Cytoadherence in paediatric malaria: ABO blood group, CD36, and ICAM1 expression and severe Plasmodium falciparum infection

As a leading cause of childhood mortality worldwide, selection pressure by Plasmodium falciparum continues to shape the human genome. Severe disturbances within the microcirculation result from the adhesion of infected erythrocytes to host receptors on monocytes, platelets, and endothelium. In this prospective study, we compared expression of all major host cytoadhesion receptors among Ugandan children presenting with uncomplicated malaria (n = 1078) versus children with severe malaria (n = 855), including cerebral malaria (n = 174), severe anaemia (n = 522), and lactic acidosis (n = 154). We report a significant survival advantage attributed to blood group O and increased monocyte expression of CD36 and ICAM1 (CD54). The high case fatality rate syndromes of cerebral malaria and lactic acidosis were associated with high platelet CD36 expression and thrombocytopenia, and severe malaria anaemia was characterized by low ICAM1 expression. In a logistic regression model of disease severity, odds ratios for the mitigating effects of blood group O, CD36, and ICAM1 phenotypes were greater than that of sickle haemoglobin. Host genetic adaptations to Plasmodium falciparum suggest new potential malaria treatment strategies

Strategies for an international association representing music merchants : ways to grow membership and participation of K-12 music educators

Strategies For an International Association Representing Music Merchants: Methods for Growing Membership and Participation of Music Education Communities By Charles Musoke Master of Arts in Music Industry Administration The purpose of this research paper is to recommend strategies to an international association representing music merchants on methods for growing its membership and participation of the K-12 music education community. We are going to introduce the problem, and thoroughly explain exactly what it is. Four main points will be paid special attention to. These are the market not being mobilized as it possibly could be, large untapped potential not yet being discovered, the lack of mutual perceptions by the client, ourselves and in general. Lastly, is the lack of educator participation in general. Next after the problem has been introduced, the actual client/company will be introduced. A brief background and information about it will be looked into. Following this will be a thorough diagnosis of the situation at hand. For example, we are going to analyze what the causes and effects of the dramatic drop in membership and what the implications are as a result. Next, eight main reasons for the lack of music educators participation in the company's activities will be thoroughly examined and solutions found. There are numerous questions that need to be answered in order for the project to be considered a success and we have already identified them and will be answering them one by one as we go. We have a system that we intend to follow as a measure of success of the project, a measure of if our client is satisfied with our efforts. A measure of if the client likes our recommendations. At the end, a summary and conclusion of the whole project will be what closes everything out.by Charles Musok

Inter-Relationships of Cardinal Features and Outcomes of Symptomatic Pediatric Plasmodium falciparum Malaria in 1,933 Children in Kampala, Uganda

Malaria remains a challenging diagnosis with variable clinical presentation and a wide spectrum of disease severity. Using a structured case report form, we prospectively assessed 1,933 children at Mulago Hospital in Kampala, Uganda with acute Plasmodium falciparum malaria. Children with uncomplicated malaria significantly differed from those with severe disease for 17 features. Among 855 children with severe disease, the case-fatality rate increased as the number of severity features increased. Logistic regression identified five factors independently associated with death: cerebral malaria, hypoxia, severe thrombocytopenia, leukocytosis, and lactic acidosis. Cluster analysis identified two groups: one combining anemia, splenomegaly, and leukocytosis; and a second group centered on death, severe thrombocytopenia, and lactic acidosis, which included cerebral malaria, hypoxia, hypoglycemia, and hyper-parasitemia. Our report updates previous clinical descriptions of severe malaria, quantifies significant clinical and laboratory inter-relationships, and will assist clinicians treating malaria and those planning or assessing future research (NCT00707200) (www.clinicaltrials.gov)

Dysregulation of the haem-haemopexin axis is associated with severe malaria in a case-control study of Ugandan children.

