Peace Corps

Next week, more than 200 science journals throughout the world will simultaneously publish papers on global poverty and human development--a collaborative effort to increase awareness, interest, and research about these important issues of our time. Some 800 million people still experience chronic and transitory hunger each year. Over the next 50 years, we face the daunting job of feeding 3.5 billion additional people, most of whom will begin life in poverty. The battle to alleviate poverty and improve human health and productivity will require dynamic agricultural development.

We measured levels of virus in sequential specimens from 137 patients with Lassa fever. The probability of fatal disease increased significantly with the level of viremia measured either on admission or during the course of illness. The odds ratio of death in patients with viremia greater than 10 TCID50/ml was 3.7 (90% confidence interval, 1.9-7.2). The same ratio in patients with viremia greater than 10 TCID50/ml and with levels of aspartate aminotransferase greater than or equal to 150 IU/liter was 21.5 (95% confidence interval, 5.2-99.0). Virus was found in throat cultures from 39% of viremic patients, compared with 14% of nonviremic patients (P less than .002); however, the level of virus was usually less than or equal to TCID50/ml. Fewer than 3% of patients were viruric during acute illness, and virus was isolated from three of three samples of cerebrospinal fluid. On admission, 53% of patients had IgG antibodies, and 67% had IgM antibodies. Recovery was not associated with the presence of either IgG or IgM. Virus was isolated from greater than 100 serum specimens that also contained high titers of IgG. Clinical Lassa fever was shown to be a disseminated systemic, primary viral infection, with an outcome highly associated with viremia but not with development of antibody.

Women and children bear the greatest burden in the midst of war and long-term disasters. Complex humanitarian emergencies are characterized by social disruption, armed conflict, population displacement, collapse of public health infrastructure, and food shortages. Humanitarian assistance for refugees and internally displaced populations requires particular attention to the common issues affecting morbidity and mortality in women and infants. Gender-based violence and reproductive health concerns are discussed within the context of populations affected by conflict and forced migration. Recommendations for midwives and women's health care providers engaging in care for women and children in complex humanitarian emergencies are discussed.

OBJECTIVES: To examine four different types of computer-aided endoscopic sinus surgical devices--the ISG Viewing Wand, the ISG infrared OptoTrak, the IGT FlashPoint 5000, and the VTI InstaTrak--with emphasis on their accuracy and ease of use. STUDY DESIGN: Prospective study utilizing laboratory experiments and intraoperative data collection. METHODS: A review of the literature is presented. Patients undergoing endoscopic sinus surgery during the study period were enlisted under FDA protocols with IRB consent. Groups of patients had surgery performed with each of the above devices--except the FlashPoint 5000. Accuracy measurements were recorded, and user and operating staff comments about ease of use were collected. The FlashPoint 5000 was used exclusively in the laboratory setting, where accuracy measurements were obtained on a cadaver skull. RESULTS: The systems all demonstrated accuracy to within 2.00 mm. Ease of use was somewhat variable, but following a learning curve by the surgeon and operating department personnel, all of the units were considered to be relatively user friendly. CONCLUSIONS: Computer-aided endoscopic sinus surgery appears to be the wave of the future. Nevertheless, the modern endoscopic sinus surgeon must have thorough training in the basic anatomy of the paranasal sinuses as well as the various surgical techniques.

Continental-scale studies of western North America have attributed recent increases in annual area burned and fire size to a warming climate, but these studies have focussed on large fires and have left the issues of fire severity and ignition frequency unaddressed. Lightning ignitions, any of which could burn a large area given appropriate conditions for fire spread, could be the first indication of more frequent fire. We examined the relationship between snowpack and the ignition and size of fires that occurred in Yosemite National Park, California (area 3027 km2), between 1984 and 2005. During this period, 1870 fires burned 77 718 ha. Decreased spring snowpack exponentially increased the number of lightning-ignited fires. Snowpack mediated lightning-ignited fires by decreasing the proportion of lightning strikes that caused lightning-ignited fires and through fewer lightning strikes in years with deep snowpack. We also quantified fire severity for the 103 fires >40 ha with satellite fire-severity indices using 23 years of Landsat Thematic Mapper data. The proportion of the landscape that burned at higher severities and the complexity of higher-severity burn patches increased with the log10 of annual area burned. Using one snowpack forecast, we project that the number of lightning-ignited fires will increase 19.1% by 2020 to 2049 and the annual area burned at high severity will increase 21.9%. Climate-induced decreases in snowpack and the concomitant increase in fire severity suggest that existing assumptions may be understated – fires may become more frequent and more severe.

