Climatic, land-use and socio-economic factors can predict malaria dynamics at fine spatial scales relevant to local health actors: Evidence from rural Madagascar.

While much progress has been achieved over the last decades, malaria surveillance and control remain a challenge in countries with limited health care access and resources. High-resolution predictions of malaria incidence using routine surveillance data could represent a powerful tool to health practitioners by targeting malaria control activities where and when they are most needed. Here, we investigate the predictors of spatio-temporal malaria dynamics in rural Madagascar, estimated from facility-based passive surveillance data. Specifically, this study integrates climate, land-use, and representative household survey data to explain and predict malaria dynamics at a high spatial resolution (i.e., by Fokontany, a cluster of villages) relevant to health care practitioners. Combining generalized linear mixed models (GLMM) and path analyses, we found that socio-economic, land use and climatic variables are all important predictors of monthly malaria incidence at fine spatial scales, via both direct and indirect effects. In addition, out-of-sample predictions from our model were able to identify 58% of the Fokontany in the top quintile for malaria incidence and account for 77% of the variation in the Fokontany incidence rank. These results suggest that it is possible to build a predictive framework using environmental and social predictors that can be complementary to standard surveillance systems and help inform control strategies by field actors at local scales.

Estimating the local spatio-temporal distribution of malaria from routine health information systems in areas of low health care access and reporting.

BACKGROUND: Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to develop a novel method to obtain accurate estimates of disease spatio-temporal incidence at very local scales from routine passive surveillance, less biased by populations' financial and geographic access to care. METHODS: We use a geographically explicit dataset with residences of the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria. RESULTS: Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations' financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. By gathering patient-level data and removing systematic biases in the dataset, the spatial resolution of passive malaria surveillance was improved over ten-fold. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years. CONCLUSIONS: Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.

The Light vs. Dark Triad of Personality: Contrasting Two Very Different Profiles of Human Nature.

While there is a growing literature on "dark traits" (i.e., socially aversive traits), there has been a lack of integration with the burgeoning research literature on positive traits and fulfilling and growth-oriented outcomes in life. To help move the field toward greater integration, we contrasted the nomological network of the Dark Triad (a well-studied cluster of socially aversive traits) with the nomological network of the Light Triad, measured by the 12-item Light Triad Scale (LTS). The LTS is a first draft measure of a loving and beneficent orientation toward others ("everyday saints") that consists of three facets: Kantianism (treating people as ends unto themselves), Humanism (valuing the dignity and worth of each individual), and Faith in Humanity (believing in the fundamental goodness of humans). Across four demographically diverse samples (N = 1,518), the LTS demonstrated excellent reliability and validity, predicting life satisfaction and a wide range of growth-oriented and self-transcendent outcomes above and beyond existing measures of personality. In contrast, the Dark Triad was negatively associated with life satisfaction and growth-oriented outcomes, and showed stronger linkages to selfish, exploitative, aggressive, and socially aversive outcomes. This exploratory study of the contrasting nomological networks of the Light vs. Dark Triad provides several ways forward for more principled and data driven approaches to explore both the malevolent and beneficent sides of human nature.

Ethics and patient and public involvement with children and young people.

Patient and public involvement (PPI) is important both in research and in quality improvement activities related to healthcare services . While PPI activities do not require formal ethical approval, they can raise a number of ethical concerns, through the introduction of complex technical medical concepts, challenging language or sensitive subject areas. There is very little published literature to guide ethical practice in this area. We have been conducting PPI with children and young people throughout a research study in paediatric palliative care. PPI started during the application process and continued to guide and shape the research as it progressed. Ethical issues can arise at any time in PPI work. Although many can be predicted and planned for, the nature of PPI means that researchers can be presented with ideas and concepts they had not previously considered, requiring reflexivity and a reactive approach. This paper describes how we considered and addressed the potential ethical issues of PPI within our research. The approach that emerged provides a framework that can be adapted to a range of contexts and will be of immediate relevance to researchers and clinicians who are conducting PPI to inform their work.

Microgravity validation of a novel system for RNA isolation and multiplex quantitative real time PCR analysis of gene expression on the International Space Station.

The International Space Station (ISS) National Laboratory is dedicated to studying the effects of space on life and physical systems, and to developing new science and technologies for space exploration. A key aspect of achieving these goals is to operate the ISS National Lab more like an Earth-based laboratory, conducting complex end-to-end experimentation, not limited to simple microgravity exposure. Towards that end NASA developed a novel suite of molecular biology laboratory tools, reagents, and methods, named WetLab-2, uniquely designed to operate in microgravity, and to process biological samples for real-time gene expression analysis on-orbit. This includes a novel fluidic RNA Sample Preparation Module and fluid transfer devices, all-in-one lyophilized PCR assays, centrifuge, and a real-time PCR thermal cycler. Here we describe the results from the WetLab-2 validation experiments conducted in microgravity during ISS increment 47/SPX-8. Specifically, quantitative PCR was performed on a concentration series of DNA calibration standards, and Reverse Transcriptase-quantitative PCR was conducted on RNA extracted and purified on-orbit from frozen Escherichia coli and mouse liver tissue. Cycle threshold (Ct) values and PCR efficiencies obtained on-orbit from DNA standards were similar to Earth (1 g) controls. Also, on-orbit multiplex analysis of gene expression from bacterial cells and mammalian tissue RNA samples was successfully conducted in about 3 h, with data transmitted within 2 h of experiment completion. Thermal cycling in microgravity resulted in the trapping of gas bubbles inside septa cap assay tubes, causing small but measurable increases in Ct curve noise and variability. Bubble formation was successfully suppressed in a rapid follow-up on-orbit experiment using standard caps to pressurize PCR tubes and reduce gas release during heating cycles. The WetLab-2 facility now provides a novel operational on-orbit research capability for molecular biology and demonstrates the feasibility of more complex wet bench experiments in the ISS National Lab environment.

Cultivating the social-emotional imagination in gifted education: insights from educational neuroscience.

Evidence from education, psychology, and neuroscience suggests that investing in the development of the social-emotional imagination is essential to cultivating giftedness in adolescents. Nurturing these capacities may be especially effective for promoting giftedness in students who are likely to lose interest and ambition over time. Giftedness is frequently equated with high general intelligence as measured by IQ tests, but this narrow conceptualization does not adequately capture students' abilities to utilize their talents strategically to fully realize their future possible selves. The brain's default mode network is thought to play an important role in supporting imaginative thinking about the self and others across time. Because this network's functioning is temporarily attenuated when individuals engage in task- and action-oriented focus (mindsets thought to engage the brain's executive attention network), we suggest that consistently focusing students on tasks requiring immediate action could undermine long-term cultivation of giftedness. We argue that giftedness-especially in science, technology, engineering, and mathematics (STEM)-can be cultivated by encouraging adolescents' intellectual curiosity and supporting their ability to connect schoolwork to a larger purpose. Improving STEM and gifted education may depend upon a shift from knowledge transmission and regimented evaluation to creative exploration, intentional reflectiveness, and mindful switching between task focus and imagining.