Pyrethroid resistance/susceptibility and differential urban/rural distribution of Anopheles arabiensis and An. gambiae s.s. malaria vectors in Nigeria and Ghana

Resistance to pyrethroid insecticides and DDT caused by the kdr gene in the malaria vector Anopheles gambiae Giles s.s. (Diptera: Culicidae) has been reported in several West African countries. To test for pyrethroid resistance in two more countries, we sampled populations of the An. gambiae complex from south-western Ghana and from urban and rural localities in Ogun State, south-west Nigeria. Adult mosquitoes, reared from field-collected larvae, were exposed to the WHO-recommended discriminating dosage of exposure for 1 h to DDT 4%, deltamethrin 0.05% or permethrin 0.75% and mortality was recorded 24 h post-exposure. Susceptibility of An. gambiae s.l. to DDT was 94-100% in Ghana and 72-100% in Nigeria, indicating low levels of DDT resistance. Deltamethrin gave the highest mortality rates: 97-100% in Ghana, 95-100% in Nigeria. Ghanaian samples of An. gambiae s.l. were fully susceptible to permethrin, whereas some resistance to permethrin was detected at 4/5 Nigerian localities (percentage mortalities 75, 82, 88, 90 and 100%), with survivors including both An. arabiensis Patton and An. gambiae s.s. identified by PCR assay. Even so, the mean knockdown time was not significantly different from a susceptible reference strain, indicating absence or low frequency of kdr-type resistance. Such low levels of pyrethroid resistance are unlikely to impair the effectiveness of pyrethroid-impregnated bednets against malaria transmission. Among Nigerian samples of An. gambiae s.l., the majority from two urban localities were identified as An. arabiensis, whereas the majority from rural localities were An. gambiae s.s. These findings are consistent with those of M. Coluzzi et al. (1979). Differences of ecological distribution between molecular forms of An. gambiae s.s. were also found, with rural samples almost exclusively of the S-form, whereas the M-form predominated in urban samples. It is suggested that 'urban island' populations of An. arabiensis and of An. gambiae s.s. M-form in the rainforest belt of West Africa might be appropriate targets for elimination of these malaria vectors by the sterile insect technique

Needs Assessment: Watershed Science for Water Resources Directors

We conducted a needs assessment to identify watershed science training needs for locally elected directors of Nebraska\u27s 23 natural resources districts (NRDs). We interviewed NRD staff and surveyed NRD directors to determine training needs and identify relevant topics and preferred delivery formats. We found that training would be valuable; however, directors are busy, meaning that opportunities for training are limited. Additionally, we learned that directors rely on printed material and other NRD personnel for watershed science information. Therefore, web-based information may be most useful if designed for collaborative learning through hybrid delivery during regular NRD activities. Our findings are relevant to current and future regulatory systems reliant on locally elected boards

Preparing students for community-based learning using an asset-based approach

One goal of service and community-based learning is to produce students who are more tightly engaged in the larger communities surrounding their institutions. Drawing on data from three courses, we argue that an asset-based approach plays a role in creating authentic campus-community partnerships that strive to engage students as members of the community from the outset and throughout their service learning courses. Asset-based activities help students come to understand the value of relationships amongst community members while also underscoring the value of their individual role in this group.  As such, students are more prepared for future work within the community

The role of drug resistance in poor viral suppression in rural South Africa: findings from a population-based study.

BACKGROUND:Understanding factors driving virological failure, including the contribution of HIV drug resistance mutations (DRM), is critical to ensuring HIV treatment remains effective. We examine the contribution of drug resistance mutations for low viral suppression in HIV-positive participants in a population-based sero-prevalence survey in rural South Africa. METHODS:We conducted HIV drug resistance genotyping and ART analyte testing on dried blood spots (DBS) from HIV-positive adults participating in a 2014 survey in North West Province. Among those with virologic failure (> 5000 copies/mL), we describe frequency of DRM to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI), report association of resistance with antiretroviral therapy (ART) status, and assess resistance to first and second line therapy. Analyses are weighted to account for sampling design. RESULTS:Overall 170 DBS samples were assayed for viral load and ART analytes; 78.4% of men and 50.0% of women had evidence of virologic failure and were assessed for drug resistance, with successful sequencing of 76/107 samples. We found ≥1 DRM in 22% of participants; 47% were from samples with detectable analyte (efavirenz, nevirapine or lopinavir). Of those with DRM and detectable analyte, 60% showed high-level resistance and reduced predicted virologic response to ≥1 NRTI/NNRTI typically used in first and second-line regimens. CONCLUSIONS:DRM and predicted reduced susceptibility to first and second-line regimens were common among adults with ART exposure in a rural South African population-based sample. Results underscore the importance of ongoing virologic monitoring, regimen optimization and adherence counseling to optimize durable virologic suppression