Excess foundry sands from gray-iron casting are a mixture of sand, bentonite, and additives that can have properties desirable for structural fills and hydraulic barriers, depending on their bentonite content. To facilitate beneficial reuse of foundry sands, typical strength parameters need to be available so that designers can make comparisons with designs employing virgin earthen materials. To provide typical design parameters, a testing program was conducted to characterize the strength of foundry sands and their interaction with geosynthetics. Small-scale direct shear tests, large-scale multistage interface shear tests, and pullout tests were conducted using foundry sands with bentonite contents representing the range normally found in the casting industry and three geosynthetics (geotextile, geogrid, and geomembrane). The results indicate that foundry sands can be used effectively in geotechnical construction. Friction angles of the as-compacted foundry sands generally ranged between 39° and 43°, and the as-compacted cohesions ranged between 17 and 28 kPa. Drained friction angles were similar to as-compacted friction angles except at high bentonite content. Typical interface friction angles ranged between 25° and 35°, with efficiencies ranging between 0.5 and 0.9. Interaction coefficients from the pullout tests ranged between 0.2 and 1.7.

A demographic study carried out in a rural area of the Gambia between January 1993 and December 1998 recorded 74 deaths among women aged 15-49 years. Reported here is an estimation of maternal mortality among these 74 deaths based on a survey of reproductive age mortality, which identified 18 maternal deaths by verbal autopsy. Over the same period there were 4245 live births in the study area, giving a maternal mortality ratio of 424 per 100,000 live births. This maternal mortality estimate is substantially lower than estimates made in the 1980s, which ranged from 1005 to 2362 per 100,000 live births, in the same area. A total of 9 of the 18 deaths had a direct obstetric cause--haemorrhage (6 deaths), early pregnancy (2), and obstructed labour (1). Indirect causes of obstetric deaths were anaemia (4 deaths), hepatitis (1), and undetermined (4). Low standards of health care for obstetric referrals, failure to recognize the severity of the problem at the community level, delays in starting the decision-making process to seek health care, lack of transport, and substandard primary health care were identified more than once as probable or possible contributing factors to these maternal deaths.

AIM: To describe experiences and perceptions of theory-practice gap in nursing in a resource-constrained setting. Theory-practice gap is extensively discussed and studied in some parts of the world. Interventions to bridge the theory-practice gap have been varied and depend on an understanding of the contextual healthcare environment. Experiences and perceptions of the theory-practice gap in a resource-constrained setting have not been comprehensively described. DESIGN: A qualitative description methodology was used. METHODS: Maximum variation sampling based on role in the events of theory-practice gap was used to recruit student nurses, nurse faculty and clinicians from two study sites for focus group discussions. Data were analysed using conventional content analysis. RESULTS: Five themes were identified: system inadequacies; resource constraints; challenges of the clinical learning environment; clinical placement and supervision; and nurse faculty factors. Systems inadequacy and resource constraints formed the spine of the challenges contributing to the theory-practice gap in the research setting.

Abstract This study examines per trip consumer surplus associated with guided Whitewater rafting on two southern rivers. First, household recreation demand functions are estimated based on the individual travel cost model using truncated count data regression methods and alternative price specifications. Findings show mean per trip consumer surplus point estimates between $89 and $286, depending on modeling assumptions and river quality. Magnitudes of these surpluses are very dependent on assumptions about the opportunity cost of time.

Abstract Camera traps are standard tools for assessing populations of medium–large terrestrial mammals, particularly for rare, elusive or cryptic species, yet few researchers have attempted to employ camera traps to document rare primates in arboreal settings. We examined different arboreal camera-trap techniques to document the Critically Endangered greater bamboo lemur Prolemur simus in Madagascar. We documented P. simus at two sites, confirming presence at one site. Most species, including 86% of all lemur occurrences, were documented in low light conditions (c. < 105 lux). Our study suggests that camera traps can be effective in validating unconfirmed sightings of rare or secretive primate species. We recommend that future work with cameras in arboreal settings considers seasonal activity patterns, targets sites with high food densities, uses local knowledge, and utilizes available techniques (e.g. traditional trapping techniques) and landscape topography to concentrate animal movement (e.g. steep slopes or ridge lines).

