Who continues to stock oral artemisinin monotherapy? Results of a provider survey in Myanmar.

BackgroundArtemisinin-based combination therapy (ACT) is a key strategy for global malaria elimination efforts. However, the development of artemisinin-resistant malaria parasites threatens progress and continued usage of oral artemisinin monotherapies (AMT) predisposes the selection of drug resistant strains. This is particularly a problem along the Myanmar/Thailand border. The artemisinin monotherapy replacement programme (AMTR) was established in 2012 to remove oral AMT from stocks in Myanmar, specifically by replacing oral AMT with quality-assured ACT and conducting behavioural change communication activities to the outlets dispensing anti-malarial medications. This study attempts to quantify the characteristics of outlet providers who continue to stock oral AMT despite these concerted efforts.MethodsA cross-sectional survey of all types of private sector outlets that were stocking anti-malarial drugs in 13 townships of Eastern Myanmar was implemented from July to August 2014. A total of 573 outlets were included. Bivariate and multivariable logistic regressions were conducted to assess outlet and provider-level characteristics associated with stocking oral AMT.ResultsIn total, 2939 outlets in Eastern Myanmar were screened for presence of any anti-malarial drugs in August 2014. The study found that 573 (19.5 %) had some kind of oral anti-malarial drug in stock at the time of survey and among them, 96 (16.8 %) stocked oral AMT. In bivariate analyses, compared to health care facilities, itinerant drug vendors, retailers and health workers were less likely to stock oral AMT (33.3 vs 12.9, 10.0, 8.1 %, OR = 0.30, 0.22, 0.18, respectively). Providers who cut blister pack or sell partial courses (40.6 vs 11.7 %, OR 5.18, CI 3.18-8.44) and those who based their stock decision on consumer demand (32.8 vs 12.1 %, OR 3.54, CI 2.21-5.63) were more likely to stock oAMT. Multivariate logistic regressions produced similar significant associations.ConclusionPrivate healthcare facilities and drug shops and providers who prioritize consumers' demand instead of recommended practices were more likely to stock oral AMT. Malaria elimination strategies should include targeted interventions to effectively reach those outlets

Cellular plasticity, caspases and autophagy; that which does not kill us, well, makes us different.

The ability to regenerate is a fundamental requirement for tissue homeostasis. Regeneration draws on three sources of cells. First and best-studied are dedicated stem/progenitor cells. Second, existing cells may proliferate to compensate for the lost cells of the same type. Third, a different cell type may change fate to compensate for the lost cells. This review focuses on regeneration of the third type and will discuss the contributions by post-transcriptional mechanisms including the emerging evidence for cell-autonomous and non-lethal roles of cell death pathways

Ionizing radiation induces stem cell-like properties in a caspase-dependent manner in Drosophila.

Cancer treatments including ionizing radiation (IR) can induce cancer stem cell-like properties in non-stem cancer cells, an outcome that can interfere with therapeutic success. Yet, we understand little about what consequences of IR induces stem cell like properties and why some cancer cells show this response but not others. In previous studies, we identified a pool of epithelial cells in Drosophila larval wing discs that display IR-induced stem cell-like properties. These cells are resistant to killing by IR and, after radiation damage, change fate and translocate to regenerate parts of the disc that suffered more cell death. Here, we report the identification of two new pools of cells with IR-induced regenerative capability. We addressed how IR exposure results in the induction of stem cell-like behavior, and found a requirement for IR-induced caspase activity and for Zfh2, a transcription factor and an effector in the JAK/STAT pathway. Unexpectedly, the requirement for caspase activity was cell-autonomous within cell populations that display regenerative behavior. We propose a model in which the requirement for caspase activity and Zfh2 can be explained by apoptotic and non-apoptotic functions of caspases in the induction of stem cell-like behavior

Asymmetric ephaptic inhibition between compartmentalized olfactory receptor neurons.

