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Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case management (iCCM). However, little is known about the cost‐effectiveness of this integrated nutrition intervention. The present study investigates the cost‐effectiveness of treating moderate acute malnutrition (MAM) through community health volunteer (CHV) and integrating it with routine iCCM. A cost‐effectiveness model compared the costs and effects of CHV sites plus health facility‐based treatment (intervention) with the routine health facility‐based treatment strategy alone (control). The costing assessments combined both provider and patient costs. The cost per DALY averted was the primary metric for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's relative value for money was evaluated using the most recent country‐specific gross domestic product threshold metrics. The intervention dominated the health facility‐based strategy alone on all computed cost‐effectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per death and DALY averted of US $ 8743 and US$397, respectively, as opposed to US $ 13,846 and US$637 in the control group. The findings also showed that the intervention group spent less per child treated and recovered than the control group: US $ 214 versus US$270 and US $ 306 versus US$485, respectively. Compared with facility‐based treatment, treating MAM by CHVs and health facilities was a cost‐effective intervention. Additional gains could be achieved if more children with MAM are enrolled and treated. Key messages Treatment of MAM by CHVs and health facilities involved a lower cost compared with the health facility‐based treatment approach alone. Treatment of MAM by CHVs and health facilities was cost‐effective compared with the health facility‐based treatment approach alone. Greater health and economic gains could be realized if more children with MAM are enrolled and treated by CHVs through the integration of acute malnutrition treatment into iCCM.

Background and objectives: Community-based Management of Acute Malnutrition (CMAM) is a proven approach for treating acute malnutrition. Its effectiveness is undermined by poor adherence to clinical protocols, inaccurate record keeping and weak supervision systems. A mobile application (app) for CMAM was developed to provide health workers (HWs) with case management tools and job aids, including response-triggered decision tree algorithms, automated referral initiating and tracking, integrated media for counselling, and automated reporting. The app was contextualized and deployed in Afghanistan, Mali, Chad, Niger, and Kenya in 2014 to determine the effectiveness and impact of the technology. Methods: Evaluations were conducted in 2016 to assess the effect of the app on protocol adherence, monitoring, reporting, user acceptability and competency. Data was collected from a sampling of one third of implementation health centers and was matched with health centers using the traditional paper-based system for comparison. Evaluation tools included: Observational Checklist, Focus Group Discussions with HWs and beneficiaries, and Key Informant Interviews with project staff, Health District officials and Community health committee members. Monitoring tools administered quarterly, provided information on user acceptability and competency. Results: Data completeness, protocol adherence, and treatment outcomes were improved across all 5 countries and HW acceptability was high if they were given enough time, training and support. The main challenges to HW uptake were battery life, screen size, network speed/coverage, and requirement to complete dual reporting (electronic and paper-based). The app prevented skipping steps in treatment protocol, resulting in longer case management times. Conclusions: The app has demonstrated the potential to transform the delivery of CMAM, improving the ability to more efficiently and effectively treat acute malnutrition in humanitarian settings. However, developing 'global specifications' was not feasible given the differences between national protocols; country contextualization was complex and time consuming; field testing with users was vital; working with a technology partner who can accommodate timeline flexibility and works in fragile contexts would be beneficial; weak CMAM services in some countries affected uptake of the app. The app has also highlighted the need to better understand what is feasible in terms of capacity and time for HWs in low resource settings, with high patient caseloads.

Background and objectives: Community Management of Acute Malnutrition (CMAM) is a proven approach in the treatment of acute malnutrition, however its effectiveness is limited by Health Workers failing to adhere to standard CMAM treatment protocol, due in part to poor monitoring and support, relying on paper based systems. A mobile health application was developed by World Vision and Dimagi and piloted by Save the Children in Wajir, Kenya to help health workers follow national CMAM treatment protocols and to provide more timely and accurate data for decision making. A cluster randomized trial was conducted to evaluate the impact of the application on CMAM reporting and treatment outcomes. Methods: Forty health facilities in Wajir were randomly allocated to an intervention and control group. Intervention facilities received a tablet with the mobile health application adapted to the Kenyan context and CMAM protocol, control sites continued to use the paper based system. Data gathered through the mobile application from intervention health facilities for a period of twelve months was compared to data gathered from paper based registers over the same period in control facilities. Data from paper based registers on treatment of acute malnutrition was also collected for all forty facilities for twelve pre intervention to serve as a baseline for comparison. Two observations of treatment were conducted in a sub sample of facilities to assess adherence to treatment protocol. Results: Data analysis is still underway and results will be available by July 2017. These will compare data quality, completeness and timeliness for decision making, adherence to treatment protocol, and treatment outcomes between the two groups. Conclusions: The CMAM mobile application has huge potential to improve CMAM services in Kenya and other countries.

