Quality of sick child care delivered by Health Surveillance Assistants in Malawi

Objective To assess the quality of care provided by Health Surveillance Assistants (HSAs)—a cadre of community-based health workers—as part of a national scale-up of community case management of childhood illness (CCM) in Malawi. Methods Trained research teams visited a random sample of HSAs (n = 131) trained in CCM and provided with initial essential drug stocks in six districts, and observed the provision of sick child care. Trained clinicians conducted ‘gold-standard' reassessments of the child. Members of the survey team also interviewed caregivers and HSAs and inspected drug stocks and patient registers. Findings HSAs provided correct treatment with antimalarials to 79% of the 241 children presenting with uncomplicated fever, with oral rehydration salts to 69% of the 93 children presenting with uncomplicated diarrhoea and with antibiotics to 52% of 58 children presenting with suspected pneumonia (cough with fast breathing). About one in five children (18%) presented with danger signs. HSAs correctly assessed 37% of children for four danger signs by conducting a physical exam, and correctly referred 55% of children with danger signs. Conclusion Malawi's CCM programme is a promising strategy for increasing coverage of sick child treatment, although there is much room for improvement, especially in the correct assessment and treatment of suspected pneumonia and the identification and referral of sick children with danger signs. However, HSAs provided sick child care at levels of quality similar to those provided in first-level health facilities in Malawi, and quality should improve if the Ministry of Health and partners act on the results of this assessmen

If you talk to God, you are praying; if God talks to you, you have schizophrenia : distinctions between psychosis and spiritual experience among Christians

Many clients within the current system who are diagnosed with psychotic spectrum disorders, such as schizophrenia, present with what mental health professionals often consider to be hallucinations and delusions with religious or spiritual content. However, these presentations often have striking similarities to spiritual experiences, in which an individual may report having a prophetic-type experience or some type of otherworldly communication that is embedded within their value and belief-system. The present study seeks to explore how these attributions are made and which contextual factors are associated with individuals\u27 interpretations of these ambiguous presentations. A sample of 177 Christian adults living in the United States were surveyed to explore how variation in religious beliefs are related to the way Christians interpret ambiguous psychotic-like spiritual presentations. This mixed-method study investigates how variations in religiosity predicts Christians\u27 understandings of these ambiguous presentations as either being rooted in a religious/spiritual experience or indications of psychopathology. Results suggested that religiosity predicted whether or not participants\u27 relied on religious or psychological/medically-based meaning-making frameworks to understand the ambiguous presentation in the vignette. Specifically, those with stronger beliefs in divine communication, higher reliance on God, and more frequent participation in religious activities were more likely to interpret the vignette as representing a religious experience and less likely to understand the vignette as being rooted in mental illness even after controlling for several background characteristics. Additionally, mental health professionals included in the present study were more likely to interpret the vignette as being indicative of mental illness and less likely to interpret it as a religious experience than those who have not worked in the field, while controlling for the same covariates. These findings indicate that even highly religious mental health professionals may have different understandings of ambiguous psychotic-like spiritual presentations than their highly religious clients. The findings of the present study offer support for the integration of a Biopsychosocial-spiritual model of care, in order to create more space for potential spiritually-based interpretations that clients may hold, despite the entrenchment of medicalized thought in the current mental health system. This study has important implications for both diagnosis and treatment with clients with psychotic-like spiritual experiences and emphasizes the need for greater attention to issues related to religion and spirituality in the education of mental health professionals

Planar lamellae and onions: a spatially resolved rheo-NMR approach to the shear-induced structural transformations in a surfactant model system

The shear-induced transformations between oriented planar lamellae and a state of closely packed multilamellar vesicles (MLVs) in a lyotropic nonionic surfactant model system were studied by the combination of nuclear magnetic resonance (NMR) spectroscopy and diffusometry with magnetic resonance imaging (MRI). (2)H NMR imaging confirmed the discontinuous nature of the transition from onions to planar lamellae, revealing the spatial coexistence of both states within the gap of the cylindrical Couette geometry. On the other hand, NMR diffusion measurements in three principal directions and at various values of strain strongly suggest that a multi-lamellar cylindrical or undulated intermediate structure exists during the continuous and spatially homogeneous transition from planar lamellae to MLVs

