Impact of the Severe Malaria "Champions Program" on the Management of Severe Malaria Cases in 12 Hospitals of the North and Far North Regions of Cameroon.

Malaria remains a main cause of morbidity and mortality in Cameroon. Since 2021, the U.S. President's Malaria Initiative Impact Malaria Project has supported the National Malaria Control Program to develop the Champions program in two northern regions. We assessed this program's preliminary effectiveness on the performance of hospitals in the management of severe malaria and reduction of malaria-related deaths. We conducted a secondary analysis of Outreach Training and Supportive Supervision (OTSS) data from four rounds (one round pre-Champions program and three rounds post-Champions program and 2020-2022 malaria-related mortality data for 12 hospitals). Using linear regressions, we measured changes in hospital readiness and competency of health workers in the management of severe malaria between baseline and subsequent rounds. There were statistically significant improvements in overall management of severe malaria scores in post-Champions OTSS rounds, with post-Champions round 3 exhibiting an increase of +14% (P = 0.013) over baseline. Overall health facility readiness scores exhibited an increase of +7% (P = 0.006) from baseline to post-Champions round 3. There were no statistically significant findings associated with providing the right treatment, as nearly all patients hospitalized with severe malaria were treated with a recommended severe malaria treatment. Reported inpatient malaria deaths and case fatality rates trended downward from 2020 to 2022, but these differences were not statistically significant. The Champions program resulted in significant improvements in quality of inpatient care for severe malaria. The downward trends in malaria deaths and case fatality rate will require further monitoring to determine whether the Champions program is having the desired impact of reducing inpatient deaths from malaria.

How Outreach Training and Supportive Supervision (OTSS) Affect Health Facility Readiness and Health-Care Worker Competency to Prevent and Treat Malaria in Niger: A Secondary Analysis of OTSS Data.

The quality of health services is key to the goal of averting morbidity and mortality from malaria. From July 2020 to August 2021, PMI Impact Malaria supported the implementation of four rounds of Outreach Training and Supportive Supervision (OTSS) in 12 health districts in the two regions of Niger: Dosso and Tahoua. Through OTSS, trained supervisors conducted onsite visits to observe an average of 174 healthcare workers (HCWs) per round in 96 public primary health facilities, managing persons with fever or conducting antenatal care (ANC) consultations, and then provided instant and individualized feedback and onsite training. Data from health facility readiness, case management, and malaria in pregnancy (MiP) checklists across the four rounds were analyzed using Wilcoxon's and the χ2 tests. These analyses highlighted improved facility readiness, including an increased likelihood that HCWs had received classroom training, and facilities had increased availability of guidelines and algorithms by round 4 compared with round 1. Median HCW performance scores showed an improvement in the correct performance and interpretation of malaria rapid diagnostic tests, in classification of malaria as uncomplicated or severe, and in the management of uncomplicated malaria across the four rounds. For MiP services, malaria prevention and the management of pregnant women with malaria also improved from round 1 to round 4. These findings provide further evidence that OTSS can achieve rapid improvements in health facility readiness and HCW competency in managing outpatients and ANC clients.

The U.S. President's Malaria Initiative's Support for Improving the Quality of Malaria Case Management Services: Fifteen Years of Progress and Learning.

Since its launch in 2005, the U.S. President's Malaria Initiative's (PMI) investment in malaria case management has evolved based on lessons learned from its support to countries. An initial focus on updating malaria treatment policies to adopt artemisinin-based combination therapies achieved limited success, in part because of the poor quality of diagnostic and treatment services in targeted countries. In response, the PMI supported the development, refinement, and expansion of Outreach Training and Supportive Supervision (OTSS), a quality improvement approach that combines structured, competency-based supervision with corrective measures, including on-the-job training, coaching, troubleshooting, action planning, and timely follow-up. With 15 years of experience, the OTSS approach has been adopted by more than a dozen countries, and its effectiveness in improving the quality of malaria case management services has been documented. Through the PMI Impact Malaria Project, launched in 2018, the OTSS approach was expanded beyond case management of uncomplicated malaria to support quality improvement of inpatient management of severe malaria and malaria in pregnancy services delivered through antenatal care clinics. The OTSS platform also enabled targeted countries to respond rapidly to the COVID-19 pandemic by adding modules related to clinical management and laboratory diagnosis of suspected cases. The OTSS approach has been established as an effective approach to improve the quality of clinical malaria services and can be expanded to cover other health priorities. Further innovations to improve the quality of inpatient and community-based services, and further integration and institutionalization of OTSS into country health systems are needed.

