Background Many patients with malaria-like symptoms seek treatment in private medicine retail outlets (PMR) that distribute malaria medicines but do not traditionally provide diagnostic services, potentially leading to overtreatment with antimalarial drugs. To achieve universal access to prompt parasite-based diagnosis, many malaria-endemic countries are considering scaling up malaria rapid diagnostic tests (RDTs) in these outlets, an intervention that may require legislative changes and major investments in supporting programs and infrastructures. This review identifies studies that introduced malaria RDTs in PMRs and examines study outcomes and success factors to inform scale up decisions. Methods Published and unpublished studies that introduced malaria RDTs in PMRs were systematically identified and reviewed. Literature published before November 2016 was searched in six electronic databases, and unpublished studies were identified through personal contacts and stakeholder meetings. Outcomes were extracted from publications or provided by principal investigators. Results Six published and six unpublished studies were found. Most studies took place in sub-Saharan Africa and were small-scale pilots of RDT introduction in drug shops or pharmacies. None of the studies assessed large-scale implementation in PMRs. RDT uptake varied widely from 8%-100%. Provision of artemisinin-based combination therapy (ACT) for patients testing positive ranged from 30%-99%, and was more than 85% in five studies. Of those testing negative, provision of antimalarials varied from 2%-83% and was less than 20% in eight studies. Longer provider training, lower RDT retail prices and frequent supervision appeared to have a positive effect on RDT uptake and provider adherence to test results. Performance of RDTs by PMR vendors was generally good, but disposal of medical waste and referral of patients to public facilities were common challenges. Conclusions Expanding services of PMRs to include malaria diagnostic services may hold great promise to improve malaria case management and curb overtreatment with antimalarials. However, doing so will require careful planning, investment and additional research to develop and sustain effective training, supervision, waste-management, referral and surveillance programs beyond the public sector.
There are a multitude of biodiversity informatics projects, datasets, databases and initiatives at the global level, and many more at regional, national, and sometimes local levels. In such a complex landscape, it can be unclear how different elements relate to each other. Based on a high-level review of global and European-level elements, we present a map of the biodiversity informatics landscape. This is a first attempt at identifying key datasets/databases and data services, and mapping them in a way that can be used to identify the links, gaps and redundancies in the landscape. While the map is predominantly focused on elements with a global scope, the sub-global focus at the European-level was incorporated in the map in order to demonstrate how a regional network such as the European Biodiversity Observation Network (EU BON) can usefully contribute to connecting some of the nodes within the landscape. We identify 74 elements, and find that the informatics landscape is complex in terms of the characteristics and diversity of these elements, and that there is high variability in their level of connectedness. Overall, the landscape is highly connected, with one element boasting 28 connections. The average "degrees of separation" between elements is low, and the landscape is deemed relatively robust to failures since there is no single point that information flows through. Examples of possible effort duplication are presented, and the inclusion of five policy-level elements in the map helps illustrate how informatics products can contribute to global processes that define and direct political targets. Beyond simply describing the existing landscape, this map will support a better understanding of the landscape's current structure and functioning, enabling responsible institutions to establish or strengthen collaborations, work towards avoiding effort duplication, and facilitate access to the biodiversity data, information and knowledge required to support effective decision-making, in the context of comparatively limited funding for biodiversity knowledge and conservation. To support this, we provide the input matrix and code that created this map as supplementary materials, so that readers can more closely examine the links in the landscape, and edit the map to suit their own purposes.
AbstractIntroductionAchieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe).MethodsUsing data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata.ResultsAnalyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum.ConclusionsWhile OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA.
