Multisectoral approach to support use of insecticide-treated net for malaria prevention among mobile and migrant populations in Myanmar: a systematic review

BACKGROUND: Myanmar is a premalaria elimination country with artemisinin-resistant malaria. A strategy for transmission control is focused on vulnerable groups such as mobile and migrant populations (MMPs), and includes improving access to insecticide-treated bed nets in the Myanmar artemisinin resistance containment (MARC) zones using multisectoral approaches (MSA). METHODS: This narrative systematic review addressed MSAs targeted to MMPs in Myanmar for malaria prevention. We searched relevant studies in electronic databases and present the narrative findings in 4 domains: stakeholder groups, net coverage and utilization, social determinates, and facilitators/barriers. RESULTS: Nine studies were included. The review identified stakeholders involved in intersectoral collaboration. Net ownership was higher than utilization rates in the MARC zones and rates remained below the WHO recommended target of 100%. There was inadequate description of roles and responsibilities for implementation and on channels of communication within the partnerships and with the Government. CONCLUSIONS: Findings show that interventions to distribute treated bed nets were supported by the multiple stakeholders. Due to the design of the primary studies, analysis of the added value of intersectoral collaboration was limited. More attention must be paid to designing studies to document and evaluate the contributions and outcomes of intersectoral collaboration

Inertial-Based Filtration Method for Removal of Microcarriers from Mesenchymal Stem Cell Suspensions

© 2018, The Author(s). Rapidly evolving cell-based therapies towards clinical trials demand alternative approaches for efficient expansion of adherent cell types such as human mesenchymal stem cells (hMSCs). Using microcarriers (100–300 µm) in a stirred tank bioreactor offers considerably enhanced surface to volume ratio of culture environment. However, downstream purification of the harvested cell product needs to be addressed carefully due to distinctive features and fragility of these cell products. This work demonstrates a novel alternative approach which utilizes inertial focusing to separate microcarriers (MCs) from the final cell suspension. First, we systematically investigated MC focusing dynamics inside scaled-up curved channels with trapezoidal and rectangular cross-sections. A trapezoidal spiral channel with ultra-low-slope (Tan(α) = 0.0375) was found to contribute to strong MC focusing (~300 < Re < ~400) while managing high MC volume fractions up to ~1.68%. Accordingly, the high-throughput trapezoidal spiral channel successfully separated MCs from hMSC suspension with total cell yield~94% (after two passes) at a high volumetric flow rate of ~30 mL/min (Re~326.5)

Quasilocal energy for rotating charged black hole solutions in general relativity and string theory

We explore the (non)-universality of Martinez's conjecture, originally proposed for Kerr black holes, within and beyond general relativity. The conjecture states that the Brown-York quasilocal energy at the outer horizon of such a black hole reduces to twice its irreducible mass, or equivalently, to \sqrt{A} /(2\sqrt{pi}), where `A' is its area. We first consider the charged Kerr black hole. For such a spacetime, we calculate the quasilocal energy within a two-surface of constant Boyer-Lindquist radius embedded in a constant stationary-time slice. Keeping with Martinez's conjecture, at the outer horizon this energy equals the irreducible mass. The energy is positive and monotonically decreases to the ADM mass as the boundary-surface radius diverges. Next we perform an analogous calculation for the quasilocal energy for the Kerr-Sen spacetime, which corresponds to four-dimensional rotating charged black hole solutions in heterotic string theory. The behavior of this energy as a function of the boundary-surface radius is similar to the charged Kerr case. However, we show that in this case it does not approach the expression conjectured by Martinez at the horizon.Comment: 15 page

Detection of asymptomatic malaria in Asian countries: a meta-analysis of diagnostic accuracy

Background: Achieving malaria elimination requires the targeting of the human reservoir of infection, including those patients with asymptomatic infection. The objective was to synthesise evidence on the accuracy of the rapid- onsite diagnostic tests (RDTs) and microscopy for the detection of asymptomatic malaria as part of the surveillance activities in Asian countries. Methods: This was a meta-analysis of diagnostic test accuracy. Relevant studies that evaluated the diagnostic per- formance of RDTs and microscopy for detection of asymptomatic malaria were searched in health-related electronic databases. The methodological quality of the studies included was assessed using the QUADAS-2 tool. Results: Ten studies assessing RDT and/or microscopy were identified. The diagnostic accuracies in all these stud- ies were verified by PCR. Overall, the pooled sensitivities of RDT, as well as microscopy for detection of any malaria parasites in asymptomatic participants, were low, while their pooled specificities were almost ideal. For the detection of Plasmodium falciparum, pooled sensitivity by RDT (59%, 95%CI:16-91%) or microscopy (55%, 95%CI: 25-82%) were almost comparable. For detection of Plasmodium vivax, pooled sensitivity of RDT (51%, 95% CI:7-94%) had also the comparable accuracy of microscopy (54%, 95%CI,11-92%). Of note are the wide range of sensitivity and specificity. Conclusion: The findings of this meta-analysis suggest that RDTs and microscopy have limited sensitivity and are inappropriate for the detection of asymptomatic Plasmodium infections. Other methods including a combination of PCR-based strategies, Loop-Mediated Isothermal Amplification (LAMP) technique must be considered to target these infections, in order to achieve malaria elimination. However, more data is needed for the wide acceptance and feasi- bility of these approaches. Studies to explore the role of asymptomatic and sub-patent infections in the transmission of malaria are of critical importance and are recommend

Retreatment with anti-EGFR based therapies in metastatic colorectal cancer: impact of intervening time interval and prior anti-EGFR response.

