Shrinking the Malaria Map: A Prospectus on Malaria Elimination

\ud Thirty-nine countries across the world are making progress toward malaria elimination. Some are committed to nationwide elimination, while others are pursuing spatially progressive elimination within their borders. Influential donor and multilateral organizations are supporting their goals of achieving malaria-free status. With elimination back on the global agenda, countries face a myriad of questions. Should they change their programs to eliminate rather than control malaria? What tools are available? What policies need to be put into place? How will they benefit from elimination? Unfortunately, answers to these questions, and resources for agencies and country program managers considering or pursuing elimination, are scarce. The 39 eliminating countries are all positioned along the endemic margins of the disease, yet they naturally experience a variety of country characteristics and epidemiologies that make their malaria situations different from one another. The Malaria Elimination Group (MEG) and this Prospectus recognize\ud that there is no single solution, strategy, or time line that will be appropriate for every country, and each is encouraged to initiate a comprehensive evaluation of its readiness and strategy for elimination. The Prospectus is designed to guide countries in conducting these assessments. The Prospectus provides detailed and informed discussion on the practical means of achieving and sustaining zero transmission. It is designed as a road map, providing direction and options from which to choose an appropriate path. As on all maps, the destination is clearly marked, but the possible routes to reach it are numerous. The Prospectus is divided into two sections: Section 1 Eliminating Malaria comprises four chapters covering the strategic components important to the periods before, during, and after an elimination program. Section 2 Tools for the Job, comprises six chapters that outline basic information about how interventions in an elimination program will be different from those in a control setting. Chapter 1, Making the Decision, evaluates the issues that a country should consider when deciding whether or not to eliminate malaria. The chapter begins with a discussion about the quantitative and qualitative benefits that a country could expect from eliminating malaria and then recommends a thorough feasibility assessment. The feasibility assessment is based on three major components: operational, technical, and financial feasibility. Cross-border and regional collaboration is a key subject in this chapter. Chapter 2, Getting to Zero, describes changes that programs must consider when moving from sustained control to an elimination goal. The key strategic issues that must be addressed are considered, including supply chains, surveillance systems, intersectoral collaboration, political will, and legislative framework. Cross-border collaboration is again a key component in Getting to Zero. Chapter 3, Holding the Line, provides recommendations on how to conduct an assessment of two key factors that will affect preventing the reemergence of malaria once transmission is interrupted: outbreak risk and importation risk. The chapter emphasizes the need for a strong surveillance system in order to prevent and, if necessary, respond to imported cases. Chapter 4, Financing Elimination, reviews the cost-effectiveness of elimination as compared with sustained control and then presents the costs of selected elimination programs as examples. It evaluates four innovative financing mechanisms that must support elimination, emphasizing the need for predictable and stable financing. Case studies from Swaziland and two provinces in China are provided. Chapter 5, Understanding Malaria, considers malaria from the point of view of elimination and provides a concise overview of the current burden of the disease, malaria transmission, and the available interventions that can be used in an elimination program. Chapter 6, Learning from History, extracts important lessons from the Global Malaria Eradication Program and analyzes some elimination efforts that were successful and some that were unsuccessful. The chapter also reviews how the malaria map has been shrinking since 1900. xiv A Prosp ectus on Mala ria Elimi natio n\ud Chapter 7, Measuring Malaria for Elimination, provides a precise language for discussing malaria and gives the elimination discussion a quantitative structure. The chapter also describes the role of epidemiological theory and mathematical modeling in defining and updating an elimination agenda for malaria. Chapter 8, Killing the Parasite, outlines the importance of case detection and management in an elimination setting. Options for diagnosis, the hidden challenge of Plasmodium vivax in an elimination setting, and the impact of immunity are all discussed. Chapter 9, Suppressing the Vector, explores vector control, a necessary element of any malaria program. It considers optimal methods available to interrupt transmission and discusses potential changes, such as insecticide resistance, that may affect elimination efforts. Chapter 10, Identifying the Gaps — What We Need to Know, reviews the gaps in our understanding of what is required for elimination. The chapter outlines a short-term research agenda with a focus on the operational needs that countries are facing today. The Prospectus reviews the operational, technical, and financial feasibility for those working on the front lines and considers whether, when, and how to eliminate malaria. A companion document, A Guide on Malaria Elimination for Policy Makers, is provided for those countries or agencies whose responsibility is primarily to make the policy decisions on whether to pursue or support a malaria elimination strategy. The Guide is available at www.malaria eliminationgroup.org

Obesity and type-2 diabetes as inducers of premature cellular senescence and ageing