BACKGROUND: Malaria is associated with haemolysis and the release of plasma haem. Plasma haem can cause endothelial injury and organ dysfunction, and is normally scavenged by haemopexin to limit toxicity. It was hypothesized that dysregulation of the haem-haemopexin pathway contributes to severe and fatal malaria infections. METHODS: Plasma levels of haemin (oxidized haem), haemopexin, haptoglobin, and haemoglobin were quantified in a case-control study of Ugandan children with Plasmodium falciparum malaria. Levels at presentation were compared in children with uncomplicated malaria (UM; n = 29), severe malarial anaemia (SMA; n = 27) or cerebral malaria (CM; n = 31), and evaluated for utility in predicting fatal (n = 19) vs non-fatal (n = 39) outcomes in severe disease. A causal role for haemopexin was assessed in a pre-clinical model of experimental cerebral malaria (ECM), following disruption of mouse haemopexin gene (hpx). Analysis was done using Kruskall Wallis tests, Mann-Whitney tests, log-rank tests for survival, and repeated measures ANOVA. RESULTS: In Ugandan children presenting with P. falciparum malaria, haemin levels were higher and haemopexin levels were lower in SMA and CM compared to children with UM (haemin, p \u3c 0.01; haemopexin, p \u3c 0.0001). Among all cases of severe malaria, elevated levels of haemin and cell-free haemoglobin at presentation were associated with subsequent mortality (p \u3c 0.05). Compared to ECM-resistant BALB/c mice, susceptible C57BL/6 mice had lower circulating levels of haemopexin (p \u3c 0.01), and targeted deletion of the haemopexin gene, hpx, resulted in increased mortality compared to their wild type littermates (p \u3c 0.05). CONCLUSIONS: These data indicate that plasma levels of haemin and haemopexin measured at presentation correlate with malaria severity and levels of haemin and cell-free haemoglobin predict outcome in paediatric severe malaria. Mechanistic studies in the ECM model support a causal role for the haem-haemopexin axis in ECM pathobiology

Doctors experiences on the quality of care for pesticide poisoning patients in hospitals in Kampala, Uganda:a qualitative exploration using donabedian's model

BACKGROUND: Pesticides are responsible for a significant percentage of deaths globally with majority occurring in sub-Saharan Africa. Deaths due to pesticide poisoning can be reduced if poisoning cases are managed optimally. However, the quality of care given to pesticide poisoning patients is still insufficient especially in sub-Saharan Africa. This study was aimed at exploring doctors' experiences on quality of care for pesticide poisoning cases in hospitals in Kampala, Uganda.METHODS: Fifteen (15) in-depth interviews were conducted with doctors who were directly involved in management of pesticide poisoning patients in the accident and emergency, Medicine, Pediatrics and Intensive Care Unit wards in 5 hospitals in Kampala, Uganda. All interviews were transcribed and subjected to directed content analysis with the guidance of the Donabedian model of quality of care which emphasizes structure, process and outcome measures as pertinent to ensuring quality of care.RESULTS: Doctors reported structural, process and outcome facets that support diagnosis and treatment of pesticide poisoning cases that improved the quality of care they provided. Among the structures includes hospital units such as Intensive Care Unit (ICU), pediatrics and internal medicine; equipment and clinical guidelines such as airway, breathing and consciousness (ABC) protocol; and doctors' knowledge and experiences. Doctors relied on history, and signs and symptoms to establish the cause and severity of pesticide poisoning. However, some patients and caretakers provided inaccurate pesticide poisoning history. Due to its availability in hospitals, doctors largely relied on atropine to manage pesticide poisoning cases whether or not relevant to treat the actual pesticide active ingredient responsible for the poisoning. Although majority of the cases treated recovered, those due to suicide were further referred to the hospital psychiatrist. Sharing experiences of managing pesticide poisoning patients among health workers and engaging in sensitization outreaches against pesticide poisoning were reported as potential activities to improve quality of care for pesticide poisoning patients.CONCLUSION: Doctors reflected on the structure, process and outcome measures of quality of care given to pesticide poisoning patients. The implications of hospital structures and clinical process to the quality of the outcomes of care demonstrates their importance in improving management of pesticide poisoning cases in hospitals in Kampala, Uganda.</p

Building Bridges into the Future: An Evaluation of Stakeholders’ Perceptions on the Actualisation of the Curriculum in Uganda’s Seed Secondary Schools

