Health inequality in resource poor environments and the pursuit of the MDGs: traditional versus modern healthcare in rural Indonesia

The article examines health inequalities and the impact of changing healthcare provision in rural Indonesia. Traditional medicine is often the only source of medical care for a majority of the population in rural Indonesia. However, the pursuit of the Millennium Development Goals (MDGs) requires the provision and implementation of modern healthcare systems. Using case studies from four rural districts in Kaledupa, a remote island in southeast Sulawesi in Indonesia, the study shows that although modern healthcare facilities are present in the sampled island, they seem to be remote with limited access in comparison with the number of traditional practitioners. High costs, cultural beliefs, distrust and distance to modern healthcare facilities appear to be the most common reasons for people opting for traditional healthcare.. However, social reconstruction in the perception and provision of care has also led to a gradual disappearance of the traditional healthcare provision. The study calls for policy intervention approaches that are geographically and culturally sensitive as the most pragmatic means towards the attainment of MDG targets for the health sector of Indonesia

Task-Related modulations of BOLD low-frequency fluctuations within the default mode Network

Spontaneous low-frequency Blood-Oxygenation Level-Dependent (BOLD) signals acquired during resting state are characterized by spatial patterns of synchronous fluctuations, ultimately leading to the identification of robust brain networks. The resting-state brain networks, including the Default Mode Network (DMN), are demonstrated to persist during sustained task execution, but the exact features of task-related changes of network properties are still not well characterized. In this work we sought to examine in a group of 20 healthy volunteers (age 33 ± 6 years, 8 F/12 M) the relationship between changes of spectral and spatiotemporal features of one prominent resting-state network, namely the DMN, during the continuous execution of a working memory n-back task. We found that task execution impacted on both functional connectivity and amplitude of BOLD fluctuations within large parts of the DMN, but these changes correlated between each other only in a small area of the posterior cingulate. We conclude that combined analysis of multiple parameters related to connectivity, and their changes during the transition from resting state to continuous task execution, can contribute to a better understanding of how brain networks rearrange themselves in response to a task

Spatiotemporal co-existence of two Mycobacterium ulcerans clonal complexes in the Offin River Valley of Ghana

In recent years, comparative genome sequence analysis of African Mycobacterium ulcerans strains isolated from Buruli ulcer (BU) lesion specimen has revealed a very limited genetic diversity of closely related isolates and a striking association between genotype and geographical origin of the patients. Here, we compared whole genome sequences of five M. ulcerans strains isolated in 2004 or 2013 from BU lesions of four residents of the Offin river valley with 48 strains isolated between 2002 and 2005 from BU lesions of individuals residing in the Densu river valley of Ghana. While all M. ulcerans isolates from the Densu river valley belonged to the same clonal complex, members of two distinct clonal complexes were found in the Offin river valley over space and time. The Offin strains were closely related to genotypes from either the Densu region or from the Asante Akim North district of Ghana. These results point towards an occasional involvement of a mobile reservoir in the transmission of M. ulcerans, enabling the spread of bacteria across different regions

Treatment outcomes among HIV-1 and HIV-2 infected children initiating antiretroviral therapy in a concentrated low prevalence setting in West Africa

