Health worker motivation in the context of HIV care and treatment challenges in Mbeya Region, Tanzania: A qualitative study

Health worker motivation can potentially affect the provision of health services. The HIV pandemic has placed additional strain on health service provision through the extra burden of increased testing and counselling, treating opportunistic infections and providing antiretroviral treatment. The aim of this paper is to explore the challenges generated by HIV care and treatment and their impact on health worker motivation in Mbeya Region, Tanzania. Thirty in-depth interviews were conducted with health workers across the range of health care professions in health facilities in two high HIV-prevalence districts of Mbeya Region, Tanzania. A qualitative framework analysis was adopted for data analysis. The negative impact of HIV-related challenges on health worker motivation was confirmed by this study. Training seminars and workshops related to HIV contributed to the shortage of health workers in the facilities. Lower status workers were frequently excluded from training and were more severely affected by the consequent increase in workload as seminars were usually attended by higher status professionals who controlled access. Constant and consistent complaints by clients have undermined health workers' expectations of trust and recognition. Health workers were forced to take responsibility for dealing with problems arising from organisational inefficiencies within the health system. HIV-related challenges undermine motivation among health workers in Mbeya, Tanzania with the burden falling most heavily on lower status workers. Strained relations between health workers and the community they serve, further undermine motivation of health workers

Scaling of Brain Metabolism with a Fixed Energy Budget per Neuron: Implications for Neuronal Activity, Plasticity and Evolution

It is usually considered that larger brains have larger neurons, which consume more energy individually, and are therefore accompanied by a larger number of glial cells per neuron. These notions, however, have never been tested. Based on glucose and oxygen metabolic rates in awake animals and their recently determined numbers of neurons, here I show that, contrary to the expected, the estimated glucose use per neuron is remarkably constant, varying only by 40% across the six species of rodents and primates (including humans). The estimated average glucose use per neuron does not correlate with neuronal density in any structure. This suggests that the energy budget of the whole brain per neuron is fixed across species and brain sizes, such that total glucose use by the brain as a whole, by the cerebral cortex and also by the cerebellum alone are linear functions of the number of neurons in the structures across the species (although the average glucose consumption per neuron is at least 10× higher in the cerebral cortex than in the cerebellum). These results indicate that the apparently remarkable use in humans of 20% of the whole body energy budget by a brain that represents only 2% of body mass is explained simply by its large number of neurons. Because synaptic activity is considered the major determinant of metabolic cost, a conserved energy budget per neuron has several profound implications for synaptic homeostasis and the regulation of firing rates, synaptic plasticity, brain imaging, pathologies, and for brain scaling in evolution

