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Pregnant women are at risk for infection and may have significant morbidity or mortality. Influenza, pertussis, zika, and cytomegalovirus produce mild or asymptomatic illness in the mother, but have profound implications for her fetus. Maternal immunization can prevent or mitigate infections in pregnant women and their infants. The Advisory Committee of Immunization Practices recommends 2 vaccines during pregnancy: inactivated influenza, and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis during pregnancy. The benefits of MMR, varicella, and other vaccines are reviewed. Novel vaccine studies for use during pregnancy for prevention of illness are explored.

Bottomland hardwood forest restoration provides a challenge for ecological engineers, because of the long time periods required for trees to grow, and hydrologic complexities. We examined avifauna communities and habitat in restored bottomland forest of Eastern Kentucky, and compared them to a reference wetland. The restored wetlands have had over 25 years to mature. Over the past 25 years, vegetation has increased in density and complexity; however, most the restored sites did not have standing water commensurate with the reference site, and the trees and shrubs are still immature. Habitat variability between the 14 different wetlands did not strongly factor into avifauna species diversity. More species of birds used the larger restored wetlands (>1 ha), compared to smaller basins (

Many Eastern Kentucky reservoirs lack algal biomass commensurate with their macronutrient concentrations. Fisheries managers sometimes suggest fertilizing these reservoirs with nitrogen (N), phosphorus (P) and carbon (C) to enhance fish production. To assess which factors could be limiting phytoplankton growth, we conducted nutrient bioassay experiments in two low alkalinity ( 3 /L), high P (>30 μg/L), low chlorophyll ( a ) reservoirs. We examined productivity (estimated as chlorophyll a concentrations) in situ in 4-L bags using various additions of N, P, and C. Results suggest primary productivity appears to be primarily limited by temperature, light-penetration (turbidity), and phosphorus. We observed that P was generally the limiting nutrient for algal productivity if the water was clear and temperature was >10 °C. We observed a secondary N limitation at high P loading. Under high loading with N + P, available carbon could become limiting in our closed system. Adding N + P in warm waters resulted in hypereutrophic algal concentrations (sometimes >100 μg/L chlorophyll a ), and could create conditions favoring nuisance algal species—neither of which would be useful for growing game fish. Adding nutrients to surface freshwaters is generally not advisable, nor a good management practice.

Middle school students (n = 354) were tested for their understanding of the control of variables strategy (CVS) 2.5 years after participating in a study comparing three different interventions for teaching CVS. The key finding was that the pattern of effects observed in the 4th grade continued to be observed in the 6th grade. This was because (a) students who had mastered CVS in the 4th grade were likely to continue to perform at mastery levels in the 6th grade whereas (b) the learning of students who had not mastered CVS in 4th grade was independent of the teaching intervention they had received in the 4th-grade study. These findings demonstrate that a brief intervention of direct instruction in CVS can produce long-lasting learning of the principle of controlling variables.

Much has been speculated regarding the influence of cultural norms on the acceptance and use of personnel selection testing. This study examined the cross-level direct effects of four societal cultural variables (performance orientation, future orientation, uncertainty avoidance and tightness-looseness) on selection practices of organizations in 23 countries. 1,153 HR professionals responded to a survey regarding testing practices in hiring contexts. Overall, little evidence of a connection between cultural practices and selection practices emerged. Implications of these findings for personnel selection and cross-cultural research as well as directions for future work in this area are described.

This commentary highlights the value of community-engaged social innovations to advance health care delivery in low- and middle-income countries and to accelerate universal health coverage. It emphasizes the importance of research to guide the innovators on what works, what does not work to make their innovations sustainable and to replicate and scale them up as relevant. It also helps to demonstrate impact and to enhance uptake within the health systems. Electronic supplementary material The online version of this article (10.1186/s40249-019-0586-9) contains supplementary material, which is available to authorized users.

Findings from participants who attended the second post-Ebola SORT-IT course are reported in five short papers on the “legacy of Ebola on health Systems in Sierra-Leone”. After a decline of health service provision and utilisation during the Ebola outbreak, present findings show recovery over time in the post-Ebola period. However, important challenges remain, including an important health workforce gap.

