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Capacity building in health research generally, and helminthiasis research particularly, is pivotal to the implementation of the research and development agenda for the control and elimination of human helminthiases that has been proposed thematically in the preceding reviews of this collection. Since helminth infections affect human populations particularly in marginalised and low-income regions of the world, they belong to the group of poverty-related infectious diseases, and their alleviation through research, policy, and practice is a sine qua non condition for the achievement of the United Nations Millennium Development Goals. Current efforts supporting research capacity building specifically for the control of helminthiases have been devised and funded, almost in their entirety, by international donor agencies, major funding bodies, and academic institutions from the developed world, contributing to the creation of (not always equitable) North–South "partnerships". There is an urgent need to shift this paradigm in disease-endemic countries (DECs) by refocusing political will, and harnessing unshakeable commitment by the countries' governments, towards health research and capacity building policies to ensure long-term investment in combating and sustaining the control and eventual elimination of infectious diseases of poverty. The Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. This paper discusses the challenges confronting capacity building for parasitic disease research in DECs, describes current capacity building strategies with particular reference to neglected tropical diseases and human helminthiases, and outlines recommendations to redress the balance of alliances and partnerships for health research between the developed countries of the "North" and the developing countries of the "South". We argue that investing in South–South collaborative research policies and capacity is as important as their North–South counterparts and is essential for scaled-up and improved control of helminthic diseases and ultimately for regional elimination.
Citation: Osei-Atweneboana MY, Lustigman S, Prichard RK, Boatin BA, Basáñez M-G (2012) A Research Agenda for Helminth Diseases of Humans: Health Research and Capacity Building in Disease-Endemic Countries for Helminthiases Control. PLoS Negl Trop Dis 6(4): e1602. https://doi.org/10.1371/journal.pntd.0001602
Editor: Jürg Utzinger, Swiss Tropical and Public Health Institute, Switzerland
Published: April 24, 2012
Copyright: © 2012 Osei-Atweneboana et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: MYO-A is funded by the European Foundation Initiative for African Research into Neglected Tropical Diseases (EFINTD) and a Career Development Fellowship award from the Special Programme for Research and Training in Tropical Diseases (TDR). SL received intramural funding from the New York Blood Center and a research grant from the NIAID/NIH (R01AI078314). Research at the Institute of Parasitology, McGill University (RKP, BAB) is supported by a Regroupement Stratégique grant from FQRNT, Quebec, to the Centre for Host-Parasite Interactions. M-GB thanks the Wellcome Trust, http://www.wellcome.ac.uk (Grants 085133/Z/08/Z and 092677/Z/10/Z). MYO-A and M-GB thank the Royal Society-Leverhulme Trust (http://www.royalsociety.org) for a Capacity Building Africa Award. The TDR provided both technical and financial support to the Disease Reference Group on Helminth Infections (DRG4), and the European Commission provided financial support under Agreement PP-AP/2008/160-163. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
During their deliberations, and in the previous reports of this collection [1]–[7], the members of the Disease Reference Group on Helminth Infections (DRG4)—established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR)—identified research gaps and priorities relevant to their thematic areas and contributed to the setting of a research agenda for the control and eventual elimination of human helminthiases. However, the group soon realised that the setting of a research agenda, although useful for advocacy and funding purposes, would not, by itself, fully contribute to the alleviation of the problem of helminthiasis [2]. The establishment and strengthening of research capacity in disease-endemic countries (DECs) are absolutely essential to make the control and elimination of these infections truly achievable and sustainable in the long-term. In the context of this paper, DECs are countries endemic for poverty-related infectious diseases in general and helminthiases in particular. Consequently, the issues concerning capacity building and research policies in DECs received the special attention of the DRG4 group after the Rio de Janeiro meeting in October 2010 [1]. In this paper, we focus on the research and development needs of these important aspects, especially in the context of Africa. We argue that investing in South–South collaborative research policies and capacity is as important as their North–South counterparts and is essential for scaled-up and improved control of helminthic diseases and ultimately for regional elimination.
Inequalities in Research Capacity
Building research capacity is a long-term process that requires a systemic and inter-sectoral approach to developing appropriate regulatory frameworks (including the establishment of institutional review boards for ethical clearance of research proposals and research governance), building and maintaining physical infrastructure, and investing in human resources, equipment, and training in an environment conducive to research commitment and institutional support [8]. Above all, it requires demand and supply for enhanced scientific research, based on a conviction that research, and particularly health research, can improve the lives of people and spur economic development. In this paper, health research refers to an umbrella term encompassing research in biomedical, epidemiological, public health, social science, and environmental (among others) disciplines related to human health. The level of infectious and parasitic disease research capacity varies greatly across the world, and significant disparities exist in research and technological expertise and facilities between developed and developing countries. Substantial heterogeneity also exists within the latter—in Africa, for instance, South Africa (classified as "scientifically proficient"), and Benin, Egypt, and Mauritius ("scientifically developing") have done reasonably well regarding national investment and productivity in science and technology, with the remaining countries in the continent falling behind ("scientifically lagging countries") [9]. Inequalities in health research contribute to inequalities in health and ultimately wealth. Some countries, such as Brazil and the People's Republic of China, have made remarkable progress, in part because their governments have invested substantially in health research and capacity building. For science to deliver its promise of improving health and enabling development, all countries should be able to participate equitably in research [8].
