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For those groups where such a situation is the case cholesterol test in hindi cheap tricor 160mg on-line, their border identity tends to be much stronger owing to its historical embeddedness cholesterol range chart canada order tricor visa. Not only are they often porous (the case of Zaire/Congo being extreme) cholesterol screening purchase tricor 160mg online, but ethnic solidarities existing across them are much more powerful than the formal citizenships people happen to carry high cholesterol medication uk buy tricor cheap. This is for a number of reasons, the most influential being physical remoteness from the seat of power; a perceived sense of political isolation, marginality, or subordination; and constant exposure to , and interaction with, another nationality across the border. In the Ilemi Triangle, for instance, neglect on the part of national authorities towards borderland development, has translated into increased dependency among the borderlanders on their kin across the border. It is even the case that traditional South African authorities will recognize Mozambican and Swazi nationals as members of their borderland village, when national law has not confirmed their legal right to reside in the country. On the contrary, tending to perceive state authority as a largely oppressive force, many borderlanders value the distance from the core, and the societal (as well as political and economic) independence and freedom that comes with that. Simala and Maurice Amutabi, "Small Arms, Cattle Raiding, and Borderlands: the Ilemi Triangle," in Illicit Flows and Criminal Things: States, Borders, and the Other Side of Globalisation, ed. Willem Van Schendel and Itty Abraham (Bloomington: Indiana University Press, 2005), 204. Modern borders: condition, performance, management the deep rootedness in the border, not all other sources of identity necessarily become extinguished. On the Niger-Nigerian border, for example, Hausa and Muslim identities are still alive and well, despite an entrenched sense of "shared borderlandness". Borderlanders often see the border zone as one economically marginalised by central authority. As described in the previous section, perceived inequality has led borderlanders in places like the Beninois-Nigerian border to actively strengthen border solidarity and interdependence, in order to appropriate what they see as their natural rights to the lucrative transborder trade. If they perceive their economic autonomy as being compromised, they often have no hesitation in responding with evasion or resistance. This is part of a wider phenomenon, namely the economic independence and self-assertiveness which tends to arise out of these spaces. Not only does this result in economic activity being directed outwards and over the border, but it also emboldens an attitude of ambivalence with regards to cooperating with national customs and trade regulations. Thus, when state practices around the border become too parasitic and a nuisance for the inhabitants, or more seriously, when they start to restrict their abilities to make an economic living, the residents can often have no qualms about circumventing the state (or bribing state officials in order to have their way). As Lee Cassanelli states with reference to the Horn of Africa, "By essentially neglecting the frontier districts, colonial bureaucrats and their African successors in both Kenya and Somalia afforded borderlanders the economic space to devel- 292 23 William F. Miles, "Development, Not Division: Local Versus External Perceptions of the Niger-Nigeria Boundary," Journal of Modern African Studies 43 (2) (2005): 299. It is at borders where the value of an item increases or decreases, and hence they can be dynamic, active sites of economic exchange. Discussing borderland traders in eastern Africa, Cassanelli explains, After the establishment of colonial rule, these experienced traders were well-positioned to circumvent colonial attempts to restrict or divert their commerce within the new, artificially constructed boundaries [. Indeed, many African borderland economic practices are tapped into wider regional (even global) economic systems to do with trade, smuggling, migrant trafficking, and so on. After the Tuarag rebellion in the Malian-Algerian borderland ended in 1996, for example, a borderland that had once served as a refuge for fighters, was transformed into a transnational economic hub, involved in various regional and international economic practices. Thus, as Thomas Husken and Georg Klute note with regards to the Egyptian-Libyan border (but which can apply to numerous African borderlands), "The image of a periph- 25 Lee Cassanelli, "The Opportunistic Economics of the Kenya-Somali Borderland in Historical Perspective," in Borders and Borderlands as Resources in the Horn of Africa, ed. Modern borders: condition, performance, management ery without connection to national and global developments is inappropriate". The remaining sections of this chapter will explore how these insights are important in shaping the kind of conflict that arises in violence-prone African borders and borderlands. In numerous African borderlands throughout the continent there are often references to discourses of marginalisation, hidden transcripts of discontent, and unresolved political issues. In discussing the conflict in Northern Uganda, Tehri Lehtinen notes, "There are several layers of grievances, symbolic representations and multiple co-existing conflicts which all converge in the narratives about Northern Uganda". Meta-narratives reflecting the unique lived experiences of African borderlanders are not the only conflict-related political dynamics to arise out of this arena, however. For example, the Malian-Algerian borderland has frequently been used by Tuarag rebels "to withdraw from the fighting and by the civilian population as refuge and shelter.