The Global Technical Strategy for Malaria 2016–2030 was adopted by the 68th World Health Assembly in May 2015. It emphasizes the importance of scaling up malaria control responses and moving towards elimination [1]. It is anticipated that such scale-up will help countries reduce and, eventually, eliminate the human suffering caused by malaria as well as contribute more broadly to the achievement of the Sustainable Development Goals. The Global Technical Strategy consists of three main pillars, underpinned by two supporting elements (Fig. 1). The first of the supporting elements, harnessing innovation and expanding research, is also recognized as critical in the global control and elimination of other diseases, such as tuberculosis [2]. It is recognized that operational and implementation research are needed to ensure that existing interventions are applied effectively and efficiently in different contexts and, as new interventions become available, to ensure that innovation is deployed appropriately and to maximum effect. Fig. 1 The World Health Organization Global Technical Strategy for Malaria 2016–2030 In 2011, the malERA Consultative Group on Health Systems and Operational Research published a Research Agenda for Malaria Eradication: Health Systems and Operational Research [3]. The WHO Global Malaria Programme (GMP) has more recently published the report of a multi-partner meeting that discussed operational challenges for malaria elimination, identified priority operational research questions and recommended ways forward [4]. Other organizations have produced similar lists of operational research priorities [5]. There is no shortage of recommendations on the priorities for operational research and most authors consider operational research to be relatively straightforward and, if using routinely-collected data, inexpensive. However, a recent review of the literature on malaria control and elimination between 2008 and 2013 (15,886 articles) revealed that less than 4 % met the definition of operational research. Of these articles only 19 (3.8 %) were related to malaria surveillance [6]. It would seem that operational research, though recognized as critically important to the success of global strategies for malaria control and elimination, is not so commonly undertaken or at least not so commonly published. Indeed, it could be argued that the difference between these two is academic since unpublished research is unlikely to inform widespread scaling up of malaria activities. Why is so little operational research done when much of it would be straightforward and inexpensive and could be done within the context of routine malaria programme activities? It is a long-standing problem. In 2007, a report of the Global Fund’s Technical Review Panel noted that operational research was often absent or inadequately elaborated in proposals [7]. The report further stated that proposals clearly described bottlenecks to progress and that these provide the basis for operational research questions that seem obvious but were not proposed. How can operational research be promoted to support the new Global Technical Strategy for Malaria? A good start would be to look at the recent experiences of other disease control programmes. In 2011, the WHO listed its priorities in operational research to improve tuberculosis care and control. One of the five priority areas for operational research was capacity-building for operational research. Key questions included: what are the existing models of operational health research capacity? What is the impact of existing training models in terms of products, outputs and outcomes? How to ensure sustainable operational research capacity at the national level? 4 years later, its Global Action Framework for TB Research described some of the lessons from this exercise and has provided case studies of how operational research capacity has been built in public health programmes in low-income and middle-income countries [2]. One of these case studies was the Structured Operational Research and Training Initiative (SORT IT) a global partnership-based initiative led by the Special Programme for Research and Training in Tropical Diseases (TDR) based at WHO [8]. Started in 2012, SORT IT aims to support countries to: conduct operational research around their own priorities, build adequate and sustainable operational research capacity within public health programmes; and make evidence-informed improvements to programme implementation. More than 400 health workers in 80 countries have been trained through SORT IT to date. Over the course of 1 year, participating health workers learn the skills required to develop operational research questions, protocols, data capture and analysis instruments and to publish their work. Over 90 % of participants publish their research in the peer reviewed literature and many go on to become facilitators in further SORT IT training courses. The training is currently being delivered in English, Russian and Spanish, with the transition into French underway. The model has been recognized as a reliable way to build the much-needed research capacity in public health programmes in LMICs [9, 10]. Having its roots in a training course run by Medecins Sans Frontieres and the International Union Against Tuberculosis and Lung Diseases, that supported tuberculosis control, SORT IT is now delivering regional and national capacity-building for operational research in all WHO regions and in number of disease areas [11, 12]. In TDR-supported SORT IT Programmes, the core training course is embedded within broader capacity-building activities in knowledge management (research needs assessments and prioritization, dissemination of research findings and evidence-informed policy making). Efforts are also made to consolidate research capacity that has been built through SORT IT by providing participants with further research training and small research grants. In 2014, two research studies related to malaria elimination were supported by SORT IT [13, 14]. In 2015–16, in collaboration with the Global Malaria Programme and the WHO African Regional Office (AFRO), a SORT IT programme supported four malaria-eliminating countries in Southern Africa: Botswana, Namibia, South Africa and Swaziland. A Supplement of Malaria Journal is in preparation to feature research outputs of this SORT IT programme. It is hoped that this Supplement will encourage others to adopt approaches like SORT IT, conduct operational research while building research capacity in malaria programmes and make evidence-informed improvements to policy and practice. On the occasion of the 2016 World Malaria Day the authors would like to highlight both the need for, and the feasibility of, building operational research capacity in malaria programmes in low- and middle-income countries if the ambitions of the Global Technical Strategy for Malaria 2016–2030 are to be achieved.

Background: The Health Product Profile Directory (HPPD), is an online database describing 8-10 key characteristics (such as target population, measures of efficacy and dosage) of product profiles for medicines, vaccines, diagnostics and other products that are intended to be accessed by populations in low- and middle-income countries. It was developed by TDR on behalf of WHO and launched on 15 May 2019. Methods: The contents of the HPPD was downloaded into an ExcelTM spreadsheet via the open access interface and analysed to identify the number of health product profiles by type, by disease, by year of publication, by status, by author organization and safety information. Findings: The HPPD contains summaries of 215 health product profiles published between 2008 and May 2019, 117 (54%) provide a hyperlink to the detailed publication from which the summary was extracted, the remaining 98 provide an email contact for further information. 55 target disease or health conditions are covered with 210 profiles describing a product with an infectious disease as the target. Only 5 product profiles in the HPPD describe a product for a non-communicable disease. Four diseases account for 40% of product profiles in the HPPD: TB 33 profiles (15%), Malaria 31 profiles (14%) HIV 13 profiles (6%) ad Chagas 10 profiles (5%). Interpretation: the HPPD provides a new tool to inform priority setting in global health - it includes all product profiles authored by WHO (51). There is a need to standardise nomenclature to more clearly distinguish between strategic publications (describing R&D priorities or preferred characteristics) compared to target product profiles to guide a specific candidate product undergoing R&D. Combining the analysis from HPPD to a mapping of funds available for R&D and those products in the R&D pipeline would create a better overview of global health priorities and how they are supported. Such analysis and increased transparency should take us another step closer to measuring and improving coordination of efforts in global health R&D. Funding Statement: TDR was funded by the Swiss Agency for Development and Cooperation. Declaration of Interests: No conflict of interest is declared by the authors. Ethics Approval Statement: Not required.

We study the effects of positive and negative advertising in presidential elections. We develop a model to disentangle these effects on voter turnout and candidate choice. The central empirical challenges are highly correlated and endogenous advertising quantities that are measured with error. To address these challenges, we construct a large set of potential instruments, including interactions with incumbency that we demonstrate provide the critical identifying variation, and apply machine-learning causal inference methods. Using data from the 2000 and 2004 U.S. presidential elections, we find that positive and negative ads play fundamentally different roles. Negative ads are more effective at driving relative candidate shares, whereas positive ads stimulate turnout. These results indicate that a candidate geographically targeting tone trades off local relative share gains and local increases in turnout for localities with a strong base. Counterfactual simulations, where the candidates adjust the quantity of positive and negative advertising while budgets remain fixed, indicate that ad tone alone can impact the outcome of close elections. Our analysis also provides potential explanations as to why past studies have produced mixed findings on both ad-tone and turnout effects. This paper was accepted by Matthew Shum, marketing. Supplemental Material: The data and online appendix are available at https://doi.org/10.1287/mnsc.2022.4347 .

