Primacy of effective communication and its influence on adherence to artemether-lumefantrine treatment for children under five years of age: a qualitative study.

BACKGROUND\ud \ud Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the drug. Although some community based studies have reported fairly high levels of adherence, data on factors influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was carried-out to explore the provider's instructions to caretakers, caretakers' understanding of the instructions and how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.\ud \ud METHODS\ud \ud A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were held with providers that included prescribers and dispensers; and caretakers whose children had just received AL treatment. Information was collected on providers' instructions to caretakers regarding dose timing and how to administer AL; and caretakers' understanding of providers' instructions.\ud \ud RESULTS\ud \ud Mismatch was found on providers' instructions as regards to dose timing. Some providers' (dogmatists) instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some doses in awkward hours and completing treatment several hours before the scheduled time. Other providers (pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment guidelines do not provide explicit information on how to address the various scenarios found in the field. A communication gap was also noted in which some important instructions on how to administer the doses were sometimes not provided or were given with false reasons.\ud \ud CONCLUSIONS\ud \ud There is need for a review of the national malaria treatment guidelines to address local context. In the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the course of their work. Further research is needed to determine the implication of completing AL treatment prior to scheduled time

Graphene-based photovoltaic cells for near-field thermal energy conversion

Thermophotovoltaic devices are energy-conversion systems generating an electric current from the thermal photons radiated by a hot body. In far field, the efficiency of these systems is limited by the thermodynamic Schockley-Queisser limit corresponding to the case where the source is a black body. On the other hand, in near field, the heat flux which can be transferred to a photovoltaic cell can be several orders of magnitude larger because of the contribution of evanescent photons. This is particularly true when the source supports surface polaritons. Unfortunately, in the infrared where these systems operate, the mismatch between the surface-mode frequency and the semiconductor gap reduces drastically the potential of this technology. Here we show that graphene-based hybrid photovoltaic cells can significantly enhance the generated power paving the way to a promising technology for an intensive production of electricity from waste heat.Comment: 5 pages, 4 figure

Formation of a galaxy with a central black hole in the Lemaitre-Tolman model

We construct two models of the formation a galaxy with a central black hole, starting from a small initial fluctuation at recombination. This is an application of previously developed methods to find a Lemaitre-Tolman model that evolves from a given initial density or velocity profile to a given final density profile. We show that the black hole itself could be either a collapsed object, or a non-vacuum generalisation of a full Schwarzschild-Kruskal-Szekeres wormhole. Particular attention is paid to the black hole's apparent and event horizons.Comment: REVTeX, 22 pages including 11 figures (25 figure files). Replacement has minor changes in response to the referee, and editorial corrections. To appear in PR

Disease acceptance and adherence to imatinib in Taiwanese chronic myeloid leukaemia outpatients

Background The launch of imatinib has turned chronic myeloid leukaemia (CML) into a chronic illness due to the dramatic improvement in survival. Several recent studies have demonstrated that poor adherence to imatinib may hamper the therapeutic outcomes and result in increased medical expenditures, whilst research on exploring the reasons for non-adherence to imatinib is still limited. Objective This study aimed to explore the experience of patients as they journey through their CML treatments and associated imatinib utilisation in order to understand the perceptions, attitudes and concerns that may influence adherence to imatinib treatment. Setting This study was conducted at oncology outpatient clinics in a medical centre in southern Taiwan. Methods CML patients who regularly attended the oncology outpatient clinics to receive imatinib treatment from October 2011 to March 2012 were invited to participate in the study. Semi-structured face-to-face interviews were used to explore patients’ experiences and views of their treatment, their current CML status and CML-related health conditions, their concerns about imatinib treatment and imatinib-taking behaviours. Patient interviews were recorded, transcribed verbatim and thematically analysed using the constant comparison approach. Main outcome measure Themes related to patients’ views of the disease and health conditions, worries and concerns influencing imatinib utilisation behaviours are reported. Results Forty-two CML patients participated in the interviews. The emerging themes included: acceptance of current disease and health status, misconceptions about disease progression, factors associated with adherence to imatinib, concerns and management of adverse drug effects. Participants regarded CML as a chronic disease but had misconceptions about disease progression, therapeutic monitoring, resistance to imatinib and symptoms of side effects. Participants were generally adherent to imatinib and favoured long-term prescriptions to avoid regular outpatient visits for medication refills. Experiencing adverse effect was the main reason influencing adherence and led to polypharmacy. Most participants altered medicine-taking behaviours to maintain long-term use of imatinib. Conclusion Taiwanese CML patients are adherent to imatinib but report changing their medication-taking behaviour due to adverse drug effects and associated polypharmacy. Patients’ misconceptions of the disease and medication suggests that it is necessary to improve communication between patients and healthcare professionals. Routinely providing updated information as part of the patient counselling process should be considered as a means of improving this communication

The growth of supermassive black holes fed by accretion disks

Supermassive black holes are probably present in the centre of the majority of the galaxies. There is a consensus that these exotic objects are formed by the growth of seeds either by accreting mass from a circumnuclear disk and/or by coalescences during merger episodes. The mass fraction of the disk captured by the central object and the related timescale are still open questions, as well as how these quantities depend on parameters like the initial mass of the disk or the seed or on the angular momentum transport mechanism. This paper is addressed to these particular aspects of the accretion disk evolution and of the growth of seeds. The time-dependent hydrodynamic equations were solved numerically for an axi-symmetric disk in which the gravitational potential includes contributions both from the central object and from the disk itself. The numerical code is based on a Eulerian formalism, using a finite difference method of second-order, according to the Van Leer upwind algorithm on a staggered mesh. The present simulations indicate that seeds capture about a half of the initial disk mass, a result weakly dependent on model parameters. The timescales required for accreting 50% of the disk mass are in the range 130-540 Myr, depending on the adopted parameters. These timescales permit to explain the presence of bright quasars at z ~ 6.5. Moreover, at the end of the disk evolution, a "torus-like" geometry develops, offering a natural explanation for the presence of these structures in the central regions of AGNs, representing an additional support to the unified model.Comment: 10 pages, 7 figures. Accepted for publication by Astronomy and Astrophysic

