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Thursday, January 5, 2012

Ten Global Health Achievements in 2011




The year 2011 brought with it a number of milestones for the global health community.
Despite real economic pressures and many competing priorities, across the world, governments, private companies, foundations, doctors, and individual volunteers worked to create a world where opportunity and hope are not crippled by poor health.
Below are ten (among many) reasons to celebrate 2011:
1) Despite the global economic downturn, governments avoid making major cuts to foreign aid budgets.
U.S. and European commitments to global health and foreign aid escaped deep reductions this year - an important achievement as the global health community works to meet the U.N. Millennium Development Goals. Of particular note is David Cameron's commitment to increase U.K. aid to .7% of the Gross National Income by 2013, making the U.K. the first G8 nation to reach the U.N.-recommended benchmark. The Global Fund's decision to cancel funding Round 11 is an obvious exception to this good news.
2) "Treatment as Prevention" as a means to reduce HIV transmission.
In May 2011, a study involving 1,763 HIV discordant couples (one positive, one negative) showed that individuals who had started antiretroviral therapy immediately after diagnosis lowered the risk of HIV transmission to their sexual partners by as much as 96%. As a result, the global health community is mobilizing time and resources to implement "test and treat" strategies for individuals and couples and is increasing treatment for HIV positive mothers to prevent mother-to-child transmission. At a World AIDS Day event on 1 December, President Obama announced that the U.S. will set a new target of helping 6 million people start HIV treatment by the end of 2013--2 million more people than the original goal.
3) The number of malaria cases and deaths continues to fall around the world.
Financial commitments towards malaria prevention and treatment have produced tremendous results. According to the WHO's 2011 Malaria Report, the global incidence of malaria dropped 17 percent since 2000 and by more than 50 percent in several endemic countries. Additionally, malaria-specific mortality rates fell by 26 percent worldwide. Much of this success is due to increased access to and use of insecticide-treated mosquito nets. This year, my organization PSI - with support from USAID, the Global Fund, UNICEF, and others, delivered its 125 millionth net. Our efforts, combined with the efforts of partners, have helped make progress against malaria one of global health's greatest success stories.
4) Exciting breakthrough in the search for an effective malaria vaccine.
A new vaccine tested in children across sub-Saharan Africa was found to reduce the risk of malaria by nearly 50 percent. This achievement was made possible by a partnership among GlaxoSmithKline Biologicals, the PATH Malaria Vaccine Initiative, and the Bill and Melinda Gates Foundation. Although still in trial stage (set to be completed by 2014), the vaccine represents a potential landmark step forward in the fight to end malaria deaths once and for all.
5) Long-acting reversible contraceptive methods are reaching more women.
Every year, 70 million unintended pregnancies occur throughout the world, contributing to the 340,000 women who die from pregnancy-related causes. Increasing access to voluntary use of long-acting reversible contraception methods, such as an intrauterine device or contraceptive implants, reduces the risk of women dying from unintended pregnancies. With growing support from donors, PSI and partner health organizations are now taking these methods to scale.
6) Kenya Hosts the First Global Conference on Social Franchising in health care.
More than 50% of people living in the developing world receive health products and services through the private sector. The future of health delivery, therefore, revolves around the expansion of private sector options, the standardization of quality, and cost reduction. From November 9th to 11th, Mombasa, Kenya hosted the first-ever gathering of health experts, donors, and implementers to share experiences about franchising private healthcare provision. The commercial franchising model can be replicated by the social sector to deliver health services with an end goal of improving quality of life rather than generating a profit. This practice has become a reputable and promising model to leverage private sector resources for public health goals.
7) Misoprostol added to WHO List of Essential Medicines.
Post-partum bleeding is responsible for 25 percent of maternal deaths every year. Misoprostol is a safe, effective, and affordable drug that can be used to prevent or treat this deadly condition. In 2011, the World Health Organization added misoprostol to its List of Essential Medicines - an important step forward to help ensure that no mother dies giving life.
8) Hillary Rodham Clinton elevates the importance of protecting the rights - and health - of LGBT populations.
Speaking before the United Nations in December, U.S. Secretary of State Hillary Rodham Clinton delivered a historic call for equality, declaring "gay rights are human rights." The speech specifically cited HIV/AIDS programs that fail to reach LGBT people due to discrimination or fear are a public health failure. Her words served as an important reminder to the global health community. Protecting the health of every person - no matter their background, age, race, gender, or sexual orientation - is our job. Period. (Read a personal commitment from PSI's Dr. Mannasseh Phiri's to increase LGBT HIV/AIDS outreach in Africa).
9) Overdue easy win number 1: Investment and action in pneumonia prevention and treatment saves lives.
Pneumonia kills more children under 5 years of age annually than AIDS, malaria, and measles combined. A new report from IVAC demonstrated significant progress has been achieved this year for pneumonia vaccinations. Within the past year alone, 10 of the 15 profiled countries have either introduced pneumococcal vaccines, been approved for introduction, or have applied for introduction support. The report also underscored the importance of scaling up access to antibiotics for children with pneumonia - a call that must be heeded in 2012. (Read Mandy Moore's call to action on pneumonia)
10) Overdue easy win number 2: Public and Private Sectors work together to improve sanitation, hygiene, and access to clean water.
Every year, approximately 1.5 million children die from diarrheal disease. The majority of these deaths could easily be prevented with proper sanitation and hygiene, as well as improved access to safe drinking water. This year, the U.S. Agency for International Development (USAID) and the Bill and Melinda Gates Foundation launched "WASH for Life". This $17 million partnership will identify, test, and take to scale new hygienic and sanitation technologies and service delivery approaches in developing countries. WASH for Life builds on a $42 million commitment from the Bill and Melinda Gates Foundation made this year to improve sanitation worldwide, and complements other programs led by governments, NGOs, and private sector companies such as Unilever and Procter & Gamble. 