Situational judgment tests (SJTs) occasionally fail to predict job performance in criterion-related validation studies, often despite much effort to follow scholarly recipes for their development. This commentary provides some plausible explanations for why this may occur as well as some tips for SJT development. In most cases, we frame the issue from an implicit trait policy (ITP) perspective (Motowidlo, Hooper, & Jackson, 2006a, 2006b) and the measurement of general domain knowledge. In other instances, we believe that the issue does not have a direct tie to the ITP concept, but our experience suggests that the issue is of sufficient importance to include in this response. The first two issues involve challenges gathering validity evidence to support the use of SJTs, and the remaining issues deal more directly with SJT design considerations.

Background The climate variables that directly influence vector-borne diseases’ ecosystems are mainly temperature and rainfall. This is not only because the vectors bionomics are strongly dependent upon these variables, but also because most of the elements of the systems are impacted, such as the host behavior and development and the pathogen amplification. The impact of the climate changes on the transmission patterns of these diseases is not easily understood, since many confounding factors are acting together. Consequently, knowledge of these impacts is often based on hypothesis derived from mathematical models. Nevertheless, some direct evidences can be found for several vector-borne diseases. Main body Evidences of the impact of climate change are available for malaria, arbovirus diseases such as dengue, and many other parasitic and viral diseases such as Rift Valley Fever, Japanese encephalitis, human African trypanosomiasis and leishmaniasis. The effect of temperature and rainfall change as well as extreme events, were found to be the main cause for outbreaks and are alarming the global community. Among the main driving factors, climate strongly influences the geographical distribution of insect vectors, which is rapidly changing due to climate change. Further, in both models and direct evidences, climate change is seen to be affecting vector-borne diseases more strikingly in fringe of different climatic areas often in the border of transmission zones, which were once free of these diseases with human populations less immune and more receptive. The impact of climate change is also more devastating because of the unpreparedness of Public Health systems to provide adequate response to the events, even when climatic warning is available. Although evidences are strong at the regional and local levels, the studies on impact of climate change on vector-borne diseases and health are producing contradictory results at the global level. Conclusions In this paper we discuss the current state of the results and draw on evidences from malaria, dengue and other vector-borne diseases to illustrate the state of current thinking and outline the need for further research to inform our predictions and response. Electronic supplementary material The online version of this article (10.1186/s40249-019-0565-1) contains supplementary material, which is available to authorized users.

Background: The Portfolio-To-Impact (P2I) Model is a novel tool, developed to estimate minimum funding needs to accelerate health product development from late stage preclinical study to phase III clinical trials, and to visualize potential product launches over time. Methods: A mixed methods approach was used. Assumptions on development costs at each phase were based on clinical trial costs from Parexel’s R&D cost sourcebook. These were further refined and validated by interviews, with a wide variety of stakeholders from Product Development Partnerships, biopharmaceutical and diagnostic companies, and major funders of global health R&D. Results: the tool was used to create scenarios describing the impact, in terms of products developed, of different product portfolios with funding ranging from $1 million per annum through to $500 million per annum. These scenarios for a new global financing mechanism have been previously presented in a report setting out the potential for a new fund for research and development which would assist in accelerating product development for the diseases of poverty. Conclusion: The P2I tool does enable a user to model different scenarios in terms of cost and number of health products launched when applied to a portfolio of health products. The model is published as open access accompanied with a user guide. The design allows it to be adapted and used for other health R&D portfolio analysis as described in an accompanying publication focussing on the pipeline for neglected diseases in 2017. We aim to continually refine and improve the model and we ask users to provide us with their own inputs that can help us update key parameters and assumptions. We hope to catalyse users to adapt the model in ways that can increase its value, accuracy, and applications.

Historically, women have been less likely to be supported through higher degree training programmes, and they continue to hold more junior positions in science. This paper reviews the current gender research and gender capacity-building efforts led by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). Created more than 40 years ago as the only United Nations-based Special Programme dedicated to research and research capacity building on infectious diseases, TDR has a longstanding track record both in supporting research into gender-specific questions and in research capacity strengthening among women scientists. We provide an overview of these approaches, then describe a recent pilot programme on Women in Science, designed to understand and remedy the gender gaps in health research. The programme focused on Africa, but it is hoped that the replication of such schemes in TDR and other international funding agencies will lead to more attention being given to women in infectious diseases research in other continents.This article may not be reprinted or reused in any way in order to promote any commercial products or services.

1. Tyler J. Williams, DO* 2. Jennifer Gibson, MD† 3. Lesli Taylor, MD† 4. Demetrio Macariola, MD† 5. Sugantha Krishnan, MD† 6. Callie Reeder, MD‡ 1. *Blue Sky Pediatrics, Asheville, NC 2. †East Tennessee State University, Johnson City, TN 3. ‡University of Tennessee, Knoxville, TN An 11-month-old girl presents with left breast swelling. Over the last 2 days, the swelling appeared as a small knot and has continued to enlarge (Fig). Her parents report that the swelling has felt warm intermittently, but there is no redness, pain on palpation, or drainage. There is no history of fever, fussiness, or fatigue. The family denies appetite changes and weight loss. Figure. Breast swelling. On physical examination, the girl’s temperature is 98.9°F (37.2°C), heart rate is 127 beats/min, and blood pressure is 108/54 mm Hg. She is playful and in no distress. Chest examination reveals a 4 x 4-cm well-circumscribed, circular, firm, nonfluctuant, mobile mass without erythema or tenderness in the left breast. There is no drainage or lymphadenopathy. Dermatologic examination reveals a severe candidal diaper rash. Her white blood cell count is 30,400/μL (30.4 × 109/μL), hemoglobin is 12.2 g/dL (122 g/L), hematocrit is 35.3% (0.35), platelet count is 399 × 103/μL (399 × 109/L), and absolute neutrophil count is 11,248/μL (11.25 × 109/L). Peripheral blood smear does not show any abnormal cells. C-reactive protein is 8.9 mg/L (84.76 nmol/L). Thyrotropin concentration is 6.67 mIU/L, free thyroxine is 1.3 ng/dL …