Introduction Food hypersensitivity (FHS), including food allergy, coeliac disease and food intolerance, is a major public health issue. The Food Standards Agency (FSA), an independent UK Government department working to protect public health and consumers' wider interests in food, sought to identify research priorities in the area of FHS. Methods A priority setting exercise was undertaken, using a methodology adapted from the James Lind Alliance—the first such exercise with respect to food hypersensitivity. A UK-wide public consultation was held to identify unanswered research questions. After excluding diagnostics, desensitization treatment and other questions which were out of scope for FSA or where FSA was already commissioning research, 15 indicative questions were identified and prioritized by a range of stakeholders, representing food businesses, patient groups, health care and academia, local authorities and the FSA. Results 295 responses were received during the public consultation, which were categorized into 70 sub-questions and used to define 15 key evidence uncertainties ('indicative questions') for prioritization. Using the JLA prioritization framework, this resulted in 10 priority uncertainties in evidence, from which 16 research questions were developed. These could be summarized under the following 5 themes: communication of allergens both within the food supply chain and then to the end consumer (ensuring trust in allergen communication); the impact of socio-economic factors on consumers with FHS; drivers of severe reactions; mechanism(s) underlying loss of tolerance in FHS; and the risks posed by novel allergens/processing. Discussion In this first research prioritization exercise for food allergy and FHS, key priorities identified to protect the food-allergic public were strategies to help allergic consumers to make confident food choices, prevention of FHS and increasing understanding of socio-economic impacts. Diagnosis and treatment of FHS was not considered in this prioritization.
Non-perennial streams are widespread, critical to ecosystems and society, and the subject of ongoing policy debate. Prior large-scale research on stream intermittency has been based on long-term averages, generally using annually aggregated data to characterize a highly variable process. As a result, it is not well understood if, how, or why the hydrology of non-perennial streams is changing. Here, we investigate trends and drivers of three intermittency signatures that describe the duration, timing, and dry-down period of stream intermittency across the continental United States (CONUS). Half of gages exhibited a significant trend through time in at least one of the three intermittency signatures, and changes in no-flow duration were most pervasive (41% of gages). Changes in intermittency were substantial for many streams, and 7% of gages exhibited changes in annual no-flow duration exceeding 100 days during the study period. Distinct regional patterns of change were evident, with widespread drying in southern CONUS and wetting in northern CONUS. These patterns are correlated with changes in aridity, though drivers of spatiotemporal variability were diverse across the three intermittency signatures. While the no-flow timing and duration were strongly related to climate, dry-down period was most strongly related to watershed land use and physiography. Our results indicate that non-perennial conditions are increasing in prevalence over much of CONUS and binary classifications of 'perennial' and 'non-perennial' are not an accurate reflection of this change. Water management and policy should reflect the changing nature and diverse drivers of changing intermittency both today and in the future. ; US National Science FoundationNational Science Foundation (NSF) [DEB-1754389] ; Published version ; This manuscript is a product of the Dry Rivers Research Coordination Network, which was supported by funding from the US National Science Foundation (DEB-1754389). Any use of trade, firm, or product names is for descriptive purposes only and does not imply endorsement by the US Government. This manuscript was improved by constructive feedback from Kristin Jaeger and three anonymous reviews.
