The importance of an active case detection (Acd) programme for malaria among migrants from malaria endemic countries: The greek experience in a receptive and vulnerable area

Greecehasbeenmalaria-freesince1974. InOctober2011,followinganoutbreakof36locally acquired malaria (LAM) cases in Evrotas Municipality, a Pro-Active Case Detection (PACD) program for malaria was implemented among migrants from malaria-endemic countries, to support early diagnosis and treatment of cases. We evaluated the PACD program for the years 2012–2017 using indicatorssuchasthenumberoflocallyacquiredcases,thedetectionrate/sensitivityandthetimeliness of diagnosis and treatment. We visited each migrant home every 7–15 days to screen migrants for malaria symptoms, performing Rapid Diagnostic Tests (RDTs) and blood smears on symptomatic patients. We estimated: (i) the number of malaria cases detected by the PACD, divided by the total number of reported malaria cases during the same period among the same population; (ii) the time betweenonsetofsymptoms,diagnosisandinitiationoftreatment. Thetotalnumberofmigrantswho were screened for malaria symptoms for the years 2012–2017 was 5057 with 84,169 fever screenings conducted, while 2288 RDTs and 1736 blood smears were performed. During the same period, 53 imported P. vivax malaria cases were detected, while incidence of malaria among migrants was estimated at 1.8% annually. Ten and one LAM cases were also reportedin 2012 and 2015, respectively. Sensitivity of PACD ranged from 86% to 100%; median timeliness between onset of symptoms and diagnosis decreased from 72 h in 2012 to 12 h in 2017 (83% decrease), while timeliness betweendiagnosis and treatment initiation was 0 h. The implementation of PACD could be considered an effective prevention and response tool against malaria re-introduction

The contingent effect of product relatedness on B2B firms’ pricing strategy. Evidence from India

This paper empirically examines the contingent effect of product-related diversification on B2B firms' pricing strategy. Drawing our arguments from the recent advances in corporate strategy (i.e., resource-based view of the firm and product diversification strategy) and industrial marketing literatures, we argue that product-related diversifiers are more capable in adopting a high rather than a low pricing strategy. We also contend that this relationship will be positively moderated by a number of firm-specific factors, namely a firm's ability to establish high barriers to entry in its focal industry, as well as its strategic decision to invest in promotion strategy. We test our hypotheses against primary data collected from India. The data consists of a cross section from 127 domestic firms and subsidiaries of foreign MNEs operating in the chemicals / pharmaceuticals and the electronics industry. The results provide support for all the aforementioned hypotheses

Comprehensive assessment of additive and class G cement properties affecting rheology, fluid loss, setting time and long term characteristics of elastic cements

Summarization: Cement sheath integrity is very important in drilling and completion. Several additives are used to aid the process of preparing flowable cement slurry gaining sufficient strength over time. Sheaths need to be elastic and resilient and withstand several temperature and pressure cycles over the life of the well. Technology has made today available very sophisticated equipment. We present a comprehensive laboratory assessment of properties of various additives which formulate non-foamed elastic cements to determine optimal quantities and to associate them to short and long term cement properties, rheology, fluid loss, thickening time, compressive and tensile strength and elastic properties. We focus on the study of additives for producing elastic cements including effect of nanoparticles using XRD, XRF and SEM, Unconfined Compressive Strength, Cat-scanning, rheological and fluid loss measurements, NMR at P,T, for monitoring hydration kinetics and gel formation at downhole conditions. We monitor shear and compressional waves at P,T to estimate thickening time, compressive strength and static gel strength evolution. Thus we combine a multitude of measurements, to provide comprehensive assessment of the effect of additive properties on the mechanical properties of the elastic cements. Elastic cements are used in difficult environments where more cement elasticity is required to prevent casing debonding. We test efficacy of various additives on improving their properties. Protocols are presented on how one can utilize optimally the design and the implementation of different analysis to evaluate the effectiveness of additives on the mechanical properties of elastic cements. Additives have been developed to improve elastic properties of cements. Property measurements are routinely implemented in such materials. We correlate advanced NMR and Ultrasonic measurements in downhole conditions and integrate them with all other available laboratory measurements to provide means for determining optimal additive concentrations and to assess the use of nanoadditives on the properties of elastic cements.Παρουσιάστηκε στο: European Unconventional Conference and Exhibitio

Prevention of Malaria Resurgence in Greece through the Association of Mass Drug Administration (MDA) to Immigrants from Malaria-Endemic Regions and Standard Control Measures.

Greece was declared malaria-free in 1974 after a long antimalarial fight. In 2011-2012, an outbreak of P. vivax malaria was reported in Evrotas, an agricultural area in Southern Greece, where a large number of immigrants from endemic countries live and work. A total of 46 locally acquired and 38 imported malaria cases were detected. Despite a significant decrease of the number of malaria cases in 2012, a mass drug administration (MDA) program was considered as an additional measure to prevent reestablishment of the disease in the area. During 2013 and 2014, a combination of 3-day chloroquine and 14-day primaquine treatment was administered under direct observation to immigrants living in the epicenter of the 2011 outbreak in Evrotas. Adverse events were managed and recorded on a daily basis. The control measures implemented since 2011 continued during the period of 2013-2014 as a part of a national integrated malaria control program that included active case detection (ACD), vector control measures and community education. The MDA program was started prior to the transmission periods (from May to December). One thousand ninety four (1094) immigrants successfully completed the treatment, corresponding to 87.3% coverage of the target population. A total of 688 adverse events were recorded in 397 (36.2%, 95% C.I.: 33.4-39.1) persons, the vast majority minor, predominantly dizziness and headache for chloroquine (284 events) and abdominal pain (85 events) for primaquine. A single case of primaquine-induced hemolysis was recorded in a person whose initial G6PD test proved incorrect. No malaria cases were recorded in Evrotas, Laconia, in 2013 and 2014, though three locally acquired malaria cases were recorded in other regions of Greece in 2013. Preventive antimalarial MDA to a high-risk population in a low transmission setting appears to have synergized with the usual antimalarial activities to achieve malaria elimination. This study suggests that judicious use of MDA can be a useful addition to the antimalarial armamentarium in areas threatened with the reintroduction of the disease

Reported adverse events associated to chloroquine and primaquine administration (n = 1094), for 2013 and 2014.

<p>* Common symptoms for both medications. The first 48 hours of co-administration, symptoms were attributed to either drug based on clinical judgement at the field.</p><p>Reported adverse events associated to chloroquine and primaquine administration (n = 1094), for 2013 and 2014.</p

Characteristics of the target immigrant population at Evrotas (n = 1094), for 2013 and 2014.

<p>Characteristics of the target immigrant population at Evrotas (n = 1094), for 2013 and 2014.</p

Monthly distribution (number and percentage) of the completed regimens in 1,094 immigrants in 2013 and 2014 in Evrotas, Greece.

<p>Monthly distribution (number and percentage) of the completed regimens in 1,094 immigrants in 2013 and 2014 in Evrotas, Greece.</p

Geographic distribution of malaria cases (imported and locally acquired) in Greece 2011–2014 focusing on Evrotas, Laconia.

<p>Geographic distribution of malaria cases (imported and locally acquired) in Greece 2011–2014 focusing on Evrotas, Laconia.</p

MDA flowchart during the years 2013 and 2014 in the area of Evrotas, Greece.

<p>MDA flowchart during the years 2013 and 2014 in the area of Evrotas, Greece.</p

Reported malaria cases by year of onset and case classification, Evrotas and other regions in Greece, 2009–2014.

<p>Reported malaria cases by year of onset and case classification, Evrotas and other regions in Greece, 2009–2014.</p