The Time Is Now



 


Hanuman's club“The situation has come to this and I am at an impasse. What course of action is appropriate and timely for achieving my objective?’ Thus Hanuman thought the matter over and over again in his mind.” (Valmiki Ramayana, Sundara Kand, 13.19)
asminn evam gate karye prāpta kālam kṣamam ca kim ||
bhaved iti matim bhūyo hanumān pravicārayan |
 
, the Vanara warrior who is brave, strong, perseverant, intelligent and enthusiastic, keeps his focus of concern on others and their interests. He never works for himself, for what does he ever need? Hanuman asks for but only one thing in life: devotion to Shri Rama, the Supreme Personality of Godhead. Has anyone ever been denied this request when it was asked for in earnest? Has anyone ever been turned down for the post of devotee when they had the qualifications for the job? Hanuman certainly was never turned down, but surprisingly assuming this role doesn’t signal the end of distresses, either physical or mental. In many cases, the hesitations increase, with doubt arising over the proper course of action. Just hearing of Hanuman’s doubt and the reason for it are enough to tug at the hardest of hearts. May that Shri Hanuman, the faithful servant of Lord Rama
 
, forever roam in the minds of the devotees given to worshiping God and attaining life’s ultimate mission.
Hanuman worshiping Sita and RamaWhy was Hanuman in distress? Was this part of his service, the job he so desperately covets? Not only does Hanuman desire to take up the post of a sincere servant of God, but he has no other wish. He doesn’t ask for riches, fame, honor, beautiful women, the company of friends, or even a long life. How can someone eschew these desires which are found in practically every person? If the mind has a steady engagement, something that keeps the thought processes active, alert and ready to fire, there is no need to rely on external objects for sustenance. We can think of it this way: If we are at work and given tasks that are both challenging and time-consuming, what time will be left for lamentation and daydreaming of a brighter future?
The steady occupation also helps increase the quality of the downtime. If we were to sit all day in front of the television watching show after show, the enjoyment would wear thin after a while. On the other hand, if we only get a few brief periods of respite from an otherwise hectic schedule, the downtime is enjoyed and savored a lot more. The principle applies to sleep as well. If we stayed at rest all day, the sleeping hours wouldn’t be eagerly anticipated or appreciated. Just notice the difference between falling asleep on a weeknight versus a weekend. On a weekend night, the desire is to stay up later, as there is no pressing need to wake up early the next morning. On the weekdays, however, time is of the essence, so any precious time spent sleeping is taken full advantage of, for the worker knows that they must arise at a certain hour and take care of their duties the next day.
Work is a necessity, but if the spirit soul finds an engagement that is exhilarating and unending in its execution, the work turns into leisure. The tools used to maintain sanity in other occupations aren’t necessarily required either. It is not that the devotees
 
