scholarly journals Scale up of a Plasmodium falciparum elimination program and surveillance system in Kayin State, Myanmar

2017 ◽  
Vol 2 ◽  
pp. 98 ◽  
Author(s):  
Daniel M. Parker ◽  
Jordi Landier ◽  
Aung Myint Thu ◽  
Khin Maung Lwin ◽  
Gilles Delmas ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Community Engagement ◽  
Operational Research ◽  
Scale Up ◽  
Malaria Prevalence ◽  
Epidemiological Surveillance ◽  
Small Scale ◽  
Cross Sectional ◽  
Health Care Infrastructure ◽  
The Impact

Background: Myanmar has one of the largest malaria burdens in the Greater Mekong Subregion (GMS). Throughout the GMS, Plasmodium falciparum parasites are increasingly resistant to artemisinin combination therapies. Given that there are no current alternative treatment therapies, one proposed solution to the threat of untreatable P. falciparum malaria is to eliminate the parasite from the region. Several small-scale elimination projects have been piloted in the GMS, including along the Myanmar-Thailand border. Following the success of the pilot elimination project along the Myanmar-Thailand border, there was a scale up to a broad area of Eastern Kayin State, Myanmar. Here we describe the establishment of the scale up elimination project in Easter Kayin State. Methods: The scale up relied on geographic reconnaissance and a geographic information system, community engagement, generalized access to community-based early diagnosis and treatment, near real-time epidemiological surveillance, cross sectional malaria prevalence surveys and targeted mass drug administration in villages with high prevalence of P. falciparum malaria. Molecular markers of drug resistance were also monitored in individuals with symptomatic and asymptomatic infections. Discussion: This protocol illustrates the establishment of an elimination project and operational research in a remote, rural area encompassing several armed groups, multiple political organizations and a near-absent health care infrastructure. The establishment of the project relied on a strong rapport with the target community, on-the-ground knowledge (through geographic surveys and community engagement), rapid decision making and an approach that was flexible enough to quickly adapt to a complex landscape. The elimination project is ongoing, now over three years in operation, and assessment of the impact of this operational research will follow. This project has relevance not only for other malaria elimination projects but also for operational research aimed at eliminating other diseases.

scholarly journals Scale up of a Plasmodium falciparum elimination program and surveillance system in Kayin State, Myanmar

2017 ◽  
Vol 2 ◽  
pp. 98 ◽  
Author(s):  
Daniel M. Parker ◽  
Jordi Landier ◽  
Aung Myint Thu ◽  
Khin Maung Lwin ◽  
Gilles Delmas ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Community Engagement ◽  
Operational Research ◽  
Scale Up ◽  
Malaria Prevalence ◽  
Epidemiological Surveillance ◽  
Small Scale ◽  
Cross Sectional ◽  
Health Care Infrastructure ◽  
The Impact

Background: Myanmar has one of the largest malaria burdens in Southeast Asia. Along the border with Thailand, Plasmodium falciparum parasites are increasingly showing reduced sensitivity to artemisinin combination therapies. Given that there are no current alternative treatment therapies, one proposed solution to the threat of untreatable P. falciparum malaria is to eliminate the parasite from the region. Several small-scale elimination projects have been piloted along the Myanmar-Thailand border. Following their success, this operational research aimed to scale up the elimination to a broad area of Eastern Kayin State, Myanmar. Methods: The project relied on geographic reconnaissance and a geographic information system, community engagement, generalized access to community-based early diagnosis and treatment, near real-time epidemiological surveillance, cross sectional malaria prevalence surveys and targeted mass drug administration in villages with high prevalence of P. falciparum malaria. Molecular markers of drug resistance were also monitored in individuals with symptomatic and asymptomatic infections. Discussion: This project illustrates the establishment of an elimination project and operational research in a remote, rural area encompassing several armed groups, multiple political organizations and a near-absent health care infrastructure. The establishment of the project relied on a strong rapport with the target community, on-the-ground knowledge (through geographic surveys and community engagement), rapid decision making and an approach that was flexible enough to quickly adapt to a complex landscape. The elimination project is ongoing, now over three years in operation, and assessment of the impact of this operational research will follow. This project has relevance not only for other malaria elimination projects but also for operational research aimed at eliminating other diseases.