Inter-country differences are mainly due to major investments that have been made by the developed world towards research and development (R&D) activities, especially in the proportion of the gross domestic product (GDP) that the countries' governments are willing to invest in research for an expected return. In some developed countries, long-term investment has resulted in extensive infrastructure, existence of national expertise and national and international academic prestige, a tradition in research funding, and a more expeditious path between basic and clinical, translational research and its implementation into public health policy and practice. Investments in research and innovative technologies have tremendously improved health in the developed world because of these countries' clear health research policies, including the setting up of priorities at institutional, national, and regional levels. The readily available and opportune deployment of such resources has led to rapid advances in controlling infectious agents that have epidemic potential. However, in the developing world, and especially in most African countries, adequate investments by most DECs in research capacity building to support prevention, control, and elimination of infectious diseases of poverty are insufficient. In addition to the paucity of highly trained researchers, there is a considerable brain drain of the already scarce numbers of trained professionals, fragmentation of research with much duplication of efforts, and a lack of focus on distinct national needs. According to Chauhan [10], lack of encouragement, unethical research practices that have left a legacy of mistrust, a colonial past that has left some degree of suspicion and engendered dependency, and most importantly, an environment of political, social, and economic instability, have all contributed to the scarcity of scientific research in Africa. Whatever the reasons, the dearth of research conducted in Africa for Africa is untenable [8] and threatens the long-term sustainability of any disease control programme.
The purpose of this review is to examine the level of capacity building in DECs, highlight some of the challenges that hinder the development of health research capacity with particular reference to poverty-related infectious diseases, summarise (not exhaustively) available research capacity building initiatives and policies and their implications for helminthiasis research and control, and provide recommendations for improvement of research capacity building towards the control and elimination of human helminthiases. Box 1 lists the abbreviations used in this paper, and Box 2 presents five salient points for capacity building in helminthiasis research.
Box 1. List of Abbreviations
ACBF, African Capacity Building Foundation
APOC, African Programme for Onchocerciasis Control
AusAID, Australian Agency for International Development
BioMalPar, Biology and Pathology of Malaria Parasite Network
B&MGF, Bill and Melinda Gates Foundation
CAPES, Brazilian Federal Agency for the Support and Evaluation of Graduate Education
CDTI, Community-Directed Treatment with Ivermectin
CGMRC, Centre of Geographical Medicine Research Coast
CNPq, National Research Council of Brazil
CSRS, Swiss Centre for Scientific Research, Côte d'Ivoire
DBL, Danish Bilaharziasis Laboratory-Institute for Health Research and Development
DEC, disease-endemic country
DFID, Department for International Development, United Kingdom
DIMACS/MBI, Center for Discrete Mathematics and Theoretical Computer Science/US–African Biomathematics Initiative
DRG4, Disease Reference Group on Helminth Infections
EFINTD, European Foundation Initiative for African Research into Neglected Tropical Diseases
FIOCRUZ, Oswaldo Cruz Foundation
GDP, gross domestic product
HKI, Helen Keller International
ICEMR, International Center of Excellence for Malaria Research
IDRC, International Development Research Centre, Canada
IRD, Institut de Recherche pour le Développement, France
JAF, Joint Action Forum (APOC)
JICA, Japan International Cooperation Agency
KEMRI, Kenya Medical Research Institute
KFPE, Commission for Research Partnerships with Developing Countries, Switzerland
KNUST, Kwame Nkrumah University of Science and Technology, Ghana
MDG, Millennium Development Goal
M&E, monitoring and evaluation
MRC, Medical Research Council, United Kingdom
NGDO, non-governmental development organisation
NTD, neglected tropical disease
OCP, Onchocerciasis Control Programme in West Africa
PDP, product development partnership
RAPLOA, rapid assessment procedure for loiasis
R&D, research and development
REA, rapid epidemiological assessment
REMO, rapid epidemiological mapping of onchocerciasis
RNSA, Regional Network for Schistosomiasis in Africa
RNAS+, Regional Network for Asian Schistosomiasis and other Zoonotic Helminths
SCI, Schistosomiasis Control Initiative
SCORE, Schistosomiasis Consortium for Operational Research and Evaluation
SPHD, Section of Parasitology, Health and Development (of former DBL)
STH, soil-transmitted helminthiasis
Swiss TPH, Swiss Tropical and Public Health Institute
TB, tuberculosis
TDR, Special Programme for Research and Training in Tropical Diseases
TWAS, The Academy of Sciences for the Developing World
UNICEF, United Nations Children's Fund (formerly United Nations International Children's Emergency Fund)
UNDP, United Nations Development Programme
USAID, United States Agency for International Development
VBD, vector-borne disease
WHO, World Health Organization
Box 2. Summary Points for Capacity Building in Helminthiasis Research
- There is great disparity in research capacity for parasitic diseases between the developed countries of the North and the developing countries of the South as well as among, and within, the latter. Inequalities in health research§ contribute to inequalities in health and ultimately wealth. These inequalities are even more pronounced in the case of infectious diseases of poverty and helminthiases
- There have been a number of high-level meetings on research for health in disease-endemic countries (DECs)‡, with the Bamako Call to Action 2008 concluding that to remedy the above, a greater proportion of the countries' GDP should be invested in science and technology and at least 2% of the ministries of health's budgets should be invested in research and research capacity
- Those countries of the South (e.g., Brazil, People's Republic of China, Cuba, India) that have invested substantially in biomedical research and research and development (R&D) have greatly increased their scientific output, halted or reversed brain drain, and excelled at product development partnerships and innovation (e.g., diagnostics, reagents, drugs, vaccines)
- Capacity building is a long-term, systemic, and inter-sectoral process, of which training of scientists is only a component. A more comprehensive approach requires physical infrastructure, appropriate equipment, conducive research environment, regulatory frameworks including the establishment of ethical review boards, attractive pay and working conditions, and substantial government support, including a competitive national research funding agency and monetary investment
- There are a number of international initiatives aiming to strengthen capacity building and establish interdisciplinary and multinational teams addressing infectious diseases of poverty in general and neglected tropical diseases (NTDs) and helminthiases in particular. Nearly all are funded by industrialised nations, accentuating North–South alignment. Although these initiatives are very welcome, they remain somewhat unbalanced
§An umbrella term referring in this paper to research in biomedical, public health, social science, and environmental (among others) disciplines related to human health.
‡In the context of this paper, DECs are countries endemic for poverty-related infectious diseases, including HIV, tuberculosis, malaria, and emerging, zoonotic, and neglected tropical diseases.
