Implementing population-based mass drug administration for malaria: experience from a high transmission setting in North Eastern Uganda.

BACKGROUND: Mass drug administration (MDA) is a suggested mean to accelerate efforts towards elimination and attainment of malaria-free status. There is limited evidence of suitable methods of implementing MDA programme to achieve a high coverage and compliance in low-income countries. The objective of this paper is to assess the impact of this MDA delivery strategy while using coverage measured as effective population in the community and population available. METHODS: Population-based MDA was implemented as a part of a larger program in a high transmission setting in Uganda. Four rounds of interventions were implemented over a period of 2 years at an interval of 6 to 8 months. A housing and population census was conducted to establish the eligible population. A team of 19 personnel conducted MDA at established village meeting points as distribution sites at every village. The first dose of dihydroartemisinin-piperaquine (DHA-PQ) was administered via a fixed site distribution strategy by directly observed treatment on site, the remaining doses were taken at home and a door-to-door follow up strategy was implemented by community health workers to monitor adherence to the second and third doses. RESULTS: Based on number of individuals who turned up at the distribution site, for each round of MDA, effective coverage was 80.1%, 81.2%, 80.0% and 80% for the 1st, 2nd, 3rd and 4th rounds respectively. However, coverage based on available population at the time of implementing MDA was 80.1%, 83.2%, 82.4% and 82.9% for rounds 1, 2, 3 and 4, respectively. Intense community mobilization using community structures and mass media facilitated community participation and adherence to MDA. CONCLUSION: A hybrid of fixed site distribution and door-to-door follow up strategy of MDA delivery achieved a high coverage and compliance and seemed feasible. This model can be considered in resource-limited settings.

Field-theoretic model of inhomogeneous supramolecular polymer networks and gels.

We present a field-theoretic model of the gelation transition in inhomogeneous reversibly bonding systems and demonstrate that our model reproduces the classical Flory-Stockmayer theory of gelation in the homogeneous limit. As an illustration of our model in the context of inhomogeneous gelation, we analyze the mean-field behavior of an equilibrium system of reacting trifunctional units in a good solvent confined within a slit bounded by parallel, repulsive walls. Our results indicate higher conversions and, consequently, higher concentrations of gel following the gelation transition near the center of the slit relative to the edges.

Discovery of ANT3310, a Novel Broad-Spectrum Serine ß-Lactamase Inhibitor of the Diazabicyclooctane Class, Which Strongly Potentiates Meropenem Activity against Carbapenem-Resistant Enterobacterales and Acinetobacter baumannii.

The diazabicyclooctanes (DBOs) are a class of serine ß-lactamase (SBL) inhibitors that use a strained urea moiety as the warhead to react with the active serine residue in the active site of SBLs. The first in-class drug, avibactam, as well as several other recently approved DBOs (e.g., relebactam) or those in clinical development (e.g., nacubactam and zidebactam) potentiate activity of ß-lactam antibiotics, to various extents, against carbapenem-resistant Enterobacterales (CRE) carrying class A, C, and D SBLs; however, none of these are able to rescue the activity of ß-lactam antibiotics against carbapenem-resistant Acinetobacter baumannii (CRAB), a WHO "critical priority pathogen" producing class D OXA-type SBLs. Herein, we describe the chemical optimization and resulting structure-activity relationship, leading to the discovery of a novel DBO, ANT3310, which uniquely has a fluorine atom replacing the carboxamide and stands apart from the current DBOs in restoring carbapenem activity against OXA-CRAB as well as SBL-carrying CRE pathogens.

Re-evaluating the use of beached bird oiling rates to assess long-term trends in chronic oil pollution.

