Transmission intensity affects almost all aspects of malaria epidemiology and the impact of malaria on human populations. Maps of transmission intensity are necessary to identify populations at ...different levels of risk and to evaluate objectively options for disease control. To remain relevant operationally, such maps must be updated frequently. Following the first global effort to map Plasmodium falciparum malaria endemicity in 2007, this paper describes the generation of a new world map for the year 2010. This analysis is extended to provide the first global estimates of two other metrics of transmission intensity for P. falciparum that underpin contemporary questions in malaria control: the entomological inoculation rate (PfEIR) and the basic reproductive number (PfR).
Annual parasite incidence data for 13,449 administrative units in 43 endemic countries were sourced to define the spatial limits of P. falciparum transmission in 2010 and 22,212 P. falciparum parasite rate (PfPR) surveys were used in a model-based geostatistical (MBG) prediction to create a continuous contemporary surface of malaria endemicity within these limits. A suite of transmission models were developed that link PfPR to PfEIR and PfR and these were fitted to field data. These models were combined with the PfPR map to create new global predictions of PfEIR and PfR. All output maps included measured uncertainty.
An estimated 1.13 and 1.44 billion people worldwide were at risk of unstable and stable P. falciparum malaria, respectively. The majority of the endemic world was predicted with a median PfEIR of less than one and a median PfRc of less than two. Values of either metric exceeding 10 were almost exclusive to Africa. The uncertainty described in both PfEIR and PfR was substantial in regions of intense transmission.
The year 2010 has a particular significance as an evaluation milestone for malaria global health policy. The maps presented here contribute to a rational basis for control and elimination decisions and can serve as a baseline assessment as the global health community looks ahead to the next series of milestones targeted at 2015.
Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17% of national health expenditures. As the population ages, these costs are expected to ...increase substantially.
To prepare for future cardiovascular care needs, the American Heart Association developed methodology to project future costs of care for hypertension, coronary heart disease, heart failure, stroke, and all other CVD from 2010 to 2030. This methodology avoided double counting of costs for patients with multiple cardiovascular conditions. By 2030, 40.5% of the US population is projected to have some form of CVD. Between 2010 and 2030, real (2008$) total direct medical costs of CVD are projected to triple, from $273 billion to $818 billion. Real indirect costs (due to lost productivity) for all CVD are estimated to increase from $172 billion in 2010 to $276 billion in 2030, an increase of 61%.
These findings indicate CVD prevalence and costs are projected to increase substantially. Effective prevention strategies are needed if we are to limit the growing burden of CVD.
Rituximab, a monoclonal antibody that targets CD20 on B cells, is now central to the treatment of a variety of malignant and autoimmune disorders. Despite this success, a substantial proportion of ...B-cell lymphomas are unresponsive or develop resistance, hence more potent anti-CD20 monoclonal antibodies (mAbs) are continuously being sought. Here we demonstrate that type II (tositumomab-like) anti-CD20 mAbs are 5 times more potent than type I (rituximab-like) reagents in depleting human CD20 Tg B cells, despite both operating exclusively via activatory Fcγ receptor–expressing macrophages. Much of this disparity in performance is attributable to type I mAb-mediated internalization of CD20 by B cells, leading to reduced macrophage recruitment and the degradation of CD20/mAb complexes, shortening mAb half-life. Importantly, human B cells from healthy donors and most cases of chronic lymphatic leukemia and mantle cell lymphoma, showed rapid CD20 internalization that paralleled that seen in the Tg mouse B cells, whereas most follicular lymphoma and diffuse large B-cell lymphoma cells were far more resistant to CD20 loss. We postulate that differences in CD20 modulation may play a central role in determining the relative efficacy of rituximab in treating these diseases and strengthen the case for focusing on type II anti-CD20 mAb in the clinic.
Professor Eric Walker: an appreciation Johnston, Peter W
Journal of pathology,
December 2018, 2018-Dec, 2018-12-00, 20181201, Volume:
246, Issue:
4
Journal Article
Workforce planning is a central issue for service provision and has consequences for medical education. Much work has been examined the career intentions, career preferences and career destinations ...of UK medical graduates but there is little published about medical students career intentions. How soon do medical students formulate careers intentions? How much do these intentions and preferences change during medical school? If they do change, what are the determining factors? Our aim was to compare medical students' career preferences upon entry into and exit from undergraduate medical degree programmes.
This was a cross-sectional questionnaire survey. Two cohorts 2009-10, 2010-11 of first and final year medical students at the four Scottish graduating medical schools took part in career preference questionnaire surveys. Questions were asked about demographic factors, career preferences and influencing factors.
The response rate was 80.9% 2682/3285. Significant differences were found across the four schools, most obviously in terms of student origin Scotland, rest of UK or overseas, age group, and specialty preferences in Year 1 and Year 5. Year 1 and Year 5 students' specialty preferences also differed within each school and, while there were some common patterns, each medical school had a different profile of students' career preferences on exit. When the analysis was adjusted for demographic and job-related preferences, specialty preferences differed by gender, and wish for work-life balance and intellectual satisfaction.