BACKGROUND: Evidence is increasing of high HIV risks among southern African men who have sex with men (MSM). This represents the first study of HIV risks and human rights contexts among MSM in Lesotho. METHODS: Two hundred and fifty-two men who reported ever having anal sex with another man were accrued with snowball sampling and were administered a structured quantitative instrument in October and November 2009. RESULTS: Of the participants, 96.4% (240/249) were ethnic Basotho with a mean age of 26.3 years (range 18-56), 49.6% (124/250) were currently employed, and 95.2% (238/250) had at least a secondary-level education. Self-reported HIV prevalence was 11.6% (22/190); 54.5% (128/235) reported being tested for HIV in the last year. HIV knowledge was low; only 3.7% (8/212) of MSM knew that receptive anal intercourse was the highest risk for HIV and that a water-based lubricant was most appropriate to use with condoms.Bivariate associations of wearing condoms during last intercourse with men include: having easy access to condoms (OR 3.1, 95% CI 1.2-8.5, p < 0.05); being older than 26 years (OR 2.3, 95% CI 1.3-4.2, p < 0.01); knowing that receptive anal intercourse is higher risk than insertive anal intercourse (OR 2.6, 95% CI 1.2-5.9, p < 0.05); wearing condoms with female sexual partners (OR 3.5, 95% 1.4-8.3, p < 0.01); using water-based lubricants (OR 2.8, 95% CI 1.4-5.5, p < 0.01); being less likely to report having been diagnosed with a sexually transmitted infecton (OR 0.21, 95% CI 0.06-0.76, p < 0.05); and being more likely to have been tested for HIV in the last year (OR 2.0, 95% CI 1.2-3.6, p > 0.05).Human rights abuses were common: 76.2% (170/223) reported at least one abuse, including rape (9.8%, 22/225), blackmail (21.3%, 47/221), fear of seeking healthcare (22.2%, 49/221), police discrimination (16.4%, 36/219), verbal or physical harassment (59.8%, 140/234), or having been beaten (18.9%, 43/228). CONCLUSIONS: MSM in Lesotho are at high risk for HIV infection and human rights abuses. Evidence-based and rights-affirming HIV prevention programmes supporting the needs of MSM should be developed and implemented.

Between January and March 1971, an unusual outbreak of hemorrhagic fever occurred in Cochabamba, Bolivia. The index case was apparently infected elsewhere, but became ill in Cochabamba, where hemorrhagic fever had never been reported. Four secondary cases occurred among hospital contacts of the index case, and a pathologist was infected after cutting himself during an autopsy of one of the secondary cases. Clinical manifestations were typical of Bolivian hemorrhagic fever, except that jaundice occurred in three cases. An arenavirus of the Tacaribe complex was isolated from three cases. One isolate was studied in detail and shown to be closely related antigenically to the prototype strains of Machupo virus.

BACKGROUND: A key goal of malaria control is to achieve universal access to, and use of, long-lasting insecticidal nets (LLINs) among people at risk for malaria. Quantifying the number of LLINs needed to achieve and maintain universal coverage requires knowing when nets need replacement. Longitudinal studies have observed physical deterioration in LLINs well before the assumed net lifespan of 3 years. The objective of this study was to describe attrition, physical integrity and insecticide persistence of LLINs over time to assist with better quantification of nets needing replacement. METHODS: 999 LLINs distributed in 2011 in two highly endemic provinces in Zambia were randomly selected, and were enrolled at 12 months old. LLINs were followed every 6 months up to 30 months of age. Holes were counted and measured (finger, fist, and head method) and a proportional hole index (pHI) was calculated. Households were surveyed about net care and repair and if applicable, reasons for attrition. Functional survival was defined as nets with a pHI <643 and present for follow-up. At 12 and 24 months of age, 74 LLINs were randomly selected for examination of insecticidal activity and content using bioassay and chemical analysis methods previously described by the World Health Organization (WHO). RESULTS: A total of 999 LLINs were enrolled; 505 deltamethrin-treated polyester nets and 494 permethrin-treated polyethylene nets. With 74 used to examine insecticide activity, 925 were available for full follow-up. At 30 months, 325 (33 %) LLINs remained. Net attrition was primarily due to disposal (29 %). Presence of repairs and use over a reed mat were significantly associated with larger pHIs. By 30 months, only 56 % of remaining nets met criteria for functional survival. A shorter functional survival was associated with having been washed. At 24 months, nets had reduced insecticidal activity (57 % met WHO minimal criteria) and content (5 % met WHO target insecticide content). CONCLUSIONS: The median functional survival time for LLINs observed the study was 2.5-3 years and insecticide activity and content were markedly decreased by 2 years. A better measure of net survival incorporating insecticidal field effectiveness, net physical integrity, and attrition is needed.

