A call from justice to support the people in Gaza

Using Madison Powers and Ruth Faden's definition of ‘well‐being,’ the authors argue that Israel, the international community and public health practitioners have a justice‐based obligation to assist the Palestinian people in the Occupied Palestinian Territories. Focusing on Palestinians in Gaza, the authors first outline a normative framework of justice, as articulated by Powers and Faden. Following Powers and Faden's assumption that empirical assessments of justice can be made using the six dimensions of well‐being, the authors next present current data on the living conditions in Gaza and describe how these conditions prevent residents from achieving sufficient levels of well‐being. Using these indicators to demonstrate that Palestinians living in Gaza suffer deficiencies in these dimensions of well‐being, the authors present a strong argument from justice to assist the residents of Gaza. The medical, public health, and bioethics community cannot sit idle while injustice continues.     

Rare Fungal Infections in Children: An Updated Review of the Literature

An increasing trend of reports of rare fungal diseases has been observed to be mainly associated with the substantial increase of high-risk immunocompromised children, as well as with the selective pressure of antifungal drugs. On the other hand, recent reports have shown that several species of these rare fungi may also cause infections in immunocompetent children without obvious underlying conditions. The clinical spectrum of these infections, and most importantly their outcome, varies greatly, implying for a rather heterogenic group of pediatric infections. Various types of superficial and subcutaneous fungal infections, as well as systemic and disseminated life-threatening infections, have been reported. Prompt diagnosis and appropriate treatment of rare fungal diseases in children remains a great challenge. Several treatment options have been used, ranging from localized to combination treatment with extensive surgical excision and long-term antifungal therapy. We review contemporary data of rare fungal infections in pediatric patients focusing on epidemiology, mycology, management and outcome, published during the last three years.     

Three Voices in a Norwegian Living Room: An Encounter from Physiotherapy Practice

This article demonstrates how uses of the body regulate togetherness and availability in clinical encounters. A first encounter between a physiotherapist and a married couple in their home is analyzed. The husband suffers from functional consequences of a stroke. The therapist's job is to assess his functional capacity and determine how he can best be helped. The article centers on the process of interaction, specifically on verbal and bodily actions pertaining to developing role negotiations. Comprehensive excerpts demonstrate that a struggle is going on between the husband and his wife over the management of information about his condition. This imposes dilemmas of control and caring on the therapist. The article describes the maneuvering of the parties and shows how the therapist manages her professional tasks. Emphasis is placed on the particular predicaments that a clinical encounter can generate in a private residence, and on how clinical tasks are embedded in social processes. Finally, the article questions the (often tacit) analytical assumption that "interaction" and "diagnostics" are separate phenomena, and shows how the understanding of both can be advanced if seen as mutually constitutive processes, [clinical encounters, communication, embodiment, physiotherapy, visiting practice]     

An example of how to build conservation evidence from case studies: Fire and raking to enhance Pulsatilla vernalis populations

Can data collected by practitioners during practical conservation work be used as decision support? To find out, we used unpublished data from attempts to enhance populations of the vascular plant Pulsatilla vernalis in Sweden. About half of the 50 located cases had generated data useful for meta-analysis. We could show that burning had a positive effect while mechanical disturbance had negligible effects on number of plants in short-term follow-ups. Furthermore, we suggest that follow-up variables related to flowering are inferior for monitoring intervention success as flowering varies greatly between years. In the broader context, our example shows that simple records from practical conservation work can be a rich source of information. It was also obvious that there is great potential for more useful evidence by making just small improvements in field protocols, documentation, and archiving. Finally, we suggest that biologists and researchers need to develop an appreciation of “different levels of evidence”, and that in circumstances where we lack relevant experiments or observational studies, case studies might be useful for improving interventions.     

Retention in Care of HIV-Infected Children from HIV Test to Start of Antiretroviral Therapy: Systematic Review

Background

In adults it is well documented that there are substantial losses to the programme between HIV testing and start of antiretroviral therapy (ART). The magnitude and reasons for loss to follow-up and death between HIV diagnosis and start of ART in children are not well defined.

Methods

We searched the PubMed and EMBASE databases for studies on children followed between HIV diagnosis and start of ART in low-income settings. We examined the proportion of children with a CD4 cell count/percentage after after being diagnosed with HIV infection, the number of treatment-eligible children starting ART and predictors of loss to programme. Data were extracted in duplicate.

Results

Eight studies from sub-Saharan Africa and two studies from Asia with a total of 10,741 children were included. Median age ranged from 2.2 to 6.5 years. Between 78.0 and 97.0% of HIV-infected children subsequently had a CD4 cell count/percentage measured, 63.2 to 90.7% of children with an eligibility assessment met the eligibility criteria for the particular setting and time and 39.5 to 99.4% of the eligible children started ART. Three studies reported an association between low CD4 count/percentage and ART initiation while no association was reported for gender. Only two studies reported on pre-ART mortality and found rates of 13 and 6 per 100 person-years.