This paper summarizes our current understanding of the biology of Plasmodium vivax, how it differs from Plasmodium falciparum, and how these differences explain the need for P. vivax-tailored interventions. The article further pinpoints knowledge gaps where investments in research are needed to help identify and develop such specific interventions. The principal obstacles to reduce and eventually eliminate P. vivax reside in 1) its higher vectorial capacity compared with P. falciparum due to its ability to develop at lower temperature and over a shorter sporogonic cycle in the vector, allowing transmission in temperate zones and making it less sensitive to vector control measures that are otherwise effective on P. falciparum; 2) the presence of dormant liver forms (hypnozoites), sustaining multiple relapsing episodes from a single infectious bite that cannot be diagnosed and are not susceptible to any available antimalarial except primaquine, with routine deployment restricted by toxicity; 3) low parasite densities, which are difficult to detect with current diagnostics leading to missed diagnoses and delayed treatments (and protracted transmission), coupled with 4) transmission stages (gametocytes) occurring early in acute infections, before infection is diagnosed.

Despite having the highest Plasmodium vivax burden in the world, molecular epidemiological data from Papua New Guinea (PNG) for this parasite remain limited. To investigate the molecular epidemiology of P. vivax in PNG, 574 isolates collected from four catchment sites in East Sepik (N = 1) and Madang (N = 3) Provinces were genotyped using the markers MS16 and msp1F3. Genetic diversity and prevalence of P. vivax was determined for all sites. Despite a P. vivax infection prevalence in the East Sepik (15%) catchments less than one-half the prevalence of the Madang catchments (27-35%), genetic diversity was similarly high in all populations (He = 0.77-0.98). High genetic diversity, despite a marked difference in infection prevalence, suggests a large reservoir of diversity in P. vivax populations of PNG. Significant reductions in transmission intensity may, therefore, be required to reduce the diversity of parasite populations in highly endemic countries such as PNG.

In this study we investigated whether African American students at historically Black colleges and universities (HBCUs) differ from African American students at predominantly White institutions (PWIs) in academic motivation and judgment, and whether type of academic institution (HBCU, PWI) moderates relationships between these differences and academic achievement. Results indicate that HBCU and PWI students differed in several characteristics, and that type of institution moderated relationships between two of the three characteristics examined and achievement. Theoretical implications in light of Peters and O'Connor's (1980) concept of situational constraints are discussed, as are practical considerations pertaining to student advising.

Aim To determine the age specific immunity profile for rubella from three discrete study populations in Papua New Guinea, and to inform policy regarding the possible introduction of rubella vaccine. Background In 2005, the Western Pacific Region (WPR), of which Papua New Guinea (PNG) is a member state, declared the goal of regional measles elimination by 2012. Recently, WPR has incorporated an accelerated control goal for rubella and congenital rubella syndrome (CRS). PNG currently recommends two doses of measles vaccination at 6 and 9 months of age with a monovalent measles vaccine, which does not include rubella vaccine. Methods Convenience samples were collected from 1326 eligible participants in PNG and assessed for rubella immunity using the Dade Behring Enzygnost™ Anti-Rubella-Virus enzyme immunoassay. Nearly 34% were collected during an age stratified prospective survey of febrile patients in Madang Province; approximately 49% were collected from women of childbearing age in East Sepik and Milne Bay Provinces. Remaining specimens were collected from 6 to 7-month-old infants in Port Moresby prior to receiving the first dose of measles vaccine. Findings Of all samples tested, 65.2% (95% confidence interval (CI): 62.6–67.8) had evidence of immunity to rubella infection. Of women more than 15 years of age, 91.6% (95% CI: 89.4–93.5) were immune. The force of infection was highest between 5 and 19 years of age. Conclusions Although a population-based sample was not used, our multi-centre study of the population immunity profile suggests that immunity against rubella is extremely high in most women of childbearing age, but women who become pregnant at an early age may be at high risk of rubella infection during pregnancy and potential delivery of an infant with CRS. Routine measles vaccine coverage, a proxy for measles-rubella vaccine coverage, as measured in recently published studies, is well below the WHO target of 80% coverage. Introduction of a child or infant dose of rubella vaccine requires caution and further study.

Despite consistent evidence of a protective effect of alpha(+)-thalassemia against severe Plasmodium falciparum disease, the mechanisms underlying this protection remain unknown. An increase in risk of Plasmodium vivax malaria in early childhood resulting in a cross-species protection against severe P. falciparum malaria has been proposed as a possible mechanism in Melanesian children. The association of alpha(+)-thalassemia genotypes with a risk of P. falciparum and P. vivax infection and uncomplicated illness was reassessed in a cohort of 1,112 Papua New Guinean children, followed from 3-21 months of age. Three hundred and eighty-nine (35.0%) children were homozygous for a(+)-thalassemia (-a/-a), 506 (45.5%) heterozygous (aa/-a) and 217 (19.5%) homozygous for the wild-type allele. No significant differences in the incidence of P. falciparum (Pf) or P. vivax (Pv) malaria were observed between alpha(+)-thalassemia homozygote (Pf: Incidence rate ratio (IRR) = 1.13, CI(95) (0.82,1.56), P = 0.45, Pv: IRR = 1.15, CI(95) (0.9881.56), P = 0.31), heterozygote (Pf: IRR = 0.98, CI(95) (0.71,1.34), P = 0.93, Pv: IRR = 1.14, CI(95) (0.88,1.48), P =0.33) and wild-type children. The prevalence of infection with either species did not differ between alpha(+)-thalassemia genotypes, although densities of P. vivax (but not of P. falciparum) infections were significantly higher in alpha(+)-thalassemia homozygote and heterozygote children. An excessive risk of moderate-to-severe anemia (hemoglobin (Hb) > 8 g/dl) was observed in alpha(+)-thalassemia homozygote children (IRR = 1.54, CI(95)(1.12, 2.11), P = 0.008). This study therefore failed to confirm an increased risk of P. vivax or P. falciparum malaria in very young, alpha(+)-thalassemic children without significant levels of acquired immunity. This confirms the lack of protection by alpha(+)-thalassemia against uncomplicated P. falciparum and challenges the hypothesis of immunological cross-protection between P. falciparum and P. vivax as a mechanism underlying alpha(+)-thalassemia protection against severe P. falciparum disease in Melanesian children