Characterizing tobacco control mass media campaigns in England

Aims To characterize publically funded tobacco control campaigns in England between 2004 and 2010 and to explore if they were in line with recommendations from the literature in terms of their content and intensity. International evidence suggests that campaigns which warn of the negative consequences of smoking and feature testimonials from real-life smokers are most effective, and that four exposures per head per month are required to reduce smoking prevalence. Design Characterization of tobacco control advertisements using a theoretically based framework designed to describe advertisement themes, informational and emotional content and style. Study of the intensity of advertising and exposure to different types of advertisement using data on population-level exposure to advertisements shown during the study period. Setting England. Measurements Television Ratings (TVRs), a standard measure of advertising exposure, were used to calculate exposure to each different campaign type. Findings A total of 89% of advertising was for smoking cessation; half of this advertising warned of the negative consequences of smoking, while half contained how-to-quit messages. Acted scenes featured in 72% of advertising, while only 17% featured real-life testimonials. Only 39% of months had at least four exposures to tobacco control campaigns per head. Conclusions A theory-driven approach enabled a systematic characterization of tobacco control advertisements in England. Between 2004 and 2010 only a small proportion of tobacco control advertisements utilized the most effective strategies—negative health effects messages and testimonials from real-life smokers. The intensity of campaigns was lower than international recommendations

Characterizing tobacco control mass media campaigns in England

Aims To characterize publically funded tobacco control campaigns in England between 2004 and 2010 and to explore if they were in line with recommendations from the literature in terms of their content and intensity. International evidence suggests that campaigns which warn of the negative consequences of smoking and feature testimonials from real-life smokers are most effective, and that four exposures per head per month are required to reduce smoking prevalence. Design Characterization of tobacco control advertisements using a theoretically based framework designed to describe advertisement themes, informational and emotional content and style. Study of the intensity of advertising and exposure to different types of advertisement using data on population-level exposure to advertisements shown during the study period. Setting England. Measurements Television Ratings (TVRs), a standard measure of advertising exposure, were used to calculate exposure to each different campaign type. Findings A total of 89% of advertising was for smoking cessation; half of this advertising warned of the negative consequences of smoking, while half contained how-to-quit messages. Acted scenes featured in 72% of advertising, while only 17% featured real-life testimonials. Only 39% of months had at least four exposures to tobacco control campaigns per head. Conclusions A theory-driven approach enabled a systematic characterization of tobacco control advertisements in England. Between 2004 and 2010 only a small proportion of tobacco control advertisements utilized the most effective strategies—negative health effects messages and testimonials from real-life smokers. The intensity of campaigns was lower than international recommendations

How does the emotive content of televised anti-smoking mass media campaigns influence monthly calls to the NHS Stop Smoking helpline in England?

OBJECTIVE: To investigate the effects of different types of televised mass media campaign content on calls to the English NHS Stop Smoking helpline. METHOD: We used UK government-funded televised tobacco control campaigns from April 2005 to April 2010, categorised as either “positive” (eliciting happiness, satisfaction or hope) or “negative” (eliciting fear, guilt or disgust). We built negative binomial generalised additive models (GAMs) with linear and smooth terms for monthly per capita exposure to each campaign type (expressed as Gross Ratings Points, or GRPs) to determine their effect on calls in the same month. We adjusted for seasonal trends, inflation-adjusted weighted average cigarette prices and other tobacco control policies. RESULTS: We found non-linear associations between exposure to positive and negative emotive campaigns and quitline calls. The rate of calls increased more than 50% as exposure to positive campaigns increased from 0 to 400 GRPs (rate ratio: 1.58, 95% CI: 1.25–2.01). An increase in calls in response to negative emotive campaigns was only apparent after monthly exposure exceeded 400 GRPs. CONCLUSION: While positive campaigns were most effective at increasing quitline calls, those with negative emotive content were also found to impact on call rates but only at higher levels of exposure

