Barrier bednets target malaria vectors and expand the range of usable insecticides

Transmission of Plasmodium falciparum malaria parasites occurs when nocturnal Anopheles mosquito vectors feed on human blood. In Africa, where malaria burden is highest, bednets treated with pyrethroid insecticide were highly effective in preventing mosquito bites and reducing transmission, and essential to achieving unprecedented reductions in malaria until 2015 (ref. ). Since then, progress has stalled , and with insecticidal bednets losing efficacy against pyrethroid-resistant Anopheles vectors , methods that restore performance are urgently needed to eliminate any risk of malaria returning to the levels seen before their widespread use throughout sub-Saharan Africa . Here, we show that the primary malaria vector Anopheles gambiae is targeted and killed by small insecticidal net barriers positioned above a standard bednet in a spatial region of high mosquito activity but zero contact with sleepers, opening the way for deploying many more insecticides on bednets than is currently possible. Tested against wild pyrethroid-resistant A. gambiae in Burkina Faso, pyrethroid bednets with organophosphate barriers achieved significantly higher killing rates than bednets alone. Treated barriers on untreated bednets were equally effective, without significant loss of personal protection. Mathematical modelling of transmission dynamics predicted reductions in clinical malaria incidence with barrier bednets that matched those of 'next-generation' nets recommended by the World Health Organization against resistant vectors. Mathematical models of mosquito-barrier interactions identified alternative barrier designs to increase performance. Barrier bednets that overcome insecticide resistance are feasible using existing insecticides and production technology, and early implementation of affordable vector control tools is a realistic prospect

Experiences of Self-Management Support Following a Stroke: A Meta-Review of Qualitative Systematic Reviews

Supporting self-management in stroke patients improves psychological and functional outcomes but evidence on how to achieve this is sparse. We aimed to synthesise evidence from systematic reviews of qualitative studies in an overarching meta-review to inform the delivery and development of self-management support interventions.We systematically searched eight electronic databases including MEDLINE, EMBASE and CINAHL for qualitative systematic reviews (published January 1993 to June 2012). We included studies exploring patients', carers' or health care professionals' experiences relevant to self-management support following a stroke, including studies describing the lived experience of surviving a stroke. We meta-synthesised the included review findings using a meta-ethnographic framework.Seven reviews, reporting 130 unique studies, were included. Themes emerging from the reviews were pertinent, consistent and showed data saturation; though explicit mention of self-management support was rare. Our meta-review highlighted the devastating impact of stroke on patients' self-image; the varying needs for self-management support across the trajectory of recovery; the need for psychological and emotional support throughout recovery particularly when physical recovery plateaus; the considerable information needs of patients and carers which also vary across the trajectory of recovery; the importance of good patient-professional communication; the potential benefits of goal-setting and action-planning; and the need for social support which might be met by groups for stroke survivors.The observed data saturation suggests that, currently, no further qualitative research simply describing the lived experience of stroke is needed; we propose that it would be more useful to focus on qualitative research informing self-management support interventions and their implementation. Our findings demonstrate both the on-going importance of self-management support and the evolving priorities throughout the stages of recovery following a stroke. The challenge now is to ensure these findings inform routine practice and the development of interventions to support self-management amongst stroke survivors

Tourism, inclusive growth and decent work: a political economy critique

This paper interrogates the ideas of ‘sustained’ and ‘inclusive’ growth that are intrinsic to one of three UN Sustainable Development Goals (SDG 8 - Decent Work and Growth) adopted by the UN World Tourism Organisation’s (UNWTO) 2030 sustainable tourism agenda. It provides a Marxian-inspired political economy critique of the UNWTO’s embrace of SDG8 and highlights the blind spot within the UNWTO’s inclusive growth-led SDG agenda with respect to questions of equity and social justice. The paper contends that the UNWTO’s SDG-led agenda is contradicted by the logics of growth, competitiveness and profit-making that drive the continued expansion and development of tourism. Rather than addressing the structural injustices that entrench inequalities and reproduce exploitative labour practices, the notion of sustained and inclusive growth reinforces the primacy of capital and market notions of justice and continues to perpetuate a growth driven tourism development model. The paper contributes to a critical theorization of sustainable tourism and offers an informed critique of the current political agenda for sustainable tourism and its potential outcomes