Today, the World Health Organization recognizes 17 major parasitic and related infections as the neglected tropical diseases (NTDs). Despite recent gains in the understanding of the nature and prevalence of NTDs, as well as successes in recent scaled-up preventive chemotherapy strategies and other health interventions, the NTDs continue to rank among the world's greatest global health problems. For virtually all of the NTDs (including those slated for elimination under the auspices of a 2012 London Declaration for NTDs and a 2013 World Health Assembly resolution [WHA 66.12]), additional control mechanisms and tools are needed, including new NTD drugs, vaccines, diagnostics, and vector control agents and strategies. Elimination will not be possible without these new tools. Here we summarize some of the key challenges in translational science to develop and introduce these new technologies in order to ensure success in global NTD elimination efforts.

Objectives To conduct an in-depth investigation of the epidemiology of malaria in the Papua New Guinea (PNG) highlands and provide a basis for evidence-based planning and monitoring of intensified malaria control activities. Methods Between December 2000 and July 2005, 153 household-based, rapid malaria population surveys were conducted in 112 villages throughout the central PNG highlands. The presence of malaria infections was determined by light microscopy and risk factors assessed using a structured questionnaire. The combined dataset from all individually published surveys was reanalysed. Results The prevalence of malaria infections in the different surveys ranged from 0.0% to 41.8% (median 4.3%) in non-epidemic surveys and 6.6% to 63.2% (median 21.2%, P 1600 m. Outside epidemics, prevalence decreased significantly with altitude, was reduced in people using bed nets [odds ratio (OR) = 0.8, P

Winter cover cropping plays an important role in conservation farming. In the Midwest region of the USA, strips planted with Austrian winter peas [AWP (Pisum sativum L.)], radishes [RAD (Raphanus sativus L.)], and a mixed cover of both cultivars (MIX) were compared during the spring season to determine their impact on the soil quality at 0–5 and 5–10 cm depths. The treatments RAD, AWP, and MIX had the highest, intermediate, and lowest soil bulk density impacts (1·67, 1·52, and 1·50 Mg m−3, respectively). An opposite trend was observed for the concentrations of soil organic carbon (15·9, 17·6, and 19·4 g kg−1, respectively) and total nitrogen (1·5, 1·7, and 2·8 g kg−1, respectively), the calcium exchange capacity (8·6, 9·5, and 11·4 cmol+c kg−1, respectively), and earthworm density (85, 221 and 226 per m2 x 0·15 m, respectively). The AWP, MIX, and RAD resulted in the highest, intermediate, and lowest water stable aggregates (91·6, 87·4, and 79·9 per cent, respectively), mean weight diameter of aggregates (3·4, 2·7, and 2·1 mm, respectively), saturated hydraulic conductivity (15·7, 13·0, and 6·3 cm h−1, respectively), and intrinsic permeability (1·69, 1·37, and 0·70 cm2 10−10, respectively). The AWP and RAD treatments resulted in a similar C:N ratio (10·5), which was larger than associated with MIX (7·2). Overall, AWP and MIX had a larger positive impact on soil quality than RAD did, and the impact was greater at the 0–5 than the 5–10 cm depth. This indicates the suitability of the various cover crops for improving the soil quality and restoring geodiversity. Copyright © 2012 John Wiley & Sons, Ltd.

Individuals vary in how they perceive cognitive ability tests; thus, it is useful for organizations to consider how individual differences influence applicant perceptions of selection tools. The present study examined the influence of implicit theories of ability and locus of control on perceptions of face validity and predictive validity for two cognitive ability tests. Relationships between perceptions and test experience, job-relevant experience, and job familiarity were also examined. Interactions between implicit theories and self-assessed performance in predicting perceptions were found, although not of the form hypothesized. Furthermore, job familiarity and prior success in selection contexts were related to perceptions. Finally, sample type interacted with test type to influence perceptions. Implications for selection system design and research on applicant perceptions are discussed.

The Asia Pacific Malaria Elimination Network (APMEN) is a collaboration of 18 country partners committed to eliminating malaria from within their borders. Over the past 5 years, APMEN has helped to build the knowledge, tools and in-country technical expertise required to attain this goal. At its inaugural meeting in Brisbane in 2009, Plasmodium vivax infections were identified across the region as a common threat to this ambitious programme; the APMEN Vivax Working Group was established to tackle specifically this issue. The Working Group developed a four-stage strategy to identify knowledge gaps, build regional consensus on shared priorities, generate evidence and change practice to optimize malaria elimination activities. This case study describes the issues faced and the solutions found in developing this robust strategic partnership between national programmes and research partners within the Working Group. The success of the approach adopted by the group may facilitate similar applications in other regions seeking to deploy evidence-based policy and practice. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0958-y) contains supplementary material, which is available to authorized users.