Morphometric Variation during Chick Development in Interior Double-crested Cormorants (\u3ci\u3ePhalacrocorax auritus\u3c/i\u3e)

In numerous avian species, egg size is correlated to female body condition, hatchling size and nestling growth. Recent demography studies of Interior Double-crested Cormorants (Phalacrocorax auritus) suggest a migratory divide across the Great Lakes; western populations winter in the Gulf of Mexico region of the southeastern United States (Alabama, Arkansas, Louisiana, and Mississippi) with extensive catfish (Ictalurus punctatus) aquaculture, and eastern populations winter in Florida, where catfish aquaculture is not pervasive. If Double-crested Cormorants have improved their overall body condition through catfish exploitation, then egg and chick sizes should also be affected. Three breeding areas in Ontario (east, central, and west) were selected for empirical measures of size variation. During the breeding seasons of 2006 and 2007, egg, naked young, fledgling, and adult morphometric data were collected. Eggs in eastern areas (volume = 465.8 ± 3.9 cm³) were on average larger than eggs in central (volume = 458.1 ± 3.5 cm³) and western (volume = 451.7 ± 3.5 cm³) areas. However, chicks in eastern areas (culmen = 54.9 ± 0.6 mm) were smaller than chicks in central (culmen = 57.6 ± 0.4 mm) and western (culmen = 59.3 ± 0.3 mm) areas, not only at hatching, but throughout development and fledging. A comprehensive Double-crested Cormorant morphometric gradient that may suggest a potential reproductive advantage for birds exploiting aquaculture facilities is presented

Morphometric Variation during Chick Development in Interior Double-crested Cormorants (\u3ci\u3ePhalacrocorax auritus\u3c/i\u3e)

In numerous avian species, egg size is correlated to female body condition, hatchling size and nestling growth. Recent demography studies of Interior Double-crested Cormorants (Phalacrocorax auritus) suggest a migratory divide across the Great Lakes; western populations winter in the Gulf of Mexico region of the southeastern United States (Alabama, Arkansas, Louisiana, and Mississippi) with extensive catfish (Ictalurus punctatus) aquaculture, and eastern populations winter in Florida, where catfish aquaculture is not pervasive. If Double-crested Cormorants have improved their overall body condition through catfish exploitation, then egg and chick sizes should also be affected. Three breeding areas in Ontario (east, central, and west) were selected for empirical measures of size variation. During the breeding seasons of 2006 and 2007, egg, naked young, fledgling, and adult morphometric data were collected. Eggs in eastern areas (volume = 465.8 ± 3.9 cm³) were on average larger than eggs in central (volume = 458.1 ± 3.5 cm³) and western (volume = 451.7 ± 3.5 cm³) areas. However, chicks in eastern areas (culmen = 54.9 ± 0.6 mm) were smaller than chicks in central (culmen = 57.6 ± 0.4 mm) and western (culmen = 59.3 ± 0.3 mm) areas, not only at hatching, but throughout development and fledging. A comprehensive Double-crested Cormorant morphometric gradient that may suggest a potential reproductive advantage for birds exploiting aquaculture facilities is presented

Fear modulates parental orienting during childhood and adolescence.

Adults quickly orient toward sources of danger and deploy fight-or-flight tactics to manage threatening situations. In contrast, infants who cannot implement the safety strategies available to adults and depend heavily on caregivers for survival are more likely to turn toward familiar adults, such as their parents, to help them navigate threatening circumstances. However, work has yet to investigate how readily children and adolescents orient toward their parents in threatening or fearful contexts. The current work addressed this question using a visual search paradigm that included arrays of parents and strangers faces as target and distractor stimuli, preceded by a fear or neutral emotional priming procedure. Linear mixed-effects models showed that children and adolescents (N = 88, age range = 4-17 years; 42M/46F) were faster to search for the face of their parent than of a stranger. However, fear priming attenuated this effect of the parent on search times, such that children and adolescents were significantly slower to orient toward their parent in an array of strangers faces if they were first primed with fear as opposed to a neutral video. This work indicates that fear priming may phasically interfere with parental orienting during childhood and adolescence, possibly because fear reallocates attention away from parents and toward (potentially threatening) unfamiliar people in the environment to facilitate the development of independent threat learning and coping systems

