Challenges for Malaria Elimination in Zanzibar: Pyrethroid Resistance in Malaria Vectors and Poor Performance of Long-Lasting Insecticide Nets.

Long-lasting insecticide treated nets (LLINs) and indoor residual house spraying (IRS) are the main interventions for the control of malaria vectors in Zanzibar. The aim of the present study was to assess the susceptibility status of malaria vectors against the insecticides used for LLINs and IRS and to determine the durability and efficacy of LLINs on the island. Mosquitoes were sampled from Pemba and Unguja islands in 2010--2011 for use in WHO susceptibility tests. One hundred and fifty LLINs were collected from households on Unguja, their physical state was recorded and then tested for efficacy as well as total insecticide content. Species identification revealed that over 90% of the Anopheles gambiae complex was An. arabiensis with a small number of An. gambiae s.s. and An. merus being present. Susceptibility tests showed that An. arabiensis on Pemba was resistant to the pyrethroids used for LLINs and IRS. Mosquitoes from Unguja Island, however, were fully susceptible to all pyrethroids tested. A physical examination of 150 LLINs showed that two thirds were damaged after only three years in use. All used nets had a significantly lower (p < 0.001) mean permethrin concentration of 791.6 mg/m2 compared with 944.2 mg/m2 for new ones. Their efficacy decreased significantly against both susceptible An. gambiae s.s. colony mosquitoes and wild-type mosquitoes from Pemba after just six washes (p < 0.001). The sustainability of the gains achieved in malaria control in Zanzibar is seriously threatened by the resistance of malaria vectors to pyrethroids and the short-lived efficacy of LLINs. This study has revealed that even in relatively well-resourced and logistically manageable places like Zanzibar, malaria elimination is going to be difficult to achieve with the current control measures

The relationship of individual comorbid chronic conditions to diabetes care quality.

ObjectiveMultimorbidity affects 26 million persons with diabetes, and care for comorbid chronic conditions may impact diabetes care quality. The aim of this study was to determine which chronic conditions were related to lack of achievement or achievement of diabetes care quality goals to determine potential targets for future interventions.Research design and methodsThis is an exploratory retrospective analysis of electronic health record data for 23 430 adults, aged 18-75, with diabetes who were seen at seven Midwestern US health systems. The main outcome measures were achievement of six diabetes quality metrics in the reporting year, 2011 (glycated haemoglobin (HbA1c) control and testing, low-density lipoprotein control and testing, blood pressure control, kidney testing). Explanatory variables were 62 chronic condition indicators. Analyses were adjusted for baseline patient sociodemographic and healthcare utilization factors.ResultsThe 62 chronic conditions varied in their relationships to diabetes care goal achievement for specific care goals. Congestive heart failure was related to lack of achievement of cholesterol management goals. Obesity was related to lack of HbA1c and BP control. Mental health conditions were related to both lack of achievement and achievement of different care goals. Three conditions were related to lack of cholesterol testing, including congestive heart failure and substance-use disorders. Of 17 conditions related to achieving control goals, 16 were related to achieving HbA1c control. One-half of the comorbid conditions did not predict diabetes care quality.ConclusionsFuture interventions could target patients at risk for not achieving diabetes care for specific care goals based on their individual comorbidities

Learning Experiences of Social Science Students in an Interdisciplinary Computing Minor

The rapid growth of the digital economy and an associated increase in user-generated data has created a strong need for interdisciplinary computing professionals possessing both technical skills and knowledge of human behavior. To help meet this need and with funds from NSF IUSE, we developed an academic minor in Applied Computing for Behavioral and Social Sciences at San Jose State University. The minor involves a four-course sequence that includes programming fundamentals, data structures and algorithms, data cleaning and management, and a culminating project. At our institution and nationwide, social science students are more diverse than engineering students, with respect to gender, race, and ethnicity. By providing social science students with computing skills that complement their domain expertise, we aim to expand their career options and address the nation\u27s need for a diverse, technology-capable workforce. We administered an exit survey on student learning experiences to two cohorts of students completing the minor. Given that the minor is new and that the first cohorts were relatively small, the number of students completing the survey was modest (n = 15). Results indicate that students were motivated to minor in Applied Computing by a desire to improve their data analysis skills and better prepare themselves for the job market/graduate school, as well as a belief that programming is a necessary skill for the future. A large majority of students indicated that their peers, instructors, and homework assignments supported their learning very well, whereas they found topics covered and course projects to be less supportive, followed by pacing of course content. With respect to career plans, a majority of students agreed that the minor provided them with their desired skills and allowed them to learn about careers in applied computing, and a large majority indicated that they planned to pursue a career utilizing applied computing. They expressed interest in fields such as human factors, data analytics, project management, teaching, clinical psychology, and various types of research. Finally, common themes that arose when providing advice to future students included not being shy in seeking help, tips for managing the level of course difficulty, encouragement to regularly practice, suggestions for how to master course content, and advice for adopting a successful mindset. These results will be instrumental in helping to optimize students\u27 experiences in the minor, ranging from how we recruit new students to how we can better support their professional development. Given the largely positive experiences of our students and their plans to pursue careers involving applied computing, we believe that our approach of adding computing education alongside a social science degree demonstrates a promising model for meeting the increasing demand for diverse interdisciplinary computing workers in this digital age