Challenges in the management of HIV-infected malnourished children in Sub-Saharan Africa

Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB.Publisher PDFPeer reviewe

Re-Focusing - Building a Future for Entrepreneurial Education & Learning

The field of entrepreneurship has struggled with fundamental questions concerning the subject’s nature and purpose. To whom and to what means are educational and training agendas ultimately directed? Such questions have become of central importance to policy makers, practitioners and academics alike. There are suggestions that university business schools should engage more critically with the lived experiences of practising entrepreneurs through alternative pedagogical approaches and methods, seeking to account for and highlighting the social, political and moral aspects of entrepreneurial practice. In the UK, where funding in higher education has become increasingly dependent on student fees, there are renewed pressures to educate students for entrepreneurial practice as opposed to educating them about the nature and effects of entrepreneurship. Government and EU policies are calling on business schools to develop and enhance entrepreneurial growth and skill sets, to make their education and training programmes more proactive in providing innovative educational practices which help and facilitate life experiences and experiential learning. This paper makes the case for critical frameworks to be applied so that complex social processes become a source of learning for educators and entrepreneurs and so that innovative pedagogical approaches can be developed in terms both of context (curriculum design) and process (delivery methods)

The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials

Objectives To determine whether antibiotic treatment leads to improvements in growth in prepubertal children in low and middle income countries, to determine the magnitude of improvements in growth, and to identify moderators of this treatment effect.Design Systematic review and meta-analysis.Data sources Medline, Embase, Scopus, the Cochrane central register of controlled trials, and Web of Science.Study selection Randomised controlled trials conducted in low or middle income countries in which an orally administered antibacterial agent was allocated by randomisation or minimisation and growth was measured as an outcome. Participants aged 1 month to 12 years were included. Control was placebo or non-antimicrobial intervention.Results Data were pooled from 10 randomised controlled trials representing 4316 children, across a variety of antibiotics, indications for treatment, treatment regimens, and countries. in random effects models, antibiotic use increased height by 0.04 cm/month (95% confidence interval 0.00 to 0.07) and weight by 23.8 g/month (95% confidence interval 4.3 to 43.3). After adjusting for age, effects on height were larger in younger populations and effects on weight were larger in African studies compared with other regions.Conclusion Antibiotics have a growth promoting effect in prepubertal children in low and middle income countries. This effect was more pronounced for ponderal than for linear growth. the antibiotic growth promoting effect may be mediated by treatment of clinical or subclinical infections or possibly by modulation of the intestinal microbiota. Better definition of the mechanisms underlying this effect will be important to inform optimal and safe approaches to achieving healthy growth in vulnerable populations.Vanier Canada Graduate ScholarshipMcGill Univ, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ, CanadaZvitambo Inst Maternal Child Hlth Res, Harare, ZimbabweQueen Mary Univ London, Blizard Inst, Ctr Paediat, London, EnglandMRC, Clin Trials Unit, London, EnglandJohns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USACornell Univ, Div Nutr Sci, Program Int Nutr, Ithaca, NY 14853 USAWashington Univ, Sch Med, Dept Pediat, St Louis, MO 63110 USAUniv Malawi, Blantyre, MalawiUniv Cambridge, Dept Archaeol & Anthropol, Div Biol Anthropol, Cambridge CB2 1TN, EnglandUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilUniv British Columbia, Sch Populat & Publ Hlth, Vancouver, BC V6T 1Z3, CanadaUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Perceiving ‘capability’ within dynamic capabilities: the role of owner-manager self-efficacy

This article combines two popular, yet separate concepts, dynamic capabilities and self-efficacy. Both are concerned with ability / capability and offer potentially valuable synergies. As such, our in-depth qualitative study based in three micro-enterprises in the United Kingdom (UK), investigated, ‘what role(s) may owner-manager perceived self-efficacy play as a micro-foundation of dynamic capabilities in micro-enterprises?’ Our findings show that perceived self-efficacy can influence dynamic capability enactment in multifaceted ways and even suggest that in some cases, perceived self-efficacy is a crucial component of dynamic capabilities, without which there may be no such capability. These insights help open up the black box of dynamic capabilities by contributing important knowledge to the growing body of research into the micro-foundations of such capabilities. Furthermore, our study illuminates the importance of idiosyncratic micro-foundations of dynamic capabilities in micro-enterprises and expands extant knowledge of the potential effects of self-efficacy in the small business and entrepreneurship domain

Minimally Invasive Right Anterior Mini-Thoracotomy Aortic Valve Replacement

Since the emergence of small skin incision aortic valve surgery in the late 1990s, minimally invasive aortic valve replacement has now become a viable alternative to standard full sternotomy. The spectrum includes (a) upper hemi sternotomy (T or J shaped), (b) lower partial sternotomy, and (c) right anterior mini-thoracotomy. Potential advantages include a cosmetically appealing scar, decreased post-operative pain and bleeding, shorter ventilation time and hospital stay, and early return to active life. The operative challenges include restricted view and access to the operative field, longer aortic cross-clamp time, and cardiopulmonary bypass time. This necessitates detailed pre-operative imaging, correct selection and assessment of patients, and good communication with perfusionists and anesthetists regarding the plan of each surgery, with a solid back-up plan in case conversion to full sternotomy is required intra-operatively. In recent times, the use of suture less valves and rapid deployment bio prosthesis has dramatically reduced operative time. Here, we describe the work-up, selection criteria, key steps, and potential pitfalls of the right anterior mini-thoracotomy approach for aortic valve replacement

Hexagonal boron nitride tunnel barriers grown on graphite by high temperature molecular beam epitaxy

