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Malaria is still a significant problem in Indonesia due to its contagious nature, as it causes death, especially in children under the age of five. Based on 2019 data, there have been 409,000 deaths from malaria out of 229 million recorded malaria cases worldwide. WHO launched that in Indonesia there were 1,412 deaths from malaria from 811,636 new cases of malaria in 2021 in Indonesia. 89% of malaria cases in Indonesia occur in Papua Province. Fakfak Regency in 2023 will experience an increase in cases to 180 cases with API 2.2 per 1,000 population and still 50 Indigenous cases. This study aims to analyze the environmental factors that are most at risk for malaria incidence in Fakfak Regency, West Papua. Method: The study is observational with a Case-control research design. The 100 respondents used a total sampling consisting of 50 positive malaria cases with indigenous classification and 50 controls. Results: The most potential environmental risk factors for malaria incidence were the presence of breeding places with p-values of 0.000 and OR 13,903 (95%CI: 3,374- 57,287), and night exit habits (p-value 0.045; OR 1,678). One important step is to break the chain of transmission by controlling environmental factors, namely the eradication of vector breeding sites, larvicide in puddles, cleaning of anopheles vector rest areas, the use of mosquito nets, Insect Residual Spraying (IRS), and other activities that can encourage the breaking of the chain of malaria transmission, which is carried out in an integrated manner by the community. [ABSTRACT FROM AUTHOR]

Pre-surgical clinical assessment of an adnexal mass is a complex process, and ideally requires accurate and rapid identification of disease status. Gold standard biomarker CA125 is extensively used off-label for this purpose; however its performance is typically inadequate, particularly for the detection of early stage disease and discrimination between benign versus malignant status. We recently described a multi-marker panel (MMP) and associated risk index for the differentiation of benign from malignant ovarian disease. In this study we applied a net reclassification approach to assess the use of MMP index to rescue those cases where low CA125 incorrectly excludes cancer diagnoses, or where benign disease is incorrectly assessed as "high risk" due to elevated CA125. Reclassification of such patients is of significant value to assist in the timely and accurate referral for patients where CA125 titer is uninformative. [ABSTRACT FROM AUTHOR]

The conventional treatment of Kasabach-Merritt Phenomenon (KMP) consists of corticosteroids with vincristine/vinblastine or others. The aim of the study is to compare the first-year direct costs and effectiveness between sirolimus and conventional treatment. A retrospective case-control study of KMP patients was conducted at a mean age of 9 months (1 day to 12 years) between 2000 and 2022 from four tertiary centers in Thailand. The direct costs, hematologic and clinical complete response (HCR, CCR), hospitalization, length of stay, and complications were compared. Of 29 patients, 13 underwent sirolimus (four upfront and nine were refractory to the conventional). The first-year total cost had no statistically significant difference between sirolimus VS conventional treatment (8,852.63 VS 9,083.56 USD: p value: 0.94). The therapeutics achievement was the same in both HCR (244.75 VS 168.94 days; p value: 0.60) and CCR (419.77 VS 399.87 days; p value: 0.90). The subgroup analysis of the first-line sirolimus (n = 4) compared with the conventional (n = 25) showed a more reduced total cost (4,907.84 VS 9,664.05 USD; p value: 0.26) rendered net total cost of −4,756.21 USD per patient (cost saving). A more significant contrast of therapeutic achievement by reduction of both HCR (11.67 VS 224.20 days; p value: 0.36) and CCR (38.50 VS 470.88 days; p value: 0.04) was shown. The sirolimus had no difference in hospitalization, length of stay, and complications. Even though, it was unable to identify significant differences in cost-effectiveness. Sirolimus is suitable for all patients who have diagnosis of KMP either for rescue therapy or first-line treatment. [ABSTRACT FROM AUTHOR]

Introduction: Cutaneous leishmaniasis is a skin infection caused by a protozoan of the genus Leishmania and it transmitted by female phlebotomus mosquitoes. Military forces staff are part of vulnerable groups with high probability of contracting disease for reasons such as participating in military maneuver, deployment in border areas, outskirts of cities in endemic areas. Some studies show that the incidence rate of cutaneous leishmaniasis among military forces is higher than its incidence rate in the civilian population. The purpose of this study is to acquaint military forces with the epidemiology of the disease, clinical symptoms, vectors, reservoirs, and prevention and treatment methods that can prevent the disease. Methods and Materials: This review article has been performed through searching in national and international reliable databases using cutaneous leishmaniasis, military forces, prevention of cutaneous leishmaniasis, uniforms stained with poison, and skin diseases keywords. Moreover, this research has been done by selecting 76 related articles until April 2024. Results: The most important axis in the control of cutaneous leishmaniasis is camps and maneuver along with other disease control and prevention programs including vaccine and drug production, improving the environment, fighting the vector, exterminating rats, improving awareness about the disease, particularly the ways of transmission and prevention methods such as the importance of using clothes or uniforms impregnated with insect repellants, repellants ointment, insecticides, mosquito nets impregnated with poison and the methods of using them, especially in endemic areas. Having the necessary and correct information is the first and most basic step to take any appropriate behavior to prevent contracting this disease. Teaching preventive behaviors of biting the cutaneous leishmaniasis vector can not only protect people from contracting this disease, but also protect the military in the battle scene against other diseases that the enemy may use insects as biological weapons and disease transmission. Discussion and Conclusion: In order to prevent contracting this disease for the military forces stationed in the barracks of endemic areas or the forces sent to these areas, providing the necessary equipment and health education classes on the topics of enhancing awareness of the methods of disease transmission, the importance of using uniforms impregnated with poisons, using mosquito nets impregnated with poison, using appropriate insect repellants on the skin of the hands, face and uncovered parts of body, particularly during rest and dressing the affected area should be planned and implemented for prevention. [ABSTRACT FROM AUTHOR]

Detecting and identifying small infrared targets has always been a crucial technology for many applications. To address the low accuracy, high false-alarm rate, and poor environmental adaptability that commonly exist in infrared target detection methods, this paper proposes a composite infrared dim and small target detection model called USES-Net, which combines the target prior knowledge and conventional data-driven deep learning networks to make use of both labeled data and the domain knowledge. Based on the typical encoder–decoder structure, USES-Net firstly introduces the self-attention mechanism of Swin Transformer to replace the universal convolution kernel at the encoder end. This helps to extract potential features related to dim, small targets in a larger receptive field. In addition, USES-Net includes an embedded patch-based contrast learning module (EPCLM) to integrate the spatial distribution of the target as a knowledge prior in the training network model. This guides the training process of the constrained network model with clear physical interpretability. Finally, USES-Net also designs a bottom-up cross-layer feature fusion module (AFM) as the decoder of the network, and a data-slicing-aided enhancement and inference method based on Slicing Aided Hyper Inference (SAHI) is utilized to further improve the model's detection accuracy. An experimental comparative analysis shows that USES-Net achieves the best results on three typical infrared weak-target datasets: NUAA-SIRST, NUDT-SIRST, and IRSTD-1K. The results of the target segmentation are complete and sufficient, which demonstrates the validity and practicality of the proposed method in comparison to others. [ABSTRACT FROM AUTHOR]

Malaria rapid diagnostic tests (mRDTs) are an essential diagnostic tool in low-resource settings; however, administration and interpretation errors reduce their effectiveness. HealthPulse, a smartphone mRDT reader application, was developed by Audere to aid health workers in mRDT administration and interpretation, with an aim to improve the mRDT testing process and facilitate timely decision making through access to digitized results. Audere partnered with PSI and PS Kenya to conduct a pilot study in Busia County, Kenya between March and September 2021 to assess the feasibility and acceptability of HealthPulse to support malaria parasitological diagnosis by community health volunteers (CHVs) and private clinic health workers (private clinic HWs). Metadata was interpreted to assess adherence to correct use protocols and health worker perceptions of the app. Changes to mRDT implementation knowledge were measured through baseline and endline surveys. The baseline survey identified clear mRDT implementation gaps, such as few health workers correctly knowing the number of diluent drops and minimum and maximum wait times for mRDT interpretation, although health worker knowledge improved after using the app. Endline survey results showed that 99.6% of health workers found the app useful and 90.1% found the app easy to use. Process control data showed that most mRDTs (89.2%) were photographed within the recommended 30-minute time frame and that 91.4% of uploaded photos passed the app filter quality check on the first submission. During 154 encounters (3.5% of all encounters) a health worker dispensed an artemisinin-based combination therapy (ACT) to their patient even with a negative mRDT readout. Overall, study results indicated that HealthPulse holds potential as a mobile tool for use in low-resource settings, with future supportive supervision, diagnostic, and surveillance benefits. Follow-up studies will aim to more deeply understand the utility and acceptance of the HealthPulse app. [ABSTRACT FROM AUTHOR]