Underpinning Sustainable Vector Control through Informed Insecticide Resistance Management

Background: There has been rapid scale-up of malaria vector control in the last ten years. Both of the primary control strategies, long-lasting pyrethroid treated nets and indoor residual spraying, rely on the use of a limited number of insecticides. Insecticide resistance, as measured by bioassay, has rapidly increased in prevalence and has come to the forefront as an issue that needs to be addressed to maintain the sustainability of malaria control and the drive to elimination. Zambia’s programme reported high levels of resistance to the insecticides it used in 2010, and, as a result, increased its investment in resistance monitoring to support informed resistance management decisions. Methodology/Principal Findings: A country-wide survey on insecticide resistance in Zambian malaria vectors was performed using WHO bioassays to detect resistant phenotypes. Molecular techniques were used to detect target-site mutations and microarray to detect metabolic resistance mechanisms. Anopheles gambiae s.s. was resistant to pyrethroids,DDT and carbamates, with potential organophosphate resistance in one population. The resistant phenotypes were conferred by both target-site and metabolic mechanisms. Anopheles funestus s.s. was largely resistant to pyrethroids and carbamates, with potential resistance to DDT in two locations. The resistant phenotypes were conferred by elevated levels of cytochrome p450s. Conclusions/Significance: Currently, the Zambia National Malaria Control Centre is using these results to inform their vector control strategy. The methods employed here can serve as a template to all malaria-endemic countries striving to create a sustainable insecticide resistance management pla

Late style and speaking out: J A Symonds's In the Key of Blue

This article examines In the Key of Blue (1893)—an essay collection by John Addington Symonds—as a case study in queer public utterance during the early 1890s. Viewed through the critical lens of late style, as theorised by Edward Said, the evolution of this project, from compilation through to reader reception, reveals Symonds's determination to “speak out” on the subject of homosexuality. Paradoxically, In the Key of Blue was thus a timely and untimely work: it belonged to a brief period of increased visibility and expressiveness when dealing with male same-sex desire, spearheaded by a younger generation of Decadent writers, but it also cut against the grain of nineteenth-century social taboo and legal repression. Symonds's essay collection brought together new and previously unpublished work with examples of his writing for the periodical press. These new combinations, appearing together for the first time, served to facilitate new readings and new inferences, bringing homosexual themes to the fore. This article traces the dialogic structure of In the Key of Blue , its strategies for articulating homosexual desire, and examines the response of reviewers, from the hostile to celebratory

Assessing the Societal Impact of Research: The Relational Engagement Approach

Marketing and policy researchers aiming to increase the societal impact of their scholarship should engage directly with relevant stakeholders. For maximum societal effect, this engagement needs to occur both within the research process and throughout the complex process of knowledge transfer. The authors propose that a relational engagement approach to research impact complements and builds on traditional approaches. Traditional approaches to impact employ bibliometric measures and focus on the creation and use of journal articles by scholarly audiences, an important but incomplete part of the academic process. The authors recommend expanding the strategies and measures of impact to include process assessments for specific stakeholders across the entire course of impact, from the creation, awareness, and use of knowledge to societal impact. This relational engagement approach involves the cocreation of research with audiences beyond academia. The authors hope to begin a dialogue on the strategies researchers can use to increase the potential societal benefits of their research

Regulation of endometrial regeneration; mechanisms contributing to repair and restoration of tissue integrity following menses