Background The fast growth of global health initiatives (GHIs) has raised concerns regarding achievement of coherence and synergy among distinct, complementary and sometimes competing activities. Herein, we propose an approach to compare GHIs with regard to their main purpose and operational aspects, using the Special Programme for Research and Training in Tropical Diseases (TDR/WHO) as a case study. The overall goal is to identify synergies and optimize efforts to provide solutions to reduce the burden of diseases. Methods Twenty-six long-established GHIs were identified from among initiatives previously associated/partnered with TDR/WHO. All GHIs had working streams that would benefit from linking to the capacity building or implementation research focus of TDR. Individual profiles were created using a common template to collect information on relevant parameters. For analytical purposes, GHIs were simultaneously clustered in five and eight groups according to their ‘intended outcome’ and ‘operational framework’, respectively. A set of specific questions was defined to assess coherence/alignment against a TDR reference profile by attributing a score, which was subsequently averaged per GHI cluster. GHI alignment scores for intended outcome were plotted against scores for operational framework; based on the analysis of coherence/alignment with TDR functions and operations, a risk level (high, medium or low) of engagement was attributed to each GHI. Results The process allowed a bi-dimensional ranking of GHIs with regards to how adequately they fit with or match TDR features and perspectives. Overall, more consistence was observed with regard to the GHIs’ main goals and expected outcomes than with their operational aspects, reflecting the diversity of GHI business models. Analysis of coherence indicated an increasing common trend for enhancing the engagement of developing country stakeholders, building research capacity and optimization of knowledge management platforms in support of improved access to healthcare. Conclusions The process used offers a broader approach that could be adapted by other GHIs to build coherence and synergy with peer organizations and helps highlight the potential contribution of each GHI in the new era of sustainable development goals. Emerging opportunities and new trends suggest that engagement between GHIs should be selective and tailored to ensure efficient collaborations. Electronic supplementary material The online version of this article (doi:10.1186/s12961-015-0062-3) contains supplementary material, which is available to authorized users.

BACKGROUND: Drug resistance remains a major obstacle to malaria treatment and control. It can arise and spread rapidly, and vary substantially even at sub-national level. National malaria programmes require cost-effective and timely ways of characterizing drug-resistance at multiple sites within their countries. METHODS: An improved multiplexed post-PCR ligase detection reaction-fluorescent microsphere assay (LDR-FMA) was used to simultaneously determine the presence of mutations in chloroquine resistance transporter (crt), multidrug resistance 1 (mdr1), dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes in Plasmodium falciparum (n = 727) and Plasmodium vivax (n = 574) isolates collected in 2006 from cross-sectional community population surveys in two geographically distinct regions (Madang and East Sepik) of Papua New Guinea (PNG) where strong regional differences in in vivo aminoquinoline and antifolate therapeutic efficacy had previously been observed. Data were compared to those of a follow-up survey conducted in 2010. RESULTS: Despite some very low parasite densities, the assay successfully amplified all P. falciparum and P. vivax loci in 77 and 69 % of samples, respectively. In 2006, prevalences of pfdhfr (59R-108 N) double mutation/wild type pfdhps haplotype, pfcrt SVMNT haplotype (72S-76T double mutation), and 86Y pfmdr1 mutation all exceeded 90 %. For P. vivax, 65 % carried at least two pvdhfr mutations, 97 % the 647P pvdhps mutation and 54 % the 976F pvmdr1 mutation. Prevalence of mutant haplotypes was higher in Madang than East Sepik for pfcrt SVMNT (97.4 vs 83.3 %, p = 0.001), pfdhfr (59R-108 N) (100 vs 90.6 %, p = 0.001), pvdhfr haplotypes (75.8 vs 47.6 %, p = 0.001) and pvmdr1 976F (71.2 vs 26.2 %, p < 0.001). Data from a subsequent Madang survey in 2010 showed that the prevalence of pfdhps mutations increased significantly from 30 % (p < 0.001) as did the prevalence of pvdhfr mutant haplotypes (from 75.8 to 97.4 %, p = 0.012). CONCLUSIONS: This LDR-FMA multiplex platform shows feasibility for low-cost, high-throughput, rapid characterization of a broad range of drug-resistance markers in low parasitaemia infections. Significant geographical differences in mutation prevalence correlate with previous genotyping surveys and in vivo trials and may reflect variable drug pressure and differences in health-care access in these two PNG populations.

Background Bacterial meningitis remains an important infection globally, with the greatest burden in children in low-income settings, including Papua New Guinea (PNG). We present serotype, antimicrobial susceptibility and outcome data from paediatric meningitis patients prior to introduction of Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines (PCVs) in PNG, providing a baseline for evaluation of immunisation programs. Methods Cerebrospinal fluid (CSF) was collected from children admitted to Goroka General Hospital with suspected meningitis between 1996 and 2005. Culture and sensitivity was conducted, and pneumococci and H. influenzae were serotyped. Laboratory findings were linked to clinical outcomes. Results We enrolled 1884 children. A recognised pathogen was identified in 375 children (19.9 %). Streptococcus pneumoniae (n = 180) and Hib (n = 153) accounted for 88.8 % of pathogens isolated. 24 different pneumococcal serogroups were identified; non-PCV types 2, 24 and 46 accounted for 31.6 % of pneumococcal meningitis. 10- and 13-valent PCVs would cover 44.1 % and 45.4 % of pneumococcal meningitis respectively. Pneumococcal isolates were commonly resistant to penicillin (21.5 %) and 23 % of Hib isolates were simultaneously resistant to ampicillin, co-trimoxazole and chloramphenicol. The case fatality rate in patients with a recognised bacterial pathogen was 13.4 % compared to 8.5 % in culture-negative patients. Conclusions If implemented in routine expanded programme of immunisation (EPI) with high coverage, current PCVs could prevent almost half of pneumococcal meningitis cases. Given the diversity of circulating serotypes in PNG serotype replacement is of concern. Ongoing surveillance is imperative to monitor the impact of vaccines. In the longer term vaccines providing broader protection against pneumococcal meningitis will be needed. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1197-0) contains supplementary material, which is available to authorized users.

Background. In malaria-endemic areas it is recommended that febrile children be tested for malaria by rapid diagnostic test (RDT) or blood slide (BS) and receive effective malaria treatment only if results are positive. However, RDTs are known to perform less well for Plasmodium vivax. We evaluated the safety of withholding antimalarial drugs from young Papua New Guinean children with negative RDT results in areas with high levels of both Plasmodium falciparum and P. vivax infections. Methods. longitudinal prospective study of children aged 3-27 months visiting outpatient clinics for fever. RDT was administered at first visit. RDT and microscopy were performed if children returned because of persistent symptoms. Outcomes were rates of reattendance and occurrence of severe illnesses. Results. Of 5670 febrile episodes, 3942 (70%) involved a negative RDT result. In 133 cases (3.4%), the children reattended the clinic within 7 days for fever, of whom 29 (0.7%) were parasitemic by RDT or microscopy. Of children who reattended, 24 (0.7%) presented with a severe illness: 2 had lower respiratory tract infections (LRTIs) with low-density P. vivax on BS; 2 received a diagnosis of P. vivax malaria on the basis of RDT but BSs were negative; 16 had LRTIs; 3 had alternative diagnoses. Of these 24, 22 were cured at day 28. Two children died of illnesses other than malaria and were RDT and BS negative at the initial and subsequent visits. Conclusion. Treatment for malaria based on RDT results is safe and feasible even in infants living in areas with moderate to high endemicity for both P. falciparum and P. vivax infections.

