Tanzania Malaria Indicator Surveys 2001 - 2008:\ud Morbidity Indicators and Coverage of Major\ud Malaria Prevention and Control Interventions

Background\ud \ud Malaria continues to be a major public health problem in Africa. In Tanzania alone, thereare an estimated 17 to 20 million malaria cases per year resulting in approximately100,000 deaths. The main strategies to control malaria are vector control through insecticide treated nets (ITNs) and idoor residual spraying (IRS), intermittent preventive treatment during pregnancy (IPTp) and early diagnosis and prompt and effective treatment of cases. In 2001, the first Malaria Mid-Term Strategic Plan (MMTSP) was launched in Tanzania followed by the second MMTSP implemented in 2008. In order to evaluate the MMTSP, the NMCP conducted 4 cross-sectional community-based surveys in the years 2001, 2003, 2005 and 2008, as well as one survey collecting only malaria biomarkers in 2006. The findings of the latest survey are presented and analyzed in the present work.\ud \ud Methods\ud The NMCP 2008 malaria indicator survey was carried out in 21 malaria sentinel districts, one per region, in Mainland Tanzania. Demographic data of all household members and information on mosquito net availability and use was collected, as well as data on use of IPTp and prompt and effective treatment of fever in children. Further, malaria prevalence and haemoglobin levels were tested in children under the age of five years and in currently pregnant women. In the analysis, logistic regressions with the outcome variables net use, prevalence of malaria and anaemia, and linear regressions with the outcome haemoglobin level were conducted, using location, altitude, distance to health facility, sex and age group as explanatories.\ud \ud Data found in this work was compared with both, the Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS) and the Tanzania National Insecticide Treated Nets Programme (NATNETS) survey (both conducted in 2008). Principle findings 8377 households were interviewed with a total population of 40,135. 65% of the households owned at least one mosquito net and 40% owned at least one ITN. Household net ownership was associated with location, altitude and distance to health facility. 42% of the population slept under a net the night before the survey and 27% under an ITN.\ud \ud Location, distance to health facility, sex and age group were significant determinants for net use. Among children under the age of five years, net use was found to be 49% for any net and 33% for ITN, while among pregnant women it was 47% for any net and 31% for ITN. Overall, household net ownership and personal net use increased over the survey years.\ud \ud Malaria and anaemia prevalence among children was 16.1% and 5.6%, respectively. Malaria prevalence was associated with location, altitude, age group and use of ITN, while anaemia prevalence was associated with altitude and age group. Both, prevalence of anaemia and malaria among children under five decreased between 2006 and 2008. 26% of the children reported to have had a fever during the past two weeks. 15% of these children received the first line antimalarial drug within 24 hours from onset. 76% of the women who had delivered during the two years prior to the survey used IPTp and 44% took at least two doses of SP as IPTp.\ud \ud Discussion\ud It was shown that increasing coverage of malaria prevention and control interventions is negatively correlated with malaria and anaemia prevalences, hence lower prevalences for both conditions. The results of the NMCP survey were similar to those of the THMIS and the NATNETS survey and were as well externally confirmed by other studies.\ud \u

Banach Manifold Structure and Infinite-Dimensional Analysis for Causal Fermion Systems

A mathematical framework is developed for the analysis of causal fermion systems in the infinite-dimensional setting. It is shown that the regular spacetime point operators form a Banach manifold endowed with a canonical Fr\'echet-smooth Riemannian metric. The so-called expedient differential calculus is introduced with the purpose of treating derivatives of functions on Banach spaces which are differentiable only in certain directions. A chain rule is proven for H\"older continuous functions which are differentiable on expedient subspaces. These results are made applicable to causal fermion systems by proving that the causal Lagrangian is H\"older continuous. Moreover, H\"older continuity is analyzed for the integrated causal Lagrangian.Comment: 38 pages, LaTeX, minor improvements (published version

The Fermionic Entanglement Entropy and Area Law for the Relativistic Dirac Vacuum State

We consider the fermionic entanglement entropy for the free Dirac field in a bounded spatial region of Minkowski spacetime. In order to make the system ultraviolet finite, a regularization is introduced. An area law is proven in the limiting cases where the volume tends to infinity and/or the regularization length tends to zero. The technical core of the paper is to generalize a theorem of Harold Widom to pseudo-differential operators whose principal symbols develop a specific discontinuity at a single point.Comment: 34 pages, LaTe

Elliptic methods for solving the linearized field equations of causal variational principles

The existence theory is developed for solutions of the inhomogeneous linearized field equations for causal variational principles. These equations are formulated weakly with an integral operator which is shown to be bounded and symmetric on a Hilbert space endowed with a suitably adapted weighted L2-scalar product. Guided by the procedure in the theory of linear elliptic partial differential equations, we use the spectral calculus to define Sobolev-type Hilbert spaces and invert the linearized field operator as an operator between such function spaces. The uniqueness of the resulting weak solutions is analyzed. Our constructions are illustrated in simple explicit examples. The connection to the causal action principle for static causal fermion systems is explained