BACKGROUND: The efficacy and safety of non–vitamin-K antagonist oral anticoagulants (NOACs) across the spectrum of body mass index (BMI) and body weight (BW) remain uncertain. METHODS: We analyzed data from COMBINE AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation), which pooled patient-level data from the 4 pivotal randomized trials of NOAC versus warfarin in patients with atrial fibrillation. The primary efficacy and safety outcomes were stroke or systemic embolic events (stroke/SEE) and major bleeding, respectively; secondary outcomes were ischemic stroke/SEE, intracranial hemorrhage, death, and the net clinical outcome (stroke/SEE, major bleeding, or death). Each outcome was examined across BMI and BW. Because few patients had a BMI <18.5 kg/m² (n=598), the primary analyses were restricted to those with a BMI ≥18.5 kg/m². RESULTS: Among 58464 patients, the median BMI was 28.3 (interquartile range, 25.2–32.2) kg/m², and the median BW was 81.0 (interquartile range, 70.0–94.3) kg. The event probability of stroke/SEE was lower at a higher BMI irrespective of treatment, whereas the probability of major bleeding was lower at a higher BMI with warfarin but relatively unchanged across BMI with NOACs. NOACs reduced stroke/SEE overall (adjusted hazard ratio [HRadj], 0.80 [95% CI, 0.73–0.88]; P<0.001), with a generally consistent effect across BMI (Ptrend across HRs, 0.48). NOACs also reduced major bleeding overall (HRadj, 0.88 [95% CI, 0.82–0.94]; P<0.001), but with attenuation of the benefit at a higher BMI (trend test across BMI [Ptrend], 0.003). The overall treatment effects of NOACs versus warfarin for secondary outcomes were consistent across BMI, with the exception of the net clinical outcome and death. While these outcomes were overall reduced with NOACs (net clinical outcome, HRadj, 0.91 [95% CI, 0.87–0.95]; P<0.001; death, HRadj, 0.91 [95% CI, 0.86–0.97]; P=0.003), these benefits were attenuated at higher BMI (Ptrend, 0.001 and 0.08, respectively). All findings were qualitatively similar when analyzed across BW. CONCLUSIONS: The treatment effect of NOACs versus warfarin in atrial fibrillation is generally consistent for stroke/SEE across the spectrum of BMI and BW, whereas the reduction in major bleeding is attenuated in those with higher BMI or BW. Death and the net clinical outcome are overall reduced with NOACs over warfarin, although there remain uncertainties for these outcomes at a very high BMI and BW. [ABSTRACT FROM AUTHOR]

Background: Following WHO guidelines, microscopy is the gold standard for malaria diagnosis in endemic countries. The Parasitology-Mycology laboratory (LPM) is the National Reference Laboratory and is currently undergoing ISO 15189 accreditation. In this context, we assessed the performance of the laboratory by confirming the reliability and the accuracy of results obtained in accordance with the requirements of the ISO 15189 standards. This study aimed to verify the method of microscopic diagnosis of malaria at the LPM, in the Aristide Le Dantec hospital (HALD) in Dakar, Senegal. Methods: This is a validation/verification study conducted from June to August 2020. Twenty (20) microscopic slides of thick/thin blood smear with known parasite densities (PD) selected from the Cheick Anta Diop University malaria slide bank in Dakar were used for this assessment. Six (6) were used to assess microscopists' ability to determine PD and fourteen (14) slides were used for detection (positive vs negative) and identification of parasites. Four (4) LPM-HALD microscopists read and recorded their results on prepared sheets. Data analysis was done with Microsoft Excel 2010 software. Results: A minimum threshold of 50% concordance was used for comparison. Of the twenty (20) slides read, 100% concordance was obtained on eight (8) detection (positive vs negative) slides. Four (4) out of the six (6) parasite density evaluation slides obtained a concordance of less than 50%. Thirteen (13) out of the fourteen (14) identification slides obtained a concordance greater than 50%. Only one (1) identification slide obtained zero agreement from the microscopists. For species identification a concordance greater than 80% was noted and the microscopists obtained scores between 0.20 and 0.4 on a scale of 0 to 1 for parasite density reading. The microscopists obtained 100% precision, sensitivity, specificity and both negative and positive predictive values. Conclusion: This work demonstrated that the microscopic method of malaria diagnosis used in the LPM/HALD is in accordance with the requirements of WHO and ISO 15189. Further training of microscopists may be needed to maintain competency. [ABSTRACT FROM AUTHOR]

The Russia-Ukraine war and other similar conflicts across the globe have heightened risks to the United States of America's (USA's) energy security. However, little is known about the severity of the effect of energy security risks on the USA's quest to attain net-zero emissions targets by 2050. To this end, we examine the effect of energy security risks on the load capacity factor (LCF) in the USA. Employing a time series dataset spinning from 1970 to 2018, the results of the Dynamic Autoregressive Distributed Lag (ARDL) simulations model suggest that energy security-related risk hampers the long-term net-zero emissions targets with its effect decreasing over time until it varnishes in about 5 years time. The results also show that foreign direct investment (FDI) inflows, renewable energy consumption, and green technology have long- and short-run positive effects on the LCF. Conversely, economic expansion and urbanization impede environmental quality by lowering the LCF both in the long run and short run. These findings are upheld by the outcomes of the multivariate quantile-on-quantile regression. Therefore, the study advocates for the consumption of renewable energy, investment in green technologies, and FDI inflows to mitigate energy security-related risks and attain the net-zero emissions targets by 2050 in the USA. [ABSTRACT FROM AUTHOR]

The emergence of High-Throughput Experimentation (HTE) as a powerful tool for reaction discovery and optimization is changing the way organic chemists are designing their experiments. It is a fantastic way to largely investigate a reaction, in a minimum of time and reagent consumption. However, HTE needs to be accessible to a wide audience for a full implementation in academic and industrial sectors. In that context, developing accessible solid dosing methodologies for submilligram dispensing is necessary. This paper aims at proposing robust mass enhancers solutions for nanomole scale dosing applicable to HTE campaigns. [ABSTRACT FROM AUTHOR]

Dengue is a wide spectrum of diseases creating menace in the community. This vector-born disease alone has a significant impact on global public health and the economy. Resources need to be mobilized to tackle the situation. The present article focused on the novice concept of "Seven-Plus-One models" as an approach to dengue prevention with vector management through community participation. A multidisciplinary approach along with exemplifying effective methods of inspectorial coordination and community participation is much required. The implementation of the Seven-Plus-One model has a positive impact on reducing dengue cases, indicating acceptance and effectiveness of the concept among the public. Dengue morbidity rate can be reduced through early detection and mobilizing the community for active participation in dengue prevention and control. [ABSTRACT FROM AUTHOR]

This article discusses the prevention and treatment of postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. The International Federation of Gynecology and Obstetrics (FIGO) provides updated recommendations for the prevention and treatment of PPH, emphasizing the importance of training and access to essential medicines and equipment, particularly in low- and middle-income countries. The article also discusses the use of uterotonics for PPH prevention, as well as various treatment options for PPH, including uterine massage, uterotonics, tranexamic acid, non-pneumatic anti-shock garments, and surgical interventions. Additionally, the article briefly mentions the prevention and treatment of malaria in pregnancy, highlighting the use of sulfadoxine-pyrimethamine (SP) and dihydroartemisinin-piperaquine (DHA/PQP) as potential options. However, the study mentioned in the article found that DHA/PQP was associated with higher rates of adverse pregnancy outcomes compared to SP, suggesting that countries should consider these results before changing their approach to intermittent prophylactic treatment in pregnancy (IPTp). [Extracted from the article]