 given to devotional service
 
, or bhakti-yoga, look down at marriage, material opulence, or the association of friends and family. Rather, these aren’t required to remain in divine trance, or samadhiSamadhi in bhakti doesn’t have to involve the rejection of activity. Shri Hanuman is a perfect example of this. In his service to Lord Rama, he is always active, keeping the mind engaged through wonderful acts of love, which melt Shri Rama’s heart. Just as Hanuman loves Rama, the Lord fully extends His endless loving sentiments to Hanuman.
“Whenever and wherever there is a decline in religious practice, O descendant of Bharata, and a predominant rise of irreligion-at that time I descend Myself.” (Lord Krishna
 
Bhagavad-gita
 
, 4.7)
Lord Rama holding His bowThis mutual adoration made Hanuman’s most daunting task all the more difficult. Rama is God, and as He is the original creator, He is open to entering any of His innumerable lands. The true purpose of these appearances can never be revealed beyond the general acceptance that God does whatever He wants for His own pleasure. He is the only person that can say this with full honesty. During the Treta Yuga, Shri Rama, the origin of life and matter, roamed the earth in the guise of a warrior prince. As is common for a warrior, there were struggles and the protection of the innocent with Rama. For the innocent to be protected, there must be evil elements. If everything were peaceful, what need would there be for protectors?
During Rama’s time on earth the most powerful evil element was concentrated in the island of Lanka. The Rakshasas lived there, and they were headed by their ruler Ravana. A Rakshasa is a human-like species particularly prone to black magic, eating animal flesh [including humans], and drinking wine. With dedication to these activities that belong to the mode of ignorance, sobriety of thought flies right out the window. With a loss of internal cleanliness comes the loss of good judgment as well. Without proper discretion, improper behavior has the chance to take over.
Not surprisingly Ravana had no clue that taking another man’s wife, especially a man who was known as the greatest fighter in the world, would bring him tremendous heartache in the end. The bottle of whiskey cries out to be emptied into the mouth of the alcoholic, but what the bottle doesn’t reveal is that the consumption of alcohol will be harmful. If such pronouncements were made and readily acknowledged by the drinker, there would be no chance for alcohol consumption to be as prevalent as it is.
Ravana, though given advice to avoid taking this particular woman, couldn’t think clearly. All he could think about was this beautiful princess residing in the forest of Dandaka. Ravana created a plan to take her away from her husband’s side while He was not around. The plan worked, and taking her back to Lanka, Ravana hoped to win her over by giving her the post of top queen. Ravana made a mistake in forgetting the unmatched brilliance in character of the woman he took away. Sita Devi
 
, the daughter of King Janaka of Mithila, could never be swayed by the advances of any man. Like Hanuman, Sita required nothing but devotion to Rama. What could any man offer her anyway? She had Rama for a husband, so her prescribed duties called for her to keep her mind fixed on His lotus feet, the same two feet from which the sacred Ganges River emanates. Those same two feet are the cherished destination for the surrendered souls, including the worshipable servants that carry the Lord wherever He goes. The water that washes those feet is the most sacred in the three worlds, and anyone who is fortunate enough to even touch it becomes purified immediately.
Lord Rama's lotus feetSita had not only caressed her beloved husband’s feet, but she had made dedication to them her life’s mission. This unshakable level of devotion was unknown to Ravana, who was only interested in short-term gains, or preyas, directed at pleasing the body. Devotion to the senses brings all the qualities that are not beneficial to a person. Devotion to the senses led to Ravana’s demise, as it caused him to try to take Sita away from Rama. He would pay dearly in the end, as not only would Sita never become his wife, he would lose his kingdom, his palaces, the association of his beautiful queens, and eventually his life.
Rama is God, so He easily could have found Sita by Himself, but the devotees crave divine action. The spiritual master
 