Effectiveness of tobacco control television advertising in changing tobacco use in England: a population‐based cross‐sectional study

AIM: To examine whether government‐funded tobacco control television advertising shown in England between 2002 and 2010 reduced adult smoking prevalence and cigarette consumption. DESIGN: Analysis of monthly cross‐sectional surveys using generalised additive models. SETTING: England. PARTICIPANTS: More than 80 000 adults aged 18 years or over living in England and interviewed in the Opinions and Lifestyle Survey. MEASUREMENTS: Current smoking status, smokers' daily cigarette consumption, tobacco control gross rating points (GRPs—a measure of per capita advertising exposure combining reach and frequency), cigarette costliness, tobacco control activity, socio‐demographic variables. FINDINGS: After adjusting for other tobacco control policies, cigarette costliness and individual characteristics, we found that a 400‐point increase in tobacco control GRPs per month, equivalent to all adults in the population seeing four advertisements per month (although actual individual‐level exposure varies according to TV exposure), was associated with 3% lower odds of smoking 2 months later [odds ratio (OR) = 0.97, 95% confidence interval (CI) = 0.95, 0.999] and accounted for 13.5% of the decline in smoking prevalence seen over this period. In smokers, a 400‐point increase in GRPs was associated with a 1.80% (95%CI = 0.47, 3.11) reduction in average cigarette consumption in the following month and accounted for 11.2% of the total decline in consumption over the period 2002–09. CONCLUSION: Government‐funded tobacco control television advertising shown in England between 2002 and 2010 was associated with reductions in smoking prevalence and smokers' cigarette consumption

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes

Impact of 13-valent pneumococcal conjugate vaccine (PCV13) in a pandemic similar to the 2009 H1N1 in the United States

Background: High rates of bacterial coinfection in autopsy data from the 2009 H1N1 influenza (“flu”) pandemic suggest synergies between flu and pneumococcal disease (PD) during pandemic conditions, and highlight the importance of interventions like the 13-valent pneumococcal conjugate vaccine (PCV13) that may mitigate the impact of a pandemic. Methods: We used a decision-analytic model, estimated from published sources, to assess the impact of pediatric vaccination with PCV13 versus the 7-valent vaccine (PCV7) on PD incidence and mortality in a normal flu season (10% flu incidence) and in a pandemic similar to 2009-2010 H1N1 (20% flu incidence, mild virulence, high impact in children). Both direct and indirect (herd) effects against PD were considered. Effectiveness of PCV13 was extrapolated from observed PCV7 data, using assumptions of serotype prevalence and PCV13 protection against the 6 serotypes not in PCV7. To simulate 2009–2010 H1N1, autopsy data were used to estimate the overall proportion of flu deaths with bacterial coinfections. By assuming that increased risk of death during the pandemic occurred among those with comorbidity (using obesity as proxy) and bacterial coinfections primarily due to S. pneumoniae or S. aureus, we estimated the proportion co-infected among all (fatal and non-fatal) flu cases (7.6% co-infected with any organism; 2.2% with S. pneumoniae). PD incidence, mortality, and total healthcare costs were evaluated over a 1-year horizon. Results: In a normal flu season, compared to PCV7, PCV13 is expected to prevent an additional 13,400 invasive PD (IPD) cases, 399,000 pneumonia cases, and 2,900 deaths, leading to cost savings of $472 M. In a pandemic similar to 2009–2010 H1N1, PCV13 would prevent 22,800 IPD cases, 872,000 pneumonia cases, and 3,700 deaths, resulting in cost savings of$1.0 B compared to PCV7. Conclusions: In a flu pandemic similar to the 2009–2010 H1N1, protection against the 6 additional serotypes in PCV13 would likely be effective in preventing pandemic-related PD cases, mortality, and associated costs