Clinical Outreach Training and Supportive Supervision Quality-of-Care Analysis: Impact of Readiness Factors on Health Worker Competencies in Malaria Case Management in Cameroon, Mali, and Niger.

Improving the quality of malaria clinical case management in health facilities is key to improving health outcomes in patients. The U.S. President's Malaria Initiative Impact Malaria Project has supported implementation of the Outreach Training and Supportive Supervision (OTSS) approach in 11 African countries to improve the quality of malaria care in health facilities through the collection and analysis of observation-based data on health facility readiness and health provider competency in malaria case management. We conducted a secondary analysis of longitudinal data collected during routine supervision in Cameroon (April 2021-March 2022), Mali (October 2020-December 2021), and Niger (November 2020-September 2021) using digitized checklists to assess how service readiness affects health worker competencies in managing patients with fever correctly and providing those with confirmed uncomplicated malaria cases with appropriate treatment and referral. Linear or logistic regression analyses were conducted to assess the effect of facility readiness and its components on observed health worker competencies. All countries demonstrated significant associations between health facility readiness and malaria case management competencies. Data from three rounds of OTSS visits in Cameroon, Mali, and Niger showed a statistically significant positive association between greater facility readiness scores (including the availability of commodities, materials, and trained staff) and health worker competency in case management. These findings provide evidence that health worker performance is likely affected by the tools and training available to them. These results reinforce the need for necessary tools and properly trained staff if high-quality malaria case management services are to be delivered at health facilities.

Software for the frontiers of quantum chemistry: An overview of developments in the Q-Chem 5 package.

This article summarizes technical advances contained in the fifth major release of the Q-Chem quantum chemistry program package, covering developments since 2015. A comprehensive library of exchange-correlation functionals, along with a suite of correlated many-body methods, continues to be a hallmark of the Q-Chem software. The many-body methods include novel variants of both coupled-cluster and configuration-interaction approaches along with methods based on the algebraic diagrammatic construction and variational reduced density-matrix methods. Methods highlighted in Q-Chem 5 include a suite of tools for modeling core-level spectroscopy, methods for describing metastable resonances, methods for computing vibronic spectra, the nuclear-electronic orbital method, and several different energy decomposition analysis techniques. High-performance capabilities including multithreaded parallelism and support for calculations on graphics processing units are described. Q-Chem boasts a community of well over 100 active academic developers, and the continuing evolution of the software is supported by an "open teamware" model and an increasingly modular design.

Workers' exposure to bioaerosols from three different types of composting facilities.

Composting is a natural dynamic biological process used to valorise putrescible organic matter. The composting process can involve vigorous movements of waste material piles, which release high concentrations of bioaerosols into the surrounding environment. There is a lack of knowledge concerning the dispersal of airborne microorganisms emitted by composting plants (CP) as well as the potential occupational exposure of composting workers. The aim of this study was to investigate the workers exposure to bioaerosols during working activities in three different types of composting facilities (domestic, manure, carcass) using two different quantification methods (cultivation and qPCR) for bacteria and moulds concentrations. As expected, even if there are differences between all CP frameworks, independently of the type of the raw compost used, the production of bioaerosols increases significantly during handling activities. Important concentrations of mesophilic moulds and mesophilic bacteria were noted in the working areas with a respective maximal concentration of 2.3 × 105 CFU/m3 and 1.6 × 105 CFU/m3. A. fumigatus and thermophilic Actinomycetes were also detected in all working areas for the 3 CP. This study emphases the risks for workers to being in contact with aerosolized pathogens such as Mycobacterium and Legionella and more specifically, L. pneumophila. The presence of high concentration of these bacteria in CP suggests a potential occupational health risk. This study may lead to recommendations for the creation of limits for occupational exposure. There is a need for identifying the standards exposure limits to bioaerosols in CP and efficient recommendation for a better protection of workers' health.