Load scheduling is an effective way of utilizing loads of smart residential buildings according to the preferences of the inhabitants or grid demands, while reducing the cost of energy. This work proposes objective functions for load scheduling to confine the cost of energy within the consumers' preference range while keeping the load consumption closer to the load demand as possible, to minimize system loss during normal and pandemic condition such as COVID-19 periods, fulfilling the unique features of a net-zero energy building. The proposed objective function is implemented by considering the realistic grid power cost, levelized cost of renewable sources, battery, and incentives offered by the utility system existing in California, USA. In addition to three different types of days such as normal working days, weekends and pandemic situations, brown out power outages are considered as operating conditions. Particle swarm optimization (PSO) is utilized in all considered operating conditions. Two terms that account for the total energy cost savings and the total delayed/scheduled load over a fixed time horizon are formulated as performance indices to illustrate the effectiveness of the proposed objective functions for load scheduling. All of the cases are optimized by the Paticle Swarm Optimization (PSO) and non-optimized systems are simulated in the MATLAB environment. It is evident from the simulation results that the proposed objective function is very efficient in tackling the energy resources, loads and grid power to maximize cost savings and minimize shifting of loads for later hours for normal and pandemic situations in net-zero energy buildings. Moreover, it is equally effective in responding to any emergency situations such as brown out energy crisis situations, which are not considered in the literature so far. In all cases, the performance index also validates the effectiveness of the proposed objective function-based scheduling system for net-zero energy buildings. [ABSTRACT FROM AUTHOR]

Background: Globally, acute malnutrition threatens the lives of several million children under 5 years of age. Malnutrition affects the social, economic, and medical aspects of all countries. In Ethiopia, acute malnutrition is not decreasing at the intended rate for unclear reasons. Objective: This study aimed to assess the burden of acute malnutrition and its associated factors among children under 5 years of age in a rural setting of southern Ethiopia. Methods: A community-based cross-sectional study was conducted from January to March 2022. A multistage sampling technique was used to select 421 children. Mothers/caretakers were interviewed using interviewer-administered questionnaire, while their children's height/length and weight were measured. Logistic regression analyses were used and presented as the crude odds ratio (COR) and adjusted odds ratio (AOR) with their 95% confidence intervals (CI). Results: The burden of acute malnutrition among children under 5 years of age in the study area was 22.6% (95% CI = 18.5-26.8). Fathers with primary education (AOR = 4.48; 95% CI = 1.93-10.39), households with improper solid waste disposal (AOR = 2.54; 95% CI = 1.11-5.82), not usually sleeping under insecticide-treated bed net (ITN) (AOR = 1.79; 95% CI = 1.01-3.19), unacceptable children dietary diversity score (DDS) (AOR = 2.56; 95% CI = 1.28-5.14), and unacceptable household DDS (AOR = 2.26; 95% CI = 1.02-5.00) were factors associated with acute malnutrition. Conclusions: The prevalence of acute malnutrition among children was critically high. Upgrading paternal educational status, encouraging safe solid waste disposal, ensuring consistent use of ITN, and improving both child and household DDS should be stressed. Plain language title: Very High Level of Acute Malnutrition and Related Factors Among Children Under 5 Years in the Rural Parts of Southern Ethiopia Plain language summary: Why was the study done?: Acute malnutrition is a cause of death for several million children under 5 years of age in the world. It affects the social, economic, and medical features of all countries. In Ethiopia, acute malnutrition is not decreasing at the intended rate for unclear reasons. Numerous studies in the country reported varying level on acute malnutrition in spite of similarities in the study area and time. Therefore, this study aimed to find out the level of acute malnutrition and related factors among children under 5 years of age in rural parts of southern Ethiopia. What did the researchers do?: The research team selected 421 representative children and collected information by asking their mothers/caretakers some relevant questions, and by weighing and measuring their height. Then, the collected information was computed by a computer software. What did the researchers find?: One out of 5 children in the rural parts of southern Ethiopia had acute malnutrition. Educational status of fathers, households with inappropriate solid waste, not usually sleeping under mosquito bed net, low level of children and household food variety were factors related to acute malnutrition. What do the findings mean?: The level of acute malnutrition among children in the study area was very high. Educating fathers, encouraging safe solid waste disposal, ensuring consistent use of mosquito bed net, and improving both the level of children and household food variety should be underlined. [ABSTRACT FROM AUTHOR]

A Rift Valley fever (RVF) outbreak occurred in at least five regions of Madagascar in 2021. The aim of this study was to provide an overview of the richness, abundance, ecology, and trophic preferences of mosquitoes in the Mananjary district and to investigate the distribution of mosquitoes that were RT-PCR-positive for RVFV. Three localities were prospected from 26 April to 4 May 2021, using light traps, BG-Sentinel traps baited with an artificial human odor, Muirhead-Thomson pit traps, and indoor pyrethroid spray catches. A total of 2806 mosquitoes belonging to at least 26 species were collected. Of 512 monospecific pools of mosquitoes tested with real-time RT-PCR, RVFV was detected in 37 pools representing 10 mosquito species. The RVFV-positive species were as follows: Aedes albopictus, Ae. argenteopunctatus, Anopheles coustani, An. gambiae s.l., An. mascarensis, An. squamosus/cydippis, Culex antennatus, Cx. decens, Cx. Tritaeniorhynchus, and Uranotaenia spp. Of the 450 tested engorged females, 78.7% had taken a blood meal on humans, 92.9% on cattle, and 71.6% had taken mixed (human–cattle) blood meals. This investigation suggests the potential role of mosquitoes in RVFV transmission within this epizootic/epidemic context and that the human populations at the three study sites were highly exposed to mosquitoes. Therefore, the use of impregnated mosquito nets as an appropriate prevention method is recommended. [ABSTRACT FROM AUTHOR]

Ethiopia has considerable freshwater potential. Currently, the recognized fish diversity in the country's freshwater ecosystem is more than 200. Despite the presence of such high fish diversity with considerable economic returns, ichthyofaunal studies on Ethiopian rivers are scarce. Thus, this study aimed to identify and compare ichthyofaunal diversity and distribution in floodplain rivers of the Abbay and Tekeze Basins, Ethiopia. Fish were collected using gillnets, cast nets, hooks, electrofishing, and mosquito nets and identified to the species level. Gillnets had stretched mesh sizes of 4–14 cm with a panel length of 25–75 m and a width of 1.5–2 m per mesh size. They were set in the afternoon (5:00 p.m.) and lifted the following morning (7:30 a.m.). Immediately after capture, fish were preliminary identified in the field and tagged with proper information (e.g., sampling locality and date of collection). Similar fishing efforts were applied at all sampling sites for two dry and two wet months over a period of two years (2018-2019). In the present study, both alpha and beta diversity indices were also examined. Identification keys and an annotated checklist of species were generated for easy naming of the entire fish species in the basins. In the ichthyological collection, 43 fish species with 11 new records from the Ayima, Gelegu, and Shinfa Rivers were identified. The first two rivers in the Abbay Basin were the richest in species and number of individuals. Gelegu River had the highest abundance as well. Generally, this study was conducted in areas where no fish biodiversity studies have been undertaken, and the results obtained from this study could be important for fish biodiversity conservation. [ABSTRACT FROM AUTHOR]

Older adults are generally amongst the most vulnerable to heat and cold. While temperature-related health impacts are projected to increase with global warming, the influence of population aging on these trends remains unclear. Here we show that at 1.5 °C, 2 °C, and 3 °C of global warming, heat-related mortality in 800 locations across 50 countries/areas will increase by 0.5%, 1.0%, and 2.5%, respectively; among which 1 in 5 to 1 in 4 heat-related deaths can be attributed to population aging. Despite a projected decrease in cold-related mortality due to progressive warming alone, population aging will mostly counteract this trend, leading to a net increase in cold-related mortality by 0.1%–0.4% at 1.5–3 °C global warming. Our findings indicate that population aging constitutes a crucial driver for future heat- and cold-related deaths, with increasing mortality burden for both heat and cold due to the aging population. This study reveals that population aging intensifies heat- and cold-related deaths, more so than climate change, in 50 countries. At 1.53 °C global warming, aging contributes to rising heat-related deaths, offsetting declines in cold related death. [ABSTRACT FROM AUTHOR]