, the guru in the line of Vaishnavas, or devotees of Vishnu [Rama], are so wonderful because they not only constantly sing the glories of Shri Rama, but they also give their disciples and admirers a full-time occupation, a way to keep the mind immersed in God consciousness. Even for the fallen souls of the Kali Yuga, who are trapped in an age where quarrel and hypocrisy are rampant, there is a method that can keep the flame of devotional service lit. That method is the chanting
 
 of the holy names, “Hare Krishna Hare Krishna, Krishna Krishna, Hare Hare, Hare Rama Hare Rama, Rama Rama, Hare Hare
 
”.
Just think of how bad the conditions of the Kali Yuga are. Make a mistake on the road and another driver will be so enraged that they’ll curse at you. Look at someone the wrong way and they’ll take it as an invitation to fight. Yet despite these horrible conditions, the guru still finds a way to keep his sincere students engaged in their occupational duty, their original disposition. Every person is naturally inclined to love God, but unless and until they are reacquainted with that occupation, they will continue to shoot in the dark, looking for answers to life’s mysteries.
Shri Rama is the original guru, so He gave the most exalted servants living in the Kishkindha forest at the time the chance to serve Him. Hanuman was the most eager of the monkeys in Sugriva’s party, so he was handed the most difficult task of finding Sita. Though all the monkeys were dispatched to search the globe for Sita, it was understood that only Hanuman had the feature-set necessary to infiltrate Lanka and find Sita without being harmed.
Seems like a fun mission, no? God entrusts you with something that will make you famous for all of time should you end up successful. Plus, you get to meet the most beautiful woman in the world and get her blessings in your devotion to Rama. Sita is the goddess of fortune, so she never leaves the devotees poor. Even if they are materially destitute, Sita ensures that they get whatever they need to keep their devotion alive. Hanuman was thus anxious to find Sita, for he knew it would bring happiness to both her and Rama.
Though he was all by himself in the latter stages, Hanuman still managed to infiltrate Lanka and scour the city. Lanka was situated across a massive ocean, so only Hanuman had the ability to leap far enough into the air to make it across. Despite making it to Lanka, he couldn’t find Sita. He saw pretty much everything else, even things he wish he hadn’t seen. Imagine flipping through the television channels and accidentally stumbling upon a pornographic or extremely violent program. The intention is not to watch something like this, especially if the mind is assigned the task of serving God.
Shri HanumanHanuman was forced to see similarly undesirable things in Lanka, yet his consciousness remain fixed on the task at hand. Only the purest souls are capable of remaining aloof in this way. It is for this reason that the Vaishnava gurus recommend that we abstain from meat eating, gambling
 
intoxication
 
 and illicit sex
 
. Simple renunciation by itself will not bring full God consciousness, but the aforementioned sinful activities work best at inhibiting the development of the consciousness in the proper direction.
Seeing unwanted things wasn’t Hanuman’s worst problem. He finally had to settle on the fact that maybe Sita wasn’t alive. Maybe Ravana had killed her or maybe she couldn’t stand the separation from her dearly beloved husband. What was Hanuman going to do now? If he returned to Rama and told Him what happened, the Lord would be devastated, for He is attached at the heart to Sita. If Hanuman went back and didn’t say anything, that would be equally as bad. Hanuman was punished if he did and punished if he didn’t.
It is one thing to go over these options as a theoretical exercise, but Hanuman was running out of time. He had to make a decision right away as to what should be done. He was in a hostile territory, all by himself, with no texting devices, computers or telephones available for retrieving help. The outcome rested with him and his ability to make the proper decision. What did Hanuman do? What other choice did he have? Of course he kept fighting ahead. Whatever option would best bring about the welfare of Shri Rama is the one Hanuman would take. As returning to Kishkindha wouldn’t help Rama, Hanuman decided to forge ahead, to continue the search for Sita.
Based on his decision we see that no one is more glorious than Hanuman. All he has in life is his devotion to Rama, and in this sense he is the wealthiest person in the world. It is said that Rama is Bhagavan because He has so many wonderful fortunes to His credit, and they are all present to the fullest extent. But in one sense Hanuman is wealthier than Shri Rama because he has the Lord and His wife residing within his heart. Then just imagine how wealthy the person who keeps Hanuman within their thoughts and prayers is. Who could ever end up a loser in life if they daily remember Hanuman and his relentless pursuit of success in the mission assigned to him? Hanuman would go on to find Sita and bring about Rama’s delight, and if we are similarly unrelenting in remembering Shri Hanuman and following devotional service, there is no doubt that we will bring a smile to the face of the sweet Vanara warrior, who is forever undeterred in his devotion.
In Closing:
“The time for action has come,
But doubt over what should be done.
Should I go home or just stay here,
Both are bad, so path remains unclear.”
Such pressure has been seen before never,
To beat the ticking clock otherwise lose chance forever.
This dire situation Hanuman did face,
Handled it with poise, resolve and grace.
Sita, Rama’s wife he would eventually find,
For devotion to God always consumes his mind.

