Gametocyte carriage in Plasmodium falciparum-infected travellers.

BACKGROUND: Gametocytes are the sexual stage of Plasmodium parasites. The determinants of gametocyte carriage have been studied extensively in endemic areas, but have rarely been explored in travellers with malaria. The incidence of gametocytaemia, and factors associated with gametocyte emergence in adult travellers with Plasmodium falciparum malaria was investigated at the Hospital for Tropical Diseases in London. METHODS: Clinical, parasitological and demographic data for all patients presenting with P. falciparum malaria between January 2001 and December 2011 were extracted from a prospective database. These data were supplemented by manual searches of laboratory records and patient case notes. RESULTS: Seven hundred and seventy three adult patients with laboratory-confirmed P. falciparum malaria were identified. Four hundred and sixty five (60%) were born in a country where malaria is endemic. Patients presented to hospital a median of four days into their illness. The median maximum parasite count was 0.4%. One hundred and ninety six patients (25%) had gametocytes; 94 (12%) on admission, and 102 (13%) developing during treatment. Gametocytaemia on admission was associated with anaemia and a lower maximum parasitaemia. Patients with gametocytes at presentation were less likely to have thrombocytopenia or severe malaria. Patients who developed gametocytes during treatment were more likely to have had parasitaemia of long duration, a high maximum parasitaemia and to have had severe malaria. There was no apparent association between the appearance of gametocytes and treatment regimen. CONCLUSIONS: The development of gametocytaemia in travellers with P. falciparum is associated with factors similar to those reported among populations in endemic areas. These data suggest that acquired immunity to malaria is not the only determinant of patterns of gametocyte carriage among patients with the disease

Understanding of spatial correspondence does not contribute to representational understanding: Evidence from the Model Room and False Belief tasks

We examine the longstanding claim that understanding relational correspondence is a general component of representational understanding (Perner, 1991). Two experiments with 175 preschool children located in Norwich, UK examined use of a scale model (DeLoache, 1987) comparing performances on a ‘Copy’ task, measuring abstract spatial arrangement ability, and the False Belief task. Consistent with previous studies, younger children performed well in scale model trials when objects were unique (e.g., one cupboard) but poorly at distinguishing objects using spatial layout (one of three identical chairs). Performance was specifically associated with Copy task but not False Belief performance. Emphasizing the representational relation between model and room was ineffective. We find no evidence for understanding relational correspondence as a general component of representational understanding

Microneurographic characterization of sympathetic responses during 1-leg exercise in young and middle-aged humans

Muscle sympathetic nerve activity (MSNA) at rest increases with age. However, the influence of age on MSNA recorded during dynamic leg exercise is unknown. We tested the hypothesis that aging attenuates the sympatho-inhibitory response observed in young subjects performing mild to moderate 1-leg cycling. After pre-determining peak oxygen uptake (VO2peak), we compared contra-lateral fibular nerve MSNA during 2 minutes each of mild (unloaded) and moderate (30-40% of the work rate at peak VO2, halved for single leg) 1-leg cycling in 18 young (23±1 years [mean±SE]) and 18 middle-aged (57±2 years) sex-matched healthy subjects. Mean height, weight, resting heart rate (HR), systolic blood pressure (BP) and percent predicted VO2peak were similar between groups. Middle-aged subjects had higher resting MSNA burst frequency and incidence (P<0.001) and diastolic BP (P=0.04). During moderate 1-leg cycling, older subjects’ systolic BP increased more (+21±5 vs.+10±1 mmHg; P=0.02) and their fall in MSNA burst incidence was amplified (-19±2 vs. -11±2 bursts/100heartbeats; P=0.01) but because HR rose less (+153 vs.+192 bpm; P=0.03), exercise induced similar reductions in burst frequency (P=0.25). Contrary to our initial hypothesis, with advancing age, mild to moderate intensity dynamic leg exercise elicits a greater rise in systolic BP and a larger fall in MSNA

Undertaking Studies Within A Trial to evaluate recruitment and retention strategies for randomised controlled trials : lessons learnt from the PROMETHEUS research programme

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/55/80) and is published in full in Health Technology Assessment; Vol. 28, No. 2. See the NIHR Funding and Awards website for further award information.Peer reviewedPublisher PD

The effectiveness of psychological support interventions for those exposed to mass infectious disease outbreaks: a systematic review