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A quality-improvement team is working with key suppliers to improve the quality of incoming materials cholesterol values mmol 160mg tricor visa. Quality-improvement teams are working with key customers to find ways to improve products and services cholesterol medication guidelines cheap tricor online visa. The sample list does not include all the activities that might be part of the process is there cholesterol in quail eggs buy tricor mastercard. For example hyper cholesterol anemia definition buy tricor line, important areas such as employee empowerment, employee feedback, and customer feedback are not on the list in order to keep it from being too lengthy. It should be obvious that all of this requires a major effort on the part of the managers and employees of an organization; however, the payoffs are well worth the effort. The quality process leads to greater sales, to lower costs, to wider profit margins, and to higher morale. It is a great way to keep customers and employees satisfied and to keep the organization profitable. Jessey the motivation-hygiene theory, underlying what is known as "job enrichment," grew out of research on job attitudes conducted by Frederick Herzberg (1966). In establishing his theory, Herzberg draws heavily on the hierarchy of needs developed by Abraham Maslow. Herzberg stresses that the factors that truly motivate work are "growth" factors, or those that give the worker a sense of personal accomplishment through the challenge of the job itself. In other words, motivation is in the content of the job, the internal dynamics that the worker experiences in completing his or her task. On the other hand, Herzberg maintains that the context, or environmental factors (hygiene), that surround the job cause dissatisfaction when they are in unhealthy condition. These dissatisfiers may be classed as "deficit" needs in that their importance is felt only in their absence. However, bad working conditions are frequently cited by workers as sources of dissatisfaction. Although not originally designed to fulfill the function, job enrichment has been significantly effective in assisting supervisors to improve their management styles. The organization development application of job enrichment is popular because (1) it can easily be adapted by all levels of management, (2) payoff (results) can be realized in a relatively short time span and, (3) it can be measured in specific terms. The primary purpose of this paper is to present an example of a practical model that I have found effective in implementing job enrichment. The model has been utilized in large and small business organizations as well as in a medium-sized civic organization. When I first enter the organization or a "family" group within an organization, I have two primary objectives in mind. First, I attempt to give a thorough interpretation of job enrichment and my role in it. I point out the possible consequences of inadequate commitment, which can affect the supervisor-subordinate relationship in the areas of trust and respect. After understanding and commitment have been established, management "family" groups attend a two-day, job-enrichment workshop, preferably removed from the work locale. The workshop is designed to (1) teach the participants the theory behind job enrichment, (2) allow them to witness how others have utilized it, (3) enable the group members to experiment with one another in applying job enrichment and, (4) assist the participants in realizing how the implementation of job enrichment will affect their own jobs as well as the jobs of their subordinates. Immediately after the workshop, I either distribute a job-reaction survey to everyone in that family organization-management and nonmanagement-or I personally interview each person. I receive permission from each person being interviewed to allow me to tape record the interview for the purpose of playing the tape back to the supervisor. In this manner, the interview feedback has full value in that the supervisor is able to sense the feelings associated with the subjects being discussed as the employees describe their reactions to their jobs. Incidentally, although I prefer the taped interview, it should be noted that it is time-consuming and, therefore, more expensive. Their main concern was that their intrinsic talents and interests are not being activated and utilized at work. After the supervisor has heard all the interviews, he or she develops a "plan of action" that is a positive reaction to the expressed desires of each individual subordinate. It is essential at this point that the supervisor recognize and accept how the implementation of job enrichment will change the focus of his or her job and that he or she begin to practice new behaviors when interacting with his or her subordinates.