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Cellular senescence is now considered as a major mechanism in the development and progression of various diseases and this may include metabolic diseases such as obesity and type-2 diabetes. The presence of obesity and diabetes is a major risk factor in the development of additional health conditions, such as cardiovascular disease, kidney disease and cancer. Since senescent cells can drive disease development, obesity and diabetes can potentially create an environment that accelerates cell senescence within other tissues of the body. This can consequently manifest as age-related biological impairments and secondary diseases. Cell senescence in cell types linked with obesity and diabetes, namely adipocytes and pancreatic beta cells will be explored, followed by a discussion on the role of obesity and diabetes in accelerating ageing through induction of premature cell senescence mediated by high glucose levels and oxidised low-density lipoproteins. Particular emphasis will be placed on accelerated cell senescence in endothelial progenitor cells, endothelial cells and vascular smooth muscle cells with relation to cardiovascular disease and proximal tubular cells with relation to kidney disease. A summary of the potential strategies for therapeutically targeting senescent cells for improving health is also presented

Requirements for a Nutrition Education Demonstrator

[Context and Motivation] Development of innovative ICT-based applications is a complex process involving collaboration of all relevant disciplines. This complexity arises due to differences in terminology, knowledge and often also the ways of working between developers in the disciplines involved. [Question/problem] Advances in each discipline bring a rich design environment of theories, models, methods and techniques. Making a selection from these makes the development of distributed applications very challenging, often requiring a holistic approach to address the needs of the disciplines involved. This paper describes early stage requirements acquisition of a mobile nutrition education demonstrator which supports overweight persons in adopting healthier dietary behaviour. [Principal idea/results] We present a novel way to combine and use known requirements acquisition methods involving a two stage user needs analysis based on scenarios which apply a theory-based model of behavioural change and are onstructed in two phases. The first phase scenarios specify an indicative description reflecting the use of the transtheoretical model of behavioural change. In the second phase, a handshake protocol adds elements of optative system-oriented descriptions to the scenarios such that the intended system can support the indicative description. [Contribution] The holistic and phased approach separates design concerns to which each of the disciplines contributes with their own expertise and domain principles. It preserves the applied domain principles in the design and it bridges gaps in terminology, knowledge and ways of working

Guideline-based decision support for the mobile patient incorporating data streams from a body sensor network

We present a mobile decision support system (mDSS) which helps patients adhere to best clinical practice by providing pervasive and evidence-based health guidance via their smartphones. Similar to some existing clinical DSSs, the mDSS is designed to execute clinical guidelines, but it operates on streaming data from, e.g., body sensor networks instead of persistent data from clinical databases. Therefore, we adapt the typical guideline-based architecture by basing the mDSS design on existing data stream management systems (DSMSs); during operation, the mDSS instantiates from the guideline knowledge a network of concurrent streaming processes, avoiding the resource implications of traditional database approaches for processing patient data which may arrive at high frequencies via multiple channels. However, unlike typical DSMSs, we distinguish four types of streaming processes to reflect the full disease management process: Monitoring, Analysis, Decision and Effectuation. A prototype of the mDSS has been developed and demonstrated on an Android smartphone