Seasonal changes in the population ecology of Anolis cupreus, a sexually dimorphic lizard, were studied over a 2—yr period in a deciduous and riparian forest ecosystem in western Costa Rica. This tropical environment undergoes strong seasonal changes, including a 6—mo yr dry season during which maximum air temperatures, hours of daily sunshine, and heavy winds occur. Many aspects of the ecology of A. cupreus undergo striking seasonal changes in response to this climatic seasonality. Both sexes were sexually active for about 6 mo of the year, with the ♀ cycle coinciding with the wet season. Fat body cycles in both sexes were inversely related to the reproductive cycles. Males and ♀ ♀ attain sexual maturity at 1 yr or less, and the population apparently undergoes an annual turnover. Population density was high (&gt; 1,200 anoles/ha) in the dry season, but in part because of changes in the structural habitat of ♂ ♂ and territorial behavior, density was much lower in the wet season. In the dry season social interactions were rarely seen, both sexes perched at or near ground level, and ♀ ♀. In contrast, in the wet season social interactions occupied a majority of the ♂ ♂ time as they defended territories and courted ♀ ♀. At this time of the year ♂ ♂ perched much higher than ♀ ♀ fed primarily on the ground; ♂ ♂ obtained at least half their food up to 6 m aboveground in the wet season. Because of seasonal changes in perch heights and size of prey items eaten, intrasexual (seasonal) values of place x food niche overlap were lower than intersexual values. The response of this anole to stressful climatic conditions is analogous to that of its Temperate Zone congener, Anolis carolinensis. Whereas A. carolinensis hibernates to avoid low winter temperatures, A. cupreus becomes inactive during periods of high winds and air temperatures.

INTRODUCTION: Depression is common, disabling, and the single most important factor leading to suicide, yet it is underdiagnosed in busy primary care settings. A key challenge facing primary care clinicians in Asia is the selection of instruments to facilitate depression screening. Although the nine-item Patient Health Questionnaire (PHQ-9) and 16-item Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR16 ) are used internationally, they have not been directly compared or widely validated in Asian primary care populations. This study aimed to validate the PHQ-9 and QIDS-SR16 against a structured interview diagnosis of Diagnostic and Statistical Manual, 4th Edition, depression based on the Mini-International Neuropsychiatric Interview in a multiethnic Asian sample. METHODS: From April through August 2011, we enrolled 400 English-speaking Singaporean primary care patients. Participants completed a demographic data form, the PHQ-9, and the QIDS-SR16 . They were assessed independently for major and minor depression using the Mini-International Neuropsychiatric Interview. RESULTS: Sensitivity and specificity for diagnosing major depression were 91.7% and 72.2%, respectively, for the PHQ-9 (optimal cutoff score of 6), and 83.3% and 84.7%, respectively, for the QIDS-SR16 (optimal cutoff score of 9). The QIDS-SR16 also detected minor depression at an optimal cutoff score of 7, with a sensitivity of 94.4% and specificity of 77.9%. The PHQ-9 and QIDS-SR16 showed good internal consistency (Cronbach's α: 0.87 and 0.79, respectively) and good convergent validity (correlation coefficient: r = 0.73, P < 0.001). The overall prevalence of major and minor depressive disorders was 9%. DISCUSSION: The PHQ-9 and QIDS-SR16 appear to be valid and reliable for depression screening in Asian primary care settings.