scholarly journals Predictive markers of transmission in areas with different malaria endemicity in north-eastern Tanzania based on seroprevalence of antibodies against Plasmodium falciparum

2021 ◽  
Author(s):  
Robert Diotrephes Kaaya ◽  
Debora C Kajeguka ◽  
Johnson J Matowo ◽  
Arnold J Ndaro ◽  
Franklin W Mosha ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Scale Up ◽  
Age Groups ◽  
Malaria Prevalence ◽  
African Countries ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Malaria Burden ◽  
North Eastern ◽  
Chi Squared

Abstract BackgroundDue to the scale-up of different interventions, Malaria burden declined significantly in many African countries between 2000 and 2015. As a result, some areas have become suitable for malaria elimination, and in such a situation, Due to the insensitivity of most commonly used methods, malaria transmission assessment is difficult. In north-eastern Tanzania, we tested for Plasmodium falciparum exposure by using serological markers.MethodsA cross-sectional survey was conducted in Bondo, Tanga and Hai, Kilimanjaro between June and December 2014. A total of 788 participants were enrolled and screened for malaria and IgG antibodies against PfAMA-1 and PfMSP-119 antigens using Enzyme-Linked Immuno-Sorbent Assay (ELISA). Malaria parasites were detected using polymerase chain reaction (PCR). The Mann–Whitney test was used to compare the Antibody levels between two independent groups (i.e. positive versus negative). The non-parametric Kruskal-Wallis test was used for comparisons between more than two age groups. Pearson's Chi-squared (χ2) test was used to compare proportions.ResultsGenerally, malaria prevalence by PCR in two sites was 20.4% (161), with Bondo having a higher prevalence of 28.1% (n= 154) as compared to Hai 2.9%, (n= 7), χ2=64.64, p<0.01. Anti-PfAMA-1 and anti-PfMSP-119 antibody concentrations were higher in malaria positive than malaria negative individuals, Mann-Whitney U test, p=0.07 and p=0.003 respectively. Antibody response against PfAMA-1 was significantly different between the three age groups (Kruskal-Wallis test, p<0.001).ConclusionPlasmodium falciparum exposure immunological indicators have proven useful for explaining the dynamics of transmission, especially in low transmission environments like Hai.

SUBMERGED CITRIC ACID FERMENTATION OF SUGAR BEET MOLASSES: INCREASE IN SCALE

1955 ◽  
Vol 1 (5) ◽  
pp. 299-311 ◽  
Author(s):  
R. Steel ◽  
C. P. Lentz ◽  
S. M. Martin
Keyword(s):  
Citric Acid ◽  
Scale Up ◽  
Aeration Rate ◽  
Small Scale ◽  
Acid Fermentation ◽  
Inoculum Level ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Beet Molasses ◽  
Initial Ph

Factors affecting the production of citric acid in the submerged fermentation of ferrocyanide-treated beet molasses by Aspergillus niger were studied in 2.5 and 36 liter fermenters. The small fermenters were used to determine the effects of changes in sterilization technique, phosphate supplement, ferrocyanide treatment, inoculum level, initial pH, fermentation temperature, and aeration rate. The relation between ferrocyanide concentration and inoculum level was also studied. Four different samples of molasses were fermented successfully. An average yield of 8.2% citric acid (64% conversion) was obtained from 51 small-scale fermentations. Comparable yields were obtained in the large fermenters under comparable conditions. Most of the information obtained with the small fermenters was applicable to the larger-scale fermenters, but in the latter the fermentation was significantly more stable. Aeration was the main problem in the scale-up and aeration rates approximately double those calculated on a fermenter cross-sectional area basis were required for comparable results in the large fermenters.

scholarly journals Energy Production from Biogas: Competitiveness and Support Instruments in Latvia

2016 ◽  
Vol 53 (5) ◽  
pp. 43-53
Author(s):  
G. Klāvs ◽  
A. Kundziņa ◽  
I. Kudrenickis
Keyword(s):  
New Technologies ◽  
Local Economic Development ◽  
Renewable Energy Sources ◽  
Distribution Network ◽  
Scale Up ◽  
Electricity Production ◽  
Small Scale ◽  
Gas Distribution ◽  
Ex Post ◽  
The Impact

