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Cambodia targets malaria elimination by 2025. Rapid elimination will depend on successfully identifying and clearing malaria foci linked to forests. Expanding and maintaining universal access to early diagnosis and effective treatment remains the key to malaria control and ultimately malaria elimination in the Greater Mekong Subregion (GMS) in the foreseeable future. Mass Drug Administration (MDA) holds some promise in the rapid reduction of Plasmodium falciparum infections, but requires considerable investment of resources and time to mobilize the target communities. Furthermore, the most practical drug regimen for MDA in the GMS-three rounds of DHA/piperaquine-has lost some of its efficacy. Mass screening and treatment benefits asymptomatic P. falciparum carriers by clearing chronic infections, but in its current form holds little promise for malaria elimination. Hopes that "highly sensitive" diagnostic tests would provide substantial advances in screen and treat programmes have been shown to be misplaced. To reduce the burden on P. falciparum and Plasmodium vivax infections in people working in forested areas novel approaches to the use of malaria prophylaxis in forest workers should be explored. During an October 2019 workshop in Phnom Penh researchers and policymakers reviewed evidence of acceptability, feasibility and effectiveness of interventions to target malaria foci and interrupt P. falciparum transmission and discussed operational requirements and conditions for programmatic implementation.

Background: Diagnosis of systemic autoimmune rheumatic diseases (SARD) relies on the presence of hallmark anti-nuclear antibodies (ANA), many of which can be detected years before clinical manifestations. However, ANAs are also seen in healthy individuals, most of whom will not develop SARD. Here, we examined a unique cohort of asymptomatic ANA + individuals to determine whether they share any of the cellular immunologic features seen in SARD., Methods: Healthy ANA - controls and ANA + (ANA ≥1:160 by immunofluorescence) participants with no SARD criteria, with at least one criterion (undifferentiated connective tissue disease (UCTD)), or meeting SARD classification criteria were recruited. Peripheral blood cellular immunological changes were assessed by flow cytometry and transcript levels of BAFF, interferon (IFN)-induced and plasma cell-expressed genes were quantified by NanoString., Results: A number of the immunologic abnormalities seen in SARD, including changes in peripheral B (switched memory) and T (iNKT, T regulatory, activated memory T follicular helper) subsets and B cell activation, were also seen in asymptomatic ANA + subjects and those with UCTD. The extent of these immunologic changes correlated with ANA titer or the number of different specific ANAs produced. Principal component analysis of the cellular data indicated that a significant proportion of asymptomatic ANA + subjects and subjects with UCTD clustered  with patients with early SARD, rather than ANA - healthy controls., Conclusions: ANA production is associated with altered T and B cell activation even in asymptomatic individuals. Some of the currently accepted cellular features of SARD may be associated with ANA production rather than the immunologic events that cause symptoms in SARD.

Background: This research examines the effectiveness of an Emergency Warming Centre (EWC) in Inuvik, Canada, at reducing rates of morbidity and mortality for homeless persons with concurrent disorders (mental health problems and addictions). Inuvik is a small town of approximately 3500 residents, with over 65% being Aboriginal. The town is situated on the Beaufort Delta in the Western Canadian Arctic and is subject to oil and gas extraction-based boom and bust economic cycles. The centre provided food and accommodation for those under the influence of alcohol or drugs who had no other place to stay., Methods: Qualitative interviews about users' experiences at the centre were conducted with guests, as they were called, centre staff and other key stakeholders in autumn 2014 and spring 2015. Samples of (9) respondents and (7) stakeholders provided significant information about the importance of the EWC. The content of the qualitative data with guests and stakeholders were analyzed for emergent themes., Results: Several emergent themes and subthemes related to participants' experiences at the EWC and success of the centre. Overall, the results showed that guests benefitted from a safe place to stay and felt better about their overall health., Conclusions: Compared with research on wet shelters in New Zealand, Great Britain and the US, this research reveals that harm reduction-based models for homeless persons with concurrent disorders require significant investments in infrastructure, which are not readily available. Yet, the lessons learned from these jurisdictions might be extrapolated to communities like Inuvik to develop alternative housing strategies.