Background: Malaria remains an enduring public health concern in Indonesia, exacerbated by its equatorial climate that fosters the proliferation of Anopheles mosquitoes. This study seeks to assess the performance of the malaria elimination programme comprehensively. Methods: Between May and August 2022, a qualitative study was conducted in Muara Enim Regency, South Sumatra Province, involving 22 healthcare professionals from diverse backgrounds. These informants were strategically chosen for their pivotal roles in providing profound insights into various facets of the malaria elimination programme. This encompasses inputs such as human resources, budgetary allocation, and infrastructural support; processes like case identification and management, capacity enhancement, epidemiological surveillance, prevention measures, outbreak control, and enhanced communication and educational initiatives; and, notably, the programme's outcomes. Data were collected through 3-h Focus Group Discussions (FGDs) divided into two groups, each with 12 participants: healthcare professionals and programme managers. Additionally, in-depth interviews (IDIs) were conducted with ten informants. Employing the Input-Process-Output (IPO) model, this study meticulously analysed the healthcare system dynamics and the interventions' efficacy. Results: The study unveiled many challenges during the input phase, including the absence of entomologists and a shortage of diagnostic tools. Despite these obstacles, it documented remarkable accomplishments in the output domain, marked by significant advancements in the distribution of mosquito nets and the successful implementation of the Early Warning System (EWS). Despite the adversities, the programme has made substantial strides towards malaria elimination. Conclusions: Urgent action is imperative to bolster the effectiveness of the malaria elimination programme. Key measures encompass augmenting the entomologist workforce, optimizing resource allocation, and ensuring stringent adherence to regional regulations. Addressing these concerns will enhance programme efficacy, yielding enduring public health benefits. This research substantially contributes to Indonesia's ongoing malaria elimination endeavours, furnishing actionable insights for programme enhancement. Consequently, this research holds significant importance for the malaria elimination drive. [ABSTRACT FROM AUTHOR]

Background: It was hypothesized that glucose-6-phosphate dehydrogenase (G6PD) deficiency confers a protective effect against malaria infection, however, safety concerns have been raised regarding haemolytic toxicity caused by radical cure with 8-aminoquinolines in G6PD-deficient individuals. Malaria elimination and control are also complicated by the high prevalence of G6PD deficiency in malaria-endemic areas. Hence, accurate identification of G6PD deficiency is required to identify those who are eligible for malaria treatment using 8-aminoquinolines. Methods: The prevalence of G6PD deficiency among 408 Thai participants diagnosed with malaria by microscopy (71), and malaria-negative controls (337), was assessed using a phenotypic test based on water-soluble tetrazolium salts. High-resolution melting (HRM) curve analysis was developed from a previous study to enable the detection of 15 common missense, synonymous and intronic G6PD mutations in Asian populations. The identified mutations were subjected to biochemical and structural characterisation to understand the molecular mechanisms underlying enzyme deficiency. Results: Based on phenotypic testing, the prevalence of G6PD deficiency (< 30% activity) was 6.13% (25/408) and intermediate deficiency (30–70% activity) was found in 15.20% (62/408) of participants. Several G6PD genotypes with newly discovered double missense variants were identified by HRM assays, including G6PD Gaohe + Viangchan, G6PD Valladolid + Viangchan and G6PD Canton + Viangchan. A significantly high frequency of synonymous (c.1311C>T) and intronic (c.1365-13T>C and c.486-34delT) mutations was detected with intermediate to normal enzyme activity. The double missense mutations were less catalytically active than their corresponding single missense mutations, resulting in severe enzyme deficiency. While the mutations had a minor effect on binding affinity, structural instability was a key contributor to the enzyme deficiency observed in G6PD-deficient individuals. Conclusions: With varying degrees of enzyme deficiency, G6PD genotyping can be used as a complement to phenotypic screening to identify those who are eligible for 8-aminoquinolines. The information gained from this study could be useful for management and treatment of malaria, as well as for the prevention of unanticipated reactions to certain medications and foods in the studied population. [ABSTRACT FROM AUTHOR]

The efficient detection of crew overboard behavior has become an important element in enhancing the ability to respond to marine disasters. It remains challenging due to (1) the lack of effective features making feature extraction difficult and recognition accuracy low and (2) the insufficient computing power resulting in the poor real-time performance of existing algorithms. In this paper, we propose a Channel-Time Dense Residual Network (CTDR-Net) for detecting crew overboard behavior, including a Dense Residual Network (DR-Net) and a Channel-Time Attention Mechanism (CTAM). The DR-Net is proposed to extract features, which employs the convolutional splitting method to improve the extraction ability of sparse features and reduce the number of network parameters. The CTAM is used to enhance the expression ability of channel feature information, and can increase the accuracy of behavior detection more effectively. We use the LeakyReLU activation function to improve the nonlinear modeling ability of the network, which can further enhance the network's generalization ability. The experiments show that our method has an accuracy of 96.9%, striking a good balance between accuracy and real-time performance. [ABSTRACT FROM AUTHOR]

Background: Malaria, a disease transmitted by Anopheles mosquitoes, is a major public health problem causing millions of deaths worldwide, mostly among children under the age of 5 years. Biotechnological interventions targeting parasite-vector interactions have shown that the microsporidian symbiont Microsporidia MB has the potential to disrupt and block Plasmodium transmission. Methods: A prospective cross-sectional survey was conducted in Zinder City (Zinder), Niger, from August to September 2022, using the CDC light trap technique to collect adult mosquitoes belonging to the Anopheles gambiae complex. The survey focused on collecting mosquitoes from three neighborhoods of Zinder (Birni, Kangna and Garin Malan, located in communes I, II and IV, respectively). Collected mosquitoes were sorted and preserved in 70% ethanol. PCR was used to identify host species and detect the presence of Microsporidia MB and Plasmodium falciparum infection. Results: Of the 257 Anopheles mosquitoes collected and identified by PCR, Anopheles coluzzii was the most prevalent species, accounting for 97.7% of the total. Microsporidia MB was exclusively detected in A. coluzzii, with a prevalence of 6.8% (17/251) among the samples. No significant difference in prevalence was found among the three neighborhoods. Only one An. coluzzii mosquito tested PCR-positive for P. falciparum. Conclusions: The results confirm the presence of Microsporidia MB in Anopheles mosquitoes in Zinder, Niger, indicating its potential use as a biotechnological intervention against malaria transmission. However, further studies are needed to determine the efficacy of Microsporidia MB to disrupt Plasmodium transmission as well as its impact on vector fitness. [ABSTRACT FROM AUTHOR]

Introduction: In the absence of evidence on the effect of mammographic screening on overall mortality, comparing the number of deaths avoided with the number of deaths caused by screening would be ideal, but the only existing models of this type adopt a very narrow definition of harms. The objective of the present study was to estimate the number of deaths prevented and induced by various mammography screening protocols in Brazil. Methods: A simulation study of cohorts of Brazilian women screened, considering various age groups and screening interval protocols, was performed based on life tables. The number of deaths avoided and caused by screening was estimated, as was the absolute risk reduction, the number needed to invite for screening—NNS, the net benefit of screening, and the ratio of "lives saved" to "lives lost". Nine possible combinations of balances between benefits and harms were performed for each protocol, in addition to other sensitivity analyses. Results and conclusions: The most efficient protocol was biennial screening from 60 to 69 years of age, with almost three times more deaths avoided than biennial screening from 50 to 59 years of age, with a similar number of deaths avoided by biennial screening from 50 to 69 years of age and with the greatest net benefit. Compared with the best scenario of annual screening from 40 to 49 years of age, the NNS of the protocol with biennial screening from 60 to 69 years of age was three-fold lower. Even in its best scenario, the addition of annual screening from 40 to 49 years of age to biennial screening from 50 to 69 years of age results in a decreased net benefit. However, even in the 50–69 year age group, the estimated reduction in breast cancer mortality for Brazil was half that estimated for the United Kingdom. [ABSTRACT FROM AUTHOR]