Health Policy and Research Capacity in Disease-Endemic Countries and Calls for Action
Research must focus on national priorities and high disease burden conditions in DECs, with emphasis on evaluating interventions that aim to strengthen research capacity and health systems, and activities that translate knowledge into action and benefits to the local population [8]. In many countries of sub-Saharan Africa, Asia, Latin America, and the Caribbean, neglected tropical diseases (NTDs) in general, and helminthiasis and polyparasitism in particular, inflict a high disease burden [1]–[3], [5], [11]. Adequate research capacity for the management of helminthiases and other infectious diseases of poverty, including the NTDs, forms an essential component of the tools needed to meet the Millennium Development Goals (MDGs) [1]. Of particular importance is the demonstration of a measurable impact on health, educational success, and economic development, which are essential to convince government officials that financial investment in control programmes generates a tangible, cost-effective return [12].
To achieve the MDGs, several recent high-level meetings on research capacity and policy have called for action on health research (Mexico City in November 2004 [13], Abuja in May 2006, Accra in June 2006 [14], and Bamako in November 2008 [15]). From the statements made and undersigned in these meetings, it is clear that African governments have recognised the importance of adopting sound policies on health research and the potential positive implications such policies may have on the health and development of their nations. The policy issues on health research at both national and regional levels aimed at developing and strengthening adequate national health research policies and strategic frameworks based on national health research and knowledge systems, as well as strengthening existing, or creating novel South–South and South–North cooperation partnerships, including technology transfer and research capacity building [15]. In the Bamako Call to Action on Research for Health (2008) held by ministers and representatives of ministries of health, science and technology, education, foreign affairs, and international cooperation from 53 countries, the focus was on developing and strengthening policies on health research and innovation for health, and development of equity at national and regional levels [15]. All stakeholders were urged to "promote and share the discovery and development of, and access to, products and technologies addressing neglected and emerging diseases which disproportionately affect low- and middle-income countries". Another important theme that ran through these meetings was the need for financial investment in health research by all African governments, including a pledge for the allocation of at least 2% of national health expenditure, and at least 5% of external aid, for health projects and programmes into research and research capacity building [16]. However, a clear commitment to meet the resolutions deriving from such meetings has not yet been made by all participating nations, particularly those of sub-Saharan Africa. In addition, it was recognised that "the nature of research and innovation for health improvement, especially in the context of the United Nations Millennium Development Goals, is not sufficiently inter-disciplinary and inter-sectoral; there is a need to mobilize all relevant sectors (public, private, civil society) to work together in effective and equitable partnerships to find needed solutions".
It is, in our opinion, important that developing countries, supported by developed countries and donors, establish internally competitive national, or regional, research support and training agencies that can prioritise areas of national (regional) interest for potential support, be transparent and conduct open competitions for the best projects, scientifically and in terms of potential impact, have the possibility for a level of sustainability, integrate research and training, and help leverage external funding to support the national and regional efforts in research and training.
It is evident that more interaction among nations with similar health problems and common infectious diseases is essential to facilitate exchange of experiences as well as training of individuals to help achieve the MDGs. This requires a great deal of investment from both international and national funding bodies to develop the facilities and the capabilities of scientists who can drive research aimed at developing more effective tools and strategies to fight infectious diseases of poverty. Improving prevention and control strategies for NTDs will result in poverty alleviation and consequent achievement of the MDGs. However, this will require a sincere commitment, a governmental political resolve, and competitive and transparent mechanisms to use health research as a driver towards sustainable human resource development, economic growth, and poverty reduction. Collaborative research is surely one of the best means for strengthening such research capacity, and in general, it has been the case that scientists in DECs welcome collaboration with the more industrialised nations of the North as a vehicle for overcoming barriers to conducting research, obtaining training and funding, and promoting the exchange of ideas. Unfortunately, scientists of DECs seem less enthusiastic about collaboration between countries within their own continents and regions [8]. In part, this is because research funding opportunities for such South–South collaboration have been limited (but see below for a number of recent Brazil–Africa initiatives).
It is also true that most efforts towards health research and NTD capacity building in DECs have been made with the impulse of institutions based in industrialised countries. One of the major international organisations that has played an important role in building research capacity is the Special Programme for Research and Training in Tropical Diseases (TDR), based at the World Health Organization (WHO). The TDR has over the past 30 years sponsored the training of graduates from DECs at both master's and doctorate levels, notwithstanding specialist technological training, and further support (in the form of re-entry grants) to return to their own countries and establish productive research. The emphasis is on developing the research, management, and leadership capacities of DEC scientists and fostering research environments for long-term sustainability, quality processes, and strategic partnerships (http://apps.who.int/tdr/svc/grants/calls/grants-dec-investigators-2010). More recently, in 2010, the TDR has sponsored research and training exchanges between African scientists from Niger, Nigeria, and Uganda and the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention in Shanghai regarding schistosomiasis control. This has resulted in a fruitful South–South connection between two previously separate TDR-supported networks in schistosomiasis, namely, the Regional Network for Asian Schistosomiasis and other Zoonotic Helminths (RNAS+, http://www.rnas.org.cn) and the Regional Network for Schistosomiasis in Africa (RNSA, http://www.rnsa.org.zm). Through this newly cemented collaboration, the two networks can learn from one another to build their capacity and expertise (http://www.who.int/tdr/publications/documents/tdrnews86.pdf). Another significant step in the right direction is the proposed relocation to Africa of the TDR-supported Initiative to Strengthen Health Research Capacity in Africa (ISHReCA), at present based at TDR/WHO in Geneva, and sponsored by the Wellcome Trust, among other funders (http://ishreca.org/).
