On White Guilt.

I didn’t always realize what white guilt was, only that it existed. It’s not as cut-and-dry as it seems. It actually took me years to understand it, which is why I was not surprised when at the Town Hall Meeting back in January, one person asked a question about how to be an ally. Specifically, I found myself reflecting on her concerns regarding “white guilt” (44:01 – 45:25). I wanted to respond, but from the audience it felt out of place, and as it is, my response took two months of putting my thoughts together. [excerpt

In the Absence of Peace

Today, the Monday after the attack, all of the flags were at half mast. Everything continued as normal, as if nothing had happened. Yet there was an intensity in the air. I didn’t notice the increased police, but it was easy to feel the increased security. [excerpt

Reduction of transmission from malaria patients by artemisinin combination therapies: a pooled analysis of six randomized trials.

BACKGROUND: Artemisinin combination therapies (ACT), which are increasingly being introduced for treatment of Plasmodium falciparum malaria, are more effective against sexual stage parasites (gametocytes) than previous first-line antimalarials and therefore have the potential to reduce parasite transmission. The size of this effect is estimated in symptomatic P. falciparum infections. METHODS: Data on 3,174 patients were pooled from six antimalarial trials conducted in The Gambia and Kenya. Multivariable regression was used to investigate the role of ACT versus non-artemisinin antimalarial treatment, treatment failure, presence of pre-treatment gametocytes and submicroscopic gametocytaemia on transmission to mosquitoes and the area under the curve (AUC) of gametocyte density during the 28 days of follow up. RESULTS: ACT treatment was associated with a significant reduction in the probability of being gametocytaemic on the day of transmission experiments (OR 0.20 95% CI 0.16-0.26), transmission to mosquitoes by slide-positive gametocyte carriers (OR mosquito infection 0.49 95% CI 0.33-0.73) and AUC of gametocyte density (ratio of means 0.35 95% CI 0.31-0.41). Parasitological treatment failure did not account for the difference between ACT and non-artemisinin impact. The presence of slide-positive gametocytaemia prior to treatment significantly reduced ACT impact on gametocytaemia (p < 0.001). Taking account of submicroscopic gametocytaemia reduced estimates of ACT impact in a high transmission setting in Kenya, but not in a lower transmission setting in the Gambia. CONCLUSION: Treatment with ACT significantly reduces infectiousness of individual patients with uncomplicated falciparum malaria compared to previous first line treatments. Rapid treatment of cases before gametocytaemia is well developed may enhance the impact of ACT on transmission

Conversation Analysis of Repair in Interaction with Adults who Have Acquired HI

“Copyright 2009, Sonova. Published version of the paper reproduced here with permission from the publisher."This chapter presents a summary of some recent re-search which has been undertaken to address the pat-terns of conversational behaviour in interaction involv-ing adults who have post-lingual hearing impairment (HI). The purpose behind this research is to develop a clinical assessment and intervention protocol for assist-ing HI adults and their conversation partners in reduc-ing the impact of conversation breakdown and its repair in everyday talk. Lind (this volume) lists various conversational be-haviours which arise in the conversation of HI adults and which have been identified by the authors as being mal-adaptive . Each of these behaviours may evolve to be a genuine target for intervention. However, at this point, the patterns of most of these behaviours as they are in-fluenced by one person’s HI are not yet well enough un-derstood nor are they yet clearly distinguished from the same behaviours as they occur in conversations not in-fluenced by HI. Until evidence of their patterns of occur-rence and their sequential consequences is established they cannot readily be translated into goals for assess-ment or intervention. Amongst these behaviours, conversation repair has been the most commonly identified therapy target, for two reasons. First, it is the only one of these behaviours that can be identified a priori as a problem for conversa-tional fluency. Repair is by its very nature the result of a breakdown in mutual understanding in the conversa-tion. Participants’ attempts to resolve the breakdown inhe immediate environment in which it occurred speaks to the importance to the talkers of re-instating mutual understanding. Second, there is now a growing body of research that identifies the patterns of repair as they may be influenced by post-lingual HI. The common se-quential behaviours in one particular type of repair were outlined briefly in Lind (this volume). Two additional ex-amples are provided here also. This series of projects from our recent research has been designed as the early stages in an attempt to ad-dress the foundation issues in conversation-based ther-apy; a model of therapy in which clinical tasks directly address conversation difficulties arising as a result of one participant having a post-lingual hearing impair-ment. The studies have been designed to address key questions about the clinical patterns of repair behaviour, including: • Can we reliably sample conversation repair? • Is repair behaviour consistent over time? • Is repair influenced by intervention? and • Does repair in conversationally-oriented clinical tasks mirror repair in conversation sampling

NK cells as effectors of acquired immune responses: effector CD4+ T cell-dependent activation of NK cells following vaccination.