Along with Beauchamp Estates, he is marketing Gibraltar's most expensive property, Admiralty House, a new ten-bedroom palace with a Pounds 21.5 million price tag. 'Once you have residency, you can work, trade companies and draw salaries outside Gibraltar,' he says. 'Income tax is at a collective maximum of Pounds 22,000 a year, based on the total salary earned by a family. Gibraltar has become one of the world's most efficiently regulated offshore finance centres and the only one with full EU membership.' The tiny territory of 30,000 residents may be hotly disputed among the British and Spanish, but Gibraltar has set itself apart from those ailing economies, seeing a 6.6 per cent growth rate. 'Gibraltar encourages entrepreneurs, which is why people in gaming, insurance and finance are moving here.' Brian Stevendale, of Ocean Village, where new villas with private moorings start at Pounds 800,000, says many high earners in Britain are considering Gibraltar. 'Since [Alistair Darling] announced the 50 per cent rate, we've been doing a lot of deals,' he says. 'An asset management company owner flew over the following day and bought on the spot.'

Chronic low-grade inflammation accompanies obesity and its related chronic conditions. Both peripheral blood mononuclear cells (PBMCs) and cell lines have been used to study whether vitamin D has immune modulating effects; however, to date a detailed systematic review describing the published evidence has not been completed. We therefore conducted a systematic review on the effect of vitamin D on the protein expression and secretion of inflammatory markers by human-derived immune cells. The review was registered at the International Prospective Register for Systematic Reviews (PROSPERO, Registration number CRD42015023222). A literature search was conducted using Pubmed, Science Direct, Scopus, Web of Science and Medline. The search strategy used the following search terms: Vitamin D or cholecalciferol or 1,25-dihydroxyvitamin or 25-hydroxy-Vitamin D and Inflam* or cytokine* and supplement* or cell*. These terms were searched in the abstract, title and keywords. Inclusion criteria for study selection consisted of human-derived immune cell lines or cellular studies where PBMCs were obtained from humans, reported in the English language, and within the time period of 2000 to 2015. The selection protocol was mapped according to PRISMA guidelines. Twenty three studies (7 cell line and 16 PBMCs studies) met our criteria. All studies selected except one used the active metabolite 1,25(OH)2, with one study using cholecalciferol and two studies also using 25(OH)D. Four out of seven cell line studies showed an anti-inflammatory effect where suppression of key markers such as macrophage chemotactic protein 1, interleukin 6 and interleukin 8 were observed. Fourteen of sixteen PBMC studies also showed a similar anti-inflammatory effect based on common inflammatory endpoints. Mechanisms for such effects included decreased protein expression of toll-like receptor-2 and toll-like receptor-4; lower levels of phosphorylated p38 and p42/42; reduced expression of phosphorylated signal transducer and activator of transcription 5 and decreased reactive oxygen species. This review demonstrates that an anti-inflammatory effect of vitamin D is a consistent observation in studies of cell lines and human derived PBMCs.

U.K. markets were pressured by the combination of a monthly rise in a housing-price index and stronger-than-forecast industrial-production figures, which could potentially add 0.1 percentage point to second- quarter GDP growth. \"The rate outlook isn't that clear so there's going to be a reaction to most data as the market adjusts its expectations,\" said one broker. After the European markets closed, all three major ratings agencies downgraded Delphi deeper into speculative, or \"junk-bond,\" territory. Standard & Poor's downgraded the company three notches to triple-C- plus, from single-B-plus, while Moody's Investors Service cut it two notches, to Caa1 from single-B-2. Fitch Ratings cut the company's rating to triple-C, a category it describes as a having a high default risk, from single-B.

WHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus (HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90–70–90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality from non-communicable diseases by 2030. The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries (LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10–14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median (range) of model predictions. In 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 (range 12·9–14·1) per 100 000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% (0·1–0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% (23·3–37·8), averting 300 000 (300 000–400 000) deaths by 2030 (with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% (61·4–66·1), averting 4·8 million (4·1–4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% (84·0–89·3), averting 13·3 million (13·1–13·6) deaths (with once-lifetime screening), or by 92·3% (88·4–93·0), averting 14·6 million (14·1–14·6) deaths (with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% (86·6–89·9), averting 45·8 million (44·7–46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% (95·0–98·0), averting 60·8 million (60·2–61·2) deaths (with once-lifetime screening), or by 98·6% (96·5–98·6), averting 62·6 million (62·1–62·8) deaths (with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half (48% [45–55]) of deaths averted would be in sub-Saharan Africa and almost a third (32% [29–34]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths (age 30–69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% (24·4–37·9) by 2030, 96·2% (94·3–96·8) by 2070, and 98·6% (96·9–98·8) by 2120. These findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives. WHO, UNDP, UN Population Fund, UNICEF–WHO–World Bank Special Program of Research, Development and Research Training in Human Reproduction, Germany Federal Ministry of Health, National Health and Medical Research Council Australia, Centre for Research Excellence in Cervical Cancer Control, Canadian Institute of Health Research, Compute Canada, and Fonds de recherche du Québec–Santé.