There is little data on responses to combination antiretroviral therapy (cART) among HIV-infected children in the West African region. We describe treatment outcomes among HIV-1 and HIV-2 infected children initiating cART in a research clinic in The Gambia, West Africa. All treatment naive HIV-infected children who initiated cART according to the WHO ART guidelines for children between October 2004 and December 2009 were included in the analysis. Kaplan-Meir estimates and sign-rank test were used to investigate the responses to treatment. 65 HIV-1 and five HIV-2 infected children aged < 15 years were initiated on cART over this time period. HIV-1 infected children were treated with a combination of Zidovudine or Stavudine + Lamivudine + Nevirapine or Efavirenz while children with HIV-2 were treated with Zidovudine + Lamivudine + ritonavir-boosted Lopinavir. HIV-1 infected children were followed-up for a median (IQR) duration of 20.1 months (6.9 – 34.3), with their median (IQR) age at treatment initiation, CD4% and plasma viral load at baseline found to be 4.9 years (2.1 – 9.1), 13.0% (7.0 – 16.0) and 5.4 log10 copies/ml (4.4 – 6.0) respectively. The median age at treatment initiation of the five HIV-2 infected children was 12 years (range: 4.6 – 14.0) while their median baseline CD4+ T cell count and HIV-2 viral load were 140 cells/mm3 (Range: 40 – 570 cells/mm3) and 4.5 log10copies/mL (Range: 3.1 - 4.9 log10copies/mL) respectively. Among HIV-1 infected children <5 years of age at ART initiation, the median (IQR) increases in CD4% from baseline to 12, 24 and 36 months were 14% (8 – 19; P = 0.0004), 21% (15 – 22; P = 0.005) and 15% (15 – 25; P = 0.0422) respectively, while the median (IQR) increase in absolute CD4 T cell count from baseline to 12, 24 and 36 months for those ≥5 years at ART initiation were 470 cells/mm3 (270 – 650; P = 0.0005), 230 cells/mm3 (30 – 610; P = 0.0196) and 615 cells/mm3 (250 – 1060; P = 0.0180) respectively. The proportions of children achieving undetectable HIV-1 viral load at 6-, 12-, 24- and 36 months of treatment were 24/38 (63.2%), 20/36 (55.6%), 8/22 (36.4%) and 7/12 (58.3%) respectively. The probability of survival among HIV-1 infected children after 12 months on ART was 89.9% (95% CI 78.8 – 95.3). CD4 T cell recovery was sub-optimal in all the HIV-2 infected children and none achieved virologic suppression. Two of the HIV-2 infected children died within 6 months of starting treatment while the remaining three were lost to follow-up. The beneficial effects of cART among HIV-1 infected children in our setting are sustained in the first 24 months of treatment with a significant improvement in survival experience up to 36 months; however the outcome was poor in the few HIV-2 infected children initiated on cART

A sero-epidemiological approach to explore transmission of Mycobacterium ulcerans

The debilitating skin disease Buruli ulcer (BU) is caused by infection with Mycobacterium ulcerans. While various hypotheses on potential reservoirs and vectors of M. ulcerans exist, the mode of transmission has remained unclear. Epidemiological studies have indicated that children below the age of four are less exposed to the pathogen and at lower risk of developing BU than older children. In the present study we compared the age at which children begin to develop antibody responses against M. ulcerans with the age pattern of responses to other pathogens transmitted by various mechanisms. A total of 1,352 sera from individuals living in the BU endemic Offin river valley of Ghana were included in the study. While first serological responses to the mosquito transmitted malaria parasite Plasmodium falciparum and to soil transmitted Strongyloides helminths emerged around the age of one and two years, sero-conversion for M. ulcerans and for the water transmitted trematode Schistosoma mansoni occurred at around four and five years, respectively. Our data suggest that exposure to M. ulcerans intensifies strongly at the age when children start to have more intense contact with the environment, outside the small movement range of young children. Further results from our serological investigations in the Offin river valley also indicate ongoing transmission of Treponema pallidum, the causative agent of yaws

Splanchnic metabolism of nutrients and hormones in steers fed alfalfa under conditions of increased absorption of ammonia and L-arginine supply across the portal-drained viscera