Marking wild birds is an integral part of many field studies. However, if marks affect the vital rates or behavior of marked individuals, any conclusions reached by a study might be biased relative to the general population. Leg bands have rarely been found to have negative effects on birds and are frequently used to mark individuals. Leg flags, which are larger, heavier, and might produce more drag than bands, are commonly used on shorebirds and can help improve resighting rates. However, no one to date has assessed the possible effects of leg flags on the demographic performance of shorebirds. At seven sites in Arctic Alaska and western Canada, we marked individuals and monitored nest survival of four species of Arctic-breeding shorebirds, including Semipalmated Sandpipers (Calidris pusilla), Western Sandpipers (C. mauri), Red-necked Phalaropes (Phalarope lobatus), and Red Phalaropes (P. fielicarius). We used a daily nest survival model in a Bayesian framework to test for effects of leg flags, relative to birds with only bands, on daily survival rates of 1952 nests. We found no evidence of a difference in nest survival between birds with flags and those with only bands. Our results suggest, therefore, that leg flags have little effect on the nest success of Arctic-breeding sandpipers and phalaropes. Additional studies are needed, however, to evaluate the possible effects of flags on shorebirds that use other habitats and on survival rates of adults and chicks. ; National Fish and Wildlife Foundation [2010-0061-015, 2011-0032-014, 0801.12.032731, 0801.13.041129]; Neotropical Migratory Bird Conservation Act of the U.S. Fish and Wildlife Service [F11AP01040, F12AP00734, F13APO535, 4073, 4102]; Alaska Department of Fish and Game; State Wildlife Grant [T-16]; Arctic National Wildlife Refuge; Bureau of Land Management; Centre for Wildlife Ecology at Simon Fraser University; Environment and Climate Change Canada; Indigenous and Northern Affairs Canada; Kansas State University; Kresge Foundation; Liz Claiborne/Art Ortenberg Foundation; Manomet Center for Conservation Sciences; National Park Service; Murie Science and Learning Center Research Fellowship Program; National Science Foundation (Office of Polar Programs)National Science Foundation (NSF) [ARC-1023396]; National Science Foundation (Doctoral Dissertation Improvement Grant)National Science Foundation (NSF) [1501479]; Natural Resources Canada (Polar Continental Shelf Program); Natural Sciences and Engineering Research Council of Canada (Strategic Grant - Discovery Grants) [357054]; Northern Scientific Training Program (Canadian Polar Commission); U.S. Fish and Wildlife Service (Migratory Bird Management Division, Survey, Monitoring and Assessment Program); U.S. Fish and Wildlife Service (Alaska National Wildlife Refuge System's Challenge Cost Share Program); U.S. Fish and Wildlife Service (Avian Influenza Health and Influenza programs); U.S. Geological Survey (Changing Arctic Ecosystem Initiative, Wildlife Program of the USGS Ecosystem Mission Area); University of Colorado Denver; University of Alaska Fairbanks; University of Missouri Columbia ; Major support for the infrastructure of the Arctic Shorebird Demographics Network was provided by the Arctic Landscape Conservation Cooperative, National Fish and Wildlife Foundation (grants 2010-0061-015, 2011-0032-014, 0801.12.032731, and 0801.13.041129), and Neotropical Migratory Bird Conservation Act of the U.S. Fish and Wildlife Service (grants F11AP01040, F12AP00734, F13APO535, 4073, and 4102). Additional funding for individual sites was provided by Alaska Department of Fish and Game (including State Wildlife Grant T-16), Arctic National Wildlife Refuge, Bureau of Land Management, Centre for Wildlife Ecology at Simon Fraser University, Environment and Climate Change Canada, Indigenous and Northern Affairs Canada, Kansas State University, Kresge Foundation, Liz Claiborne/Art Ortenberg Foundation, Manomet Center for Conservation Sciences, National Park Service (including Murie Science and Learning Center Research Fellowship Program), National Science Foundation (Office of Polar Programs grant ARC-1023396 and Doctoral Dissertation Improvement Grant 1501479), Natural Resources Canada (Polar Continental Shelf Program), Natural Sciences and Engineering Research Council of Canada (Strategic Grant - 357054, Discovery Grants), Northern Scientific Training Program (Canadian Polar Commission), U.S. Fish and Wildlife Service (Migratory Bird Management Division, Survey, Monitoring and Assessment Program, Alaska National Wildlife Refuge System's Challenge Cost Share Program, and Avian Influenza Health and Influenza programs), U.S. Geological Survey (Changing Arctic Ecosystem Initiative, Wildlife Program of the USGS Ecosystem Mission Area), University of Colorado Denver, University of Alaska Fairbanks, and University of Missouri Columbia. We thank local communities and landowners, including the people of the Inuvialuit Settlement Region, North Slope Borough, Ukpeagvik Inupiat Corporation, and Sitnasuak Native Corporation for permitting us to conduct research on their lands. Logistical support was provided by Arctic National Wildlife