Soil-transmitted helminth infections

More than a quarter of the world's population is at risk of infection with the soil-transmitted helminths Ascaris lumbricoides, hookworm (Ancylostoma duodenale and Necator americanus), Trichuris trichiura, and Strongyloides stercoralis. Infected children and adults present with a range of medical and surgical conditions, and clinicians should consider the possibility of infection in individuals living in, or returning from, endemic regions. Although safe and effective drugs are donated free to endemic countries, only half of at-risk children received treatment in 2016. This Seminar describes the epidemiology, lifecycles, pathophysiology, clinical diagnosis, management, and public health control of soil-transmitted helminths. Previous work has questioned the effect of population-level deworming; however, it remains beyond doubt that treatment reduces the severe consequences of soil-transmitted helminthiasis. We highlight the need for refined diagnostic tools and effective control options to scale up public health interventions and improve clinical detection and management of these infections

Teaching in nature

SNH has a remit for people’s enjoyment and understanding of the natural heritage as well as the care of it. The potential for the educational use of National Nature Reserves (NNRs) (and similar ‘wild’ places for nature) is not well understood. This research was designed to enable practicing teachers from primary and secondary schools to collaboratively explore how National Nature Reserves could be used to provide for learning across a range of subject areas. This work was conducted within the context of the new national curriculum initiative in Scotland, Curriculum for Excellence (CfE) (LTS, 2010). For further information (including videos of outdoor excursions, lesson plans, and supporting commentaries), visit the project website: http://teachinginnature.stir.ac.u

A new in-situ method to estimate fish target strength reveals high variability in broadband measurements

Acknowledgements The authors thank the Greenland Institute of Natural Resources (GINR), the University of Aberdeen, and Marine Alliance for Science and Technology for Scotland (MASTS) for funding this study. MASTS is funded by the Scottish Funding Council (grant no. HR09011) and contributing institutions. Further, they thank GINR for providing access to their facilities.Peer reviewedPublisher PD

The new COVID-19 poor and the neglected tropical diseases resurgence

More than 100 million people are facing a return to extreme poverty because of coronavirus disease 2019 (COVID-19), while new estimates suggest that threenations—India, Nigeria, and the Democratic Republic of the Congo—may suffer the greatest economic contractions. Such findings will have profound consequences in terms of our ability to control or eliminate the most widely prevalent neglected tropical diseases

Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy

Objectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis. Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-generation devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field. Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (.2 percent) for devices costing as much as £60,000. Sensitivity of the conclusions to both device cost and QALY valuation is examined. Conclusions: In the event that the price of the device in use would reduce to £40,000, the value of the survival information can readily justify investment in further trials

The New Zealand Kauri (Agathis Australis) Research Project: A Radiocarbon Dating Intercomparison of Younger Dryas Wood and Implications for IntCal13

We describe here the New Zealand kauri (Agathis australis) Younger Dryas (YD) research project, which aims to undertake Δ14C analysis of ~140 decadal floating wood samples spanning the time interval ~13.1–11.7 kyr cal BP. We report 14C intercomparison measurements being undertaken by the carbon dating laboratories at University of Waikato (Wk), University of California at Irvine (UCI), and University of Oxford (OxA). The Wk, UCI, and OxA laboratories show very good agreement with an interlaboratory comparison of 12 successive decadal kauri samples (average offsets from consensus values of –7 to +4 14C yr). A University of Waikato/University of Heidelberg (HD) intercomparison involving measurement of the YD-age Swiss larch tree Ollon505, shows a HD/Wk offset of ~10–20 14C yr (HD younger), and strong evidence that the positioning of the Ollon505 series is incorrect, with a recommendation that the 14C analyses be removed from the IntCal calibration database

Influence of Schistosoma mansoni and Hookworm Infection Intensities on Anaemia in Ugandan Villages.

BACKGROUND: The association of anaemia with intestinal schistosomiasis and hookworm infections are poorly explored in populations that are not limited to children or pregnant women. METHODS: We sampled 1,832 individuals aged 5-90 years from 30 communities in Mayuge District, Uganda. Demographic, village, and parasitological data were collected. Infection risk factors were compared in ordinal logistic regressions. Anaemia and infection intensities were analyzed in multilevel models, and population attributable fractions were estimated. FINDINGS: Household and village-level predictors of Schistosoma mansoni and hookworm were opposite in direction or significant for single infections. S. mansoni was found primarily in children, whereas hookworm was prevalent amongst the elderly. Anaemia was more prevalent in individuals with S. mansoni and increased by 2.86 fold (p-value<0.001) with heavy S. mansoni infection intensity. Individuals with heavy hookworm were 1.65 times (p-value = 0.008) more likely to have anaemia than uninfected participants. Amongst individuals with heavy S. mansoni infection intensity, 32.0% (p-value<0.001) of anaemia could be attributed to S. mansoni. For people with heavy hookworm infections, 23.7% (p-value = 0.002) of anaemia could be attributed to hookworm. A greater fraction of anaemia (24.9%, p-value = 0.002) was attributable to heavy hookworm infections in adults (excluding pregnant women) as opposed to heavy hookworm infections in school-aged children and pregnant women (20.2%, p-value = 0.001). CONCLUSION: Community-based surveys captured anaemia in children and adults affected by S. mansoni and hookworm infections. For areas endemic with schistosomiasis or hookworm infections, WHO guidelines should include adults for treatment in helminth control programmes.This is the final version of the article. It first appeared from PLoS via http://dx.doi.org/10.1371/journal.pntd.000419

The impact of diabetes-related complications on preference-based measures of health-related quality of life in adults with Type I diabetes

Introduction: This study estimates health-related quality of life (HRQoL) or utility decrements associated with type 1 diabetes mellitus (T1DM) using data from a UK research programme on the Dose Adjustment For Normal Eating (DAFNE) education programme. Methods: A wide range of data was collected from 2,341 individuals who undertook a DAFNE course in 2009-12, at baseline and for two subsequent years. We use fixed and random effects linear models to generate utility estimates for T1DM using different instruments: EQ-5D, SF-6D and EQ-VAS. We show models with and without controls for HbA1c and depression, which may be endogenous (if, for example, there is reverse causality in operation). Results: We find strong evidence of an unobserved individual effect, suggesting the superiority of the fixed effects model. Depression shows the greatest decrement across all the models in the preferred fixed effects model. The fixed effects EQ-5D model also finds a significant decrement from retinopathy, BMI and HbA1c(%). Estimating a decrement using the fixed effects model is not possible for some conditions where there are few new cases. In the random effects model diabetic foot disease shows substantial utility decrements, yet these are not significant in the fixed effects models. Conclusion: Utility decrements have been calculated for a wide variety of health states in T1DM which can be used in economic analyses. However, despite the large dataset, the low incidence of several complications leads to uncertainty in calculating the utility weights. Depression and diabetic foot disease result in a substantial loss in HRQoL for patients with T1DM. HbA1c(%) appears to have an independent negative impact upon HRQoL, although concerns remain regarding the potential endogeneity of this variable