Evaluation of the health-related quality of life of children in Schistosoma haematobium-endemic communities in Kenya: a cross-sectional study.

BACKGROUND: Schistosomiasis remains a global public health challenge, with 93% of the ~237 million infections occurring in sub-Saharan Africa. Though rarely fatal, its recurring nature makes it a lifetime disorder with significant chronic health burdens. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric. METHODOLOGY/PRINCIPAL FINDINGS: In our study, we used Pediatric Quality of Life Inventory (PedsQL), a modular instrument available for ages 2-18 years, to assess health-related quality of life (HrQoL) among children living in a Schistosoma haematobium-endemic area in coastal Kenya. The PedsQL questionnaires were administered by interview to children aged 5-18 years (and their parents) in five villages spread across three districts. HrQoL (total score) was significantly lower in villages with high prevalence of S. haematobium (-4.0%, p<0.001) and among the lower socioeconomic quartiles (-2.0%, p<0.05). A greater effect was seen in the psychosocial scales as compared to the physical function scale. In moderate prevalence villages, detection of any parasite eggs in the urine was associated with a significant 2.1% (p<0.05) reduction in total score. The PedsQL reliabilities were generally high (Cronbach alphas ≥0.70), floor effects were acceptable, and identification of children from low socioeconomic standing was valid. CONCLUSIONS/SIGNIFICANCE: We conclude that exposure to urogenital schistosomiasis is associated with a 2-4% reduction in HrQoL. Further research is warranted to determine the reproducibility and responsiveness properties of QoL testing in relation to schistosomiasis. We anticipate that a case definition based on more sensitive parasitological diagnosis among younger children will better define the immediate and long-term HrQoL impact of Schistosoma infection

Application of a two-step approach for mapping ice thickness to various glacier types on Svalbard

The basal topography is largely unknown beneath most glaciers and ice caps, and many attempts have been made to estimate a thickness field from other more accessible information at the surface. Here, we present a two-step reconstruction approach for ice thickness that solves mass conservation over single or several connected drainage basins. The approach is applied to a variety of test geometries with abundant thickness measurements including marine- and land-terminating glaciers as well as a 2400-km2 ice cap on Svalbard. The input requirements are kept to a minimum for the first step. In this step, a geometrically controlled, non-local flux solution is converted into thickness values relying on the shallow ice approximation (SIA). In a second step, the thickness field is updated along fast-flowing glacier trunks on the basis of velocity observations. Both steps account for available thickness measurements. Each thickness field is presented together with an error-estimate map based on a formal propagation of input uncertainties. These error estimates point out that the thickness field is least constrained near ice divides or in other stagnant areas. Withholding a share of the thickness measurements, error estimates tend to overestimate mismatch values in a median sense. We also have to accept an aggregate uncertainty of at least 25-% in the reconstructed thickness field for glaciers with very sparse or no observations. For Vestfonna ice cap (VIC), a previous ice volume estimate based on the same measurement record as used here has to be corrected upward by 22-%. We also find that a 13-% area fraction of the ice cap is in fact grounded below sea level. The former 5-% estimate from a direct measurement interpolation exceeds an aggregate maximum range of 6-23-% as inferred from the error estimates here.This study received primary funding from the German Research Foundation (DFG) under grant number FU1032/1-1. Results presented in this publication are based on numerical simulations conducted at the high-performance computing centre of the Regionales Rechenzentrum Erlangen (RRZE) of the University of Erlangen-Nuremberg. The reconstruction approach also benefits from co-development work of the Elmer/Ice team at the CSC-IT Center for Science Ltd. (Finland). The velocity analysis on Svalbard was funded by DFG within the priority programme 1158 Antarctic Research with Comparable Investigations in Arctic Sea Ice Areas under contract number BR2105/9-1 and received financial support from the Helmholtz Association of the German Research Centres (HGF) Alliance on Remote Sensing and Earth System Dynamics. Thickness data collection in Wedel Jarlsberg Land was funded by the Spanish R&D projects C11093001 and C150954001, NCBiR/PolarCLIMATE-2009/2-2/2010 from the Polish National Centre for R&D, by IPY/269/2006 from the Polish Ministry of Science and Higher Education, by Polish-Norwegian funding through the AWAKE (PNRF-22-AI-1/07) project, by the EU FP7 ice2sea programme (grant number 226375) and by funds of the Leading National Research Centre (KNOW) received by the Centre for Polar Studies of the University of Silesia, Poland. The DEM generation inWedel Jarlsberg Land received financial support from the European Research Council (grant 320816) and from ESA (project Glaciers CCI, 4000109873/14/I-NB). TanDEM-X data were provided under AO XTIGLAC6770. The WRF-SMB field was produced within the PERMANOR project funded by the Norwegian Research Council (255331)