Background Owing to the increased cases of malaria in older children, the World Health Organization has recently recommended extending seasonal malaria chemoprevention (SMC) to children >5 years of age and using other effective drugs for malaria. In this study, we report the safety and efficacy of dihydroartemisinin-piperaquine (DHA-PQ) for SMC in school-aged children in Mali. Method This randomized, controlled trial included 345 participants aged 6–15 years randomized to receive DHA-PQ, sulfadoxine-pyrimethamine plus amodiaquine (SP-AQ), or no chemoprevention (albendazole) at a 1:1:1 ratio. Four rounds of SMC were conducted from September to December 2021. The participants were assessed 7 days after each round for safety and efficacy of the interventions. Results Abdominal pain (11.8% vs 29.2%), headache (11.2% vs 19.2%), and vomiting (5.7% vs 15.2%) were frequently reported in the DHA-PQ and SP-AQ arms. On Day 120 of follow up, the incidence of clinical malaria was 0.01 episodes/person-month in the DHA-PQ and SP-AQ arms and 0.17 episodes/person-month in the control arm (P <.0001). Gametocytes were detected in 37 participants in all arms. Conclusions Children in DHA-PQ arm reported less adverse events compared to the SP-AQ arm. Both drugs were effective against clinical malaria and infection. [ABSTRACT FROM AUTHOR]

Background: Long-lasting insecticidal nets (LLINs) may have different impacts on distinct mosquito vector species. We assessed the efficacy of pyrethroid-pyriproxyfen and pyrethroid-chlorfenapyr LLINs on the density of Anopheles gambiae s.s. and An. coluzzii compared to pyrethroid-only nets in a three-arm cluster randomised control trial in Benin. Methods: Indoor and outdoor collections of adult mosquitoes took place in 60 clusters using human landing catches at baseline and every 3 months for 2 years. After morphological identification, around 15% of randomly selected samples of An. gambiae s.l. were dissected to determine parity, species (using PCR). Results: Overall, a total of 46,613 mosquito specimens were collected at baseline and 259,250 in the eight quarterly collections post-net distribution. Post-net distribution, approximately 70% of the specimens of An. gambiae s.l. speciated were An. coluzzii, while the rest were mostly composed of An. gambiae s.s. with a small proportion (< 1%) of hybrids (An. gambiae/coluzzii). There was no evidence of a significant reduction in vector density indoors in either primary vector species [An. coluzzii: DR (density ratio) = 0.62 (95% CI 0.21–1.77), p = 0.3683 for the pyrethroid-pyriproxyfen LLIN and DR = 0.56 (95% CI 0.19–1.62), p = 0.2866 for the pyrethroid-chlorfenapyr LLIN, An. gambiae s.s.: DR = 0.52 (95% CI 0.18–1.46), p = 0.2192 for the pyrethroid-pyriproxyfen LLIN and DR = 0.53 (95% CI 0.19–1.46), p = 0.2222 for the pyrethroid-chlorfenapyr]. The same trend was observed outdoors. Parity rates of An. gambiae s.l. were also similar across study arms. Conclusions: Compared with pyrethroid-only LLINs, pyrethroid-chlorfenapyr LLINs and pyrethroid-pyriproxyfen LLINs performed similarly against the two primary mosquito species An. gambiae s.s. and An. coluzzii in Benin. [ABSTRACT FROM AUTHOR]

Background: The revision knee complexity classification (RKCC) stratifies knee revision operations depending on their level of complexity from simple revisions (R1) to highly complex cases (R3). Current financial codes used for calculation of reimbursement for knee revision services provided at the Trust, rely on patients' comorbidities. However, previous research has demonstrated that this approach may not yield an accurate financial account of knee revision arthroplasty cost. This is a single centre study from a secondary and tertiary revision unit, with work previously presented by the authors demonstrating that the majority of complex revision knee replacement within the region, take place in this unit. The aims of this study were to illustrate the current cost profile and renumeration service currently in place for revision knee and show the differences in cost based on complexity of the operation. Methods: In this retrospective study, 90 cases who underwent revision knee operations in 2019 were analysed. Data was obtained from a tertiary referral centre where the episodes had occurred. Mean cost, tariff, and subsequent deficit were calculated for the R1, R2 and R3 episodes. Results: R2 and R3 episodes were significantly more expensive than R1 episodes. The increase in cost between R3 and R2 episodes was not significant. The total cost of the revision operations was £1,162,343. Tariffs received for R2 and R3 revision operations were significantly more expensive than R1 operations. However, the increase in tariffs received for R3 operations was not significant in relation to R2 operations. The total amount of tariffs received by the Trust was £ 770,996 generating a net deficit of - £ 391,347. Conclusion: Current financial coding for revision knee does not accurately predict costs associated with revision knee surgery. Net deficit varies depending on the RKCC grade of the knee revision episode with more complex operations resulting in a higher mean net deficit. Implementation of the RKCC could prove to be a useful tool in generating an accurate prediction of the cost associated with knee revision surgery. [ABSTRACT FROM AUTHOR]

Seasonal vaccination with the RTS,S/AS01 E vaccine combined with seasonal malaria chemoprevention (SMC) prevented malaria in young children more effectively than either intervention given alone over a 3 year period. The objective of this study was to establish whether the added protection provided by the combination could be sustained for a further 2 years. This was a double-blind, individually randomised, controlled, non-inferiority and superiority, phase 3 trial done at two sites: the Bougouni district and neighbouring areas in Mali and Houndé district, Burkina Faso. Children who had been enrolled in the initial 3-year trial when aged 5–17 months were initially randomly assigned individually to receive SMC with sulphadoxine-pyrimethamine and amodiaquine plus control vaccines, RTS,S/AS01 E plus placebo SMC, or SMC plus RTS,S/AS01 E. They continued to receive the same interventions until the age of 5 years. The primary trial endpoint was the incidence of clinical malaria over the 5-year trial period in both the modified intention-to-treat and per-protocol populations. Over the 5-year period, non-inferiority was defined as a 20% increase in clinical malaria in the RTS,S/AS01 E -alone group compared with the SMC alone group. Superiority was defined as a 12% difference in the incidence of clinical malaria between the combined and single intervention groups. The study is registered with ClinicalTrials.gov , NCT04319380 , and is complete. In April, 2020, of 6861 children originally recruited, 5098 (94%) of the 5433 children who completed the initial 3-year follow-up were re-enrolled in the extension study. Over 5 years, the incidence of clinical malaria per 1000 person-years at risk was 313 in the SMC alone group, 320 in the RTS,S/AS01 E -alone group, and 133 in the combined group. The combination of RTS,S/AS01 E and SMC was superior to SMC (protective efficacy 57·7%, 95% CI 53·3 to 61·7) and to RTS,S/AS01 E (protective efficacy 59·0%, 54·7 to 62·8) in preventing clinical malaria. RTS,S/AS01 E was non-inferior to SMC (hazard ratio 1·03 [95% CI 0·95 to 1·12]). The protective efficacy of the combination versus SMC over the 5-year period of the study was very similar to that seen in the first 3 years with the protective efficacy of the combination versus SMC being 57·7% (53·3 to 61·7) and versus RTS/AS01 E -alone being 59·0% (54·7 to 62·8). The comparable figures for the first 3 years of the study were 62·8% (58·4 to 66·8) and 59·6% (54·7 to 64·0%), respectively. Hospital admissions for WHO-defined severe malaria were reduced by 66·8% (95% CI 40·3 to 81·5), for malarial anaemia by 65·9% (34·1 to 82·4), for blood transfusion by 68·1% (32·6 to 84·9), for all-cause deaths by 44·5% (2·8 to 68·3), for deaths excluding external causes or surgery by 41·1% (−9·2 to 68·3), and for deaths from malaria by 66·8% (−2·7 to 89·3) in the combined group compared with the SMC alone group. No safety signals were detected. Substantial protection against malaria was sustained over 5 years by combining seasonal malaria vaccination with seasonal chemoprevention, offering a potential new approach to malaria control in areas with seasonal malaria transmission. UK Joint Global Health Trials and PATH's Malaria Vaccine Initiative (through a grant from the Bill & Melinda Gates Foundation). For the French translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