We assessed the functional success of restored wetlands by determining if the patterns in dissolved oxygen (DO), temperature, and pH were similar to those conditions observed in natural wetlands. The Beaver Creek Wetlands Complex consists of dozens of marshes and ponds built in a former Licking River floodplain, in the hills of east Kentucky, USA. In natural wetland ecosystems, aquatic primary production is highest in emergent and submerged vegetations zones; where daybreak dissolved oxygen (DO) is often near zero, and DO may rise to well over 100% saturation past mid-day. Open-water areas, dominated by phytoplankton, have less dramatic diel DO fluctuations—often without pre-dawn anoxia. Compared to open water, temperatures fluctuate less dramatically in vascular vegetation, due to shading and suppression of wind and waves. Measurements of ecosystem metabolism (diel changes in DO and pH) in three aquatic habitats of the constructed wetlands (emergent vegetation, submerged vegetation, open water) were compared to these natural ideals. In Beaver Creek Wetlands, water temperature patterns were not as dramatic as in natural habitats, nor did they did follow a similar trend. Waters in emergent vegetation (29.5 °C) were warmest; submerged vegetation coolest (26.5 °C); open-water intermediate (27.4 °C). Diel DO and pH patterns were not similar to natural habitats. Highest net primary production (NPP) and gross primary production (GPP) were measured in emergent vegetation waters (mean GPP = 7.58 g m −2 d −1 ); lowest in submerged vegetation (mean GPP = 5.48 g m −2 d −1 ); and intermediate in open-water (mean GPP = 6.95 g m −2 d −1 ). Diel pH changes were greatest in the highly productive emergent waters (median maximum daily difference of 0.36), and not as pronounced in submerged vegetation and open-water (median maximum change = 0.16 and 0.22, respectively). Water-column respiration was generally about double NPP. Like natural ecosystems, near anoxic DO concentrations were consistently measured in emergent and submerged plants before dawn; whereas open-water zones were generally >4 mg l −1 . These restored wetland systems may need more time to be functionally equivalent to natural marshes.

Increasing C sequestration through no-till (NT) can reduce agricultural CO₂ emissions. However, for long-term NT, information is lacking on the effect of biophysical C pools and processes on C sequestration. Composite soil samples taken at 7.5-cm increments to a 30-cm depth from conventionally tilled (CT) and 2 (NT₂), 23 (NT₂₃), and 44 yr (NT₄₄) of NT corn (Zea mays L.) plots in northwest Ohio were analyzed. The microbial biomass (SMB) was 13, 83, and 86% higher in NT₂, NT₂₃, and NT₄₄, respectively, than in CT. No-till had slightly higher basal respiration rates but significantly lower specific maintenance respiration rates and SMB loss than CT. Aggregate stability in NT was 35 to 45% higher than in CT. Macroaggregate-protected C (CMₐA) was 24, 80, and 92% higher in NT₂, NT₂₃, and NT₄₄, respectively, than in CT. For all tillage treatments, these properties decreased with depth. The C sequestration rates for SMB were 22, 13, 7, and 3 kg ha⁻¹ yr⁻¹ at the 0- to 7.5-, 7.5- to 15-, 15- to 22.5-, and 22.5- to 30-cm depths, respectively for the first 10 yr of NT. During the same time, the CMₐA sequestration rates were 92, 63, 47, and 37 kg ha⁻¹ yr⁻¹ at the four depths, and macroaggregate (MaA) formation rates were 3170, 350, 170, and 70 kg ha⁻¹ yr⁻¹, respectively However, these rates decreased over the 44 yr of NT. By 20 yr of NT, at all depths the C sequestered in SMB reached a plateau. Similarly, CMₐA sequestration plateaued at the surface by 20 yr and MaA formation at the surface leveled out by 10 yr.

We used inorganic fertilizer in three ponds at the Minor Clark Fish Hatchery and compared results with three ponds treated with a traditional combination of organic and inorganic fertilizer. Organic augmentation resulted in significantly higher water concentrations of chlorophyll a (16 vs. 7 µg L−1), total P (167 vs. 89 µg L−1), SRP (9.3 vs. 6.6 µg L−1), and inorganic nitrogen (230 vs. 184 µg L−1). Secchi depth and DO (7.9 vs. 11.2 mg L−1) were lower in the organically fertilized ponds. No filamentous algal blooms occurred in any ponds. Rotifers were the predominant zooplankton in all ponds; but traditionally fertilized ponds had greater copepod biomass. Fish survival (37%) and yield (36 kg ha−1) in inorganically fertilized ponds were much lower than previously found at Minor Clark Hatchery (about 90% survival). Although use of inorganic fertilization alone may reduce fertilizer and supplemental aeration costs in some hatcheries, it did not offset lost fish production in this study.

The Duffy antigen receptor for chemokines (DARC or Fy glycoprotein) carries antigens that are important in blood transfusion and is the main receptor used by Plasmodium vivax to invade reticulocytes. Southeast Asian ovalocytosis (SAO) results from an alteration in RBC membrane protein band 3 and is thought to mitigate susceptibility to falciparum malaria. Expression of some RBC antigens is suppressed by SAO, and we hypothesized that SAO may also reduce Fy expression, potentially leading to reduced susceptibility to vivax malaria. Blood samples were collected from individuals living in the Madang Province of Papua New Guinea. Samples were assayed using a flow cytometry assay for expression of Fy on the surface of RBC and reticulocytes by measuring the attachment of a phycoerythrin-labeled Fy6 antibody. Reticulocytes were detected using thiazole orange. The presence of the SAO mutation was confirmed by PCR. There was a small (approximately 10%) but statistically significant (p=0.049, Mann-Whitney U test) increase in Fy expression on SAO RBC compared with RBC from individuals without this polymorphism: mean Fy expression (mean fluorescence intensity [MFI]) was 10.12 ± 1.22 for SAO heterozygotes versus an MFI of 8.95 ± 1.1 for individuals without SAO. For reticulocytes the MFI values were 27.61 ± 19.12 for SAO heterozygotes and 16.47 ± 3.81 for controls. SAO is associated with increased and not decreased Fy6 expression so that susceptibility to P. vivax infection is unlikely to be affected. Immunohematology 2009;25:63–66.