In the Drosophila antenna, different subtypes of olfactory receptor neurons (ORNs) housed in the same sensory hair (sensillum) can inhibit each other non-synaptically. However, the mechanisms underlying this underexplored form of lateral inhibition remain unclear. Here we use recordings from pairs of sensilla impaled by the same tungsten electrode to demonstrate that direct electrical ("ephaptic") interactions mediate lateral inhibition between ORNs. Intriguingly, within individual sensilla, we find that ephaptic lateral inhibition is asymmetric such that one ORN exerts greater influence onto its neighbor. Serial block-face scanning electron microscopy of genetically identified ORNs and circuit modeling indicate that asymmetric lateral inhibition reflects a surprisingly simple mechanism: the physically larger ORN in a pair corresponds to the dominant neuron in ephaptic interactions. Thus, morphometric differences between compartmentalized ORNs account for highly specialized inhibitory interactions that govern information processing at the earliest stages of olfactory coding

Psychosocial risk factors in the development of fibromyalgia; and Compassion-Focused Therapy for chronic pain: mediators of improvement

Background: Chronic pain is a worldwide problem that can cause a great level of disability in a person’s life. The aetiology of conditions such as fibromyalgia is still under debate, and there are many biological, psychological and social hypotheses for its development. Past research in this area has explored the predictive impact of abuse and post-traumatic stress, but these are just some of the factors implicated in a wider picture. Psychological approaches to chronic pain have focused on Cognitive Behavioural Therapy and Acceptance and Commitment Therapy, two approaches that result in similar outcomes. Currently, very little research exists on Compassion-Focused Therapy (CFT) for chronic pain, even though the literature suggests conceptual overlaps between CFT and existing therapies. Objective: This thesis aims to reconcile existing information on the psychosocial risk factors that lead to the development of fibromyalgia (Chapter 1) and evaluate the suitability of an 11-week Compassion-Focused Therapy group intervention for adults with chronic pain (Chapter 2). Furthermore, this research also seeks to explore self-compassion, psychological flexibility and psychological inflexibility as potential mediators of improvement in outcome. Limited research and clinical resources can be better used by focusing on how therapies work, instead of if they work against similar treatments that have already proven efficacious. Methods: The evidence base for psychosocial risk factors in the development of fibromyalgia is systematically reviewed in Chapter 1. Electronic databases were searched for various descriptions of fibromyalgia, risk factors and observational study designs. Populations that included physical comorbidities were excluded. In Chapter 2, 122 participants attended the Pain Management Programme at the NHS Lothian Chronic Pain Service. Outcome measures were collected at three timepoints (pre, mid and post-group). One-way ANOVAs were used to evaluate the efficacy of the intervention, along with multiple regressions to perform mediation analysis. Results: 10 studies from a search of 889 potentially relevant studies met the inclusion criteria for systematic review. Most of these studies were deemed to be of good quality. Commonalities across studies included appropriate selection of control and comparison groups, valid random sampling techniques and adequate length to follow-up in the case of cohort studies. Studies, however, varied across their methods in ascertaining fibromyalgia and researchers relied on their own reports to establish outcomes. In Chapter 2, statistically significant improvements were demonstrated in measures of pain interference, anxiety, depression, psychological flexibility, psychological inflexibility, self-compassion and mental wellbeing by the end of the PMP. The largest improvements were found to occur in the second half of the PMP. Self-compassion was shown to mediate improvements in pain interference, whereas psychological flexibility and psychological inflexibility was shown to mediate improvements in depression and mental wellbeing. Neither predictor variable mediated improvements in anxiety. Discussion: Prospective cohort studies represent the best evidence for determining risk factors. Depression, anxiety, childhood adversity, work stress and low education were found to be risk factors for developing fibromyalgia. Based on these results, it is recommended that more conservative estimates of effect size be used. This research also provides evidence for the use of CFT as a group intervention for chronic pain. It can be concluded that pain interventions targeting psychological flexibility and psychological inflexibility are likely to be further improved by emphasising selfcompassion. CFT and ACT already share similar values, despite their differing theoretical backgrounds. Patients will be able to benefit from a combined approach since self-compassion, psychological flexibility and psychological inflexibility were shown to mediate improvement in different outcomes

Понятие и основные признаки административных налоговых правонарушений

Hadoop distributed file system (HDFS) wasoriginally designed for large files. HDFS stores eachsmall file as one separate block although the size ofseveral small files is lesser than the size of block size.Therefore, a large number of blocks are created withmassive small files. When the large number of smallfiles is accessed, NameNode often becomes thebottleneck. The problem of storing and accessinglarge number of small files is named as small fileproblem. In order to solve this issue in HDFS, anapproach of merging small files on HDFS isproposed. In this paper, small files are merged into alarger file based on the agglomerative hierarchicalclustering mechanism to reduce NameNode memoryconsumption. This approach will provide small filesfor cloud storage