Abstract Use of renewable energy sources (RES) might be one of the key factors for the triple win-win: improving energy supply security, promoting local economic development, and reducing greenhouse gas emissions. The authors ex-post evaluate the impact of two main support instruments applied in 2010-2014 – the investment support (IS) and the feed-in tariff (FIT) – on the economic viability of small scale (up to 2MWel) biogas unit. The results indicate that the electricity production cost in biogas utility roughly corresponds to the historical FIT regarding electricity production using RES. However, if in addition to the FIT the IS is provided, the analysis shows that the practice of combining both the above-mentioned instruments is not optimal because too high total support (overcompensation) is provided for a biogas utility developer. In a long-term perspective, the latter gives wrong signals for investments in new technologies and also creates unequal competition in the RES electricity market. To provide optimal biogas utilisation, it is necessary to consider several options. Both on-site production of electricity and upgrading to biomethane for use in a low pressure gas distribution network are simulated by the cost estimation model. The authors’ estimates show that upgrading for use in a gas distribution network should be particularly considered taking into account the already existing infrastructure and technologies. This option requires lower support compared to support for electricity production in small-scale biogas utilities.

scholarly journals Combined measurement of velocity and temperature in liquid metal convection

2019 ◽  
Vol 876 ◽  
pp. 1108-1128 ◽  
Author(s):  
Till Zürner ◽  
Felix Schindler ◽  
Tobias Vogt ◽  
Sven Eckert ◽  
Jörg Schumacher
Keyword(s):  
Reynolds Number ◽  
Liquid Metal ◽  
Large Scale ◽  
Scale Up ◽  
Convection Cell ◽  
Small Scale ◽  
Convection Flow ◽  
Large Scale Circulation ◽  
Large Scale Flow ◽  
The Impact

Combined measurements of velocity components and temperature in a turbulent Rayleigh–Bénard convection flow at a low Prandtl number of $Pr=0.029$ and Rayleigh numbers of $10^{6}\leqslant Ra\leqslant 6\times 10^{7}$ are conducted in a series of experiments with durations of more than a thousand free-fall time units. Multiple crossing ultrasound beam lines and an array of thermocouples at mid-height allow for a detailed analysis and characterization of the complex three-dimensional dynamics of the single large-scale circulation roll in a cylindrical convection cell of unit aspect ratio which is filled with the liquid metal alloy GaInSn. We measure the internal temporal correlations of the complex large-scale flow and distinguish between short-term oscillations associated with a sloshing motion in the mid-plane as well as varying orientation angles of the velocity close to the top/bottom plates and the slow azimuthal drift of the mean orientation of the roll as a whole that proceeds on a time scale up to a hundred times slower. The coherent large-scale circulation drives a vigorous turbulence in the whole cell that is quantified by direct Reynolds number measurements at different locations in the cell. The velocity increment statistics in the bulk of the cell displays characteristic properties of intermittent small-scale fluid turbulence. We also show that the impact of the symmetry-breaking large-scale flow persists to small-scale velocity fluctuations thus preventing the establishment of fully isotropic turbulence in the cell centre. Reynolds number amplitudes depend sensitively on beam-line position in the cell such that different definitions have to be compared. The global momentum and heat transfer scalings with Rayleigh number are found to agree with those of direct numerical simulations and other laboratory experiments.

scholarly journals Pilot Educational Intervention to Promote Safe Pesticide Use Practices Among Farmworkers in Nepal

2020 ◽  
Vol 64 (8) ◽  
pp. 866-875
Author(s):  
Pramesh Koju ◽  
Prabin R Shakya ◽  
Archana Shrestha ◽  
Biraj M Karmacharya ◽  
Sudip Shrestha ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Pesticide Exposure ◽  
Scale Up ◽  
Personal Hygiene ◽  
Future Research ◽  
Health And Environmental Effects ◽  
Cross Sectional ◽  
Handling Practices ◽  
Hands And Feet ◽  
The Impact