In 2009, the Wellcome Trust funded the African Institutions Initiative, aiming to develop institutional capacity to support and conduct health-related research vital to enhancing people's health, lives, and livelihoods through the formation of seven new international and pan-African consortia (Figure 1), with each partnership being led by an African institution (http://www.wellcome.ac.uk/News/Media-office/Press-releases/2009/WTX055742.htm). This is in addition to longer-established African-based programmes such as the KEMRI-Wellcome Trust Research Programme at the Centre of Geographical Medicine Research Coast (CGMRC), in Kilifi, Kenya (http://www.kemri-wellcome.org/). There are many other such programmes, and Table S1 lists some examples of current capacity building initiatives in the area of health research and NTDs, particularly in Africa, with external support. The African Capacity Building Foundation (ACBF), though not focused on health, aims at building sustainable human and institutional capacity for poverty reduction in Africa. Since its inception in 1991, the ACBF has supported a total of 246 programmes and projects in some 44 sub-Saharan African countries and committed more than US$400 million to capacity building (http://www.acbf-pact.org/).
(Redrawn from http://www.wellcome.ac.uk/news/2009/features/wtx055738.htm.)
Regarding South–South initiatives, Brazil has, since 2008, supported collaboration and training of African scientists through the Pro-Africa Program for Thematic Cooperation in Science and Technology of the National Research Council (CNPq, http://www.cnpq.br). This scheme funds meetings, research, and seed money to evaluate potential on collaborative efforts. In partnership with the Academy of Sciences for the Developing World (TWAS, http://www.twas.org/), an autonomous international organisation based in Italy that promotes scientific capacity and excellence for sustainable development in the South, CNPq also supports students from African countries to be trained in Brazil at post-graduate and post-doctoral levels. Furthermore, the Oswaldo Cruz Foundation (FIOCRUZ), with support from the Brazilian government, recently established an initiative with the Mozambican National Institute of Health to create a master's programme in health sciences, with the goal of providing qualified human resources for health research and innovation for Mozambique [17]. For a more comprehensive account of Brazil's conception of South–South cooperation in health, the reader is referred to [18].
Challenges for Research Capacity Building in Disease-Endemic Countries
As mentioned in the introductory paper of this collection [1], R&D investment in the areas of NTDs in general, and helminthiases in particular, pales into insignificance [11] in comparison to that made for HIV/AIDS, malaria, and tuberculosis (TB) according to the G-FINDER reports of 2009 and 2010 [19], [20]. It is, therefore, not surprising, given the overall shrinking levels of R&D investment made on helminthiases by industrialised nations [11], that in most DECs, research on NTDs and helminthiases is not considered a priority, receiving very little attention and being further hindered by some of the obstacles described below.
Outflow of Trained Staff
The science and health sectors in Africa, and to a lesser extent Latin America and parts of Asia, suffer from a continuous outward drain of trained staff, a problem that donors have addressed primarily by financing training. But training is only part of the solution to building human capacity, because low salaries, poor and unattractive working conditions and environments, and lack of institutional incentives to allow the development of the individuals' full scientific potential in their own countries also contribute to low morale and high outflow. Technical assistance and training have often proved ineffective in helping to build sustained capacity. What is needed is a comprehensive approach to human resource management as well as a systemic approach to capacity building [21], including recognition of the importance of developing a strong research culture in DECs.
Lack of Governmental Support
A report commissioned by the World Bank showed that with the exception of South Africa and Egypt and a few others, most DECs in Africa (and also in Latin America, with the exception of Brazil and Cuba, and Asia, excepting the People's Republic of China and India) incur very low national investments in research in general, and have a low productivity in science and technology [9]. This generalisation probably masks the fact that scientifically less advanced countries may have reasonable capacity in certain areas, but there is no doubt that the situation of health research in Africa is dire [8]. Another World Bank report [21] found that most capacity support remains fragmented, that the countries do not fully "own" the capacity building agenda, and that the challenges of capacity building vary across sectors within countries as well as across countries. Research capacity building requires the investment of meaningful amounts of funds, which many of the DEC governments are not willing to make because research is considered a long-term undertaking that only rich countries can afford, and because of other perceived pressing needs. Governments are inclined to follow agendas demanded by powerful, well-organised lobby interests more readily than those sought by seemingly weaker or more diffuse, decentralised interests, such as investment in education and health [21]. There is a lack of sufficient funds from the individual governments of DECs to support institutional infrastructure, to fund medium- and long-term research projects, and to create well-remunerated job opportunities for local scientists. Moreover, these are major factors preventing African scholars trained abroad from returning to their home countries to pursue careers in health research. Despite these small national inputs, research capacity development has been identified as an important endeavour that should be fostered in order to obtain the evidence-based knowledge that is relevant to the health concerns of local communities and that policy-makers can use for implementation of adequate practices [22].
Underdeveloped Collaborations and Networks
Establishing and nurturing collaborations in research is undoubtedly one of the best vehicles for building and strengthening research capacity in DECs, and emphasis should be placed on long-term partnerships. Efforts to incorporate as co-workers multinational members of interdisciplinary teams can be of immense value, which should be encouraged and cultivated [10]. Regrettably, the collaborative links between the North and the South are stronger than those between South and South, probably because it is perceived that countries in the North can bring resources and technologies not available in the South. Feeble South–South networking prevents exchange of expertise between countries affected by the same infections and often sharing the same transmission zones, and imperceptibly contributes to the drain of the best researchers in the South towards the North. There is a need to strengthen South–South collaborations and to fund and establish research networks that support, for example, technology transfer aimed at the development and manufacturing of new diagnostic tools and anthelmintics for the management and control of helminthiases.