Shape-dependence of near-field heat transfer between a spheroidal nanoparticle and a flat surface

We study the radiative heat transfer between a spheroidal metallic nanoparticle and a planar metallic sample for near- and far-field distances. In particular, we investigate the shape dependence of the heat transfer in the near-field regime. In comparison with spherical particles, the heat transfer typically varies by factors between 1/2 and 2 when the particle is deformed such that its volume is kept constant. These estimates help to quantify the deviation of the actual heat transfer recorded by a near-field scanning thermal microscope from the value provided by a dipole model which assumes a perfectly spherical sensor

The Right Place at the Right Time: Creative Spaces in Libraries

Purpose This essay explores the recent trend in libraries: that of the establishment of spaces specifically set aside for creative work. The rise of these dedicated creative spaces is owed to a confluence of factors that happen to be finding their expression together in recent years. This essay examines the history of these spaces and explores the factors that gave rise to them and will fuel them moving forward. Design/Methodology/Approach A viewpoint piece, this essay combines historical research and historical/comparative analyses to examine the ways by which libraries have supported creative work in the past and how they may continue to do so into the 21st century. Findings The key threads brought together include a societal recognition of the value of creativity and related skills and attributes; the philosophies, values, and missions of libraries in both their longstanding forms and in recent evolutions; the rise of participatory culture as a result of inexpensive technologies; improved means to build community and share results of efforts; and library experience and historical practice in matters related to creativity. The chapter concludes with advice for those interested in the establishment of such spaces, grounding those reflections in the author’s experiences in developing a new creative space at Virginia Commonwealth University. Originality/value While a number of pieces have been written that discuss the practicalities of developing certain kinds of creative spaces, very little has been written that situates these spaces in larger social and library professional contexts; this essay begins to fill that gap

Cognitive and behavioral predictors of light therapy use

Objective: Although light therapy is effective in the treatment of seasonal affective disorder (SAD) and other mood disorders, only 53-79% of individuals with SAD meet remission criteria after light therapy. Perhaps more importantly, only 12-41% of individuals with SAD continue to use the treatment even after a previous winter of successful treatment. Method: Participants completed surveys regarding (1) social, cognitive, and behavioral variables used to evaluate treatment adherence for other health-related issues, expectations and credibility of light therapy, (2) a depression symptoms scale, and (3) self-reported light therapy use. Results: Individuals age 18 or older responded (n = 40), all reporting having been diagnosed with a mood disorder for which light therapy is indicated. Social support and self-efficacy scores were predictive of light therapy use (p's<.05). Conclusion: The findings suggest that testing social support and self-efficacy in a diagnosed patient population may identify factors related to the decision to use light therapy. Treatments that impact social support and self-efficacy may improve treatment response to light therapy in SAD. © 2012 Roecklein et al

What are the Differences between Happiness and Self-Esteem

The present study investigated theoretically and empirically derived similarities and differences between the constructs of enduring happiness and self-esteem. Participants (N = 621), retired employees ages 51-95, completed standardized measures of affect, personality, psychosocial characteristics, physical health, and demographics. The relations between each of the two target variables (happiness and self-esteem) and the full set of remaining variables were assessed through a series of successive statistical analyses: (1) simple Pearson's correlations, (2) partial correlations, and (3) hierarchical regression analyses. The results revealed that happiness and self-esteem, while highly correlated (r = 0.58), presented unique patterns of relations with the other measured variables. The best predictors of happiness were the following: mood and temperamental traits (i.e., extraversion and neuroticism), social relationships (lack of loneliness and satisfaction with friendships), purpose in life, and global life satisfaction. By contrast, self-esteem was best predicted by dispositions related to agency and motivation (i.e., optimism and lack of hopelessness). Implications for the understanding of happiness and self-esteem are discussed. © Springer 2006

Potassium acetate solution as a promising option to osmotic distillation for sour cherry (Prunus cerasus L.) juice concentration

Different osmotic agents (OA), such as potassium acetate (CH3COOK), potassium carbonate (K2CO3) and ammonium nitrate (NH4NO3), have been examined as alternatives to the traditionally used calcium chloride (CaCl2) for osmotic distillation concentrating of clarified and pre-concentrated sour cherry (Prunus cerasus L.) juice. Comparison of the process performances based on the permeate fluxes has been carried out. Regarding the permeate flux results, simplified estimation of the overall mass transfer coefficient of the most effective osmotic agent and the reference (CaCl2) solution has been also performed. Furthermore, analytical methods such as total antioxidant activity (TAA) and total polyphenolic content (TPC) using spectrophotometric assays have been also carried out to evaluate the effect of the osmotic distillation on the valuable compounds content of concentrated sour cherry juice. CH3COOK was found to be the most effective, resulted more than 25% higher permeate flux during the sour cherry juice concentration. K2CO3 and NH4NO3 were less effective. The simplified mass transfer estimation showed that the CH3COOK is more effective only at near saturated concentrations compared to the CaCl2. Regarding the TAA and TPC contents, a significant loss was found in case of all OAs during the concentration procedures