This cross-sectional study examined malaria awareness and prevention practices among 245 tribal inhabitants in the Koraput district of Odisha, a region highly affected by malaria. Data regarding knowledge, attitudes, and practices related to malaria were collected using structured questionnaires. The study found that the community had moderate levels of awareness and understanding about malaria, with an average knowledge score of 67%. Males had slightly higher knowledge scores compared to females. The attitude score was 80.57%, indicating a generally positive mindset towards malaria prevention. In terms of practices, the score was 78.67%, reflecting a fair adoption of preventive measures like mosquito net usage and maintenance of environmental cleanliness. The study emphasized the crucial role of health workers as the primary source of information about malaria prevention. However, it also identified gaps in women's understanding of malaria symptoms and transmission, as well as the limited diversity in information channels. The findings suggest the need for more targeted educational initiatives and community-centric health strategies to enhance overall health practices in tribal communities affected by malaria. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) endoscopy is among the highest waste generator in healthcare facilities. The major reasons include production of large‐volume non‐renewable waste, use of single‐use devices, and reprocessing or decontamination processes. Single‐use endoscopic accessories have gradually replaced reusable devices over last two decades contributing to the rising impact of GI endoscopy on ecosystem. Several reports of infection outbreaks with reusable duodenoscopes raised concerns regarding the efficacy and adherence to standard disinfection protocols. Even the enhanced reprocessing techniques like double high‐level disinfection have not been found to be the perfect ways for decontamination of duodenoscopes and therefore, paved the way for the development of single‐use duodenoscopes. However, the use of single‐use endoscopes is likely to amplify the net waste generated and carbon footprint of any endoscopy unit. Moreover, single‐use devices challenge one of the major pillars of sustainability, that is, "reuse." In the era of climate change, a balanced approach is required taking into consideration patient safety as well as financial and environmental implications. The possible solutions to provide optimum care while addressing the impact on climate include selective use of disposable duodenoscopes and careful selection of accessories during a case. Other options include use of disposable endcaps and development of effective high‐level disinfection techniques. The collaboration between the healthcare professionals and the manufacturers is paramount for the development of environmental friendly devices with low carbon footprint. [ABSTRACT FROM AUTHOR]

In Sub‑Saharan African (SSA) countries the main channels of morbidity and mortality are preventable and treatable diseases. Yet, SSA countries invest little in preventive healthcare. Literature has shown that providing health information can have an impact on health behaviors. The arrival of optic fiber submarine cables in 2010 brought broadband connectivity to Senegal, allowing access to healthcare information online. Using the Demographic and Health Surveys datasets combined with the Afterfibre database, and a difference‑in‑differences methodology, this study aims to assess the impact of the arrival of broadband internet on preventive health behaviors in Senegal. Broadband access is found to be positively associated with the use of bed‑ net, mixed results are found regarding the use of antenatal care and child immunization. If the positive impacts of internet access are confirmed, the expansion of broadband internet could be important to improve health. [ABSTRACT FROM AUTHOR]

The text discusses the development and implementation of pre-erythrocytic malaria vaccines, focusing on RTS,S/AS01 and R21/Matrix-M. These vaccines target different stages of the malaria parasite life cycle and have shown promising efficacy in preventing malaria illness. The WHO has recommended both vaccines for children in high-transmission settings, marking significant progress in malaria vaccine development. Other vaccine candidates, such as mRNA-based vaccines and whole sporozoite approaches, are also being explored, offering hope for further advancements in malaria prevention. [Extracted from the article]

Background Malaria remains one of the deadliest diseases worldwide, especially among young children in sub-Saharan Africa. Predictive models are necessary for effective planning and resource allocation; however, statistical models suffer from association pitfalls. In this study, we used empirical dynamic modelling (EDM) to investigate causal links between climatic factors and intervention coverage with malaria for short-term forecasting. Methods Based on data spanning the period from 2008 to 2022, we used convergent cross-mapping (CCM) to identify suitable lags for climatic drivers and investigate their effects, interaction strength, and suitability ranges on malaria incidence. Monthly malaria cases were collected at St. Elizabeth Lwak Mission Hospital. Intervention coverage and population movement data were obtained from household surveys in Asembo, western Kenya. Daytime land surface temperature (LSTD), rainfall, relative humidity (RH), wind speed, solar radiation, crop cover, and surface water coverage were extracted from remote sensing sources. Short-term forecasting of malaria incidence was performed using state-space reconstruction. Results We observed causal links between climatic drivers, bed net use, and malaria incidence. LSTD lagged over the previous month; rainfall and RH lagged over the previous two months; and wind speed in the current month had the highest predictive skills. Increases in LSTD, wind speed, and bed net use negatively affected incidence, while increases in rainfall and humidity had positive effects. Interaction strengths were more pronounced at temperature, rainfall, RH, wind speed, and bed net coverage ranges of 30–35°C, 30–120 mm, 67–80%, 0.5–0.7 m/s, and above 90%, respectively. Temperature and rainfall exceeding 35°C and 180 mm, respectively, had a greater negative effect. We also observed good short-term predictive performance using the multivariable forecasting model (Pearson correlation coefficient=0.85, root mean square error=0.15). Conclusions Our findings demonstrate the utility of CCM in establishing causal linkages between malaria incidence and both climatic and non-climatic drivers. By identifying these causal links and suitability ranges, we provide valuable information for modelling the impact of future climate scenarios. [ABSTRACT FROM AUTHOR]

After adopting the Paris Agreement, many countries (including developing countries) have started to develop targets aimed at achieving net-zero emissions to realize a "decarbonized society" in response to the 1.5 °C target. Effective plans and actions need to be urgently developed on how to achieve the ambitious targets associated with these targets, but not many countries have developed long-term strategies to achieve net zero emissions. The Asia–Pacific Integrated Model (AIM) team has been working with researchers and policymakers in Japan and other Asian countries to develop a long-term strategy toward a decarbonized society. Asia is a region with diverse countries, and there are many different pathways to achieve decarbonized societies. This paper presents the process of developing a long-term strategy for several Asian countries based on our experiences to date and discusses challenges and solutions, including how to use the AIM models in the policy-making process. [ABSTRACT FROM AUTHOR]

The article focuses on the unintended negative consequences of health-care policies and initiatives. Topics discussed include main reasons for the occurrence of unintended adverse consequences (UACs), one of the key drivers of UACs, according to Professor of Evidence Policy at the London School of Hygiene and Tropical Medicine, Kathryn Oliver, and scope for more methodological approaches to mitigating unintended consequences according to Oliver.

Introduction: Malaria is one of the most prevalent infectious diseases in subSaharan Africa, with 247 million cases reported worldwide in 2021 according to the World Health Organization. Optical microscopy remains the gold standard technique for malaria diagnosis, however, it requires expertise, is time-consuming and difficult to reproduce. Therefore, new diagnostic techniques based on digital image analysis using artificial intelligence tools can improve diagnosis and help automate it. Methods: In this study, a dataset of 2571 labeled thick blood smear images were created. YOLOv5x, Faster R-CNN, SSD, and RetinaNet object detection neural networks were trained on the same dataset to evaluate their performance in Plasmodium parasite detection. Attention modules were applied and compared with YOLOv5x results. To automate the entire diagnostic process, a prototype of 3D-printed pieces was designed for the robotization of conventional optical microscopy, capable of auto-focusing the sample and tracking the entire slide. Results: Comparative analysis yielded a performance for YOLOv5x on a test set of 92.10% precision, 93.50% recall, 92.79% F-score, and 94.40% mAP0.5 for leukocyte, early and mature Plasmodium trophozoites overall detection. F-score values of each category were 99.0% for leukocytes, 88.6% for early trophozoites and 87.3% for mature trophozoites detection. Attention modules performance show non-significant statistical differences when compared to YOLOv5x original trained model. The predictive models were integrated into a smartphone-computer application for the purpose of image-based diagnostics in the laboratory. The system can perform a fully automated diagnosis by the auto-focus and X-Y movements of the robotized microscope, the CNN models trained for digital image analysis, and the smartphone device. The new prototype would determine whether a Giemsa-stained thick blood smear sample is positive/negative for Plasmodium infection and its parasite levels. The whole system was integrated into the iMAGING smartphone application. Conclusion: The coalescence of the fully-automated system via auto-focus and slide movements and the autonomous detection of Plasmodium parasites in digital images with a smartphone software and AI algorithms confers the prototype the optimal features to join the global effort against malaria, neglected tropical diseases and other infectious diseases. [ABSTRACT FROM AUTHOR]