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Comparison of short-course multidrug treatment with standard therapy for visceral leishmaniasis in India: an open-label cholesterol chart american heart association buy cheapest tricor, non-inferiority cholesterol medication history order tricor 160mg online, randomised controlled trial cholesterol deep conditioner discount tricor generic. Recommendations for treating leishmaniasis with sodium stibogluconate (Pentostam) and review of pertinent clinical studies cholesterol hiv medication cheap tricor 160 mg online. Successful miltefosine treatment of post-kala-azar dermal leishmaniasis occurring during antiretroviral therapy. Influence of highly active antiretroviral therapy on the outcome of subclinical visceral leishmaniasis in human immunodeficiency virus-infected patients. High frequency of serious side effects from meglumine antimoniate given without an upper limit dose for the treatment of visceral leishmaniasis in human immunodeficiency virus type-1-infected patients. Tegumentary leishmaniasis as the cause of immune reconstitution inflammatory syndrome in a patient co-infected with human immunodeficiency virus and Leishmania guyanensis. Diffuse cutaneous leishmaniasis associated with the immune reconstitution inflammatory syndrome. Post-kala-azar dermal leishmaniasis as an immune reconstitution inflammatory syndrome in a patient with acquired immune deficiency syndrome. The role of interferon-gamma in the treatment of visceral and diffuse cutaneous leishmaniasis. Granulocyte-macrophage colony-stimulating factor in combination with pentavalent antimony for the treatment of visceral Leishmaniasis. Pentamidine as secondary prophylaxis for visceral leishmaniasis in the immunocompromised host: report of four cases. Cutaneous leishmaniasis during pregnancy: exuberant lesions and potential fetal complications. The effects of metals on the chick embryo: toxicity and production of abnormalities in development. Maternal and perinatal outcomes of visceral leishmaniasis (kala-azar) treated with sodium stibogluconate in eastern Sudan. A comparison of liposomal amphotericin B with sodium stibogluconate for the treatment of visceral leishmaniasis in pregnancy in Sudan. Congenital transmission of visceral leishmaniasis (Kala Azar) from an asymptomatic mother to her child. Fifteen countries, mainly in sub-Saharan Africa, account for 80% of malaria cases and 78% of deaths worldwide. Reports of vertical transmission and infection after blood transfusion do exist, but these routes of transmission are uncommon in non-endemic areas. Given this substantial overlap, even modest interactions between them have public health importance. Consideration of malaria in returning travelers who are febrile is important: Of the nearly 50 million individuals who travel to developing countries each year, between 5% and 11% develop a fever during or after travel. Children who survive these infections usually acquire partial immunity by age 5 years, and if they remain in the area where malaria is endemic, they maintain this immunity into adulthood. However, as noted previously, patients who leave endemic areas and subsequently return may be at high risk of disease because they likely have lost partial immunity 6 months after leaving endemic regions. For populations in these areas, the overwhelming clinical manifestation is acute febrile disease that can be complicated by cerebral malaria, affecting persons of all ages. When pregnant women in areas of unstable transmission develop acute malaria, the consequences may include spontaneous abortion and stillbirth. In more stable transmission areas, pregnant women, particularly primigravidas, may lose some acquired immunity. Although infections may continue to be asymptomatic, infected pregnant women may acquire placental malaria that contributes to intrauterine growth retardation, low birth weight, and increased infant mortality. Patients with malaria can exhibit various symptoms and a broad spectrum of severity, depending upon factors such as the infecting species and level of acquired immunity in the host. Patients can present much later (>1 year), but this pattern is more common with other species, especially P.