That images of the future motivate behavior in the present is a theory with both socio‐historical and psychological evidence. Due to the difficulty of generating positive images of the future in the nuclear age, in contrast to the Utopian imagery of earlier ages, an experimental workshop was developed by Boulding and Ziegler to help people imagine positive futures—specifically, to image a future world without weapons. The workshop procedures are described, and three case examples are given of imaging groups with widely different background characteristics. Participants were able to create positive imagery in the workshop setting, and their imagery varied according to the background of the participating group. The paper explores the relationships among the intensity of the imaging experience, its saliency for the imager, and the action readiness of the imager; and it raises questions about the role of imaging workshops in the peace movement and the kinds of research that might make such workshops more effective.

BACKGROUND: Among all high school sports, football has the highest rate of injury. Prior research has been limited primarily because of challenges in surveillance, defining injuries, and measuring exposures. HYPOTHESIS: Football injury patterns differ across player and session characteristics. STUDY DESIGN: Descriptive epidemiology study. METHODS: More than 5000 football players from 87 high schools in California were observed for 2 seasons (2001 and 2002). School representatives were trained to collect data on injuries, player characteristics, and daily exposures. Data were analyzed using descriptive statistics and clustered Poisson regression. RESULTS: Players sustained 25.5 injuries per 100 players, 9.3 injuries per 10,000 player-hours, and 8.4 injuries per 100 session-hours. Session rates were highest during games, on artificial turf (13.8 of 100), during foggy weather (25.1 of 100), and on clear evenings (21 of 100). Offensive and defensive backfielders had about a 20% increased rate of injury compared with linemen. The adjusted injury rate for starters was 60% higher than the rate for nonstarters (relative rate, 1.6; 95% confidence interval, 1.4-1.9). CONCLUSION: Risk profiles differed by experience, playing position, and surface types. We recommend future sports injury research that measures time-dependent exposures at the individual level and for various types of environmental playing conditions.

Federally qualified health centers, also known as community health centers, play an essential role in providing health care to millions of Americans. In return for providing primary care to underserved, homeless, and migrant populations, these centers are reimbursed at a higher rate than other providers by public programs such as Medicaid. Under the Affordable Care Act of 2010, the role of the centers is expected to grow. To examine the quality of care that the centers provide, the Colorado Department of Health Care Policy and Financing compared the use of costly hospital-related services by Medicaid clients whose usual source of care was a community health center with the use by clients whose usual source of care was a private, fee-for-service provider. The study found that community health center users were about one-third less likely than the other group to have emergency department visits, inpatient hospitalizations, or preventable hospital admissions. Public funders such as states should work with community health centers to improve the quality and reduce the cost of care even further.

A cross-sectional survey of 102 Peace Corps volunteers in Niger, West Africa, in 1998 had previously demonstrated a high rate of thyroid dysfunction and goiter attributable to excess iodine from their water filters. The Peace Corps volunteers were followed-up a mean of 30 wk after they ceased using iodine-based water filtration systems. Goiter was present in 44% of subjects during excess iodine ingestion and in 30% after removal of excess iodine. Mean serum iodine decreased from 293 micro g/liter during excess iodine ingestion to 84 micro g/liter after cessation of excess iodine. Mean total serum T(4) values increased from 100.4 to 113.3 nmol/liter (7.8 to 8.8 micro g/dl). Mean serum free T(4) increased from 32.2 to 34.7 pmol/liter (2.5 to 2.7 ng/dl). Mean serum TSH decreased from 4.9 to 1.8 mU/liter. Mean serum thyroid peroxidase antibody levels decreased from 33,000 to 22,000 IU/liter (33 to 22 IU/ml). We found that during prolonged excess iodine exposure there were marked increases in serum total iodine concentrations, and the prevalence of goiter, elevated serum TSH values, and elevated serum thyroid peroxidase antibody values increased. The prevalence of all abnormalities decreased after removal of excess iodine from the drinking water system.

The report evaluates the need for paediatric surgical care in an urban area of sub-Saharan Africa. Seven hundred and forty-one children were treated for surgical problems from January through December 1997. The most common surgical problems were injuries (67.1%), congenital anomalies (15.0%) and surgical infections (6.7%). Forty-six per cent of children presenting with a surgical problem required a surgical procedure, 68.2% of which were classified as minor. The annual presentation rate for all surgical conditions was 543 per 10,000 children aged 0-14 years. The estimated cumulative risk for all surgical conditions is 85.4% by age 15 years. Our data suggest surgical diseases commonly affect children living in Banjul. Surgical care should be an essential component of child health programmes in developing countries.