Conclusion

Most children who presented for HIV care met eligibility criteria for ART. There is an urgent need for strategies to improve the access to and retention to care of HIV-infected children in resource-limited settings.     

Voices from beyond the grave: The impact of apoptosis on the microenvironment

Programmed cell death, in particular apoptosis, has vital functions in every healthy organism. In a highly regulated manner cells which are no longer needed or are harmful to the organism undergo suicide. More than just the mere elimination of a cell, apoptosis is increasingly being recognized performing important roles in cellular communication with the microenvironment. These interactions with surrounding cells can have various, and sometimes competing outcomes. Apoptotic cells can promote survival, proliferation and inflammation, but depending on the context also prevent survival and inflammation. In this review, we will summarize the emerging literature on how dying cells can transfer information to their neighbours, and which outcomes this communication has for the whole tissue.     

Fire in Australian savannas: from leaf to landscape

Savanna ecosystems comprise 22% of the global terrestrial surface and 25% of Australia (almost 1.9 million km²) and provide significant ecosystem services through carbon and water cycles and the maintenance of biodiversity. The current structure, composition and distribution of Australian savannas have coevolved with fire, yet remain driven by the dynamic constraints of their bioclimatic niche. Fire in Australian savannas influences both the biophysical and biogeochemical processes at multiple scales from leaf to landscape. Here, we present the latest emission estimates from Australian savanna biomass burning and their contribution to global greenhouse gas budgets. We then review our understanding of the impacts of fire on ecosystem function and local surface water and heat balances, which in turn influence regional climate. We show how savanna fires are coupled to the global climate through the carbon cycle and fire regimes. We present new research that climate change is likely to alter the structure and function of savannas through shifts in moisture availability and increases in atmospheric carbon dioxide, in turn altering fire regimes with further feedbacks to climate. We explore opportunities to reduce net greenhouse gas emissions from savanna ecosystems through changes in savanna fire management.     

Review: from chemosphere to biosphere

An understanding of how the Earth's chemosphere was transformed to a biosphere is central to our understanding of the origin of life and the search for extraterrestrial life or life signatures. Once early prokaryotic life originated and colonized the Earth, the biosphere was well on its way to being formed. In this paper, information and knowledge is integrated to examine the possibility how life first self-assembled and transformed a lifeless chemosphere into a complex biosphere that we still do not understand today.     

Etiopathogenesis of Psoriasis from Genetic Perspective: An updated Review

Psoriasis is an organ-specific autoimmune disease characterized by the aberrant proliferation and differentiation of keratinocytes, leading to skin lesions. Abnormal immune responses mediated by T cells and dendritic cells and increased production of inflammatory cytokines have been suggested as underlying mechanisms in the pathogenesis of psoriasis. Emerging evidence suggests that there is a heritable basis for psoriatic disorders. Moreover, numerous gene variations have been associated with the disease risk, particularly those in innate and adaptive immune responses and antigen presentation pathways. Herein, this article discusses the genetic implications of psoriatic diseases'' etiopathogenesis to develop novel investigative and management options.     

Gender Determinants of Vaccination Status in Children: Evidence from a Meta-Ethnographic Systematic Review

Using meta-ethnographic methods, we conducted a systematic review of qualitative research to understand gender-related reasons at individual, family, community and health facility levels why millions of children in low and middle income countries are still not reached by routine vaccination programmes. A systematic search of Medline, Embase, CINAHL, Cochrane Library, ERIC, Anthropological Lit, CSA databases, IBSS, ISI Web of Knowledge, JSTOR, Soc Index and Sociological Abstracts was conducted. Key words were built around the themes of immunization, vaccines, health services, health behaviour, and developing countries. Only papers, which reported on in-depth qualitative data, were retained. Twenty-five qualitative studies, which investigated barriers to routine immunisation, were included in the review. These studies were conducted between 1982 and 2012; eighteen were published after 2000. The studies represent a wide range of low- to middle income countries including some that have well known coverage challenges. We found that women''s low social status manifests on every level as a barrier to accessing vaccinations: access to education, income, as well as autonomous decision-making about time and resource allocation were evident barriers. Indirectly, women''s lower status made them vulnerable to blame and shame in case of childhood illness, partly reinforcing access problems, but partly increasing women''s motivation to use every means to keep their children healthy. Yet in settings where gender discrimination exists most strongly, increasing availability and information may not be enough to reach the under immunised. Programmes must actively be designed to include mitigation measures to facilitate women''s access to immunisation services if we hope to improve immunisation coverage. Gender inequality needs to be addressed on structural, community and household levels if the number of unvaccinated children is to substantially decrease.     

Other People's Children: An Intimate Account of the Dilemmas Facing Middle-Class Parents and the Women They Hire to Raise Their Children

Other People's Children: An Intimate Account of the Dilemmas Facing Middle-Class Parents and the Women They Hire to Raise Their Children. Julia Wrigley New York: Basic Books, 1995. 177 pp.