This study evaluates stakeholders’ perceptions of the actualisation of the formal, non-formal, as well as guidance and counselling curriculum in Uganda’s Seed secondary schools. Using a stratified four-stage cluster design, twelve Seed secondary schools, 630 students from senior three and four, and 93 teachers were randomly selected. Using purposive sampling, eight school administrators, four officials from the Directorate of Education Standards (DES), and 48 parents, were selected. Data collection was through administering interviews with school administrators and DES officials, conducting focus group discussions with teachers and parents, and self-administered questionnaires to students. A document review of institutional files and documents was done. Qualitative data was analysed using thematic coding and major themes emerged from the analysis; quantitative data was analysed using SPSS software. Findings on the actualisation of the formal curriculum show low levels of lesson preparations, teacher punctuality, parents’ monitoring of students learning, formative assessments, full-time teaching, equipped science laboratories, and the presence of computer laboratories, digital resources, and ICT teachers. Concerning the implementation of the non-formal curriculum, findings reveal inadequate time, facilities and equipment for co-curricular activities, several stakeholders managing discipline among students including prefects, disciplinary committees, parents, and the disciplinary committee of the board of governors, and poor medical care for students since the posted nurses abscond from duty. Lastly, concerning the implementation of guidance and counselling curriculum, findings indicate that several mechanisms like guidance and counselling programs, the existence of a career’s master/mistress, class visiting days are missing in most of the schools, and the psychosocial needs of students were not met. It is concluded that, to a large extent, a significant gap exists in the implementation of the official curriculum in seed secondary schools of Uganda. The study recommends the recruitment of more teachers on the government payroll in all seed secondary schools in the country. This will make teachers available at the school for consultation with students at all times. Construction and equipping of both science laboratories and computer laboratories in all seed secondary schools. Regular monitoring and close supervision of seed secondary schools by the relevant organs of the Ministry of Education and Sports should be effectively carried out. There is a need for the construction of staff houses at seed schools to maintain teacher presence for the effective implementation of non-formal curricular activities

Strengthening the community health worker programme for health improvement through enhancing training, supervision and motivation in Wakiso district, Uganda

Objective: The objective of the project was to strengthen the community health worker (CHW) programme in Ssisa sub-county, Wakiso district, Uganda by providing a coherent, structured and standardized training, supervision and motivation package so as to enhance their performance. Results: The project trained all 301 CHWs who received non-financial incentives of t-shirts, gumboots and umbrellas, and 75 of them received solar equipment to support lighting their houses and charging phones. Twenty-four of the CHWs who had coordination roles received additional training. Three motorcycles were also provided to enhance transportation of CHW coordinators during their work including supervision. By end of the project, the CHWs had conducted 40,213 household visits, carried out health education sessions with 127,011 community members, and treated 19,387 children under 5 years of age. From the project evaluation, which used both quantitative and qualitative methods, 98% of the CHWs reported having improved competence in performance of their roles. In addition, the CHWs were highly motivated to do their work. The motorcycles were instrumental in supporting the work of CHW coordinators including monthly collection of reports and distribution of medicines. The project demonstrated that by improving training, supervision and motivation, performance of CHW programmes can be enhanced

Estrus Synchronization in Ugandan Cattle Herds

This survey aimed to assess the breeding practices and pregnancy rates of cattle on farms that utilized artificial insemination (AI) after estrus synchronization in Uganda. Management and breeding data were collected from 297 farms using a semi-structured questionnaire and supported by breeding record reviews and AI technician interviews. Kruskal-Wallis tests were used to determine associations between breeding practices and pregnancy rates using the R software. Breed categories on the farms were exotic dairy and their crosses (64.7%), exotic beef and their crosses (15.1%), and indigenous breeds of Ankole longhorn and shorthorn Zebu (20.2%). Main breeding methods on the farms were natural mating (53.3%), AI after natural estrus (34.7%), and AI after estrus synchronization (11.9%). Estrus synchronization protocols used on the farms were Ovsynch (42.4%), 7-day Co-synch + progesterone-releasing intravaginal device (P4ID) (32.3%), Prostaglandin F2α (PG) single injection (23.4%), and 7-day Co-synch (2.4%). Mean pregnancy rates to AI after synchronization were not significantly different (P>0.05) among protocols and were 33.00%, 42.65%, 36.87%, and 41.33% for 7-day Co-synch, 7-day Co-synch+P4ID, Ovsynch, and PG single injection protocols, respectively. Mean pregnancy rates were 29.9%, 40.4%, and 42.7% for indigenous breeds, exotic beef/crosses, and exotic dairy/crosses, respectively, and significantly lower in indigenous breeds than exotic dairy/crosses (P.adj<0.001) and exotic beef breeds/crosses (P.adj=0.004). Pregnancy rates were also significantly lower on farms where the main breeding method was natural mating than AI on natural heat (P.adj=0.03) and AI after synchronization (P.adj=0.02). Ovsynch, 7-day Co-synch+P4ID, PG single injection and 7-day Co-synch were the estrus synchronization protocols used in Uganda. Estrus synchronization was more common in dairy exotic cattle than in beef exotic or indigenous cattle. Pregnancy rates with synchronized AI were lower in B. indicus than B. taurus herds.  Improvements in management and design of controlled reproductive studies are required to enhance the success of reproductive technologies in B. indicus cattle