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In Tanzania cholesterol lowering foods vegetables buy tricor 160mg fast delivery, Plasmodium falciparum is the most common cholesterol levels nzgg discount 160 mg tricor with mastercard, and causes severe malaria cholesterol qr buy discount tricor, which can be fatal if not recognised promptly and properly managed poor cholesterol ratio generic tricor 160 mg on-line. Children under age 5 and pregnant women are at greatest risk of severe malaria because they have insufficient immunity against malaria. In addition, individuals from malaria-free or very low endemic areas are also likely to have low immunity and an elevated risk of severe disease if infected. The Government of Tanzania, in collaboration with its partners, is implementing recommended preventive and curative interventions according to Malaria Strategic Plans. The Tanzania Mainland plan focuses on sustaining the achievements of the previous phase, further reducing malaria transmission, and exploring the possibilities of moving towards the malaria pre-elimination phase by 2020. The Zanzibar Malaria Elimination Plan also aims at consolidating malaria control achievements toward pre-elimination by 2018. Chapter 12 presents data that are useful for assessing how well malaria control strategies are implemented, including the availability and use of mosquito nets, indoor residual spraying of dwellings with insecticides, the prophylactic use of antimalarial drugs by pregnant women, diagnostic testing for malaria, the therapeutic use of antimalarial drugs in children with fever, and the prevalence of anaemia and malaria among children under age 5. Two mass campaigns were implemented between 2009 and 2011; these included the under-five catch-up campaign from 2009 to mid-2010 and the universal coverage campaign to cover all sleeping spaces, from 2010 to mid-2011. Other reported reasons included: there are no mosquitoes (28%), the usual users did not sleep in the household last night (8%), it is too hot (6%), the net is too old or is torn (4%), and the net is too dirty (3%) (Table 12. Sample: Pregnant women who slept in the household the previous night Children under age 5 and pregnant women have historically been targeted for malaria interventions because they are at highest risk of morbidity and mortality in highly endemic settings. Sample: Women age 15-49 with a live birth in the two years before the survey In areas of high malaria transmission, by the time an individual reaches adulthood, she or he has acquired partial immunity that can protect him/her against severe disease. However, pregnant women-especially those pregnant for the first time-lose some immunity and are once again susceptible to the disease. Malaria in pregnancy is associated with adverse health outcomes for both mother and child, including anaemia and low birth weight. Sample: Children under age 5 with a fever in the two weeks before the survey Diagnosis of malaria in children under 5 with fever Percentage of children under age 5 with a fever in the two weeks before the survey who had blood taken from a finger or heel for testing. Sample: Children under age 5 with a fever in the two weeks before the survey who took any antimalarial drugs In moderately to highly endemic areas of malaria, acute clinical disease is almost always confined to young children who suffer from high parasitic densities. Fever is a major manifestation of malaria in young children, although it also accompanies other illnesses. Children with uncomplicated malaria should receive an appropriate antimalarial drug within 24 hours of the onset of fever. For 80% of these children, advice or treatment was sought for the fever, and for 45% of them, advice or treatment was sought during the same or next day after the fever began. More than one-third of children under age 5 with fever (36%) had blood taken from a finger or heel for diagnostic testing (Table 12. Half of children under age 5 with fever in the two weeks before the survey took any antimalarial medication (Table 12. Thirty-four percent sought advice or treatment from the public sector, most commonly from health centres (23%) (Table 12. Trends: the percentage of children with fever who had blood taken from a finger or heel for testing has increased from 25% in 2011-12 to 36% in 2015-16. Patterns by background characteristics the percentage of children under age 5 reported to have had a fever in the two weeks before the survey is lowest in the Central Zone (8%) and highest in the Southern and Lake zones (23%). Children age 12-35 months have the highest prevalence of fever (22-23%) and children age 48-59 months have the lowest (13%). Urban children with fever in the two weeks preceding the survey are twice as likely as rural children to have blood taken from a finger or heel for testing (62% compared to 27%). However, poor dietary intake of iron is only one of numerous causes of anaemia; malarial infection can also cause anaemia. The cutoff of 8 g/dl is often used to classify malaria-related anaemia (Korenromp et al.

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