Abstract Objectives The misuse of pesticides among farmworkers in Nepal is commonplace. To address this, we implemented a pilot educational intervention (three modules delivered over 3 days and lasting approximately 3 h each) in Kavre District of Nepal. Modules included: (i) health and environmental effects of pesticides, (ii) use of personal protective equipment, and (iii) label literacy and behavioral factors that influence pesticide exposure. In addition, 10 posters with key messages from each of the modules were hung throughout communities. Methods Surveys were administered to cross-sectional convenience samples of farmworkers at baseline (n = 106) and 1 year later (n = 98). Practices relating to pesticides at baseline and endline were compared using multivariable logistic regression to adjust for differences in demographic and socioeconomic characteristics between the samples. Results Compared with the baseline sample, farmworkers in the endline sample were significantly more likely to report: getting information regarding the amount of pesticides to use from experts or pesticide labels (versus personal judgment); wearing gloves while mixing pesticides; wearing boots while working in the field; using personal hygiene practices after handling pesticides such as bathing or washing hands and feet; changing clothes after handling pesticides; checking the wind direction before spraying; and delaying entry for a longer period of time after spraying. Conclusions These results suggest that a simple educational intervention can improve pesticide handling practices among farmworkers in Nepal. Future research should explore the impact of such interventions on pesticide exposure levels and health outcomes, and the potential to scale up these programs nationally.

scholarly journals Malaria Prevalence Investigation among Pregnant Women in Relation to Their Social Well Being: A Case Study of Lugbe and Gosa, Abuja, Nigeria

2020 ◽  
pp. 7-15
Author(s):  
Onyemaechi Ngozi Edith ◽  
Malann Yoila David
Keyword(s):  
Pregnant Women ◽  
Well Being ◽  
Malaria Prevalence ◽  
Living Conditions ◽  
High Rate ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Smear Preparation ◽  
Study Results ◽  
The Impact

Aim: This research aim was to investigate the impact of living conditions (Socio demographic characteristics) of pregnant women on their malarial status. Study Design: In order to achieve the objectives of the study, Cross sectional survey was used. This is because only a subsect of the population was used. Descriptive designs was utilised in the Questionnaire aspect of the study. Place and Duration of Study: The Presidential Malarial initiative PMI/USAID - funded Insectary Laboratory at Nasarawa State University, Keffi/six (6) Months. Methodology: Blood samples were collected from the participating pregnant women by pricking their thumb and the blood droplet was examined using a direct thin and thick blood smear preparation stained with giemsa for the presence of the ring form stages of the parasites in the blood of the individuals in the laboratory. Qualitative data were sourced through Questionnaire administration to 589 pregnant women in Antenatal care clinics (ANC) in the area and their malaria status was also determined. Results: Study results showed a high prevalence rate of malaria in pregnancy (70.5%), the greater number of occurrences being in Lugbe (42.3%) than in Gosa (28.2%). Those living in houses built with wood recorded more positive cases of malaria and are at greater risk of infection (odds = 1.866%). Conclusion: This study has shown an increased rate of malaria infection amongst pregnant women living in wood and mud houses. The result also shows high rate of malaria occurrences due to low living conditions amongst pregnant women domiciled in this area of study. Hence, pregnant women should as a routine be placed on malaria prophylaxis and periodically checked as they can be asymptomatic, only exhibiting symptoms when its already late.

PP24  Does a paramedic practitioner self-tasking dispatch model benefit their self-sufficiency in patient management? A cross sectional study

2020 ◽  
Vol 37 (10) ◽  
pp. e11.2-e12
Author(s):  
Liam Cotterill ◽  
Mary Halter
Keyword(s):  
Emergency Services ◽  
Cross Sectional Study ◽  
Scope Of Practice ◽  
Small Scale ◽  
Sectional Study ◽  
Cross Sectional ◽  
Emergency Operations ◽  
Self Sufficiency ◽  
Rigorous Research ◽  
The Impact