Background: Mass outbreaks such as pandemics are associated with mental health problems requiring effective psychological interventions. Although several forms of psychological interventions may be advocated or used, some may lack strong evidence of efficacy and some may not have been evaluated in mass infectious disease outbreaks. This paper reports a systematic review of published studies (PROSPERO CRD:42020182094. Registered: 24.04.2020) examining the types and effectiveness of psychological support interventions for the general population and healthcare workers exposed to mass infectious disease outbreaks. Methods: A systematic review was conducted. Randomised Controlled Trials (RCT) were identified through searches of electronic databases: Medline (Ovid), Embase (Ovid), PsycINFO (EBSCO) and the Cochrane Library Database from inception to 06.05.2021 using an agreed search strategy. Studies were included if they assessed the effectiveness of interventions providing psychological support to the general population and / or healthcare workers exposed to mass infectious disease outbreaks. Studies were excluded if they focused on man-made or natural disasters or if they included armed forces, police, fire-fighters or coastguards. Results: Twenty-two RCTs were included after screening. Various psychological interventions have been used: therapist-guided therapy (n=1); online counselling (n=1); `Emotional Freedom Techniques’ (n=1); mobile phone apps (n=2); brief crisis intervention (n=1); psychological-behavioural intervention (n=1); Cognitive Behavioural Therapy (n=3); progressive muscle relaxation (n=2); emotional-based directed drawing (n=1); psycho-educational debriefing (n=1); guided imagery (n=1); Eye Movement Desensitization and Reprocessing (EMDR) (n=1); expressive writing (n=2); tailored intervention for patients with a chronic medical conditions (n=1); community health workers (n=1); self-guided psychological intervention (n=1), and a digital behaviour change intervention (n=1). Meta-analyses showed that psychological interventions had a statistically significant benefit in managing depression (Standardised Mean Difference [SMD]: -0.40; 95% Confidence Interval [CI]: -0.76 to -0.03), and anxiety (SMD: -0.72; 95% CI: -1.03 to -0.40). The effect on stress was equivocal (SMD: 0.16; 95% CI: -0.19 to 0.51). The heterogeneity of studies, studies’ high risk of bias, and the lack of available evidence means uncertainty remains. Conclusions: Further RCTs and intervention studies involving representative study populations are needed to inform the development of targeted and tailored psychological interventions for those exposed to mass infectious disease outbreaks

Keeping doors open: transnational families and curricular nationalism

This paper reviews sociological literature to explore the challenge transnational populations pose for nation-based curriculum, and vice versa. With increasing access to dual citizenship and temporary migration, more people are living transnational lifestyles. This poses new challenges in raising the transnational child. Transnationalism has emerged ‘bottom-up’ from individualised choices and circumstances rather than ‘top-down’ through institutional strategy. As a result, education sectors are yet to respond with a reoriented curriculum that can accommodate polycentric lives. This paper adapts Beck’s critique of methodological nationalism and proposes a parallel concept in the curricular nationalism underpinning much official curriculum. It then reviews literature reporting on three curricular experiments that seek to cultivate citizenships above and beyond the nation. While such transcendent designs on citizenship unsettle curricular nationalism, they fail to address the specificities of transnational child’s memberships both here and there. The pedagogic principle of ‘connectedness’ is retooled as a pragmatic way forward

Staff training to improve participant recruitment into surgical randomised controlled trials : A feasibility study within a trial (SWAT) across four host trials simultaneously

The PROMoting THE Use of SWATs (PROMETHEUS) programme was funded by the Medical Research Council (MRC) [grant number MR/R013748/1]. The DISC host trial is funded by the Health Technology Assessment Programme (Grant Ref: 15/102/04). IntAct is funded by the Efficacy and Mechanism Evaluation (EME) Programme, an MRC and NIHR partnership (Grant Ref: 14/150/62). The EME Programme is funded by the MRC and NIHR, with contributions from the CSO in Scotland and Health and Care Research Wales and the HSC R&D Division, Public Health Agency in Northern Ireland. PROFHER-2 is funded by the Health Technology Assessment Programme (Grant Ref: 16/73/03). START: REACTS is funded by the NIHR Evaluation, Trials and Studies Co-ordinating Centre (NETSCC); Grant Codes: 16/61/18. The development of the training intervention was funded by the MRC Network of Hubs for Trials Methodology Research (MR/L004933/1- R53) and supported by the MRC ConDuCT-II Hub (Collaboration and innovation for Difficult and Complex randomized controlled Trials In Invasive procedures - MR/K025643/1). The online version of the training intervention was funded by the NIHR and is hosted on the NIHR Learn platform (https://learn.nihr.ac.uk/course/view.php?id=385). It is based on the face-to face GRANULE training course funded by the Bowel Disease Research Foundation in collaboration with the University of Birmingham, University of Bristol and former MRC ConDuCT-II Hub. This work was part-funded by the Wellcome Trust [ref: 204829] through the Centre for Future Health (CFH) at the University of York. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the MRC or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.Peer reviewedPublisher PD