Funding Issues and Ownership of Programmes
Most research capacity building efforts within and between DECs are supported entirely by external donor agencies, research funding bodies and foundations, pharmaceutical companies, and non-governmental development organisations (NGDOs) such as the World Bank (http://www.worldbank.org/); the Bill & Melinda Gates Foundation (B&MGF, http://www.gatesfoundation.org/); the Carter Center (http://www.cartercenter.org/index.html); Fogarty International Center (http://www.fic.nih.gov/); GlaxoSmithKline (http://www.gsk.com/); Helen Keller International (HKI, http://www.hki.org/); the Japan International Cooperation Agency (JICA, http://www.jica.go.jp/; see Figure S1) and others mentioned in Table S1 and below. For instance, the B&MGF, through a five-year grant to the University of Georgia Research Foundation, is funding the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE), established in December 2008 to answer strategic questions about schistosomiasis control and elimination (http://score.uga.edu/). The challenge is how to ensure that low-income countries create a stable demand for sustainable control, anthelmintic distribution, and the research that supports these activities. In responding to this demand, it is crucial that there is an appropriate supply of trained personnel at various levels, and that the countries are able to raise adequate resources to complement or eventually replace what is already received from external sources, thus sustaining the success of control and elimination efforts made once donor fatigue occurs, or donor funding is diverted somewhere else. An excellent example of such a transition from external donor funding to internal, DEC funding is the African Programme for Onchocerciasis Control (APOC). APOC is funded entirely from voluntary contributions channeled through the APOC Trust Fund, and has fostered North–South, North–South–South, and South–South partnerships (Box 3 and Figure 2).
Box 3. Research Capacity and the African Programme for Onchocerciasis Control
The World Bank is the fiscal agent of the African Programme for Onchocerciasis Control (APOC); it manages the APOC Trust Fund and reports annually to the Joint Action Forum (JAF) on the financial situation of APOC. Community-directed treatment with ivermectin (CDTI) activities are funded through three mechanisms: trust funds available through APOC, contributions from the national governments of APOC countries, and funds from non-governmental development organisations (NGDOs). To extend APOC activities until 2015, US$60 million were raised during the JAF meeting in Brussels in December 2007, when in celebration of the 20th anniversary of the donation of Mectizan (ivermectin), the manufacturer and donor of the drug, Merck & Co., Inc., also became a financial donor of APOC.
Over 80% of funds are spent on technical and operational activities in endemic countries. Figure 2 shows how spending will decrease from 2008 to 2015, when APOC's mandate was intended to end. By this time, it is planned that funding for sustained CDTI will be provided fully by the governments and NGDOs of the participating countries, completing the transition from external to internal funding (http://www.who.int/apoc/about/funding/en/index.html).
Not only are the treatment activities of CDTI financed through this mechanism, but also APOC provides funds to encourage operations research and enable evaluation of its impact by multidisciplinary and international teams with a strong cadre of African scientists. Examples are the studies for the feasibility of elimination through insecticidal larviciding of the Bioko form of Simulium yahense, which have led to the elimination of this vector species on the Bioko island of Equatorial Guinea [47], and quantification of the impact of CDTI on skin disease [48].
APOC is an example of North–South support being extended to South–South cooperation. APOC and TDR have supported relevant operations research in the areas of rapid epidemiological mapping of onchocerciasis (REMO), rapid epidemiological assessment (REA) of onchocerciasis, rapid assessment procedure for loiasis (RAPLOA), and CDTI as a community-empowering strategy. All this has contributed significantly to improved capability and increased number of researchers in onchocerciasis-endemic countries of Africa. APOC has supported research in the onchocerciasis-endemic countries either financially (Figure 2) or by making high-level research experts from DECs or from other countries available as mentors for local researchers.
Since the inception of APOC in 1995, expenditure has increased steadily until 2007, mainly with external donor support (listed in http://www.who.int/apoc/about/funding/en/index.html). The orange and dark turquoise portion of the bars represents investment in administration, and the grey and light turquoise portions indicate support for technical activities, operations research, and capacity building. External funding has decreased since 2007 and it is anticipated that from 2015 onwards the programme will be fully devolved to participating countries and their NGDOs. Recently, APOC's mandate has been extended to 2025.
Basic and Operations Research and Specialised Training
The successes achieved by control programmes, like the former Onchocerciasis Control Programme in West Africa (OCP), the current APOC, and the Schistosomiasis Control Initiative (SCI), have been partly realised because of the fundamental and operations research carried out within the umbrella of the programmes activities [1]. In most DECs, there is moderate capacity for research in the areas of epidemiology, parasitology, malacology, and entomology, but research capacity is lacking or dwindling in some other specialised areas that are essential to support successful control measures, such as transmission dynamics modelling (see DIMACS/MBI in Table S1), advanced statistical analysis of helminth and NTD epidemiological data, parasite population biology and genetics, vector ecology, and expertise for detection and monitoring of resistance to anti-parasitic drugs and anti-vectorial measures. Expertise in these areas and evidence-based research output are essential for supporting appropriate decisions by policy-makers in the context of implementation and evaluation over time of single and/or integrated helminth control programmes [6], [11]. In this context, authors of this paper (MYO-A, RKP, M-GB) recently organised and taught a course, funded by the Leverhulme–Royal Society Africa Award (Table S1), on "Epidemiology, Transmission Dynamics and Control of Vector-Borne (VBDs) and Neglected Tropical Diseases (NTDs)" at the University of Ghana, including topics on anthelmintic resistance, vector biology, infectious disease modelling, and NTD epidemiology and control.
Insufficient Mentorship
In many DECs, scientists and/or lecturers from research institutions and universities work mainly as individuals rather than as teams. This leaves the new entrant, the young scientist/lecturer, in a place where there is little or no guidance, direction, or an environment that will facilitate his/her career development and progression. Moreover, facilities and inputs for scientific research available to the young scientist are limited. To facilitate research capacity in DECs, there is a need for senior scientists/faculty staff members at higher levels to mentor junior researchers. Having a mentor with expertise, peer esteem, and networking skills provides an invaluable triad function: guidance and direction for the development of a career pathway; research facilities, laboratories, and group support for practical experience; and access to a network of contacts for projection in the national and international arenas. Mentors and role models provide not only exposure to robust and demanding academic and research environments and a vision of what is expected and possible to achieve, but also opportunities to participate and present in international conferences, and obtain feedback on research dissemination activities, manuscripts, oral presentations, and grant preparation. The introduction of the junior fellowships by the European Foundation Initiative for African Research into Neglected Tropical Diseases (EFINTDs) (Table S1) is a step in the right direction, as young scientists will receive mentorship from experienced scientists both from strong research institutions in the North and in the South. This should help raise a generation of young scientists with the required expertise to themselves serve as mentors for the next generation. Mentorship programmes are crucial in DECs, since unlike the institutions of the developed nations, most DECs do not have the period of post-doctoral internship and further training that new PhD graduates often have access to in the North. It will be very helpful to DECs if international funding agencies were able to provide more fellowships with mentorship options for promising junior scientists, just after completing their PhDs, and who are willing to remain in or return to their home countries to build their own career with the intention of focusing in their country's research needs [23].