Background: HIV and malaria are serious public health concerns, particularly in Tanzania. HIV-infected individuals are more likely to get malaria and its complications. However, data on the interaction of the two diseases in Tanzania are limited. This cross-sectional study aimed to determine the prevalence of malaria infection and associated factors among HIV-infected adults attending HIV care and treatment clinic at Kitete regional referral hospital in Tabora region, Tanzania. Methodology: The cross-sectional study was carried out between March and May 2022 at Kitete regional referral hospital in Tanzania. A total of 246 HIV-infected adults were selected by systematic random sampling. Malaria was diagnosed using both malaria rapid diagnostic test (mRDT) and malaria microscopy. Social demographic data were collected using a structured questionnaire, while clinical history and laboratory parameters were extracted from patients' files. Data were analyzed using STATA version 15.1, and a p value < 0.05 was considered statistically significant. The study included consenting HIV+ adults and excluded pregnant women and recent antimalarial users. Results: Twenty-six out of 242 participants 10.7% (95% CI 6.9–15.6%) tested positive for malaria using mRDT, while 20 out of 242 participants 8.3% (95% CI 4.9–13.1%) tested positive for malaria using blood smear for malaria microscopy. Independent factors associated with malaria infection were living in rural areas (aOR = 2.81, 95% CI = 1.06–7.45, p = 0.038), poor adherence to anti-retroviral therapy (aOR = 3.66, 95% CI = 1.04–12.7, p = 0.043), HIV viral load of ≥ 1000 copies/mL (aOR = 3.2, 95% CI = 1.00–10.5, p = 0.02, CD4 count ≤ 350 cells/µL (aOR = 2.8, 95% CI = 1.10–7.30, p = 0.03), while using mosquito nets (aOR = 0.27, 95% CI = 0.08–0.90, p = 0.033) and receiving health education (aOR = 0.26, 95% CI = 0.09–0.71, p = 0.009) were protective factors. Conclusions: The study reveals a concerning prevalence of malaria infection among adult HIV patients at Kitete regional referral hospital. Risk factors identified include a high HIV viral load, low CD4 count, lack of health education, rural residence, and non-use of mosquito nets. The results emphasize the necessity for focused health education, enhanced access to preventive measures, and consistent adherence to ART to reduce the risk of malaria in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are two core interventions for control and prevention of malaria infection. This descriptive cross-sectional study aimed to determine the knowledge and practices of women regarding malaria and its preventive measures in a malarious area in the Jask County, southeast of Iran. Methods: Data was collected from 400 households through a two-stage random cluster sampling method in six villages. Pre-tested structured questionnaire was used to collect data. During the survey, visual observations were also made by the interviewers to check use of LLINs and IRS. The data were analyzed by SPSS software version 21. Results: The majority of households had a high level of knowledge about symptoms (98%, n=392) and transmission (74.5%, n=298) of malaria. The main preventive measures against malaria were: LLINS (39.5%, n=158), IRS (32%, n=128), and screens on doors/windows (16.7%, n=67). In addition, participants with primary or higher educational level reported that they practice more malaria preventive measures, compared to those who were illiterate (OR=3.3, 95% CI= 1.6–6.6, p=0.0001, Table 6). In spite of positive perceptions about IRS and LLINs, only 35.5% (n=142) and 17% (n=68) of households used IRS and LLINs, respectively. Conclusion: According to the results of this study, despite a high level of knowledge about malaria and its preventive measures, a small number of participants use LLINs and IRS for malaria prevention. Therefore, implementation of effective educational interventions is recommended to improve preventive practices against malaria in the study area. [ABSTRACT FROM AUTHOR]

Concerns about climate change and energy security are driving a global shift towards renewable energy sources and green technologies such as electric vehicles (EVs), energy storage and wind turbines. This commentary analyses the policy challenges raised by the growing demand for critical metals needed for this green transition to net zero. It is crucial that the UK's strategy looks beyond merely increasing primary supply or new mining, towards strategies to ensure better stewardship of secondary mineral resources already contained in a range of products. Furthermore, creating an enabling regulatory environment for procuring key technology metals will be key to addressing future supply threats for the UK, especially post-Brexit, and that failure to do so will put the UK at significant risk of falling behind in the global race to secure supplies. [ABSTRACT FROM AUTHOR]

Mobile phone interviews are becoming an increasingly appealing mode of data collection in low- and middle-income countries. Therefore, we used data from 36 countries to examine mobile phone coverage of adults aged 15–49 years. We paid special attention to the (1) coverage rate (percentage of individuals who own at least one mobile phone) versus penetration rate (mobile phone subscriptions per 100 inhabitants), and (2) proxy-covered population (i.e. persons who do not own mobile phones but are potentially accessible through devices owned by other household members). Study findings suggest that (1) penetration rates notably overestimate mobile phone coverage of the population; (2) mobile phone coverage structure varies substantially; (3) mobile phone owners are more likely to be males, urban residents, literate, married, and relatively wealthy; and (4) proxy-covered adults are distinct with regard to demographic characteristics and survey outcomes in comparison to directly covered and not-covered adults. This study informs practitioners about the current coverage structure in several low- and middle-income countries and promotes proper procedures for studying coverage structure before implementing mobile phone interviews in those countries. Finally, this study introduces the term proxy-coverage and advocates for approaching the proxy-covered population to reduce noncoverage bias, especially in settings where mobile phone sharing among family members is common. [ABSTRACT FROM AUTHOR]

Purpose: Anaemia remains a serious concern among pregnant women, and thus, it is closely monitored from the onset of pregnancy through to delivery to help prevent adverse maternal and neonatal outcomes. In malaria-endemic settings, continuous low-level carriage of P.falciparum parasites is common and its contribution to maternal anaemia should not be underestimated. In this study, we evaluated the impact of adherence to malaria control measures [number of antenatal clinics (ANC) attended, supervised intake of sulphadoxine pyrimethamine (SP), and use of insecticide treated bed nets (ITNs)] on asymptomatic malaria and anaemia outcomes among pregnant women on ANC in hospitals in the Central region of Ghana. Methods: The study was conducted during two seasons; October–November 2020 (dry season, n = 124) and May–June 2021 (rainy season, n = 145). Among the women, there was a high adherence to the control measures for both seasons (ANC ≥ 3 visits; ~ 82.0%, intake of SP; ~ 80.0% and ITNs use; ~ 75.0%). Results: Asymptomatic P. falciparum carriage was high for both seasons (44.4% for the dry season; 46.9% for the rainy season). Correspondingly, the occurrence of anaemia was high for both seasons (57.3% for the dry season; 68.3% for the rainy season) and was strongly predicted by carriage of P. falciparum parasites. Despite the high adherence to ANC protocols, asymptomatic P. falciparum infection was common and contributed to the high burden of maternal anaemia. Conclusions: Our findings emphasize the need for improved control measures that can clear asymptomatic/sub-microscopic P. falciparum infection and protect against malaria-induced anaemia among pregnant women attending ANC in malaria endemic-settings. [ABSTRACT FROM AUTHOR]

Background World Health Organization recommend the use of malaria vaccine, Mosquirix, as a malaria prevention strategy. However, Mosquirix has failed to reduce the global burden of malaria because of its inefficacy. The Mosquirix vaccine's modest effectiveness against malaria, 36% among kids aged 5 to 17 months who need at least four doses, fails to aid malaria eradication. Therefore, highly effective and efficacious malaria vaccines are required. The well-characterized P. falciparum circumsporozoite surface protein can be used to discover adjuvants that can increase the efficacy of Mosquirix. Therefore, the study sought to undertake an in-silico discovery of Plasmodium falciparum circumsporozoite surface protein inhibitors with pharmacological properties on Mosquirix using hierarchical virtual screening and molecular dynamics simulation. Results Monoclonal antibody L9, an anti-Plasmodium falciparum circumsporozoite surface protein molecule, was used to identify Plasmodium falciparum circumsporozoite surface protein inhibitors with pharmacological properties on Mosquirix during a virtual screening process in ZINCPHARMER that yielded 23 hits. After drug-likeness and absorption, distribution, metabolism, excretion, and toxicity property analysis in the SwissADME web server, only 9 of the 23 hits satisfied the requirements. The 9 compounds were docked with Plasmodium falciparum circumsporozoite surface protein using the PyRx software to understand their interactions. ZINC25374360 (-8.1 kcal/mol), ZINC40144754 (-8.3 kcal/mol), and ZINC71996727 (-8.9 kcal/mol) bound strongly to Plasmodium falciparum circumsporozoite surface protein with binding affinities of less than -8.0 kcal/mol. The stability of these molecularly docked Plasmodium falciparum circumsporozoite surface protein-inhibitor complexes were assessed through molecular dynamics simulation using GROMACS 2022. ZINC25374360 and ZINC71996727 formed stable complexes with Plasmodium falciparum circumsporozoite surface protein. They were subjected to in vitro validation for their inhibitory potential. The IC50 values ranging between 250 and 350 ng/ml suggest inhibition of parasite development. Conclusion Therefore, the two Plasmodium falciparum circumsporozoite surface protein inhibitors can be used as vaccine adjuvants to increase the efficacy of the existing Mosquirix vaccine. Nevertheless, additional in vivo tests, structural optimization studies, and homogenization analysis are essential to determine the anti-plasmodial action of these adjuvants in humans. [ABSTRACT FROM AUTHOR]