Meltwater produced by wind–albedo interaction stored in an East Antarctic ice shelf

Surface melt and subsequent firn air depletion can ultimately lead to disintegration of Antarctic ice shelves1,2 causing grounded glaciers to accelerate3 and sea level to rise. In the Antarctic Peninsula, foehn winds enhance melting near the grounding line4, which in the recent past has led to the disintegration of the most northerly ice shelves5,6. Here, we provide observational and model evidence that this process also occurs over an East Antarctic ice shelf, where meltwaterinduced firn air depletion is found in the grounding zone. Unlike the Antarctic Peninsula, where foehn events originate from episodic interaction of the circumpolar westerlies with the topography, in coastal East Antarctica high temperatures are caused by persistent katabatic winds originating from the ice sheet’s interior. Katabatic winds warm and mix the air as it flows downward and cause widespread snow erosion, explaining >3 K higher near-surface temperatures in summer and surface melt doubling in the grounding zone compared with its surroundings. Additionally, these winds expose blue ice and firn with lower surface albedo, further enhancing melt. The in situ observation of supraglacial flow and englacial storage of meltwater suggests that ice-shelf grounding zones in East Antarctica, like their Antarctic Peninsula counterparts, are vulnerable to hydrofracturing7

Mechanisms driving variability in the ocean forcing of Pine Island Glacier

Pine Island Glacier (PIG) terminates in a rapidly melting ice shelf, and ocean circulation and temperature are implicated in the retreat and growing contribution to sea level rise of PIG and nearby glaciers. However, the variability of the ocean forcing of PIG has been poorly constrained due to a lack of multi-year observations. Here we show, using a unique record close to the Pine Island Ice Shelf (PIIS), that there is considerable oceanic variability at seasonal and interannual timescales, including a pronounced cold period from October 2011 to May 2013. This variability can be largely explained by two processes: cumulative ocean surface heat fluxes and sea ice formation close to PIIS; and interannual reversals in ocean currents and associated heat transport within Pine Island Bay, driven by a combination of local and remote forcing. Local atmospheric forcing therefore plays an important role in driving oceanic variability close to PIIS

Actively evolving subglacial conduits and eskers initiate ice shelf channels at an Antarctic grounding line

Ice-shelf channels are long curvilinear tracts of thin ice found on Antarctic ice shelves. Many of them originate near the grounding line, but their formation mechanisms remain poorly understood. Here we use ice-penetrating radar data from Roi Baudouin Ice Shelf, East Antarctica, to infer that the morphology of several ice-shelf channels is seeded upstream of the grounding line by large basal obstacles indenting the ice from below. We interpret each obstacle as an esker ridge formed from sediments deposited by subglacial water conduits, and calculate that the eskers’ size grows towards the grounding line where deposition rates are maximum. Relict features on the shelf indicate that these linked systems of subglacial conduits and ice-shelf channels have been changing over the past few centuries. Because ice-shelf channels are loci where intense melting occurs to thin an ice shelf, these findings expose a novel link between subglacial drainage, sedimentation and ice-shelf stability

Društveno-ekonomski aspekti učiteljstva

U radu se prvo definira učiteljstvo kao profesija, zajednički stručni naziv – učitelj (i za učitelja, nastavnika, profesora i stručnog suradnika u školi). Zatim se govori o vrijednosti učiteljske profesije. Slijedi analiza materijalne osnove i financiranja učiteljstva, plaće učitelja i ostala materijalna prava. Potom slijedi prikaz učiteljskih udruga i učiteljske nagrade „Ivan Filipović“. Posebno se obrađuje pitanje – kakvi su učitelji potrebni novoj hrvatskoj školi. Hrvatskoj školi potrebni su sposobni, obrazovni, stručno pedagoško osposobljeni, motivirani, materijalno situirani, zadovoljni, samostalni, slobodni i demokratski učitelji. Svjetski dan učitelja prigoda je da se sjetimo svoje učiteljice-učitelja, njihovih riječi i djela koja su obilježila naše odrastanje i ostavili duboki trag u našim srcima