BackgroundThis retrospective study aims to investigate the activity of retreatment with anti-EGFR-based therapies in order to explore the concept of clonal evolution by evaluating the impact of prior activity and intervening time interval.MethodsEighty-nine KRAS exon 2-wild-type metastatic colorectal patients were retreated on phase I/II clinical trials containing anti-EGFR therapies after progressing on prior cetuximab or panitumumab. Response on prior anti-EGFR therapy was defined retrospectively per physician-records as response or stable disease ≥6 months. Multivariable statistical methods included a multiple logistic regression model for response, and Cox proportional hazards model for progression-free survival.ResultsRetreatment anti-EGFR agents were cetuximab (n = 76) or cetuximab plus erlotinib (n = 13). The median interval time between prior and retreatment regimens was 4.57 months (range: 0.46-58.7). Patients who responded to the prior cetuximab or panitumumab were more likely to obtain clinical benefit to the retreatment compared to the non-responders in both univariate (p = 0.007) and multivariate analyses (OR: 3.38, 95 % CI: 1.27, 9.31, p = 0.019). The clinical benefit rate on retreatment also showed a marginally significant association with interval time between the two anti-EGFR based therapies (p = 0.053). Median progression-free survival on retreatment was increased in prior responders (4.9 months, 95 % CI: 3.6, 6.2) compared to prior non-responders (2.5 months, 95 % CI, 1.58, 3.42) in univariate (p = 0.064) and multivariate analysis (HR: 0.70, 95 % CI: 0.43-1.15, p = 0.156).ConclusionOur data lends support to the concept of clonal evolution, though the clinical impact appears less robust than previously reported. Further work to determine which patients benefit from retreatment post progression is needed

Anxiety and depressive symptoms and coping strategies in Nasopharyngeal carcinoma patients in Hospital Kuala Lumpur

Introduction: Nasopharyngeal Carcinoma (NPC) is the second most common cancer among men in Malaysia. Establishing local data will help to improve the treatment strategies and lower the anxiety and depression level among NPC patients. Our aim was to compare the level of symptoms of anxiety and depression and the coping strategies employed between NPC and cancer-free patients. Methods: A comparative cross-sectional study with universal sampling was conducted on 22 NPC patients and 30 cancer-free patients from the Oncology and Radiotherapy Department and Ear, Nose and Throat clinic of Hospital Kuala Lumpur (HKL) between 12 to 29 May 2008. In this study, the symptoms of depression and anxiety were obtained by using the Hospital Anxiety and Depression Scale (HADS) while Brief COPE questionnaire was used to understand patients’ coping strategies. Results: The prevalence of NPC was higher in the Chinese, men, aged between 40 and 59 years, and those from the lower income group. The levels of anxiety and depression symptoms were found to be higher in the NPC group as compared to the cancer-free group. However, only the level of depression was found significantly related to the NPC group (p=0.002). This study also found that the two comparison groups were using different types of coping strategies. The NPC patients mainly used ‘acceptance’ as their coping strategy while the comparative group most often used ‘religion’. Among the types of coping strategies reported by the patients, ‘use of instrumental support’ type was found to be associated with a lower level of anxiety (p = 0.035) and ‘humour’ type was associated with lower depressive symptoms (p = 0.269). On the contrary, ‘selfblame’ type was associated with both anxiety (p =0.0001) and depression (p = 0.001) symptoms. In addition, patients with different gender, ethnicity, educational levels, and monthly income were also found to have significant differences in their levels of anxiety and depression as well as type of coping strategies. Conclusions: NPC patients had higher anxiety and depression levels as compared to the comparative group. Different socio-demographic backgrounds and different types of coping strategies had an influence on patients resulting in different levels of anxiety and depression

Pendataan Jumlah Penduduk, Bangunan dan Usaha di Kelurahan Rufei Sorong

Kelurahan Rufei sendiri merupakan kelurahan yang memiliki tingkat kepadatan penduduk cukup besar dimana sebagian besar penduduk terutama masyarakat yang baru tinggal banyak yang belum terdaftar/terdata di kelurahan. Berdasarkan data hasil interview dengan Kepala Kelurahan Rufei pendataan penduduk di kelurahan ini khususnya di RW 03 belum dilakukan secara optimal. Program yang akan dilakukan dalam kegiatan pengabdian ini adalah membantu pihak kelurahan untuk melakukan pendataan penduduk khususnya di wilayah RW 3 yang memiliki 4 RT. Pendataan yang akan dilakukan terbagi menjadi 3 (tiga) bidang yaitu bidang kependudukan, bidang bangunan, dan bidang usaha. Hasil dari program pengabdian ini diperoleh data bahwa RW 03 memiliki jumlah penduduk laki-lakinya hampir sama dengan penduduk perempuan, dimana dalam keluarga memiliki rata-rata Anggota Rumah Tangga (ART) sekitar 4-5 orang. Masyarakat yang ada pada kelurahan Rufei khususnya RW 03 juga kebanyakan penduduknya non Papua dibanding Papua. Bangunan terbanyak yang ada di RW ini adalah bangunan permanen, dimana bangunan yang ada sebagian besar adalah milik sendiri. Ada juga masyarakat yang tinggal di RW ini hanya sewa, dan tidak menetap secara permanen. Masyarakat yang memiliki usaha di RW ini kebanyakan tidak memiliki ijin usaha, hal ini dikarenakan usaha yang ada hanya usaha Mikro. Usaha yang memiliki ijin usaha adalah usaha yang sudah termasuk dalam usaha menengah keatas