We demonstrate direct epitaxial growth of high-quality hexagonal boron nitride (hBN) layers on graphite using high-temperature plasma-assisted molecular beam epitaxy. Atomic force microscopy reveals mono- and few-layer island growth, while conducting atomic force microscopy shows that the grown hBN has a resistance which increases exponentially with the number of layers, and has electrical properties comparable to exfoliated hBN. X-ray photoelectron spectroscopy, Raman microscopy and spectroscopic ellipsometry measurements on hBN confirm the formation of sp2-bonded hBN and a band gap of 5.9 ± 0.1 eV with no chemical intermixing with graphite. We also observe hexagonal moiré patterns with a period of 15 nm, consistent with the alignment of the hBN lattice and the graphite substrate

Strategies to Combine 3D Vasculature and Brain CTA With Deep Neural Networks: Application to LVO

Automated tools to detect large vessel occlusion (LVO) in acute ischemic stroke patients using brain computed tomography angiography (CTA) have been shown to reduce the time for treatment, leading to better clinical outcomes. There is a lot of information in a single CTA and deep learning models do not have an obvious way of being conditioned on areas most relevant for LVO detection, i.e., the vasculature structure. In this work, we compare and contrast strategies to make convolutional neural networks focus on the vasculature without discarding context information of the brain parenchyma and propose an attention-inspired strategy to encourage this. We use brain CTAs from which we obtain 3D vasculature images. Then, we compare ways of combining the vasculature and the CTA images using a general-purpose network trained to detect LVO. The results show that the proposed strategies allow to improve LVO detection and could potentially help to learn other cerebrovascular-related tasks

Intrapartum Antibiotic Chemoprophylaxis Policies for the Prevention of Group B Streptococcal Disease Worldwide: Systematic Review.

Background: Intrapartum antibiotic chemoprophylaxis (IAP) prevents most early-onset group B streptococcal (GBS) disease. However, there is no description of how IAP is used around the world. This article is the sixth in a series estimating the burden of GBS disease. Here we aimed to review GBS screening policies and IAP implementation worldwide. Methods: We identified data through (1) systematic literature reviews (PubMed/Medline, Embase, Literature in the Health Sciences in Latin America and the Caribbean [LILACS], World Health Organization library database [WHOLIS], and Scopus) and unpublished data from professional societies and (2) an online survey and searches of policies from medical societies and professionals. We included data on whether an IAP policy was in use, and if so whether it was based on microbiological or clinical risk factors and how these were applied, as well as the estimated coverage (percentage of women receiving IAP where indicated). Results: We received policy information from 95 of 195 (49%) countries. Of these, 60 of 95 (63%) had an IAP policy; 35 of 60 (58%) used microbiological screening, 25 of 60 (42%) used clinical risk factors. Two of 15 (13%) low-income, 4 of 16 (25%) lower-middle-income, 14 of 20 (70%) upper-middle-income, and 40 of 44 (91%) high-income countries had any IAP policy. The remaining 35 of 95 (37%) had no national policy (25/33 from low-income and lower-middle-income countries). Coverage varied considerably; for microbiological screening, median coverage was 80% (range, 20%-95%); for clinical risk factor-based screening, coverage was 29% (range, 10%-50%). Although there were differences in the microbiological screening methods employed, the individual clinical risk factors used were similar. Conclusions: There is considerable heterogeneity in IAP screening policies and coverage worldwide. Alternative global strategies, such as maternal vaccination, are needed to enhance the scope of global prevention of GBS disease

In Situ Observations during Chemical Vapor Deposition of Hexagonal Boron Nitride on Polycrystalline Copper.

Using a combination of complementary in situ X-ray photoelectron spectroscopy and X-ray diffraction, we study the fundamental mechanisms underlying the chemical vapor deposition (CVD) of hexagonal boron nitride (h-BN) on polycrystalline Cu. The nucleation and growth of h-BN layers is found to occur isothermally, i.e., at constant elevated temperature, on the Cu surface during exposure to borazine. A Cu lattice expansion during borazine exposure and B precipitation from Cu upon cooling highlight that B is incorporated into the Cu bulk, i.e., that growth is not just surface-mediated. On this basis we suggest that B is taken up in the Cu catalyst while N is not (by relative amounts), indicating element-specific feeding mechanisms including the bulk of the catalyst. We further show that oxygen intercalation readily occurs under as-grown h-BN during ambient air exposure, as is common in further processing, and that this negatively affects the stability of h-BN on the catalyst. For extended air exposure Cu oxidation is observed, and upon re-heating in vacuum an oxygen-mediated disintegration of the h-BN film via volatile boron oxides occurs. Importantly, this disintegration is catalyst mediated, i.e., occurs at the catalyst/h-BN interface and depends on the level of oxygen fed to this interface. In turn, however, deliberate feeding of oxygen during h-BN deposition can positively affect control over film morphology. We discuss the implications of these observations in the context of corrosion protection and relate them to challenges in process integration and heterostructure CVD.P.R.K. acknowledges funding from the Cambridge Commonwealth Trust and the Lindemann Trust Fellowship. R.S.W. acknowledges a research fellowship from St. John’s College, Cambridge. S.H. acknowledges funding from ERC grant InsituNANO (no. 279342), EPSRC under grant GRAPHTED (project reference EP/K016636/1), Grant EP/H047565/1 and EU FP7 Work Programme under grant GRAFOL (project reference 285275). The European Synchrotron Radiation Facility (ESRF) is acknowledged for provision of synchrotron radiation and assistance in using beamline BM20/ROBL. We acknowledge Helmholtz-Zentrum-Berlin Electron storage ring BESSY II for synchrotron radiation at the ISISS beamline and continuous support of our experiments.This is the final version. It was first published by ACS at http://pubs.acs.org/doi/abs/10.1021/cm502603