Access to Literature and Unedited Databases
Strict open-access publication policies, subsidies by the research funders of wealthier nations, and the growth of prestigious and high impact open-access journals (for instance in the Public Library of Science and BioMed Central families) have ameliorated the access of scientists in DECs to high quality and updated peer-reviewed research. In particular, BioMed Central has recently launched "Open Access Africa", a collection of initiatives designed to increase the output and visibility of scientific research published by African learning institutes. The Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana, is the first African Foundation Member to participate in BioMed Central's free membership scheme (http://www.biomedcentral.com/developingcountries/events/openaccessafrica). However, a considerable amount of investment by higher education and research institutions is needed to maintain the necessary funding for electronic journals, digitised archives, bibliographic databases, and printed literature that are not easily available in DECs. Furthermore, fast and reliable Internet access is sometimes lacking in DECs, which in turn limits the access of researchers in those countries to open-access information via the Internet. For a compilation of web-based bibliography databases of epidemiology, parasitology, and tropical medicine resources from the Spanish-speaking Latin America and Caribbean regions, see [24]. Without affiliation to a strong library in an academic institution, individual Internet access even at broadband speed is not sufficient. This hampers research and research capacity. As a positive example, the Brazilian Federal Agency for the Support and Evaluation of Graduate Education (CAPES) subscribes to all major peer-review journals, a remarkable effort to make scientific publications available to all academic and educational institutions in Brazil. In addition, CAPES works with the Cambridge Overseas Trust to offer the CAPES Cambridge Scholarship, which welcomed its first recipients (Brazilian nationals) for PhD training in October 2011 (http://www.cambridgetrusts.org/partners/capes-brazil.html).
The issue of open access to helminth epidemiology databases for the purposes of mathematical modelling is more fully discussed in [6]. This ongoing issue has been an important hurdle in developing collaborative programmes and has been addressed in the preparatory meetings for the Bamako Call to Action [25]. While several institutions would like to have all data collected from countries where diseases of the poor are prevalent placed on open-access databases, this proposal has not had general acceptance because it appears to give countries with highly structured, efficient institutions, access to data at apparently no cost, which have been generated, at great cost, by low- and middle-income countries. The analysis of these data should be conducted and shared between the latter before it is open to the former, or password-protected access could be granted after mutually beneficial agreements or memoranda of understanding for joint analysis and publication of hard-earned data have been signed by participant institutions and researchers [25]. There are also intellectual property issues needing further discussion [26], [27]. Investment in data collection and curation can be substantial, and there has been little mutual collaboration between the developed countries of the North using data from developing countries of the South. It is clear that capacity building for data analysis and translation of findings for improving health, together with new research questions to be addressed, need further discussion. A system needs to be developed where different stakeholders will participate and share findings [25].
Lack of Advanced Enabling Technology Tools
DECs face challenges in research capacity for helminthiases and other infectious diseases, especially in areas that require the application of advanced technology for disease control such as functional genomics and bioinformatics research. This may be either due to the lack of trained personnel in such specialised areas, the lack of appropriate infrastructure and equipment, or the brain drain of the few local scientists and health professionals who may have such expertise. Research capacity building in DECs faces the greatest challenge in areas requiring the application of advanced technologies such as genetics for disease control, genomics, functional genomics (and other "omics"), bioinformatics, and computational biology that can, in the medium and long term, have a major impact on disease control or elimination [28], [29]. There is a lack of expertise in DECs for the development of new reagents, products and approaches for diagnosis, anthelmintics, vaccines, and integrated vector control, which are crucial for the sustained success of current programmes for the control and elimination of helminthiases [30]. If DECs had the adequate research capacity for the development of effective functional genomics tools and bioinformatics, areas like the study of gene function could be applied for the development of novel drugs based, for instance, on locally available natural products (see the LANBIO and ANDI initiatives described in Text S1).
The path forward is not impossible, however. Some DECs in South America, the Caribbean, and the African regions, despite similar challenges, have been able to develop adequate research capacity. For example, Brazil, Cuba, and South Africa have made major technological advancements in the field of functional genomics, bioinformatics, and vaccine development. Notably, the scientific output and impact of these countries' researchers have increased internationally, and consequently the brain drain has been reduced or halted [31]. Such progress is mostly due to the financial investments made by the governments of such countries to build and support adequate research capacity in their national institutions. This is now yielding expertise in new technologies, leading to the development of innovative interventions and effective management of various diseases, with resultant progress in infectious disease control. For instance, the first effective meningitis B vaccine was developed at the Cuban Finlay Institute (http://www.finlay.sld.cu/english/eindex.htm), and was recently licensed to GlaxoSmithKline [32]. The FIOCRUZ/Bio-Manguinhos and Butantan Institutes of Brazil and other collaborative institutions are full members in the product development partnerships (PDPs) for the Human Hookworm Vaccine Initiative [33]. The People's Republic of China is one of the world's leading producers of penicillin, and together with India and Brazil, produces praziquantel for schistosomiasis treatment. The National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention in Shanghai, following a collaborative effort between Chinese, European, and African scientists, has investigated the effects of artemether, singly or in combination with praziquentel, against the major human schistosome species [34]. The Serum Institute of India is the world's leading manufacturer of diphtheria-pertussis-tetanus vaccine. Over 60% of the United Nations Children Fund's vaccine requirements for the Expanded Programme on Immunization are met by Brazil, Cuba, India, and Indonesia [35].