This is the first multi-centre study exploring students' career preferences and preference influences upon entry into and exit from undergraduate medical degree programmes. We found various factors influenced career preference, confirming prior findings. What this study adds is that, while acknowledging student intake differs by medical school, medical school itself seems to influence career preference. Comparisons across medical school populations must therefore control for differences in input the students as well as context and process the medical school when looking at output e.g., performance. A robust, longitudinal study is required to explore how medical students' career preferences change as they progress through medical school and training to understand the influence of the learning environment on training choice and outcomes.
In recent years, there has been a large expansion in literature pertaining to the game of Australian football (AF). Furthermore, there have been a number of rule changes that are likely to have ...changed the demands of the game. Based on these advances and changes, it seemed important to conduct a review assessing the scientific literature surrounding the sport.
The review evaluates the match demands of AF, the qualities required for success, and the impact training and competition have on adaptation, injury and fatigue.
A systematic search of PubMed, CINAHL, SPORTDiscus, Web of Science and Scopus for AF literature was conducted; studies investigating match demands, physical qualities, training practices and injury were included. Weighted means and standard deviations were calculated for match demands and physical and anthropometric profiles across playing standards.
A total of 1830 articles were retrieved in the initial search, with 888 removed as duplicates, 626 removed for being non-relevant and a further 152 removed for being AF papers but not relevant to the review. As such, 164 AF papers were included in the review. Due to the intermittent high-intensity nature of match-play, players need a wide range of physical and technical qualities to excel, with speed, aerobic fitness, reactive agility and well-developed lean mass being central to success. Training for AF at the elite level is associated with high workloads, with players engaging in numerous training modalities; even altitude and heat training camps have been utilised by Australian Football League (AFL) teams to further augment fitness improvements. While high chronic workloads can be tolerated and are needed for improving physical qualities, careful planning and monitoring of internal and external workloads is required to minimise sharp spikes in load that are associated with injury.
There is a complex interaction between numerous contextual factors that influence the match demands that are discussed in this review. Whilst players must have the physical capacities to cope with the intense physical demands of AF matches, the successful execution of technical skills during match-play is central to success. To develop these skills and attributes, specific and carefully planned and monitored training must be performed over a number of years.
Insect phylogeny has recently been the focus of renewed interest as advances in sequencing techniques make it possible to rapidly generate large amounts of genomic or transcriptomic data for a ...species of interest. However, large numbers of markers are not sufficient to guarantee accurate phylogenetic reconstruction, and the choice of the model of sequence evolution as well as adequate taxonomic sampling are as important for phylogenomic studies as they are for single-gene phylogenies. Recently, the sequence of the genome of a strepsipteran has been published and used to place Strepsiptera as sister group to Coleoptera. However, this conclusion relied on a data set that did not include representatives of Neuropterida or of coleopteran lineages formerly proposed to be related to Strepsiptera. Furthermore, it did not use models that are robust against the long branch attraction artifact. Here we have sequenced the transcriptomes of seven key species to complete a data set comprising 36 species to study the higher level phylogeny of insects, with a particular focus on Neuropteroidea (Coleoptera, Strepsiptera, Neuropterida), especially on coleopteran taxa considered as potential close relatives of Strepsiptera. Using models robust against the long branch attraction artifact we find a highly resolved phylogeny that confirms the position of Strepsiptera as a sister group to Coleoptera, rather than as an internal clade of Coleoptera, and sheds new light onto the phylogeny of Neuropteroidea.
Responses to rising patient demand, financial constraints, and political dogma in the UK may be well intended and focus on patient need, but they fail to respect the human nature of the professional ...groups on whom we rely to deliver care. Senior doctors retire early to avoid pressures and financial penalties on their pensions resulting from continued employment.
Recent research identifies that certain training load (TL) patterns increase the injury risk to athletes. However, physical fitness must also be considered to establish optimal TL patterns. The aim ...of this study was to identify TL patterns optimal for injury and aerobic fitness by exploring the TL-injury and TL-fitness relationship concurrently over an Australian rules football (ARF) preseason. Individual TL, aerobic fitness, and injury data were collected over a 14-week preseason in 60 subelite ARF players (age = 21.3 ± 2.9 years). Individual TL, assessed through session rating of perceived exertion (sRPE), was compared with noncontact, lower limb soft tissue injury to examine the TL-injury relationship. A 2-km time trial was used as the measure of aerobic fitness to examine the optimal TL for aerobic fitness improvement. Aerobic fitness improved by 4.10 ± 2.20% (range = -7.35-19.05%) over the preseason. Training load between 1,600 and 2,000 AU per week was associated with the greatest aerobic fitness improvement (effect size ES = 0.47-1.01). Players with preseason TL <1,250 AU per week had the highest injury rate (ES = 0.52-0.62). Large 2-week TL (>4,000 AU, odds ratio OR = 2.80) and spikes in weekly TL (15-49%, OR = 3.76) significantly increased injury risk the following week. Performing small amounts of training seems to be the most detrimental to changes in aerobic fitness and injury rate. High TL is not responsible for injuries and is required to maximize improvements in aerobic fitness. However, TL exceeding 2,000 AU over several weeks may attenuate aerobic fitness improvements and increase injury risk. In addition, large increments in weekly TL increase injury risk.
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