Background: Neuroendocrine tumors (NETs) early diagnosis is a clinical challenge that require a deep understanding of molecular and genetic features of this heterogeneous group of neoplasms. However, few biomarkers exist to aid diagnosis and to predict prognosis and treatment response. In the oncological field, tumor-educated platelets (TEPs) have been implicated as central players in the systemic and local responses to tumor growth, thereby altering tumor specific RNA profile. Although TEPs have been found to be enriched in RNAs, few studies have investigated the potential of a type of RNA, circular RNAs (circRNA), as platelet-derived biomarkers for cancer. In this proof-of-concept study, we aim to demonstrate whether the circRNAs signature of tumor educated platelets can be used as a liquid biopsy biomarker for the detection of gastroenteropancreatic (GEP)-NETs and the prediction of the early response to treatment. Methods: We performed a 24-months, prospective proof-of-concept study in men and women with histologically proven well-differentiated G1-G2 GEP-NET, aged 18–80 years, naïve to treatment. We performed a RNAseq analysis of circRNAs obtained from TEPs samples of 10 GEP-NETs patients at baseline and after 3 months from therapy (somatostatin analogs or surgery) and from 5 patients affected by non-malignant endocrinological diseases enrolled as a control group. Results: Statistical analysis based on p < 0.05 resulted in the identification of 252 circRNAs differentially expressed between GEP-NET and controls of which 109 were up-regulated and 143 were down-regulated in NET patients. Further analysis based on an FDR value ≤ 0.05 resulted in the selection of 5 circRNAs all highly significant downregulated. The same analysis on GEP-NETs at baseline and after therapy in 5 patients revealed an average of 4983 remarkably differentially expressed circRNAs between follow-up and baseline samples of which 2648 up-regulated and 2334 down-regulated, respectively. Applying p ≤ 0.05 and FDR ≤ 0.05 filters, only 3/5 comparisons gave statistically significant results. Conclusions: Our findings identified for the first time a circRNAs signature from TEPs as potential diagnostic and predictive biomarkers for GEP-NETs. [ABSTRACT FROM AUTHOR]

Background: Pyrethroid-PBO nets have demonstrated improved impact against clinical malaria transmitted by pyrethroid resistant mosquito vectors and are being scaled up across Africa. However very little is known about their physical and insecticidal durability under operational conditions. This study will investigate the attrition, fabric integrity, insecticide content and bioefficacy of DuraNet® Plus, a new WHO prequalified alphacypermethrin and PBO incorporated net developed by Shobikaa Impex Private Limited over 3 years of field use in communities in Benin, Cameroon and Tanzania. Methods: The study will be conducted in parallel in selected villages in Zakpota District in Benin, Mbalmayo, District in Cameroon and Muheza District in Tanzania. In each country, ~ 1800 households will be recruited and randomised to receive DuraNet® Plus or DuraNet® (a WHO prequalified alphacypermethrin-only ITN). Follow up surveys will be performed at 1 month post distribution to investigate adverse events and subsequently every 6–12 months to assess ITN attrition and fabric integrity following standard WHO procedures. A second cohort of nets will be withdrawn every 6–12 months and assessed for alpha-cypermethrin and PBO content and for entomological activity in laboratory bioassays (cone bioassays and tunnel tests). Alpha-cypermethrin bioefficacy will be monitored using the susceptible Anopheles gambiae Kisumu strain in cone bioassays while PBO bioefficacy will be monitored using pyrethroid resistant strains with overexpressed P450 enzymes in tunnel tests to determine the proportion of efficacious nets (≥ 95% knockdown, ≥ 80% mortality or ≥ 90% blood feeding inhibition in tunnels) at each time point. Nets withdrawn at 12, 24 and 36 months from each country will also be tested in experimental hut trials against wild free-flying pyrethroid resistant Anopheles gambiae sl in Côvè Benin to investigate the superiority of DuraNet® Plus over DuraNet® at each time point under semi field conditions. Conclusion: This large-scale multi country trial will provide useful information on the durability of a pyrethroid-PBO net (DuraNet® Plus) in 3 different regions in sub-Saharan Africa. The methods proposed for bioefficacy testing could also contribute towards the development of new standardised guidelines for monitoring the insecticidal efficacy of pyrethroid-PBO nets under operational conditions. [ABSTRACT FROM AUTHOR]

Background: The overlap in the epidemiology of malaria and helminths has been identified as a potential area to exploit for the development of an integrated control strategy that may help to achieve elimination of malaria and helminths. A randomized, controlled, observer-blind trial was conducted to assess the feasibility and safety of combining mass drug administration (MDA) for schistosomiasis and soil transmitted helminths (STH) with seasonal malaria chemoprevention (SMC) among children living in Senegal. Methods: Female and male children aged 1–14 years were randomized 1:1:1, to receive Vitamin A and Zinc on Day 0, followed by SMC drugs (sulfadoxine-pyrimethamine and amodiaquine) on Days 1–3 (control group); or praziquantel and Vitamin A on Day 0, followed by SMC drugs on Days 1–3 (treatment group 1); or albendazole and praziquantel on Day 0, followed by SMC drugs on Days 1–3 (treatment group 2). Safety assessment was performed by collecting adverse events from all children for six subsequent days following administration of the study drugs. Pre- and post-intervention, blood samples were collected for determination of haemoglobin concentration, malaria microscopy, and PCR assays. Stool samples were analyzed using Kato-Katz, Merthiolate-iodine-formalin and PCR methods. Urine filtration, PCR and circulating cathodic antigen tests were also performed. Results: From 9 to 22 June 2022, 627 children aged 1–14 years were randomized into the three groups described above. Mild, transient vomiting was observed in 12.6% (26/206) of children in treatment group 2, in 10.6% (22/207) in group 1, and in 4.2% (9/214) in the control group (p = 0.005). Pre-intervention, the geometric mean value of Plasmodium falciparum parasite density was highest among children who received albendazole, praziquantel with SMC drugs. Post-intervention, the parasite density was highest among children who received SMC drugs only. Children who received praziquantel and SMC drugs had a lower risk of developing severe anaemia than their counterparts who received SMC drugs alone (OR = 0.81, 95% CI 0.13–5.00, p = 0.63). Conclusions: Integration of MDA for helminths with SMC drugs was safe and feasible among Senegalese children. These findings support further evaluation of the integrated control model. Trial registration: The study is registered at Clinical Trial.gov NCT05354258. [ABSTRACT FROM AUTHOR]

The wealth-health relationship is not unambiguous and constant. Greater wealth affects individual and population health in opposite ways. Increased risk factors especially raise the probability of noncommunicable diseases (NCDs) impacting a population. Conversely, better healthcare and awareness reduce the chances of developing these diseases or increase the likelihood of treatment and cure. Therefore, this paper aims to assess and quantify the hard-to-grasp overall impact of prosperity on mortality from selected NCDs, allowing us to capture the relevant differences between European regions. In particular, we attempt to estimate the net effect of affluence and the health economic threshold of the GDP-mortality relationship, by developing a dedicated analytical tool based on joinpoint regression and forecasting methods. Our results show that in the case of most investigated diseases in more impoverished regions, a clear pattern reflects mortality rising with prosperity. After crossing the health economic threshold of around 20 thousand euros per capita, the trend changes by stabilising or reversing. The research we present shows that health policy should be more diversified locally to enable health convergence at the national and European regional levels. Moreover, health policy should evolve to prioritise mental and neurological disorders, by improving the resource allocation and increasing public awareness. [ABSTRACT FROM AUTHOR]