We characterized vaccine-induced cellular responses to rabies virus in naive adult volunteers. Contrary to current paradigms, we observed potent and prolonged in vitro NK cell cytokine production and degranulation responses after restimulation of PBMCs with inactivated rabies virus in vaccinated, but not in unvaccinated, individuals. This "recall" NK cell response was absolutely dependent on Ag-specific IL-2 from CD45RO(+) CD4(+) T cells as well as IL-12 and IL-18 from accessory cells. Importantly, NK cells represented over 70% of all IFN-gamma-secreting and degranulating cells in the first 12-18 h after virus rechallenge indicating they may be required for rapid control of infection after vaccination. Activation of NK cells may be a critical function of IL-2-secreting effector memory T cells. Although IL-2-dependent postvaccination NK cell activation has been reported previously, this is the first time the magnitude of this effect and its contribution to the overall vaccine-induced response has been appreciated and the mechanisms of NK activation postvaccination have been elucidated. Our data will allow standard protocols for evaluating vaccine-induced immunity to be adapted to assess NK cell effector responses

Insecticide-treated bednets for the prevention of Plasmodium falciparum malaria in Cambodia: a cluster-randomized trial.

OBJECTIVES: To validate and quantify the impact of insecticide-treated bednets (ITN) on malaria morbidity and mortality in Cambodia. METHODS: A paired, cluster-randomized trial of ITN was conducted in Rattanakiri, North East Cambodia. Thirty-four villages with a total population of 10,726 were randomized to receive deltamethrin-impregnated bednets or to control (no net provision). Cross-sectional surveys measured Plasmodium falciparum prevalence at baseline and 10 months after ITN distribution. Village malaria volunteers in control and intervention villages treated dipstick-positive P. falciparum cases with artesunate and mefloquine. The resulting passive surveillance data were used as an estimate of the incidence of clinical P. falciparum infections. RESULTS: There was a protective efficacy of 28% in P. falciparum incidence (adjusted rate ratio 0.72, 95% CI 0.47-1.08) and 9% in P. falciparum prevalence (adjusted prevalence ratio 0.91, 95% CI 0.65-1.28) in ITN relative to control villages; however, neither of these estimates reached statistical significance. Individual-level analysis indicated a greater reduction in P. falciparum prevalence among under 5-year-olds (adjusted OR = 0.63, 95% CI 0.26-1.53) compared to older individuals (interaction P = 0.042). The protective efficacy of 35% (95% CI -28, 67%) with respect to clinical P. falciparum incidence in under 5-year-olds was more pronounced than the corresponding estimates for prevalence but was again not significant. CONCLUSIONS: Lack of statistical significance in the results is likely to be due to a lack of power. The analysis provides further evidence for ITN effectiveness in South East Asia, particularly among individuals under 5 years of age

Reducing Plasmodium falciparum malaria transmission in Africa: a model-based evaluation of intervention strategies.

BACKGROUND: Over the past decade malaria intervention coverage has been scaled up across Africa. However, it remains unclear what overall reduction in transmission is achievable using currently available tools. METHODS AND FINDINGS: We developed an individual-based simulation model for Plasmodium falciparum transmission in an African context incorporating the three major vector species (Anopheles gambiae s.s., An. arabiensis, and An. funestus) with parameters obtained by fitting to parasite prevalence data from 34 transmission settings across Africa. We incorporated the effect of the switch to artemisinin-combination therapy (ACT) and increasing coverage of long-lasting insecticide treated nets (LLINs) from the year 2000 onwards. We then explored the impact on transmission of continued roll-out of LLINs, additional rounds of indoor residual spraying (IRS), mass screening and treatment (MSAT), and a future RTS,S/AS01 vaccine in six representative settings with varying transmission intensity (as summarized by the annual entomological inoculation rate, EIR: 1 setting with low, 3 with moderate, and 2 with high EIRs), vector-species combinations, and patterns of seasonality. In all settings we considered a realistic target of 80% coverage of interventions. In the low-transmission setting (EIR approximately 3 ibppy [infectious bites per person per year]), LLINs have the potential to reduce malaria transmission to low levels (90%) or novel tools and/or substantial social improvements will be required, although considerable reductions in prevalence can be achieved with existing tools and realistic coverage levels. CONCLUSIONS: Interventions using current tools can result in major reductions in P. falciparum malaria transmission and the associated disease burden in Africa. Reduction to the 1% parasite prevalence threshold is possible in low- to moderate-transmission settings when vectors are primarily endophilic (indoor-resting), provided a comprehensive and sustained intervention program is achieved through roll-out of interventions. In high-transmission settings and those in which vectors are mainly exophilic (outdoor-resting), additional new tools that target exophagic (outdoor-biting), exophilic, and partly zoophagic mosquitoes will be required