Malaria eradication within a generation: ambitious, achievable, and necessary

50 years after a noble but flawed attempt to eradicate malaria in the mid-20th century, the global malaria community is once again seriously considering eradication. Momentum towards eradication has been building for decades, and more than half of the world's countries are now malaria free. Since 2000, a surge of global progress has occurred, facilitated by the roll-out of new technologies and the substantial growth in political and financial commitment by countries, regions, and their global partners. Annual domestic and international spending on malaria increased from roughly US$1·5 billion in 2000 to$4·3 billion in 2016. Simultaneously, the number of countries with endemic malaria dropped from 106 to 86, the worldwide annual incidence rate of malaria declined by 36%, and the annual death rate declined by 60%. Inspired by these outstanding achievements, and troubled by a stagnation in progress that saw 55 countries report an increase in cases between 2015 and 2017, the Lancet Commission on Malaria Eradication (the Commission) was convened to consider whether malaria eradication is feasible, affordable, and worthwhile. In this report of the Commission, we synthesise existing evidence and new epidemiological and financial analyses to show that malaria eradication by 2050 is a bold but attainable goal, and a necessary one given the never-ending struggle against drug and insecticide resistance and the social and economic costs associated with a failure to eradicate. Global social, economic, and environmental trends are, in most places, reducing malaria. Our models show that these trends alone will lead to greatly reduced but still widespread malaria by 2050. When the effects of enhanced access to high-quality diagnosis, treatment, and vector control are factored in, the 2050 projections show a world largely free of malaria, but with pockets of low-level transmission persisting in a belt across Africa, from Senegal in the northwest to Mozambique in the southeast. In view of these projections, we explore the responses to the operational, biological, and financial challenges that are required to bend the curve (ie, to accelerate the decline in malaria cases and deaths) and achieve elimination everywhere outside of Africa by 2030 and worldwide eradication by 2050. Operational obstacles limit the success of malaria programmes in many countries, including ineffective management, inadequate use of data to inform strategies, poorly incentivised staff, and disengaged communities. Solutions to most of these challenges are available and inexpensive but require access to management training and tools, which many malaria programmes do not have. Strengthening programme management and improving the availability and use of data for decision making are operational priorities which, if addressed, would enhance programme effectiveness and accelerate the path to malaria eradication. Leveraging the expertise and comparative advantages of the private sector and forming close partnerships with private health-care providers will further strengthen performance. Multiple challenges arise from the complexity of malaria biology: malaria parasites and their mosquito vectors are constantly evolving resistance to widely used drugs and insecticides, the most common methods of parasite detection are not sensitive enough to identify all infections, simian malaria is now common in humans in parts of southeast Asia, and the effectiveness of standard vector control interventions is low in areas with the highest transmission intensity and where outdoor biting is common. Encouragingly, the research and development pipeline for drugs, insecticides, diagnostics, and vector control tools is robust. Promising new products with strong potential to overcome existing challenges have become available in the past 5 years or are scheduled to roll out over the next decade. Continued investment in research and development will be essential, with prioritisation of technologies that provide long durations of efficacy, do not require difficult or protracted compliance from individuals and households, and drive down malaria in high-transmission or otherwise problematic settings. The cost of malaria eradication is not known and will be highly dependent on managerial efficiency, the efficacy and cost of new tools, and the degree to which interventions can be targeted. Estimates suggest that annual spending of $6 billion or more is required; current global expenditure is approximately$4·3 billion. The Commission believes that an additional investment of $2 billion per year is necessary, with a quarter of that coming from increased development assistance from external donors and the rest from government health spending in malaria-endemic countries. Securing additional funding will not be easy. Development assistance for health has plateaued since 2011, but opportunities exist for new and smaller donors to step in and fill the gap. In addition, our analyses show that government spending on malaria in high-burden countries has increased faster than their growth in gross domestic product, indicating that health in general, and malaria specifically, is a high priority. The opportunities for increased public expenditure on malaria and reduced reliance on donor funds need to be assessed and acted upon country by country. For both donors and countries, a shared and time-bound commitment to eradication will catalyse enthusiasm and financial support. Strong and committed leadership and governance, reinforced through transparency and independent accountability mechanisms, are essential to ensure that eradication is achieved. Leadership and ambition are increasingly coming from the national and regional levels. Global malaria eradication will be achieved through regional elimination. Global organisations should focus on supporting and enabling countries and regions by developing guidance, coordinating across stakeholders, and advocating for sustained investment and research. There is value in closer collaboration and clearer definition of roles between the two apex organisations, WHO and the RBM Partnership to End Malaria. Opportunities also exist for greater alignment of policies and investment strategies between The Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President's Malaria Initiative, the two major malaria funders. Finally, the Commission recommends the creation of an independent monitoring board for malaria eradication. Beyond the obvious benefits of eradicating a disease that has caused untold morbidity and mortality throughout human history, malaria eradication also contributes to broader health and development goals. Strengthening global health security and meeting many of the Sustainable Development Goals—including achieving universal health coverage, promoting equity, and reducing poverty—are all supported and reinforced by progress towards malaria eradication, and vice versa. Malaria eradication has multiple benefits for human welfare and prosperity, the value of which will greatly exceed the investment required to get the job done. In this report, the Commission concludes that malaria eradication is possible, worthwhile, and affordable, and that the alternatives to eradication are untenable. We identify opportunities for specific actions that will overcome challenges and accelerate progress, starting with an immediate, firm, global commitment to achieving eradication by 2050

Ecology and evolution of soil nematode chemotaxis.

Plants influence the behavior of and modify community composition of soil-dwelling organisms through the exudation of organic molecules. Given the chemical complexity of the soil matrix, soil-dwelling organisms have evolved the ability to detect and respond to these cues for successful foraging. A key question is how specific these responses are and how they may evolve. Here, we review and discuss the ecology and evolution of chemotaxis of soil nematodes. Soil nematodes are a group of diverse functional and taxonomic types, which may reveal a variety of responses. We predicted that nematodes of different feeding guilds use host-specific cues for chemotaxis. However, the examination of a comprehensive nematode phylogeny revealed that distantly related nematodes, and nematodes from different feeding guilds, can exploit the same signals for positive orientation. Carbon dioxide (CO(2)), which is ubiquitous in soil and indicates biological activity, is widely used as such a cue. The use of the same signals by a variety of species and species groups suggests that parts of the chemo-sensory machinery have remained highly conserved during the radiation of nematodes. However, besides CO(2), many other chemical compounds, belonging to different chemical classes, have been shown to induce chemotaxis in nematodes. Plants surrounded by a complex nematode community, including beneficial entomopathogenic nematodes, plant-parasitic nematodes, as well as microbial feeders, are thus under diffuse selection for producing specific molecules in the rhizosphere that maximize their fitness. However, it is largely unknown how selection may operate and how belowground signaling may evolve. Given the paucity of data for certain groups of nematodes, future work is needed to better understand the evolutionary mechanisms of communication between plant roots and soil biota