Silk microneedles deliver controlled-release drugs painlessly



 by Biomechanism 

Bioengineers at Tufts University School of Engineering have developed a new silk-based microneedle system that delivers precise amounts of drugs over time and without refrigeration. The tiny needles can be fabricated under average temperature and pressure and from water, so they can be loaded with sensitive biochemical compounds and maintain their activity before use. They are also biodegradable and biocompatible. 
The research paper “Fabrication of Silk Microneedles for Controlled-Release Drug Delivery” appeared in Advanced Functional Materials on December 2 online before print.
The Tufts researchers successfully demonstrated the ability of the silk microneedles to deliver a large-molecule, enzymatic model drug, horseradish peroxidase (HRP), at controlled rates while maintaining bioactivity. In addition, silk microneedles loaded with tetracycline were found to inhibit the growth of Staphylococcus aureus, demonstrating the potential of the microneedles to prevent local infections while also delivering therapeutics. Continue reading…

“By adjusting the silk protein's post-processing conditions and varying the silk protein's drying time, we were able to precisely control the drug release rates in laboratory experiments,” said Fiorenzo Omenetto, Ph.D., senior author on the paper. “The new system addresses long-standing drug delivery challenges, and we believe the technology could also be applied to other biological storage applications.”
The Drug Delivery Dilemma
While some drugs can be swallowed, others can’t survive the gastrointestinal tract. Hypodermic injections can be painful and don’t allow a slow release of medication. Only a limited number of small-molecule drugs can be transmitted through transdermal patches. Microneedles—no more than a micron in size and able to penetrate the upper layer of the skin without reaching nerves—are emerging as a painless new drug delivery mechanism. But their development has been limited by constraints ranging from harsh manufacturing requirements that destroy sensitive biochemicals to the inability to precisely control drug release or deliver sufficient drug volume to problems with infections due to the small skin punctures.
The process developed by the Tufts bioengineers addresses all of these limitations. The process involves ambient pressure and temperature and aqueous processing. Aluminium microneedle moulding masters were fabricated into needle arrays of about 500 µm needle height and tip radii of less than 10 µm. The elastomer polydimethylsiloxane (PDMS) was cast over the master to create a harmful mould; a drug-loaded silk protein solution was then cast over the mold. When the silk was dry, the drug-impregnated silk microneedles were removed. Further processing through water vapour annealing and various temperature, mechanical and electronic exposures provided control over the diffusivity of the silk microneedles and drug release kinetics.
“Changing the structure of the secondary silk protein enables us to ‘pre-program’ the properties of the microneedles with great precision,” said David L. Kaplan, Ph.D., coauthor of the study, chair of biomedical engineering at Tufts and a leading researcher on silk and other novel biomaterials. “This very flexible technology can be scaled up or down, shipped and stored without refrigeration and administered as easily as a patch or bandage. We believe the potential is enormous.”
________________
Other co-authors on the paper, all associated with the Department of Biomedical Engineering, are Konstantinos Tsioris, doctoral student; Waseem Raja, post-doctoral associate; Eleanor Pritchard, post-doctoral associate; and Bruce Panilaitis, research assistant professor.
Reference:
Tsioris, K., Raja, W. K., Pritchard, E. M., Panilaitis, B., Kaplan, D. L. and Omenetto, F. G. (2011), Fabrication of Silk Microneedles for Controlled-Release Drug Delivery. Advanced Functional Materials. doi: 10.1002/adfm.201102012

