The Fourth Child Cj Carmichael E
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The Fourth Child Cj Carmichael E
The primary participants in this intervention were two types of FLWs: the Accredited Social Health Activist (ASHA) and the Anganwadi Worker (AWW). ASHAs (from the Ministry of Health and Family Welfare, MoHFW) and AWWs (from the Ministry of Women and Child Development, MWCD) share a broad mandate for supporting a range of RMNCHN services, in addition to some services that are specific to one or the other FLW/department. The ASHA supports antenatal, childbirth and newborn care, and child immunizations as part of MoHFW services. The AWW focuses on preschool education and supplemental nutrition for pregnant women and young children through the Integrated Child Development Services (ICDS) scheme. Each village (or village segment, in large villages) is typically served by one ASHA and one AWW, who live in the community. For the purposes of Ananya, they had the same supervisor (either a Lady Supervisor or an Auxiliary Nurse Midwife, ANM) as efforts were made to facilitate planning and actions as a team. An important objective of the ICT-CCS tool was to facilitate interaction between ASHAs and AWWs, in hopes that this interaction would improve their effectiveness. CARE provided extensive training in the use of the ICT-CCS tool at health sub-centers, which consisted of 16 sessions of approximately 3 hours each over a period of 8 weeks. A substantial part of this training was aimed at enabling the FLWs to become comfortable in the use of the algorithm-loaded mobile phones (Nokia C2-01), including using the keyboard to type text such as the names of mothers and children and simple responses to questions such as Y or N.
As observed recently in neighboring Uttar Pradesh, facilitation of adherence to protocols through implementation of tools like the ICT-CCS may be insufficient to improve maternal and child health outcomes in the absence of system-wide shifts in incentives and improvements in skills in communicating with families and managing behavior change [20,21,29,30].
Primary immunodeficiency (PID) is characterized by recurrent and often life-threatening infections, autoimmunity and cancer, and it poses major diagnostic and therapeutic challenges. Although the most severe forms of PID are identified in early childhood, most patients present in adulthood, typically with no apparent family history and a variable clinical phenotype of widespread immune dysregulation: about 25% of patients have autoimmune disease, allergy is prevalent and up to 10% develop lymphoid malignancies1-3. Consequently, in sporadic (or non-familial) PID genetic diagnosis is difficult and the role of genetics is not well defined. Here we address these challenges by performing whole-genome sequencing in a large PID cohort of 1,318 participants. An analysis of the coding regions of the genome in 886 index cases of PID found that disease-causing mutations in known genes that are implicated in monogenic PID occurred in 10.3% of these patients, and a Bayesian approach (BeviMed4) identified multiple new candidate PID-associated genes, including IVNS1ABP. We also examined the noncoding genome, and found deletions in regulatory regions that contribute to disease causation. In addition, we used a genome-wide association study to identify loci that are associated with PID, and found evidence for the colocalization of-and interplay between-novel high-penetrance monogenic variants and common variants (at the PTPN2 and SOCS1 loci). This begins to explain the contribution of common variants to the variable penetrance and phenotypic complexity that are observed in PID. Thus, using a cohort-based whole-genome-sequencing approach in the diagnosis of PID can increase diagnostic yield and further our understanding of the key pathways that influence immune responsiveness in humans.
The comparison of Hispanic children with NHB children had the greatest number of defects (n=20) for which disparities existed. Of the 12 defects that had a statistic