Union Seniority Rules as a Determinant of Intra-Firm Job-Changes

Les études d'Oison et de Berger (1982) et celles d'Abraham et de Medoff (1985) estiment que l'influence de l'effet de la compétence, dans la détermination des promotions à l'intérieur d'une entreprise syndiquée, se trouve améliorée lorsque les clauses d'une convention collective de travail stipulent qu'il faut également tenir compte de l'ancienneté comme facteur déterminant dans les promotions. Le présent article s'appuie sur les études d'Oison et de Berger (1982) en utilisant des données recueillies au niveau d'une entreprise pour observer le processus des changements d'occupation dans une entreprise déterminée, ce qui permet de nuancer la grille d'analyse de façon à y inclure tous les changements d'occupation qui peuvent se produire. Aussi, le point central de cette analyse consiste-t-ii dans un examen des effets de l'ancienneté dans la caractérisation des changements d'occupation selon les modèles strictement définis : mouvements comportant une augmentation de salaire (WIM's — wage increasing moves), changement d'occupation qui a un effet positif sur le taux du salaire; mouvements neutres (WNM's — wage neutral moves), changement d'occupation sans modification du taux de salaire; mouvements décroissants du salaire (WDM's — wage decreasing moves), changement d'occupation accompagne d'un taux de salaire inférieur.On a supposé un modèle de changement d'occupation choisi par un travailleur du rang par lequel celui-ci assume la décision de changer d'occupation uniquement si ce mouvement lui est profitable. Tous les changements d'occupation sont considérés comme des mouvements de nature à procurer des avantages. Pour estimer la probabilité d'un changement d'occupation, on a utilisé des équations de changement d'occupation de forme réduite. Le vecteur des caractéristiques personnelles comprend l'âge du travailleur, son statut matrimonial, le nombre de ses dépendants, la fréquence des accidents à son poste actuel. On y inclut ensuite à la fois l'ancienneté et l'ancienneté au carre comme variables indépendantes.Nous nous attendions à un rôle très marque de l'ancienneté dans la détermination des changements d'occupation dans cette entreprise comme conséquence de l'importance de l'ancienneté dans les stipulations relatives à la fois à l'affichage des postes et aux changements d'occupation dans la convention collective de travail. On s'attendait à un coefficient positif de l'ancienneté, car les travailleurs, en obtenant la permanence, seraient plus enclins à obtenir aussi les changements d'occupation souhaites puisque l'ancienneté est un critère explicite de toute réaffectation de poste.Tout changement d'occupation exige un investissement de ressources humaines sous forme de formation sur place; en conséquence, nous nous attendions donc à ce que l'entreprise et les travailleurs refusent un tel investissement supplémentaire à cause de l'âge des travailleurs, étant donné que le temps qui leur reste pour bénéficier des avantages va diminuant. Aussi, nous attendions-nous à un effet négatif de l'âge. Surtout, nous nous attendions à ce que à la fois l'ancienneté et l'âge soient des causes déterminantes majeures des changements d'occupation tant dans les régressions binaires que multinomiales. Nous n'avions aucune raison a priori de nous attendre à ce que l'un ou l'autre effet prédominent. Par conséquent, que l'effet d'ancienneté l'emporte sur l'effet de l'âge est une question empirique.La source des microdonnées consiste en un échantillon du profil de 593 personnes travaillant dans un des établissements d'une entreprise industrielle qui en compte plusieurs. La main-d’œuvre est exclusivement formée de cols bleus demeurant dans une zone urbaine en Ontario. Les travailleurs sont régis par une convention collective de travail négocié par une section locale affiliée à un grand syndicat industriel américain. Il s'agit d'une firme du secteur privé qui est active dans le domaine international. Les données relatives aux travailleurs pris individuellement sont disponibles comme profils de microdonnées pour l'année 1980 et ils ont été obtenus à peu près au milieu d'une convention collective de longue durée. L'analyse empirique commence par l'examen de la décision du travailleur de changer ou non de poste en utilisant la régression logistique à deux voies. Afin de découvrir les effets de l'ancienneté dans les promotions (WIM' s), les mutations (WNM' s) et les rétrogradations (WDM' s), nous considérons la régression logistique des changements d'occupation selon les quatre voies que peut choisir un travailleur :statu quo, changement d'occupation comportant soit une augmentation ou une diminution de salaire, aucune modification du salaire.Les résultats empiriques sous-entendent que, comme échantillon moyen, l'effet de l'ancienneté l'emporte sur l'influence de l'âge tant pour les mutations (WNM' s) que pour les promotions (WIM' s) tel qu'on s'y attendait, étant donne le rôle marque de l'ancienneté dans les clauses de la convention collective de travail relatives aux changements de poste. En matière d'ancienneté, les promotions (WIM' s) sont concaves tandis que les mutations (WNM' s) augmentent de façon linéaire pour ce qui est de l'ancienneté. Cependant, et les promotions (WIM' s) et les mutations (WNM' s) décroissent de façon linéaire pour l'âge. L'effet de l'âge l'emporte sur l'effet de l'ancienneté, en tant qu'échantillon moyen, en ce qui concerne les rétrogradations (WDM' s). Les rétrogradations (WDM' s) sont concaves en ce qui a trait à l'ancienneté et décroissent de façon linéaire en ce qui concerne l'âge. L'influence de l'ancienneté est plus grande pour les promotions (WIM' s), suivie par les mutations (WNM' s) et les rétrogradations (WDM' s), en ordre décroissant. On pourrait développer l'analyse en obtenant des résultats de dimension longitudinale afin de vérifier l'importance progressive de l'ancienneté dans la détermination des changements d'occupation dans le temps. Malheureusement, nous ne disposions pas de données pour l'appréciation de la performance (compétence) des travailleurs. Ces données permettraient d'élargir cette étude en facilitant des vérifications directes de l'importance relative de la compétence par rapport à l'ancienneté comme critères dans les décisions portant sur les changements d'occupation.Micro-data from a Canadian industrial union establishment are explored in order to ascertain the extent to which seniority rules determine job-change decisions