The Implementation of Managed Entry Agreements in Central and Eastern Europe : Findings and Implications

Funding Information: In Bosnia and Herzegovina, both The Federation of Bosnia and Herzegovina and the Republic of Srpska, also have special funds and budgets in place for the financing of expensive medicines, which are innovative and under patent. Similar earmarked funds are available in Scotland (the New Medicines Fund funded by the Pharmaceutical Price Regulation Scheme [PPRS] rebates) [35] and England (the Cancer Drugs Fund) [36]. However, support for such earmarked funds is mixed. While they facilitate access, critics raised issues about fairness towards other disease areas and patient groups that are not eligible for special funding [3, 39]. Further, the views of a Patient and Clinician Engagement meeting in Scotland [37] and the end-of-life criteria in England [38] offer opportunities for special considerations affecting medicines for end-of-life and very rare conditions to be taken into account in the health technology assessment process. Funding Information: The authors would like to acknowledge Dr. Jan Jones from the Scottish Medicines Consortium, Scotland, for contributing to the discussion with information on Scotland, Drs. Lyudmila Bezmelnitsyna and Anastasia Isaeva for contributing to data collection in Russia and Dr. Kate?ina Podrazilov? from SZP ?R for providing information on the Czech Republic. Alessandra Ferrario was a Research Officer at the LSE Health at the time this research was conducted. She is now a postdoctoral Research Fellow at the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA. Email: [email protected] No sources of funding were used for this study. The authors declare they have no conflicts of interest. However, Di?na Ar?ja, Maria Dimitrova, Jurij F?rst, Ieva Grei?i?t?-Kuprijanov, Iris Hoxha, Arianit Jakupi, Erki Laidm?e, Vanda Markovic-Pekovic, Dmitry Meshkov, Guenka Petrova, Maciej Pomorski and Patricia Vella Bonanno work directly for national health authorities or are advisers to them. Alessandra Ferrario, Tomasz Bochenek, Ileana Mardare, Dominik Tomek, Luka Voncina, Alan Haycox, Panos Kanavos,?Olga L?blov?, and Brian Godman are academics and independent researchers also working with national and regional health authorities and others to improve the quality and efficiency of prescribing, and Tarik Catic, D?vid Dank?,and Tanja Novakovic are involved with pharmaceutical, pharmacoeconomics and outcomes research groups in their countries. Olga L?blov? has also carried out remunerated consultancy activities for A&R Partners, Baxter AG and Instytut Arcana and Ileana Mardare has signed a consulting contract with Ewopharma A.G. Romania. The content of the paper and the conclusions are those of each author and may not necessarily reflect those of any organisation that employs them. Publisher Copyright: © 2017, The Author(s).Background: Managed entry agreements (MEAs) are a set of instruments to facilitate access to new medicines. This study surveyed the implementation of MEAs in Central and Eastern Europe (CEE) where limited comparative information is currently available. Method: We conducted a survey on the implementation of MEAs in CEE between January and March 2017. Results: Sixteen countries participated in this study. Across five countries with available data on the number of different MEA instruments implemented, the most common MEAs implemented were confidential discounts (n = 495, 73%), followed by paybacks (n = 92, 14%), price-volume agreements (n = 37, 5%), free doses (n = 25, 4%), bundle and other agreements (n = 19, 3%), and payment by result (n = 10, >1%). Across seven countries with data on MEAs by therapeutic group, the highest number of brand names associated with one or more MEA instruments belonged to the Anatomical Therapeutic Chemical (ATC)-L group, antineoplastic and immunomodulating agents (n = 201, 31%). The second most frequent therapeutic group for MEA implementation was ATC-A, alimentary tract and metabolism (n = 87, 13%), followed by medicines for neurological conditions (n = 83, 13%). Conclusions: Experience in implementing MEAs varied substantially across the region and there is considerable scope for greater transparency, sharing experiences and mutual learning. European citizens, authorities and industry should ask themselves whether, within publicly funded health systems, confidential discounts can still be tolerated, particularly when it is not clear which country and party they are really benefiting. Furthermore, if MEAs are to improve access, countries should establish clear objectives for their implementation and a monitoring framework to measure their performance, as well as the burden of implementation.publishersversionPeer reviewe

