei ANKA infection and reveals that IFN-γ is required for efficient contraction of the pool of activated T cells
Dispelling the Myths Behind First-author Citation Counts
No full textWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Pelevin’s Trinity in the novel “t”: author – protagonist – reader
No full textThe article attempts to interpret Pelevin's artistic strategy in the novel "T" by exploring its subject organization and addressing the key problems of the author, the protagonist, and the reader as they are seen by the researcher. The article analyzes the peculiarities of constructing the narrative reality in the novel "T", and goes on to discuss Pelevin's philosophic models of the development of the humankind, and the emergence of his new anthropology
Measuring industry-science links through inventor-author relations: A profiling method
No full textIn this pilot study we examine the performance of text-based profiling in recovering a set of validated inventor-author links. In a first step we match patents and publications solely based on their similarity in content. Next, we compare inventor and author names on the highest ranked matches for the occurrence of name matches. Finally, we compare these candidate matches with the names listed in a validated set of inventor-author names. Our text-based profile methodology performs significantly better than a random matching of patents and publications, suggesting that text-based profiling is a valuable complementary tool to the name searches used in previous studies.innovation; industry-science links; text-based profiling;
Garba III (Melka Kunture, Ethiopia): a MSA site with archaic Homo sapiens remains revisited
No full textGarba III, in the upper Awash Valley of Ethiopia, is one of the many sub-sites of Melka Kunture, where the overall archaeological record starts at c. 1.8 Ma. Garba III was excavated over several years in the 1970s, under the direction of Francis Hours, who was able to publish only preliminary reports before his untimely death. At the base of the sequence, Acheulean layers were discovered and, above then, MSA layers characterized by ferruginous concretions, where three cranial fragments of Homo sapiens were also found. An age close to 150 ka was suggested for the human remains and associated industry of the upper layers, which are the focus of the current re-assessment. At the time, however, no clear-cut distinction was made between Acheulean and MSA. In 2011, the original site was re-located, geological trenches were dug, the stratigraphic sequence was documented in detail, and a geomorphological reconstruction was prepared. Lithic collections and anthropological remains, kept in Addis Ababa, were also re-studied. New field research highlights complex site formation processes, including cyclic phases of erosion and re-deposition of pre-existing soils and deposits. However, pedogenetic processes, which developed twice, also point to prolonged phases of stability, in good accordance with the state of preservation of the lithic industry, which is neither rolled nor fragmented. Small-sized obsidian pebbles were knapped, which were available locally in the alluvium deposits. The technological and typological analysis confirms that the lithic industry is Early MSA. A variety of knapping methods were in use, including the Levallois method, well established and mostly recurrent. Points were produced, as well as scrapers, denticulates, and scaled pieces. Circumstantial evidence points to an age not later than an early phase of MIS 5e. The anthropological remains, one of which was so far undescribed, are fragments of a right parietal bone, of a parietal or, more likely, of a frontal bone, and of an occipital bone. They contribute to the still scanty fossil record available at the key-time of the "archaic" H. sapiens emergence and early spread. © 2013 Elsevier Ltd and INQUA
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