Fidgeting your way to fitness



 by  

Walking to the photocopier and fidgeting at your desk are contributing more to your cardiorespiratory fitness than you might think.
Researchers have found that both the duration and intensity of incidental physical activities (IPA) are associated with cardiorespiratory fitness. The intensity of the activity seems to be particularly important, with a cumulative 30-minute increase in moderate physical activity throughout the day offering significant benefits for fitness and long-term health.
“It’s encouraging to know that if we just increase our incidental activity slightly–a little bit more work around the house, or walking down the hall to speak with a co-worker as opposed to sending an email–we can really benefit our health in the long-term,” says Ashlee McGuire, the study’s lead researcher and a graduate student in the School of Kinesiology and Health Studies. “Best of all, these activities don’t take up a lot of time, they’re not difficult to do, and you don’t have to go to a gym.”


Ms McGuire and fellow researcher Robert Ross, a professor in the School of Kinesiology and Health Studies, define IPA as non-purposeful physical activity accrued through activities of daily living, such as doing housework, climbing stairs or walking around the office.
Since a large proportion of the Canadian population doesn’t participate in a more structured, higher intensity exercise regime, Ms McGuire and Dr. Ross wanted to find out whether the time and intensity of incidental physical activity had any impact on cardiorespiratory fitness.
None of the study’s participants met Canada’s physical activity guidelines and were engaging solely in incidental physical activity. Activity levels were gauged using an accelerometer, which measures the duration and intensity of movement. Participants wore the accelerometer for a week and also took part in a test to measure their cardiorespiratory fitness.
These findings were recently published in Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine.

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Do you know anyone with disabilities? Read this…

New national exercise guidelines for persons with disabilities

Amy Latimer is part of a research team that has developed new national exercise guidelines for spinal cord injuries, a first for any disability group in Canada.
Amy Latimer is part of a research team that has developed new national exercise guidelines for spinal cord injuries.
“There was a clear need for exercise guidelines for people with spinal cord injuries,” explains the Kinesiology and Health Studies professor. “Until this point the only available exercise guidelines have been designed for the general population. These guidelines are often too much as a recommended starting point for people who have been inactive and need to progressively build up their muscle strength and cardiovascular fitness to avoid injury. Once someone is active they should strive to exceed the guidelines.”
The new guidelines recommend 20 minutes of moderate to heavy intensity exercise two times a week plus two strength-training sessions. Research evidence suggests that people with spinal cord injuries can gain significant fitness benefits from this amount of exercise. Exercise guidelines for the general population recommend 150 minutes per week of moderate to heavy intensity plus two strength training sessions.
The idea of creating specific guidelines came from the success of programs similar to the Queen’s University ‘Revved Up’ program, where undergraduate and community volunteers assist people with variety of mobility issues to improve their cardiovascular and strength capabilities.
The team of researchers followed 700 Ontarians with spinal cord injuries for a year and a half. The team found that over half of the sample population reported no leisure time physical activity at all.
“This is often more to do with the nature of the barriers people with spinal cord injuries face in trying to exercise, rather than because of the nature of their injury,” says Dr. Latimer, who notes that many gyms do not provide accessible fitness equipment.
The most common form of exercise for people with spinal cord injuries is wheeling, but aerobic workouts can also be done using arm ergometers, treadmills with wheelchair capability, and seated ellipticals. Interacting with Wii, a home video game console, may also help improve cardiovascular fitness, while strength training can be done on standard equipment with the seats removed or with free weights and resistance bands.
Dr. Latimer’s own team has also received funding to create separate exercise guidelines for people with multiple sclerosis.
The spinal cord exercise guidelines were developed in conjunction with SCI Action Canada. The project was led by Dr. Kathleen Martin Ginis and Dr. Audrey Hicks from McMaster University.

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