Scarce Evaluation of Capacity Building and Research Partnership Coalitions
A further challenge hampering the effective development of research capacity building is the lack of application of the same rigorous monitoring and evaluation (M&E) practices to capacity building work that are implemented in other areas, with most activities lacking standard quality assurance processes at the design stage, and not being routinely tracked, monitored, and evaluated [21]. Scientific training and outputs could, for instance, be measured in terms of abundance and quality of research dissemination activities; numbers of peer-reviewed papers published by authors from DECs; number of grants in which the principal investigator and research instigator are based in DECs; number of trainees at undergraduate and post-graduate levels who receive education in DECs or return to their home countries to pursue health research careers; and number and impact of courses, workshops, internships, or academic visits hosted or organised in DECs, among others. Sustainability outputs could be assessed in terms of having created a demand for sustainable parasite control and for trained, local personnel to conduct and supervise it as well as a corresponding supply and retention of such personnel; impact of research findings on policy and practice, and in terms of the countries' capacity to assume ownership of and co-finance control programmes implementation and M&E [23], [36].
National, Regional, and Global Efforts and Strategies towards Capacity Building for Research in Infectious Diseases of Poverty
North–South Partnerships
Given the lack of political will and financial commitment by most DECs to support research capacity building, the role of global and regional efforts has become crucial in supporting and sustaining the control of helminth infections. These efforts include various established research partnerships between the developed countries and the developing nations. Establishing these North–South partnerships in the form of consortia, networks, and collaborations between research institutions has made valuable contributions to research capacity and should be encouraged, although this requires significant financial investments [31], [37], [38]. These partnerships are essential for the training of skilled personnel in research methods and dissemination, the translation of the results of research into tangible actions, products, or improved practices and policies for the benefit of communities and individuals [31], [39], [40], and the deployment of current interventions or the development of novel strategies within national, regional, and global control programmes [38]. Text S1 describes examples of such partnerships for the research and control of helminthiases, the investigation of infectious diseases of poverty, poverty elimination, and environmental sustainability (see also Figure S1). For a more comprehensive and general account of international initiatives for building research capacity in the South, the reader is referred to [41].
For such partnerships to work effectively, they should include major players such as local research institutions, universities, and researchers on infectious diseases of poverty, managers of control programmes, and policy-makers. They should also provide a forum for an active involvement of the DECs and their scientists to ensure that the priority needs of these countries, as well as the training of local human resources, are met. For a more comprehensive account of "desirables" in establishing "win-win" partnerships between the North and the South, readers are referred to the "11 Principles for Research in Partnership with Developing Countries" prepared and published by the Swiss Commission for Research Partnerships with Developing Countries (KFPE) [42], and more recently extended to 12 principles [43], [44]. Bonfoh et al. [40] discuss how the application of these principles, and the evolution of the partnerships from a very basic field station, driven by external projects, to a fully fleshed research centre, partnered with other African institutions, have ensured that research at the Swiss Centre for Scientific Research (CSRS) in Côte d'Ivoire has survived a decade of serious civil unrest.
Malaria research initiatives are good examples of such integrated successes. Although it is a large and highly competitive field, a number of networks exist to foster collaboration, communication, and interactions not only amongst international members, but also among local members. An example is the Biology and Pathology of Malaria Parasite (BioMalPar), a network of excellence funded by the European Commission, which has been successful in establishing and strengthening malaria communities and laboratories in both Europe and malaria-endemic countries [45]. A more recent example, described in Text S1, is the creation of International Centers of Excellence for Malaria Research (ICEMR), which has established a global network of independent research centres in malaria-endemic settings to provide knowledge, tools, and evidence-based strategies to support researchers working in a variety of endemic areas, especially within governments and health care institutions.
South–South Partnerships
In addition to these North–South partnerships, research capacity building can be reinforced by facilitating and providing more opportunities for South–South collaborations [17], [18]. Text S1 also describes some of these initiatives. For instance, in the Latin American and Caribbean region, Brazil and Cuba have made major research investments resulting in a calibre of research expertise and research institutions that are recognised internationally [18], [32]. These well-established institutions could play a major role as regional and inter-continental focal points for South–South collaborations and capacity strengthening for other endemic countries such as the Brazil–Africa programmes previously described [17], [18]. In Africa, only a few countries, such as South Africa, have developed sound fiscal policies supporting knowledge-based development and leading to wealth creation. This has enabled them to invest in science and technology, build substantial research capacity [9], and importantly, to provide attractive remuneration packages to keep their scientists and other expertise in the country. With such expertise and infrastructure, South Africa could also serve as a regional focal point for South–South collaborations within Africa and between other DECs.
Since such partnerships involve considerable financial commitment, extended and continued support will still be needed from global and regional donors, including the WHO, TDR, and other major agencies, schemes, research and development institutions, and funding bodies committed to capacity building such as the Health Programme of the European Commission (http://ec.europa.eu/health/programme/funding_schemes/index_en.htm); the training and capacity building programmes of the Section for Parasitology, Health and Development (SPHD, http://www.ivs.life.ku.dk/English/Sections/SPHD.aspx) of the former Danish Bilharziasis Laboratory (DBL–Centre for Health Research and Development), and of the former Swiss Tropical Institute (now Swiss Tropical and Public Health Institute [Swiss TPH)] in Basel, http://www.swisstph.ch/); the US Agency for International Development (USAID, http://www.usaid.gov/), and in particular the USAID's Neglected Tropical Disease Program (http://www.neglecteddiseases.gov/index.html); the Neglected and Other Infectious Diseases Program of the B&MGF (http://www.gatesfoundation.org/topics/Pages/neglected-diseases.aspx); the New York-based Ford Foundation International Fellowships Program (http://www.fordifp.net/); the International Development Research Centre of Canada (IDRC, http://www.idrc.ca); AusAID (http://www.ausaid.gov.au/) in Australia; the Institut de Recherche pour le Développement (IRD, http://www.ird.fr/) in France; the Department for International Development of the United Kingdom (DFID, http://www.dfid.gov.uk/); the Wellcome Trust (http://www.wellcome.ac.uk/), and the Medical Research Council (MRC, http://www.mrc.ac.uk/index.htm) also in the UK, as well as other foundations, initiatives, and programmes (such as those listed in Table S1, summarised in Text S1, and described in [41], which also provide awards to support candidates from DECs for post-graduate studies at master's and doctoral levels, post-doctoral careers, and research projects). However, these funding opportunities are highly competitive, and therefore for nationals of DECs to access such funds, local scientists should establish strong networks and collaborations and also strengthen their publication and proposal-writing skills to enable them to tap into such opportunities for research capacity building [23].