Modelling and Forecasting of the Under-Five Mortality Rates in Myanmar and Some Neighbouring Countries (Tin Mar Su, 2020)

The under-five mortality rate is a key indicator of the state of public health of a society. Under-five mortality statistics is not only important indicators of demographic situation but also social and health conditions of Myanmar and some neighbouring countries. The secondary data used in this study was extracted from ADB and the World Bank Database. In this study, the under-five mortality rates over the years (2003-2017) are modeled using time series analysis. This study designs to predict the future of Myanmar and some neighbouring countries by selecting the appropriate model among four commons models as Linear, Quadratic, Cubic, and Exponential. In Myanmar, the values of coefficient in the Exponential model are statistically significant and the value MSE (63.2685) for Exponential model is the smallest on comparing with other models. Thus, the Exponential model was chosen as the most appropriate and predictable future model in Myanmar. It found that the forecast value of U5MR in Myanmar was decreased little by little from 40.66 in 2018 to 32.91 in 2021. In Thailand, the values of coefficient in four common models are statistically significant and the value of MSE (6.9064) for the Cubic model is the smallest on comparing with other models. Thus, the Cubic model was chosen as the most appropriate and predictable future model in Thailand. It found that the forecast value of U5MR in Thailand was decreased little by little from 5.66 in 2018 to -14.51 in 2021. In China, the values of coefficient in four common models are statistically significant and the value of MSE (0.4459) for the Cubic model is the smallest on comparing with other models. Thus, the Cubic model was chosen as the most appropriate and predictable future model in China. It found that the forecast value of U5MR in China was decreased little by little from 7.47 in 2018 to 0.117 in 2021. In India, the values of coefficient in the Linear model are statistically significant and the value of MSE (3.4277) for the Linear model is the smallest on comparing with other models. Thus, the Linear model was chosen as the most appropriate and predictable future model in India. It found that the forecast value of U5MR in India was decreased little by little from 36.13 in 2018 to 26.22 in 2021. In Bangladesh, the values of coefficient in Quadratic model are statistically significant and the value MSE (9.6080) for the Quadratic model is the smallest on comparing with other models. Thus, the Quadratic model was chosen as the most appropriate and predictable future model in Bangladesh. It found that the forecast value of U5MR in Bangladesh was decreased little by little from 30.4 in 2018 to 26.43 in 2021. Thus, the forecast values of under-five mortality rates (2018 to 2021) were decreasing in Myanmar and neighbouring countries. Forecasting is very important in future decisions making. The forecast based on the appropriate models were also validated in this thesis to support future decision making for planning purpose

Exploring the experience of travelling with and taking care for a guide dog: an interpretative phenomenological analysis

The mobility support that guide dogs provide to the visually impaired person is one of the most established forms of assistive dog partnership. The UK has the highest number of guide dog owners per capita globally. While there exists a small body of literature on guide dog partnerships, very few studies have specifically addressed owners in the UK or examined partnerships as experienced by first-time owners. Little attention is paid to the professionals who work with guide dog-owner teams. This thesis explores the guide dog–person partnership as it is perceived by guide dog professionals and first-time owners in the UK. Two empirical studies are presented; data collection and analysis are guided by Interpretative Phenomenological Analysis. Study 1 examines the perspectives of five mobility specialists and dog trainers employed by Guide Dogs UK. Study 2 concerns 11 London-based first-time owners and their guide dog experience within and outside the contexts of joint mobility. The two studies foreground the ambivalence and fluidity that characterise the participants’ perceptions of guide dog-person partnerships. The professionals’ and owners’ accounts depict the guide dogs taking up different and conflicting characters; they shift between being trustworthy guides and forces of dangerous unpredictability, between working animals and subjects of tender loving care. The person’s role in the partnership can also take different forms, such as user, carer, ‘manager,’ and ‘client.’ The first-time owners’ interviews shed further light on the guide dogs’ impact on the existential level. The partnership helps re-establish the security and openness of the self’s embodied relation with the physical world and re-embrace the possibility of a more home-like being within the sense of uncanny existence aggravated by sight loss. The owners’ connections with their guide dogs also shape the social terrain through which their senses of self arise, in both welcome and unwelcome ways