BackgroundParamedic Practitioner (PP) scope of practice is not comprehensively understood by Emergency Operations Centre (EOC) staff and tasking may be suboptimal. In one UK ambulance trust in November 2018, one PP team was enabled to remotely monitor live incidents and, alongside some continued EOC-dispatch, to self-task to incidents they judged would benefit from their additional knowledge and skills. Evidence on self-tasking benefit was found from helicopter emergency services only.MethodsA retrospective cross-sectional study was utilised to evaluate the impact on self-sufficiency - defined as incidents completed by a PP without the need for further ambulance resources - and conveyance rates of PPs utilising a ‘self-tasking’ dispatch model. PP-completed shift reports were collected over a 6-month period from ten PPs working in one trust locality. Excluded cases: Category-1 calls, healthcare professional calls, PP referrals and back-up requests originating from on-scene ambulance clinicians. Descriptive statistics were used to compare rates of self-sufficiency and conveyance between self-tasked and EOC-dispatched incidents.ResultsShift reports detailing 964 incidents were analysed; 705 were self-tasked and 259 were EOC-tasked. PPs showed a statistically significant increase in self-sufficiency when utilising the self-tasking method of dispatch compared to EOC initiated dispatch (88% self-tasked versus 72% EOC-tasked, χ2 40.4, df 1, p<0.01). There was also an increased non-conveyance rate self-tasking compared to EOC-led tasking (64% versus 56%, χ2 5.3, df 1, p<0.05).ConclusionsPPs appear to find it easier to identify incidents suited to their scope to be self-sufficient than EOC staff. This study is a small-scale evaluation in one site, does not adjust for confounders, and does not constitute a direct comparison of the two models. There remains a need for more rigorous research on this topic, though this evaluation suggests that there may be benefits to be gained from PPs self-tasking.

scholarly journals Community Dialogue Approach for addressing the drivers of antibiotic resistance in Bangladesh: a mixed methods study on developing a sustainable and scalable approach to community engagement

2020 ◽  
Author(s):  
Rebecca King ◽  
Joseph Hicks ◽  
Christian Rassi ◽  
Muhammad Shafique ◽  
Deepa Barua ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Mixed Methods ◽  
Health System ◽  
Community Engagement ◽  
Cultural Context ◽  
Scale Up ◽  
International Standards ◽  
Mixed Methods Study ◽  
Small Scale ◽  
Engagement Interventions

Abstract Background Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explores the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example. Methods The intervention was developed using a sequential mixed methods study design. This consisted of: exploring the evidence base through an umbrella review, and identifying key international standards on the appropriate use of antibiotics; undertaking detailed exploratory research through a) a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and to understand patterns of knowledge, attitudes and practice regarding antibiotics and antibiotic resistance; and b) a household survey – which drew on the qualitative findings - to quantify knowledge, and reported attitudes and practice regarding antibiotics and antibiotic resistance within the target population; and c) drawing on appropriate theories regarding change mechanisms and experience of implementing community engagement interventions to co-produce the intervention processes and materials with key stakeholders at policy, health system and community level. Results A community engagement intervention was co-produced and was explicitly designed to link into existing health system and community structures and be appropriate for the cultural context, and therefore have the potential to be implemented at scale. We anticipate that taking this approach increases local ownership, as well as the likelihood that the intervention will be sustainable and scalable. Conclusions This study demonstrates the value of ensuring that a range of stakeholders co-produce the intervention, and ensuring that the intervention is designed to be appropriate for the health system, community and cultural context.

scholarly journals A process for developing a sustainable and scalable approach to community engagement: Community Dialogue Approach for addressing the drivers of antibiotic resistance in Bangladesh

2020 ◽  
Author(s):  
Rebecca King ◽  
Joseph Hicks ◽  
Christian Rassi ◽  
Muhammad Shafique ◽  
Deepa Barua ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Health System ◽  
Community Engagement ◽  
Low Income ◽  
Cultural Context ◽  
Scale Up ◽  
International Standards ◽  
Low Income Countries ◽  
Small Scale ◽  
Engagement Interventions

Abstract Background Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explores the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example.Methods The intervention was developed using a sequential mixed methods study design. This consisted of: exploring the evidence base through an umbrella review, and identifying key international standards on the appropriate use of antibiotics; undertaking detailed formative research through a) a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and to understand patterns of knowledge, attitudes and practice regarding antibiotics and antibiotic resistance; and b) a household survey – which drew on the qualitative findings - to quantify knowledge, and reported attitudes and practice regarding antibiotics and antibiotic resistance within the target population; and c) drawing on appropriate theories regarding change mechanisms and experience of implementing community engagement interventions to co-produce the intervention processes and materials with key stakeholders at policy, health system and community level.Results A community engagement intervention was co-produced and was explicitly designed to link into existing health system and community structures and be appropriate for the cultural context, and therefore have the potential to be implemented at scale. We anticipate that taking this approach increases local ownership, as well as the likelihood that the intervention will be sustainable and scalable.Conclusions This study demonstrates the value of ensuring that a range of stakeholders co-produce the intervention, and ensuring that the intervention is designed to be appropriate for the health system, community and cultural context.

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