The oiling rate (oiled birds/total birds) has become the international standard to analyze beached bird survey data. However, this index may not reliably track long-term changes in marine oil pollution in regions where other activities that kill seabirds vulnerable to oil, such as hunting and gill-netting, are also changing. We compare the oiling rate from beached bird surveys conducted in southeastern Newfoundland between 1984 and 2006 to an alternative approach, namely trends derived from a model examining the linear density of oiled birds (birds/km). In winter, there was no change in the oiling rate since 1984, while in summer oiling rates significantly increased. In contrast, the number of oiled birds/km showed a significant decline in both winter and summer. The discrepancy in these trends was attributed to steep declines in the number of unoiled birds found in both seasons. In winter, the decline in unoiled birds/km was related to a reduction in the legal murre hunt and less onshore winds, while in summer a reduced cod fishery resulting in fewer murres drowning in nets and warming summers may have lead to the decline. The significant declines in oiled birds/km over the past three decades are hopefully an indication of less oil being present in the marine environment. Although oiled bird densities since 2000 have remained relatively low for the region (winter: 0.58 birds/km, summer: 0.27 birds/km), they still exceed densities reported elsewhere in the world.

Superior oblique muscle paresis and restriction secondary to orbital mucocele.

Mucoceles are chronic cystic lesions of the paranasal sinuses lined by respiratory epithelium. Their extension into the adjacent orbit may result in proptosis, ocular motility disorders, and diplopia. Brown syndrome secondary to extension of a mucocele into the orbit has been reported previously. Superior oblique (SO) muscle weakness, either isolated or in combination with an ipsilateral limitation to elevation in adduction, has not been previously reported in patients with orbital mucocele.

Ingestion of plastic marine debris by Common and Thick-billed Murres in the northwestern Atlantic from 1985 to 2012.

Plastic ingestion by seabirds is a growing conservation issue, but there are few time series of plastic ingestion with large sample sizes for which one can assess temporal trends. Common and Thick-billed Murres (Uria aalge and U. lomvia) are pursuit-diving auks that are legally harvested in Newfoundland and Labrador, Canada. Here, we combined previously unpublished data on plastic ingestion (from the 1980s to the 1990s) with contemporary samples (2011-2012) to evaluate changes in murres' plastic ingestion. Approximately 7% of murres had ingested plastic, with no significant change in the frequency of ingestion among species or periods. The number of pieces of plastic/bird, and mass of plastic/bird were highest in the 1980s, lowest in the late 1990s, and intermediate in contemporary samples. Studying plastic ingestion in harvested seabird populations links harvesters to conservation and health-related issues and is a useful source of large samples for diet and plastic ingestion studies.

Correction of congenital blepharoptosis in oculomotor-abducens synkinesis.

A 4-year-old boy was referred for blepharoptosis. Examination revealed the presence of oculomotor-abducens synkinesis (right upper eyelid elevation with right gaze). Reports of congenital oculomotor-abducens synkinesis syndromes are rare. Two surgeries required more levator resection than anticipated to obtain the first, to our knowledge, reported successful result in this condition.

Congenitally enlarged extraocular muscles: can congenital thyroid eye disease exist in a euthyroid infant?

A 2-month-old boy presented with hypotropia, eyelid retraction, and proptosis of the left eye. CT and ultrasound demonstrated enlarged extraocular muscles. Both the infant and mother were euthyroid. The patient underwent inferior rectus recession, lower eyelid retractor disinsertion, and entropion repair. Biopsy of the inferior rectus and oblique muscles was normal. The clinical presentation and workup appear to be most consistent with thyroid eye disease, which, to our knowledge, would be the first reported case of euthyroid congenital thyroid eye disease with a euthyroid mother.

Alternating ptosis associated with intermittent exotropia.

A unique case of alternating, poorly controlled, intermittent strabismus that improved after repair of bilateral, alternating congenital ptosis is described. A 7-year-old boy with bilateral, alternating congenital ptosis and poorly controlled, intermittent exotropia underwent bilateral frontalis suspensions. After surgery, the patient demonstrated improved control of his exotropia. We conclude that an alternating ptosis may lead to sensory deprivation of the occluded eye and decreased fusion, causing an intermittent strabismus to be poorly controlled. Repair of the ptosis to a sufficient eyelid height bilaterally may improve control of the strabismus, obviating strabismus surgery.