HIV, malaria and beyond: reducing the disease burden of female adolescents

In sub-Saharan Africa the highest overlap between malaria and HIV infections occurs in female adolescents. Yet control activities for these infections are directed to different target groups, using disparate channels. This reflects the lack of priority given to adolescents and the absence of an accepted framework for delivering health and health-related interventions to this high-risk group. In this paper it is argued that female adolescents require a continuum of care for malaria and HIV – prior to conception, during and after pregnancy and that this should be provided through adolescent services. The evidence for this conclusion is presented. A number of African countries are commencing to formulate and implement adolescent-friendly policies and services and disease control programs for malaria and HIV will need to locate their interventions within such programs to ensure widespread coverage of this important target group. Failure to prioritize adolescent health in this way will seriously limit the success of disease control programs for malaria and HIV prevention

Jump jets for the ADF?

This report argues that the costs of Australia acquiring F-35B Joint Strike Fighter short take-off, vertical landing aircraft outweigh the potential benefits. Overview Is there a case for Australia to acquire F-35B Joint Strike Fighter short take-off, vertical landing (STOVL) aircraft to operate from the two new Canberra-class landing helicopter docks (LHDs)? The government has directed that this question be addressed in the development of the 2015 Defence White Paper. This report is an independent assessment of the costs and potential benefits of such an acquisition. Reintroducing organic naval air power into the ADF would be a big strategic decision, and very complex and expensive, so it’s important to have a clear view of the circumstances in which it might be beneficial enough to be worth pursuing. And it’s important to be aware not only of the direct costs but also of the potential risks and opportunity costs. Overall, this report concludes that the benefits would be marginal at best, wouldn’t be commensurate with the costs and other consequences for the ADF, and would potentially divert funding and attention from more valuable force

Sex differentials in susceptibility to lymphatic filariasis and implications for maternal child immunity

This paper reviews epidemiological data to see if there are sex differentials in prevalence, density and clinical pathology due to lymphatic filariasis. Of 53 studies from Africa, South East Asia, the Indian Subcontinent and The Americas, 43 showed a lower mean prevalence of infection in females than in males. Prevalence is consistently lower in women of reproductive age and this is statistically significant in 16 of 32 studies classified by age and sex. Density of infection is also lower in the reproductive age but may be higher in children and in older women. Clinical disease is also lower in women and pathology has a later age of onset and rise to peak prevalence than in males. The paper assesses the evidence that lower rates of infection and clinical pathology are due to less exposure of females to infective vectors. It seems unlikely that exposure alone could account for these differences which are observed for both bancroftian and brugian filariasis, irrespective of periodicity. Several investigators have suggested that females have increased resistance to infection and this is supported by serological studies showing high antibody positivity to adult worm antigens in females. The review concludes that the association with the reproductive years suggests a pregnancy-associated mechanism. This has important implications for maternal - fetal interactions and maternal filarial infection may influence the development of immunity in childre

Expanded Fly Ash Clay Aggregate a Sustainable Alternative Coarse Aggregate for Concrete

Demand for natural aggregates in making concrete is increasing every day. Concrete is widely used in turnkey projects and small-scale projects. An alternative sustainable coarse aggregate for natural coarse aggregate can reduce the amount of pollution and preserve natural resource. An attempt is made in this research project to use locally available soil from the site and fly ash waste to prepare an alternative sustainable coarse aggregate for concrete to be used in small constructions. Concrete mix is prepared with natural aggregate and expanded fly ash clay aggregate EFCA and their fresh state, strength and durability properties were studied. The slump value of EFCA concrete under same water content is similar to that of natural aggregate concrete. A compressive strength of 21.45 MPa is achieved for EFCA concrete, which is acceptable for normal structural concrete. Flexural strength of 3.67 MPa is measured. Rapid chloride penetration test conducted on EFCA concrete showed moderate resistance to sulfate attack and a higher water penetration

Expanded Fly Ash Clay Aggregate a Sustainable Alternative Coarse Aggregate for Concrete