The human endometrium is a dynamic, multi-cellular tissue that lines the inside of the uterine cavity. During a woman’s reproductive lifespan the endometrium is subjected to cyclical episodes of proliferation, angiogenesis, differentiation/decidualisation, shedding (menstruation), repair and regeneration in response to fluctuating levels of oestrogen and progesterone secreted by the ovaries. The endometrium displays unparalleled, tightly regulated, tissue remodelling resulting in a healed, scar-free tissue following menses or parturition. Mechanisms responsible for initiation of menses have been well documented: following progesterone withdrawal there is an increase in inflammatory mediators, focal hypoxia and induction and activation of matrix-degrading enzymes. In contrast, the molecular and cellular changes responsible for rapid, regulated, tissue repair at a time when oestrogen and progesterone are low are poorly understood. Histological studies using human menstrual phase endometrium have revealed that tissue destruction and shedding occur in close proximity to re-epithelialisation/repair. It has been proposed that re-epithelialisation involves proliferation of glandular epithelial cells in the remaining basal compartment; there is also evidence for a contribution from the underlying stroma. A role for androgens in the regulation of apoptosis of endometrial stromal cells has been proposed but the impact of androgens on tissue repair has not been investigated. Studies using human xenografts and primates have been used to model some aspects of the impact of progesterone withdrawal but simultaneous shedding (menses) and repair have not been modelled in mice; the species of choice for translational biomedical research. In the course of the studies described in this thesis, the following aims have been addressed: 1. To establish a model of menses in the mouse which mimics menses in women, namely; simultaneous breakdown and repair, overt menstruation, immune cell influx, tissue necrosis and re-epithelialisation. 2. To use this model to determine if the stromal cell compartment contributes to endometrial repair. 3. To examine the impact of androgens on the regulation of menses (shedding) and repair. An informative mouse model of endometrial breakdown that was characterised by overt menses, as well as rapid repair, was developed. Immunohistological evidence for extensive tissue remodelling including active angiogenesis, transient hypoxia, epithelial cell-specific proliferation and re-epithelialisation were obtained by examining uterine tissues recovered during an “early window of breakdown and repair” (4 to 24 hours after progesterone withdrawal). Novel data included identification of stromal cells that expressed epithelial cell markers, close to the luminal surface following endometrial shedding, suggesting a role for mesenchymal to epithelial transition (MET) in re-epithelialisation of the endometrium. In support of this idea, array and qRTPCR analyses revealed dynamic changes in expression of mRNAs encoded by genes known to be involved in MET during the window of breakdown and repair. Roles for hypoxia and tissue-resident macrophages in breakdown and tissue remodelling were identified. Treatment of mice with dihydrotestosterone to mimic concentrations of androgens circulated in women at the time of menses had an impact on the timing and duration of endometrial breakdown. Array analysis revealed altered expression of genes implicated in MET and angiogenesis/inflammation highlighting a potential, previously unrecognised role for androgens in regulation of tissue turnover during menstruation. In summary, using a newly refined mouse model new insights were obtained, implicating androgens and stromal MET in restoration of endometrial tissue homeostasis during menstruation. These findings may inform development of new treatments for disorders associated with aberrant repair such as heavy menstrual bleeding and endometriosis

Genomic analyses identify hundreds of variants associated with age at menarche and support a role for puberty timing in cancer risk

The timing of puberty is a highly polygenic childhood trait that is epidemiologically associated with various adult diseases. Using 1000 Genomes Project-imputed genotype data in up to similar to 370,000 women, we identify 389 independent signals (P <5 x 10(-8)) for age at menarche, a milestone in female pubertal development. In Icelandic data, these signals explain similar to 7.4% of the population variance in age at menarche, corresponding to similar to 25% of the estimated heritability. We implicate similar to 250 genes via coding variation or associated expression, demonstrating significant enrichment in neural tissues. Rare variants near the imprinted genes MKRN3 and DLK1 were identified, exhibiting large effects when paternally inherited. Mendelian randomization analyses suggest causal inverse associations, independent of body mass index (BMI), between puberty timing and risks for breast and endometrial cancers in women and prostate cancer in men. In aggregate, our findings highlight the complexity of the genetic regulation of puberty timing and support causal links with cancer susceptibility