Effects of increased ammonia and/or arginine absorption on net splanchnic (portal-drained viscera [PDV] plus liver) metabolism of nonnitrogenous nutrients and hormones in cattle were examined. Six Hereford × Angus steers (501 ± 1 kg BW) prepared with vascular catheters for measurements of net flux across the splanchnic bed were fed a 75% alfalfa:25% (as-fed basis) corn and soybean meal diet (0.523 MJ of ME/[kg BW0.75.d]) every 2 h without (27.0 g of N/kg of DM) and with 20 g of urea/kg of DM (35.7 g of N/kg of DM) in a split-plot design. Net flux measurements were made immediately before and after a 72-h mesenteric vein infusion of L-arginine (15 mmol/h). There were no treatment effects onPDVor hepaticO2 consumption. Dietary urea had no effect on splanchnic metabolism of glucose or L-lactate, but arginine infusion decreased net hepatic removal of L-lactate when urea was fed (P < 0.01). Net PDV appearance of n-butyrate was increased by arginine infusion (P < 0.07), and both dietary urea (P < 0.09) and arginine infusion (P < 0.05) increased net hepatic removal of n-butyrate. Dietary urea also increased total splanchnic acetate output (P < 0.06), tended to increase arterial glucagon concentration (P < 0.11), and decreased arterial ST concentration (P < 0.03). Arginine infusion increased arterial concentration (P < 0.07) and net PDV release (P < 0.10) and tended to increase hepatic removal (P < 0.11) of insulin, as well as arterial concentration (P < 0.01) and total splanchnic output (P < 0.01) of glucagon. Despite changes in splanchnic N metabolism, increased ammonia and arginine absorption had little measurable effect on splanchnic metabolism of glucose and other nonnitrogenous components of splanchnic energy metabolism

Minimal set of generators of controllability space for singular linear dynamical systems

Due to the significant role played by singular systems in the form E ¿ x ( t ) = Ax ( t ) , on mathematical modeling of science and engineering problems; in the last years recent years its interest in the descriptive analysis of its structural and dynamic properties. However, much less effort has been devoted to studying the exact con- trollability by measuring the minimum set of controls needed to direct the entire system E ¿ x ( t ) = Ax ( t ) to any desired state. In this work, we focus the study on obtaining the set of all matrices B with a minimal number of columns, by making the singular system E ¿ x ( t ) = Ax ( t ) + Bu ( t ) controllable.Postprint (author's final draft

The urban park Bangr-Wéoogo : an area of the conservation of the floristic diversity in the city of Ouagadougou, Burkina Faso

Les résultats de 227 relevés phytosociologiques selon l’approche phytosociologique effectuées au Parc Urbain Bangr-Wéoogo de Braun-Blanquet (1932) montrent que malgré son contexte de forte pression anthropique avec plus d´un million d’habitants aux alentours, cette forêt urbaine conserve encore de nos jours une diversité floristique appréciable avec 327 espèces inventoriées comprenant 117 espèces ligneuses et 210 espèces herbacées. Cette flore qui est répartie dans 11 groupements individualisés grâce aux espèces différentielles, est constituée essentiellement de phanérophytes et de thérophytes. La répartition phytogéographique des espèces montre leur appartenance à plusieurs empires phytogéographiques dominés par les espèces Soudano-Zambeziennes et Pantropicales. La richesse floristique du parc qui contraste avec son environnement, est le résultat d’une politique d’aménagement et de conservation efficace de la biodiversité initiée par l'État et ses partenaires depuis 1936. Mots clés: Flore, conservation, aménagement, spectre biologique, Parc Urbain, Ouagadougou, Burkina Faso, groupements végétauxThe results of 227 relevés taken in the urban park of Bangr-weoogo by applying the phytosociological approach of Braun-Blanquet (1932) show that the park, consisting mainly of forest formations, still has an important species richness in spite of the high human pressure caused by more than 1 million habitants in the surroundings. The total number of species is 327 comprising 117 woody species and 210 herbaceous species. The flora forms 11 plant communities and is mostly constituted by phanerophytes and therophytes. The phytogeographical distribution of species shows that Soudano-Zambesian and pantropical species are dominating. Key words: Flora, conservation, management, biological spectrum, urban park, Ouagadougou, Burkina Faso, plant communitie