The WHO Director-General has issued a call for action to eliminate cervical cancer as a public health problem. To help inform global efforts, we modelled potential human papillomavirus (HPV) vaccination and cervical screening scenarios in low-income and lower-middle-income countries (LMICs) to examine the feasibility and timing of elimination at different thresholds, and to estimate the number of cervical cancer cases averted on the path to elimination. The WHO Cervical Cancer Elimination Modelling Consortium (CCEMC), which consists of three independent transmission-dynamic models identified by WHO according to predefined criteria, projected reductions in cervical cancer incidence over time in 78 LMICs for three standardised base-case scenarios: girls-only vaccination; girls-only vaccination and once-lifetime screening; and girls-only vaccination and twice-lifetime screening. Girls were vaccinated at age 9 years (with a catch-up to age 14 years), assuming 90% coverage and 100% lifetime protection against HPV types 16, 18, 31, 33, 45, 52, and 58. Cervical screening involved HPV testing once or twice per lifetime at ages 35 years and 45 years, with uptake increasing from 45% (2023) to 90% (2045 onwards). The elimination thresholds examined were an average age-standardised cervical cancer incidence of four or fewer cases per 100 000 women-years and ten or fewer cases per 100 000 women-years, and an 85% or greater reduction in incidence. Sensitivity analyses were done, varying vaccination and screening strategies and assumptions. We summarised results using the median (range) of model predictions. Girls-only HPV vaccination was predicted to reduce the median age-standardised cervical cancer incidence in LMICs from 19·8 (range 19·4–19·8) to 2·1 (2·0–2·6) cases per 100 000 women-years over the next century (89·4% [86·2–90·1] reduction), and to avert 61·0 million (60·5–63·0) cases during this period. Adding twice-lifetime screening reduced the incidence to 0·7 (0·6–1·6) cases per 100 000 women-years (96·7% [91·3–96·7] reduction) and averted an extra 12·1 million (9·5–13·7) cases. Girls-only vaccination was predicted to result in elimination in 60% (58–65) of LMICs based on the threshold of four or fewer cases per 100 000 women-years, in 99% (89–100) of LMICs based on the threshold of ten or fewer cases per 100 000 women-years, and in 87% (37–99) of LMICs based on the 85% or greater reduction threshold. When adding twice-lifetime screening, 100% (71–100) of LMICs reached elimination for all three thresholds. In regions in which all countries can achieve cervical cancer elimination with girls-only vaccination, elimination could occur between 2059 and 2102, depending on the threshold and region. Introducing twice-lifetime screening accelerated elimination by 11–31 years. Long-term vaccine protection was required for elimination. Predictions were consistent across our three models and suggest that high HPV vaccination coverage of girls can lead to cervical cancer elimination in most LMICs by the end of the century. Screening with high uptake will expedite reductions and will be necessary to eliminate cervical cancer in countries with the highest burden. WHO, UNDP, UN Population Fund, UNICEF–WHO–World Bank Special Program of Research, Development and Research Training in Human Reproduction, Canadian Institute of Health Research, Fonds de recherche du Québec–Santé, Compute Canada, National Health and Medical Research Council Australia Centre for Research Excellence in Cervical Cancer Control.

Background Typically, animal models studying gastrointestinal microbiotas compromised in early life have employed either germ-free animals or mice treated with a cocktail of antibiotics. Such studies intend to mimic scenarios of infants born by caesarean section and/or subjected to antibiotic treatment. However, the antibiotics used in these studies are rarely prescribed to infants. Therefore, an early life model was developed in which the murine gastrointestinal microbiota was severely disrupted by clindamycin treatment. Results In this mouse model, we investigated the extent supplementation with a synbiotic mixture of prebiotics, being scGOS/lcFOS with the human milk oligosaccharide 2’-Fucosyllactose (2’-FL), in combination with or without single strain or mix of “infant type” bifidobacteria, can rescue an antibiotic-compromised microbiota. Shotgun metagenomic sequencing showed that the microbiota was severely disrupted by the clindamycin challenge. No recovery was observed 3 weeks post-challenge in the scGOS/lcFOS/2’FL group, while the group that received the synbiotic treatment of scGOS/lcFOS/2’-FL with Bifidobacterium breve NRBB01 showed partial recovery. Strikingly in the scGOS/lcFOS/2’-FL group receiving the mixture of bifidobacteria resulted in a recovery of the microbiota disruption. Histological analyses showed that the clindamycin-treated animals at the end of the experiment still suffered from mild oedema and villi/colonic crypt irregularities which was ameliorated by the synbiotic intervention. Conclusion Our study demonstrates that supplementation of synbiotic mixture of scGOS/lcFOS/2’-FL in combination with a specific mix of infant-type bifidobacterial strains is able to partially revive an antibiotic-perturbed gastrointestinal microbiota. DqAiaRikLfonWr824rkSor Video Abstract

Turkey's $1.5 billion bond due 2030 dipped slightly on rumors of the deal earlier in the session, but it recovered after confirmation, \"which tells you this deal's going to fly,\" Mr. [Robin Evans] said. Investors also are looking to a third issue from HBOS Treasury's U.K. covered-bond program. The unit of HBOS PLC has mandated ABN Amro, Citigroup and Deutsche Bank to lead the deal. Mr. Davies said further euro gains were likely to make the ECB nervous, prompting attempts to talk the currency down, then possibly currency intervention, and finally even monetary easing. \"If the euro gets to $1.33-1.35 on a sustained basis, the markets will be betting heavily on the above,\" he said.