Recent progress in understanding and projecting regional and global mean sea-level change

Considerable progress has been made in understanding the present and future regional and global sea level in the 2 years since the publication of the Fifth Assessment Report (AR5) of the Intergovernmental Panel on Climate Change. Here, we evaluate how the new results affect the AR5’s assessment of (i) historical sea level rise, including attribution of that rise and implications for the sea level budget, (ii) projections of the components and of total global mean sea level (GMSL), and (iii) projections of regional variability and emergence of the anthropogenic signal. In each of these cases, new work largely provides additional evidence in support of the AR5 assessment, providing greater confidence in those findings. Recent analyses confirm the twentieth century sea level rise, with some analyses showing a slightly smaller rate before 1990 and some a slightly larger value than reported in the AR5. There is now more evidence of an acceleration in the rate of rise. Ongoing ocean heat uptake and associated thermal expansion have continued since 2000, and are consistent with ocean thermal expansion reported in the AR5. A significant amount of heat is being stored deeper in the water column, with a larger rate of heat uptake since 2000 compared to the previous decades and with the largest storage in the Southern Ocean. The first formal detection studies for ocean thermal expansion and glacier mass loss since the AR5 have confirmed the AR5 finding of a significant anthropogenic contribution to sea level rise over the last 50 years. New projections of glacier loss from two regions suggest smaller contributions to GMSL rise from these regions than in studies assessed by the AR5; additional regional studies are required to further assess whether there are broader implications of these results. Mass loss from the Greenland Ice Sheet, primarily as a result of increased surface melting, and from the Antarctic Ice Sheet, primarily as a result of increased ice discharge, has accelerated. The largest estimates of acceleration in mass loss from the two ice sheets for 2003–2013 equal or exceed the acceleration of GMSL rise calculated from the satellite altimeter sea level record over the longer period of 1993–2014. However, when increased mass gain in land water storage and parts of East Antarctica, and decreased mass loss from glaciers in Alaska and some other regions are taken into account, the net acceleration in the ocean mass gain is consistent with the satellite altimeter record. New studies suggest that a marine ice sheet instability (MISI) may have been initiated in parts of the West Antarctic Ice Sheet (WAIS), but that it will affect only a limited number of ice streams in the twenty-first century. New projections of mass loss from the Greenland and Antarctic Ice Sheets by 2100, including a contribution from parts of WAIS undergoing unstable retreat, suggest a contribution that falls largely within the likely range (i.e., two thirds probability) of the AR5. These new results increase confidence in the AR5 likely range, indicating that there is a greater probability that sea level rise by 2100 will lie in this range with a corresponding decrease in the likelihood of an additional contribution of several tens of centimeters above the likely range. In view of the comparatively limited state of knowledge and understanding of rapid ice sheet dynamics, we continue to think that it is not yet possible to make reliable quantitative estimates of future GMSL rise outside the likely range. Projections of twenty-first century GMSL rise published since the AR5 depend on results from expert elicitation, but we have low confidence in conclusions based on these approaches. New work on regional projections and emergence of the anthropogenic signal suggests that the two commonly predicted features of future regional sea level change (the increasing tilt across the Antarctic Circumpolar Current and the dipole in the North Atlantic) are related to regional changes in wind stress and surface heat flux. Moreover, it is expected that sea level change in response to anthropogenic forcing, particularly in regions of relatively low unforced variability such as the low-latitude Atlantic, will be detectable over most of the ocean by 2040. The east-west contrast of sea level trends in the Pacific observed since the early 1990s cannot be satisfactorily accounted for by climate models, nor yet definitively attributed either to unforced variability or forced climate change

Safeguarding pollinators and their values to human well-being

Wild and managed pollinators provide a wide range of benefits to society in terms of contributions to food security, farmer and beekeeper livelihoods, social and cultural values, as well as the maintenance of wider biodiversity and ecosystem stability. Pollinators face numerous threats, including changes in land-use and management intensity, climate change, pesticides and genetically modified crops, pollinator management and pathogens, and invasive alien species. There are well-documented declines in some wild and managed pollinators in several regions of the world. However, many effective policy and management responses can be implemented to safeguard pollinators and sustain pollination services