Demand for natural aggregates in making concrete is increasing every day. Concrete is widely used in turnkey projects and small-scale projects. An alternative sustainable coarse aggregate for natural coarse aggregate can reduce the amount of pollution and preserve natural resource. An attempt is made in this research project to use locally available soil from the site and fly ash waste to prepare an alternative sustainable coarse aggregate for concrete to be used in small constructions. Concrete mix is prepared with natural aggregate and expanded fly ash clay aggregate EFCA and their fresh state, strength and durability properties were studied. The slump value of EFCA concrete under same water content is similar to that of natural aggregate concrete. A compressive strength of 21.45 MPa is achieved for EFCA concrete, which is acceptable for normal structural concrete. Flexural strength of 3.67 MPa is measured. Rapid chloride penetration test conducted on EFCA concrete showed moderate resistance to sulfate attack and a higher water penetration

Perspectives on the design and methodology of periconceptional nutrient supplementation trials.

Periconceptional supplementation could extend the period over which maternal and fetal nutrition is improved, but there are many challenges facing early-life intervention studies. Periconceptional trials differ from pregnancy supplementation trials, not only because of the very early or pre-gestational timing of nutrient exposure but also because they generate subsidiary information on participants who remain non-pregnant. The methodological challenges are more complex although, if well designed, they provide opportunities to evaluate concurrent hypotheses related to the health of non-pregnant women, especially nulliparous adolescents. This review examines the framework of published and ongoing randomised trial designs. Four cohorts typically arise from the periconceptional trial design--two of which are non-pregnant and two are pregnant--and this structure provides assessment options related to pre-pregnant, maternal, pregnancy and fetal outcomes. Conceptually the initial decision for single or micronutrient intervention is central--as is the choice of dosage and content--in order to establish a comparative framework across trials, improve standardisation, and facilitate interpretation of mechanistic hypotheses. Other trial features considered in the review include: measurement options for baseline and outcome assessments; adherence to long-term supplementation; sample size considerations in relation to duration of nutrient supplementation; cohort size for non-pregnant and pregnant cohorts as the latter is influenced by parity selection; integrating qualitative studies and data management issues. Emphasis is given to low resource settings where high infection rates and the possibility of nutrient-infection interactions may require appropriate safety monitoring. The focus is on pragmatic issues that may help investigators planning a periconceptional trial

The Challenge of Warning Time in the Contemporary Strategic Environment

This Centre of Gravity paper is based on an ANU public lecture given by the authors on 23 June 2021. The lecture in turn drew heavily on the authors’ paper for the Australian Strategic Policy Institute, Deterrence through denial: a strategy for an era of reduced warning time, published in May 2021.1 The authors are grateful to the Australian Strategic Policy Institute for agreeing that the material could be re-published in this way

An analysis of anemia and child mortality

The relationship of anemia as a risk factor for child mortality was analyzed by using cross-sectional, longitudinal and case-control studies, and randomized trials. Five methods of estimation were adopted: 1) the proportion of child deaths attributable to anemia; 2) the proportion of anemic children who die in hospital studies; 3) the population-attributable risk of child mortality due to anemia; 4) survival analyses of mortality in anemic children; and 5) cause-specific anemia-related child mortality. Most of the data available were hospital based. For children aged 0-5 y the percentage of deaths due to anemia was comparable for reports from highly malarious areas in Africa (Sierra Leone 11.2%, Zaire 12.2%, Kenya 14.3%). Ten values available for hemoglobin values /L showed a variation in case fatality from 2 to 29.3%. The data suggested little if any dose-response relating increasing hemoglobin level (whether by mean value or selected cut-off values) with decreasing mortality. Although mortality was increased in anemic children with hemoglobin /L, the evidence for increased risk with less severe anemia was inconclusive. The wide variation for mortality with hemoglobin /L is related to methodological variation and places severe limits on causal inference; in view of this, it is premature to generate projections on population-attributable risk. A preliminary survival analysis of an infant cohort from Malawi indicated that if the hemoglobin decreases by 10 g/L at age 6 mo, the risk of dying becomes 1.72 times higher. Evidence from a number of studies suggests that mortality due to malarial severe anemia is greater than that due to iron-deficiency anemia. Data are scarce on anemia and child mortality from non-malarious regions. Primary prevention of iron-deficiency anemia and malaria in young children could have substantive effects on reducing child mortality from severe anemia in children living in malarious areas