Effects of storm clustering on beach/dune evolution

Impacts of storm clustering on beach/dune morphodynamics were investigated by applying the state-of-the-art numerical model XBeach to Formby Point (Sefton coast, UK). The adopted storm cluster was established by analysing the observed winter storms from December 2013 to January 2014 using a storm threshold wave height. The first storm that occurred during this period is regarded as exceptionally intense, and the occurrence of such a cluster of events is very unusual. A 1D model was setup for the highly dynamic cross-shore at Formby Point. After initial calibration of the model parameters against available post-storm profile data, the model was used for the simulation of the storm cluster. It was assumed that no beach recovery occurred between adjacent storms due to the very short time intervals between storms. As a result, the final predicted post-storm profile of the previous storm was used as the pre-storm profile of the subsequent storm. The predicted evolution during each storm was influenced by the previous storms in the cluster. Due to the clustering effect, the bed level change is not proportional to the storm power of events within the cluster, as it would be in an individual storm case. Initially, the large storm events interact with the multi-bared foreshore enabling the subsequent weaker storms to influence the upper beach and lower dune system. This results in greater change at the dune toe level also during less severe subsequent storms. It is also shown that the usual water level threshold used to define dune erosion is over predicted by about 1 m for extreme storm conditions. The predicted profile evolution provides useful insights into the morphodynamic processes of beach/dune systems during a storm cluster (using Formby Point as an example), which is very useful for quantifying the clustering effects to develop tools for coastal management

Development partner support to the health sector at the local level in Morogoro region, Tanzania

Background: The Tanzanian health sector receives large amounts of funding from multiple international development partners to support a broad range of population-health interventions. However, little is known about the partners’ level of commitment to sustain funding, and the implications of uncertainties created by these funding mechanisms.  This study had the following objectives: 1) To present a theoretical model for assessing funding commitments by health development partners in a specified region; 2) to describe development partner funding commitments against this framework, using a case study example of Morogoro Region, Tanzania; and 3) to discuss policy considerations using this framework for district, regional and national level.Methods: Qualitative case study methodology was used to assess funding commitments of health-related development partners in Morogoro Region, Tanzania. Using qualitative data, collected as part of an evaluation of maternal and child health programs in Morogoro Region, key informants from all development partners were interviewed and thematic analysis was conducted for the assessment. Results: Our findings show that decisions made on where to commit and direct funds were based on recipient government and development partner priorities. These decisions were based on government directives, such as the need to provide health services to vulnerable populations; the need to contribute towards alleviation of disease burden and development partner interests, including humanitarian concerns. Poor coordination of partner organizations and their funding priorities may undermine benefits to target populations. This weakness poses a major challenge on development partner investments in health, leading to duplication of efforts and resulting in stagnant disease burden levels.Conclusion: Effective coordination mechanisms between all stakeholders at each level should be advocated to provide a forum to discuss interests and priorities, so as to harmonize them and facilitate the implementation of development partner funded activities in the recipient countries

Characteristics and outcomes among US patients hospitalized for ischemic stroke before vs during the COVID-19 pandemic

Importance: After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. Objective: To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. Design, Setting, and Participants: This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. Exposure: Ischemic stroke and laboratory-confirmed COVID-19. Main Outcomes and Measures: Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. Results: Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged ≥80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged ≥80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged ≥80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554) discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or pulmonary embolus (1.9% vs 2.4% vs 6.8%) and to require intubation (11.3% vs 12.3% vs 37.6%). After adjusting for baseline factors, patients with IS and COVID-19 were more likely to die in the hospital than were patients with IS in 2019 (adjusted odds ratio, 5.17; 95% CI, 4.83-5.53; National Institutes of Health Stroke Scale adjusted odds ratio, 3.57; 95% CI, 3.15-4.05). Conclusions and Relevance: In this cohort study, after the emergence of COVID-19, hospital discharges of patients with IS decreased in the US but returned to prepandemic levels by July 2020. Among patients with IS between April and December 2020, comorbid COVID-19 was relatively common, particularly among Black and Hispanic populations, and morbidity was high