Endothelial cell differentiation of human breast tumour stem/progenitor cells

Breast tumour stem cells have been reported to differentiate in the epithelial lineage but a cross-lineage potential has not been investigated. We aimed to evaluate whether breast tumour stem cells were able to differentiate also into the endothelial lineage. We isolated and cloned a population of breast tumour stem cells, cultured as mammospheres that expressed the stem markers nestin and Oct-4 and not epithelial and endothelial differentiation markers, and formed serially transplantable tumours in SCID mice. When cultured in the presence of serum, mammosphere-derived clones differentiated in the epithelial lineage. When cultured in the presence of VEGF, the same clones were also able to differentiate in the endothelial lineage acquiring endothelial markers and properties, such as the ability to organize in Matrigel into capillary-like structures. In the transplanted tumours, originated from mammospheres, we demonstrate that some of the intratumour vessels were of human origin, suggesting an in vivo endothelial differentiation of mammosphere-derived cells. Finally, endothelial cell clones originated from mammospheres were able, when implanted in Matrigel in SCID mice, to form after 7 days a human vessel network and, after 3–4 weeks, an epithelial tumour suggesting that in the endothelial-differentiated cells a tumourigenic stem cell population is maintained. In conclusion, the results of the present study demonstrate that stem cells of breast cancer have the ability to differentiate not only in epithelial but also in endothelial lineage, further supporting the hypothesis that the tumour-initiating population possesses stem cell characteristics relevant for tumour growth and vascularization

Photoactivated chemotherapy (PACT) : the potential of excited-state d-block metals in medicine

The fields of phototherapy and of inorganic chemotherapy both have long histories. Inorganic photoactivated chemotherapy (PACT) offers both temporal and spatial control over drug activation and has remarkable potential for the treatment of cancer. Following photoexcitation, a number of different decay pathways (both photophysical and photochemical) are available to a metal complex. These pathways can result in radiative energy release, loss of ligands or transfer of energy to another species, such as triplet oxygen. We discuss the features which need to be considered when developing a metal-based anticancer drug, and the common mechanisms by which the current complexes are believed to operate. We then provide a comprehensive overview of PACT developments for complexes of the different d-block metals for the treatment of cancer, detailing the more established areas concerning Ti, V, Cr, Mn, Re, Fe, Ru, Os, Co, Rh, Pt, and Cu and also highlighting areas where there is potential for greater exploration. Nanoparticles (Ag, Au) and quantum dots (Cd) are also discussed for their photothermal destructive potential. We also discuss the potential held in particular by mixed-metal systems and Ru complexes

Review of seasonal heat storage in large basins: water tanks and gravel-water pits

In order to respond to climatic change, many efforts have been made to reduce harmful gas emissions. According to energy policies, an important goal is the implementation of renewable energy sources, as well as electrical and oil combustion savings through energy conservation. This paper focuses on an extensive review of the technologies developed, so far, for central solar heating systems employing seasonal sensible water storage in artificial large scale basins. Among technologies developed since the late 70s, the use of underground spaces as an energy storage medium - Underground Thermal Energy Storage (UTES) - has been investigated and closely observed in experimental plants in many countries, most of them, as part of government programmes. These projects attempt to optimise technical and economic aspects within an international knowledge exchange; as a result, UTES is becoming a reliable option to save energy through energy conservation. Other alternatives to UTES include large water tanks and gravel-water pits, also called man-made or artificial aquifers. This implies developing this technology by construction and leaving natural aquifers untouched. The present article reviews most studies and results obtained in this particular area to show the technical and economical feasibility for each system and specifics problems occurred during construction and operation. Advantages and disadvantages are pointed out to compare both alternatives. The projects discussed have been carried out mainly in European states with some references to other countries

Direct Anthropometry Overestimates Cranial Asymmetry—3D Digital Photography Proves to Be a Reliable Alternative

This study compared manual and digital measurements of plagiocephaly and brachycephaly in infants and evaluated whether three-dimensional (3D) digital photography measurements can be used as a superior alternative in everyday clinical practice. A total of 111 infants (103 with plagiocephalus and 8 with brachycephalus) were included in this study. Head circumference, length and width, bilateral diagonal head length, and bilateral distance from the glabella to the tragus were assessed by manual assessment (tape measure and anthropometric head calipers) and 3D photographs. Subsequently, the cranial index (CI) and cranial vault asymmetry index (CVAI) were calculated. Measured cranial parameters and CVAI were significantly more precise using 3D digital photography. Manually acquired cranial vault symmetry parameters were at least 5 mm lower than digital measurements. Differences in CI between the two measuring methods did not reach significance, whereas the calculated CVAI showed a 0.74-fold decrease using 3D digital photography and was highly significant (p < 0.001). Using the manual method, CVAI calculations overestimated asymmetry, and cranial vault symmetry parameters were measured too low, contributing to a misrepresentation of the actual anatomical situation. Considering consequential errors in therapy choices, we suggest implementing 3D photography as the primary tool for diagnosing deformational plagiocephaly and positional head deformations