Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali.

IntroductionModerate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6-35 months of age in Mali.MethodsWe conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn-soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal-legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.ResultsCompared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.ConclusionMAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.Trial registrationNCT01015950

Understanding the role of MAM molecular weight in the production of PMMA/MAM nanocellular polymers

Nanostructured polymer blends with CO2-philic domains can be used to produce nanocellular materials with controlled nucleation. It is well known that this nanostructuration can be induced by the addition of a block copolymer poly(methyl methacrylate)-poly(butyl acrylate)-poly(methyl methacrylate) (MAM) to a poly(methyl methacrylate) (PMMA) matrix. However, the effect of the block copolymer molecular weight on the production of nanocellular materials is still unknown. In this work, this effect is analysed by using three types of MAM triblock copolymers with different molecular weights, and a fixed blend ratio of 90 wt% PMMA and 10 wt% of MAM. Blends were produced by extrusion. As a result of the extrusion process, a non-equilibrium nanostructuration takes place in the blends, and the micelle density increases as MAM molecular weight increases. Micelle formation is proposed to occur as result of two mechanisms: dispersion, controlled by the extrusion parameters and the relative viscosities of the polymers, and self-assembly of MAM molecules in the dispersed domains. On the other hand, in the nanocellular materials produced with these blends, cell size decreases from 200 to 120 nm as MAM molecular weight increases. Cell growth is suggested to be controlled by the intermicelle distance and limited by the cell wall thickness. Furthermore, a theoretical explanation of the mechanisms underlying the limited expansion of PMMA/MAM systems is proposed and discussed

Performativity, fabrication and trust: exploring computer-mediated moderation

Based on research conducted in an English secondary school, this paper explores computer mediated moderation as a performative tool. The Module Assessment Meeting (MAM) was the moderation approach under investigation. I mobilise ethnographic data generated by a key informant, and triangulated with that from other actors in the setting, in order to examine some of the meanings underpinning moderation within a performative environment. Drawing on the work of Ball (2003), Lyotard (1979) and Foucault (1977, 1979), I argue that in this particular case performativity has become entrenched in teachers’ day-to-day practices, and not only affects those practices but also teachers’ sense of self. I suggest that MAM represented performative and fabricated conditions and (re)defined what the key participant experienced as a vital constituent of her educational identities - trust. From examining the case in point, I hope to have illustrated for those interested in teachers’ work some of the implications of the interface between technology and performativity

Low-density PMMA/MAM nanocellular polymers using low MAM contents: Production and characterization

Low-density nanocellular polymers are required to take advantage of the full potential of these materials as high efficient thermal insulators. However, their production is still a challenging task. One promising approach is the use of nanostructured polymer blends of poly(methyl methacrylate) (PMMA) and a block copolymer poly(methyl methacrylate)-poly(butyl acrylate)-poly(methyl methacrylate) (MAM), which are useful for promoting nucleation but seem to present a severe drawback, as apparently avoid low relative densities. In this work, new strategies to overcome this limitation and produce low-density nanocellular materials based on these blends are investigated. First, the effect of very low amounts of the MAM copolymer is analysed. It is detected that nanostructuration can be prevented using low copolymer contents, but nucleation is still enhanced as a result of the copolymer molecules with high CO2 affinity dispersed in the matrix, so nanocellular polymers are obtained using very low percentages of the copolymer. Second, the influence of the foaming temperature is studied. Results show that for systems in which there is not a clear nanostructuration, cells can grow more freely and smaller relative densities can be achieved. For these studies, blends of PMMA with MAM with copolymer contents from 10 wt% and as low as 0.1 wt% are used. For the first time, the production strategies proposed in this work have allowed obtaining low density (relative density 0.23) nanocellular polymers based on PMMA/MAM blends. Graphical abstrac

Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia

Background: Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations. Methods: We defined MAM as mid-upper arm circumference (MUAC) of ≥11.0cm and <12.5cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6–59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data. Results: By the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4–15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering. Conclusions: Children with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered

S6S^6 and the geometry of nearly K\"ahler 66-manifolds

We review results on and around the almost complex structure on $S^6$, both from a classical and a modern point of view. These notes have been prepared for the Workshop "(Non)-existence of complex structures on $S^6$" (\emph{Erste Marburger Arbeitsgemeinschaft Mathematik -- MAM-1}), held in Marburg in March 2017.Comment: 12 page

Household-level factors associated with relapse following discharge from treatment for moderate acute malnutrition

AbstractFactors associated with relapse among children who are discharged after reaching a threshold denoted ‘recovered’ from moderate acute malnutrition (MAM) are not well understood. The aim of this study was to identify factors associated with sustained recovery, defined as maintaining a mid-upper-arm circumference≥12·5 cm for 1 year after release from treatment. On the basis of an observational study design, we analysed data from an in-depth household (HH) survey on a sub-sample of participants within a larger cluster randomised controlled trial (cRCT) that followed up children for 1 year after recovery from MAM. Out of 1497 children participating in the cRCT, a subset of 315 children participated in this sub-study. Accounting for other factors, HH with fitted lids on water storage containers (P=0·004) was a significant predictor of sustained recovery. In addition, sustained recovery was better among children whose caregivers were observed to have clean hands (P=0·053) and in HH using an improved sanitation facility (P=0·083). By contrast, socio-economic status and infant and young child feeding practices at the time of discharge and HH food security throughout the follow-up period were not significant. Given these results, we hypothesise that improved water, sanitation and hygiene conditions in tandem with management of MAM through supplemental feeding programmes have the possibility to decrease relapse following recovery from MAM. Furthermore, the absence of associations between relapse and nearly all HH-level factors indicates that the causal factors of relapse may be related mostly to the child’s individual, underlying health and nutrition status.</jats:p

Adaptive Protection and Control in Power System for Wide-Area Blackout Prevention

This paper presents a new approach in adaptive outof-step (OOS) protection settings in power system in real-time. The proposed method uses extended equal area criterion (EEAC) to determine the critical clearing time (CCT) and critical clearing angle (CCA) of the system, which are vital information for OOS protection setting calculation. The dynamic model parameters and the coherency groups of the system for EEAC analysis are determined in real time to ensure that the newly calculated settings suit with the prevalent system operating condition. The effectiveness of the method is demonstrated in a simulated data from 16-machine 68-bus system model

A Morphological Associative Memory Employing A Stored Pattern Independent Kernel Image and Its Hardware Model

An associative memory provides a convenient way for pattern retrieval and restoration, which has an important role for handling data distorted with noise. As an effective associative memory, we paid attention to a morphological associative memory (MAM) proposed by Ritter. The model is superior to ordinary associative memory models in terms of calculation amount, memory capacity, and perfect recall rate. However, in general, the kernel design becomes difficult as the stored pattern increases because the kernel uses a part of each stored pattern. In this paper, we propose a stored pattern independent kernel design method for the MAM and design the MAM employing the proposed kernel design with a standard digital manner in parallel architecture for acceleration. We confirm the validity of the proposed kernel design method by auto- and hetero-association experiments and investigate the efficiency of the hardware acceleration. A high-speed operation (more than 150 times in comparison with software execution) is achieved in the custom hardware. The proposed model works as an intelligent pre-processor for the Brain-Inspired Systems (Brain-IS) working in real world