The goal of every surgery is a successful outcome with the shortest hospital stay. Morbidly obese patients with their myriad of comorbidities have confounded surgeons over the years, usually leading to an increased length of hospital stays after complicated surgeries. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has proven to be an effective treatment for the morbidly obese with a usual length of stay of 3 days. The purpose of this article is to review our experience with 23-hour stays for LRYGB over a 13-month period and to apply a recently published risk score to these patients. A single surgeon performed 173 bariatric surgeries of which 96 were LRYGB, the study group. The demographics of this group found the overwhelming majority were female, white, slightly older than the men but with a somewhat smaller body mass index (BMI). The ethnic breakdown was 67.7 per cent white, 22.9 per cent black, and 9.4 per cent Hispanic. The average for all patients was 41.7 years and the BMI was 49.25 kg/m2. Using the Obesity Surgery Mortality Risk Score, 62.5 per cent of our patients were low risk or Class A, 37.5 per cent intermediate risk or Class B, and none of our patients qualified as high risk or Class C. Our average patient score was 1.3. In terms of length of stay, 91 of the 96 patients (94.8%) were discharged within 23 hours of surgery without mortality or 30-day readmission. The remaining five patients (5.2%) had unexplained, sustained tachycardia and were re-explored on the first postoperative day laparoscopically. Three of these patients had negative explorations. One had a jejunojejunostomy revision and the other was found to have a small bowel injury, which was laparoscopically repaired. All five patients were discharged within the next 23 hours. All patients were discharged on a clear liquid diet and advanced to a regular diet over the next month. No diet intolerance was noted nor were any patients converted to an open operation. In conclusion, we have demonstrated that a comprehensive bariatric program in a small teaching community hospital can successfully perform LRYGB and discharge a high percentage of patients within 23 hours with a very low complication rate. We also believe the Obesity Surgery Mortality Risk Score will help bariatric programs to risk-stratify their patients preoperatively. This will contribute to decision-making and further inform patients of their risk as part of their education preoperatively.

During pregnancy, specific variants of Plasmodium falciparum-infected erythrocytes (IEs) can accumulate in the placenta through adhesion to chondroitin sulfate A (CSA) mediated by expression of PfEMP1 encoded by var2csa-type genes. Antibodies against these variants are associated with protection from maternal malaria. We evaluated antibodies among Kenyan, Papua New Guinean, and Malawian men and Kenyan children against two different CSA-binding P. falciparum isolates expressing var2csa variants. Specific IgG was present at significant levels among some men and children from each population, suggesting exposure to these variants is not exclusive to pregnancy. However, the level and prevalence of antibodies was substantially lower overall than exposed multigravidas. IgG-binding was specific and did not represent antibodies to subpopulations of non-CSA-binding IEs, and some sera inhibited IE adhesion to CSA. These findings have significant implications for understanding malaria pathogenesis and immunity and may be significant for understanding the acquisition of immunity to maternal malaria.

Papua New Guinea is in the midst of a generalized HIV epidemic. As part of a larger behavioral survey aiming to further characterize the HIV epidemic occurring in PNG, samples were collected from 1175 participants from seven different provinces. Seventy-one (6%) of these samples were HIV-1 positive, and 35 (49%) successfully underwent a double nested RT-PCR that was designed to amplify the C2-V4 region of the HIV-1 envelope. Sequence analysis showed that 33 (94%) samples were subtype C and the remaining 2 (6%) were subtype B. Further phylogenetic analysis demonstrated that there was no province-specific clustering among the samples and that within the global pandemic, PNG subtype C isolates most closely resembled those from East Africa.

Although Plasmodium malariae was first described as an infectious disease of humans by Golgi in 1886 and Plasmodium ovale identified by Stevens in 1922, there are still large gaps in our knowledge of the importance of these infections as causes of malaria in different parts of the world. They have traditionally been thought of as mild illnesses that are caused by rare and, in case of P. ovale, short-lived parasites. However, recent advances in sensitive PCR diagnosis are causing a re-evaluation of this assumption. Low-level infection seems to be common across malaria-endemic areas, often as complex mixed infections. The potential interactions of P. malariae and P. ovale with Plasmodium falciparum and Plasmodium vivax might explain some basic questions of malaria epidemiology, and understanding these interactions could have an important influence on the deployment of interventions such as malaria vaccines.

Community-based interventions using artemisinin-derived suppositories may potentially reduce malaria-related childhood mortality. However, their sociocultural acceptability is unknown in Papua New Guinea and a formal examination of caregiver's attitudes to rectal administration was needed to inform effective deployment strategies. Caregivers (n = 131) of children with uncomplicated malaria were questioned on their prior experience with, and attitudes to, rectal administration and then offered artesunate suppositories as treatment of their child. The 29% who refused this alternative were further questioned to determine their reasons for this refusal. Lack of spousal approval and fear of side effects were the most common reasons for refusal. Sixty-six percent of caregivers agreed to self-administer suppositories, which were perceived as effective (99%), safe (96%), and fast-acting (91%), but problematic to administer to a struggling child (56%). Shame, embarrassment, and hygiene were not significant concerns. Acceptability of rectal administration should be relatively high in Papua New Guinea. However, deployment must be accompanied by health education that addresses the practical aspects of administration, is appropriate for the illiterate, and is directed at fathers as well as mothers.