Refuge (U.S. Fish and Wildlife Service), Barrow Arctic Science Consortium, Cape Krusenstern National Monument (National Park Service), ConocoPhillips Alaska, Inc., Sisualik National Wildlife Refuge (U.S. Fish and Wildlife Service), and Umiaq, LLC. We thank the many field assistants who helped on this project throughout the years, including S. Carvey, T. Donnelly, A. Gottesman, D. Pavlik, and B. Wilkinson for their key roles in field work at the Colville River Delta, and D. Payer for his key role in implementing and overseeing field work at Canning River Delta. J. Lamb, L. Rosen, and B. Ross provided comments on an early draft of the manuscript. Animal handling, marking, and monitoring procedures were approved by animal care and use committees and permitting agencies at Environment and Climate Change Canada, Kansas State University, National Park Service, University of Alaska Fairbanks, U.S. Fish and Wildlife Service, and U.S. Geological Survey - Alaska Science Center. The findings and conclusions in this article are those of the author(s) and do not necessarily represent the views of the U.S. Fish and Wildlife Service. Any use of trade names is for descriptive purposes only and does not imply endorsement by the U.S. Government. ; Public domain authored by a U.S. government employee
The Agenda for Social Justice: Solutions for 2016 provides accessible insights into some of the most pressing social problems in the United States and proposes public policy responses to those problems. Written by a highly respected team of authors brought together by the Society for the Study of Social Problems (SSSP), it offers recommendations for action by elected officials, policy makers, and the public around key issues for social justice, including a discussion of the role of key issues of sustainability and technology in the development and timbre of future social problems. It will be of interest to scholars, practitioners, advocates, and students interested in public sociology and the study of social problems
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Whilst the last decades have seen a clear shift in emphasis from managing natural hazards to managing risk, the majority of natural-hazard risk research still focuses on single hazards. Internationally, there are calls for more attention for multi-hazards and multi-risks. Within the European Union (EU), the concepts of multi-hazard and multi-risk assessment and management have taken centre stage in recent years. In this perspective paper, we outline several key developments in multi-(hazard-)risk research in the last decade, with a particular focus on the EU. We present challenges for multi-(hazard-)risk management as outlined in several research projects and papers. We then present a research agenda for addressing these challenges. We argue for an approach that addresses multi-(hazard-)risk management through the lens of sustainability challenges that cut across sectors, regions, and hazards. In this approach, the starting point is a specific sustainability challenge, rather than an individual hazard or sector, and trade-offs and synergies are examined across sectors, regions, and hazards. We argue for in-depth case studies in which various approaches for multi-(hazard-)risk management are co-developed and tested in practice. Finally, we present a new pan-European research project in which our proposed research agenda will be implemented, with the goal of enabling stakeholders to develop forward-looking disaster risk management pathways that assess trade-offs and synergies of various strategies across sectors, hazards, and spatial scales.
Whilst the last decades have seen a clear shift in emphasis from managing natural hazards to managing risk, the majority of natural-hazard risk research still focuses on single hazards. Internationally, there are calls for more attention for multi-hazards and multi-risks. Within the European Union (EU), the concepts of multi-hazard and multi-risk assessment and management have taken centre stage in recent years. In this perspective paper, we outline several key developments in multi-(hazard-)risk research in the last decade, with a particular focus on the EU. We present challenges for multi-(hazard-)risk management as outlined in several research projects and papers. We then present a research agenda for addressing these challenges. We argue for an approach that addresses multi-(hazard-)risk management through the lens of sustainability challenges that cut across sectors, regions, and hazards. In this approach, the starting point is a specific sustainability challenge, rather than an individual hazard or sector, and trade-offs and synergies are examined across sectors, regions, and hazards. We argue for in-depth case studies in which various approaches for multi-(hazard-)risk management are co-developed and tested in practice. Finally, we present a new pan-European research project in which our proposed research agenda will be implemented, with the goal of enabling stakeholders to develop forward-looking disaster risk management pathways that assess trade-offs and synergies of various strategies across sectors, hazards, and spatial scales.