Design and manufacturing of a piezoelectric traveling-wave pumping device.

In this article, we present the design and construction of a micropump exhibiting a nontraditional pumping principle whose design is achievable at very low scales. The operation is based on the action of a mechanical traveling wave deforming the bottom wall of a flexible channel containing a fluid. The paper treats for the first time the influence of the traveling wave parameters on the performance of the pump with the help of finite element simulations. The results obtained from the simulation are subsequently used for the dimensioning of the linear ultrasonic traveling wave actuator that drives the device. Finally, a very simple channel-reservoirs structure was conceived to test the device. At this point, several measurements of flow rate and back pressure were carried out to estimate the performance of the prototype for different values of wave amplitude. The article finishes with a comparison between the numerical and experimental results and a brief section of discussion and conclusions.

General formulation of spin-flip time-dependent density functional theory using non-collinear kernels: theory, implementation, and benchmarks.

We report an implementation of the spin-flip (SF) variant of time-dependent density functional theory (TD-DFT) within the Tamm-Dancoff approximation and non-collinear (NC) formalism for local, generalized gradient approximation, hybrid, and range-separated functionals. The performance of different functionals is evaluated by extensive benchmark calculations of energy gaps in a variety of diradicals and open-shell atoms. The benchmark set consists of 41 energy gaps. A consistently good performance is observed for the Perdew-Burke-Ernzerhof (PBE) family, in particular PBE0 and PBE50, which yield mean average deviations of 0.126 and 0.090 eV, respectively. In most cases, the performance of original (collinear) SF-TDDFT with 50-50 functional is also satisfactory (as compared to non-collinear variants), except for the same-center diradicals where both collinear and non-collinear SF variants that use LYP or B97 exhibit large errors. The accuracy of NC-SF-TDDFT and collinear SF-TDDFT with 50-50 and BHHLYP is very similar. Using PBE50 within collinear formalism does not improve the accuracy.

Distribution of r·p in atomic systems.

We present formulas for computing the probability distribution of the posmom s = r · p in atoms, when the electronic wave function is expanded in a single particle Gaussian basis. We study the posmom density, S(s), for the electrons in the ground states of 36 lightest atoms (H-Kr) and construct an empirical model for the contribution of each atomic orbital to the total S(s). The posmom density provides unique insight into types of trajectories electrons may follow, complementing existing spectroscopic techniques that provide information about where electrons are (X-ray crystallography) or where they go (Compton spectroscopy). These, a priori, predictions of the quantum mechanically observable posmom density provide an challenging target for future experimental work.

Compact expressions for spherically averaged position and momentum densities.

Compact expressions for spherically averaged position and momentum density integrals are given in terms of spherical Bessel functions (j(n)) and modified spherical Bessel functions (i(n)), respectively. All integrals required for ab initio calculations involving s, p, d, and f-type Gaussian functions are tabulated, highlighting a neat isomorphism between position and momentum space formulae. Spherically averaged position and momentum densities are calculated for a set of molecules comprising the ten-electron isoelectronic series (Ne-CH(4)) and the eighteen-electron series (Ar-SiH(4), F(2)-C(2)H(6)).

Intracule functional models. Part III. The dot intracule and its Fourier transform.

The dot intracule D(x) of a system gives the Wigner quasi-probability of finding two of its electrons with u.v = x, where u and v are the interelectronic distance vectors in position and momentum space, respectively. In this paper, we discuss D(x) and show that its Fourier transform d(k) can be obtained in closed form for any system whose wavefunction is expanded in a Gaussian basis set. We then invoke Parseval's theorem to transform our intracule-based correlation energy method into a d(k)-based model that requires, at most, a one-dimensional quadrature.

Mosquitoborne infections after Hurricane Jeanne, Haiti, 2004.

After Hurricane Jeanne in September 2004, surveillance for mosquitoborne diseases in Gonaïves, Haiti, identified 3 patients with malaria, 2 with acute dengue infections, and 2 with acute West Nile virus infections among 116 febrile patients. These are the first reported human West Nile virus infections on the island of Hispaniola.