An important need to be addressed by both North–South and South–South partnerships is that of improving the graduate-level training for students in DECs. Unfortunately, the NTD knowledge base in DECs is often not extensive and the investigators who are involved in intervention programmes are usually associated with ministries of health rather than with national universities. Although this still would entail a great deal of involvement by partners from the North, if external universities could provide support for investigators to provide in-country training within DECs to build up a critical mass of able personnel, the ability to carry out and evaluate NTD control without relying on external direction will one day become a reality. Often, for good training, DEC students must travel elsewhere, which contributes to the exit of qualified scientists who stay in their country of training rather than returning to their home countries (but see Text S1 and Table S1 for examples of current initiatives aiming to remedy this very problem).
Concluding Remarks and Recommendations
Support for and from DECs for building relevant, DEC-led research capacity for the control and elimination of human helminthiases and infectious diseases of poverty is still inadequate despite the many initiatives that exist, as these initiatives mainly focus on research portfolios, researcher profiles, and administrative requirements of the developed world [23], [46]. Thus, a large proportion of the funding for building research capacity in DECs has tended to originate from donor agencies, funding bodies, and research institutions whose epicentre is not located in DECs, and whose principal investigators and research leaders represent the interests of academic centres from the North rather than those from the South. There is a vast disparity in the capacity to conduct world-class research between the nations of the North and the less developed countries of the South, partly based on a lack of understanding of the potential for scientific research in general, and health-associated research in particular to give the countries' economies and development the necessary knowledge base to break out of the poverty cycle. However, this potential will not be realised if research does not translate into policies, actions, and products destined to improve the situation of the afflicted populations and break the cycle of poverty and deprivation that the NTDs inflict on the most marginalised populations of the world. This requires a concerted effort by the DECs and the many national, regional, and global initiatives towards the development of true, win-win partnerships. This would be a welcome path towards meeting the MDGs.
In addition to the dearth of capacity in operations research and appropriate, low-cost technologies to support the implementation and, importantly, the M&E of helminthiases control programmes by DECs, these countries also face challenges in areas that require the application of advanced technology tools for disease control such as genetics methods for the control of parasites and their vectors, functional genomics, bioinformatics, computational biology, and the development of new and optimised products for diagnosis, treatment, and prophylaxis. This technological gap further accentuates the chasm between the North and the South and contributes to deepen the sense of dependency and inferiority that prevents the DECs from fully assuming the responsibility of tackling their pressing health needs and owning the intervention programmes. Other areas of importance for the confident development of research, which is appropriate and flexible in light of ongoing interventions, is the lack of training in transmission dynamics, epidemiological modelling [6], the prompt and opportune detection of resistance to anti-parasitic drugs and anti-vectorial products [3], and the economic evaluation of interventions for demonstrating their cost-effectiveness [12] to the scientific, donor, and political communities. Some policies on health research and capacity building have already been developed and implemented at both national and regional levels in the Africa, Asia, Latin America and the Caribbean, and the Pacific island regions. However, more concerted efforts are required to ensure that the gaps in research capacity, commitment, and R&D investment become narrower rather than wider in the current climate of global financial instability and constraint [20].
Policies supporting the development of effective and truly collaborative linkages and partnerships with international health research agencies are in place and are necessary to augment regional health research capability. Regional commitment and strong advocacy are required to strengthen policies on health research programmes aimed to provide evidence to justify health actions and practice. As much as these policies are required, they nonetheless have to be flexible and responsive to the short- and long-term national needs. Cooperation and active interaction among countries, not only in North–South alignments but also, and importantly, in South–South alliances and other possible configurations, will facilitate the development of clear policies in the countries and institutions that will enhance research capacity building and networking towards equitable health development. In this respect, African countries could put in place research-friendly legislative reforms that will facilitate exchange of expertise and the sharing of valuable epidemiological databases whilst ensuring intellectual property rights protection [6], [25]–[27]. Finally, strong and long-standing advocacy is needed to encourage governments and policy makers to extend more financial and political will towards the more diffuse and longer-term activities of scientific and health research, instead of the agendas of powerful lobbies and short-term economic targets. This would eventually lead to DECs building their own capacity to develop their appropriate enabling technologies and innovative products. Box 4 lists five recommendations for improving capacity in health research in general and helminth research in particular stemming from this report.
Box 4. Five Recommendations for Improving Capacity in Helminthiasis Research in Disease-Endemic Countries (DECs)
- In addition to North–South collaborations, capacity building initiatives should also encourage South–South networking and fund schemes centred in DECs. Groups of research excellence in the South may then act as national and regional poles of reference and training
- The initiatives above should have a formal mentorship component, with appointment of senior tutors from both within and outside DECs and the accompanying funding to facilitate mentoring meetings and exchanges with junior researchers
- DECs may have reasonable capacity in some niche research areas, and in the case of helminthiases there is local strength in parasitology and entomology. Areas identified that require further capacity building to strengthen helminthiasis control are:
- Parasite and vector population biology and ecology
- Parasite and vector population genetics
- Mathematical and statistical analysis of transmission dynamics
- Epidemiological modelling of helminth infections
- Parasite and vector genomics, functional genomics and others (transcriptomics, proteomics), bioinformatics, and computational biology
- Detection and monitoring of resistance to anti-parasitic and anti-vectorial measures
- Optimisation of existing, and development of novel diagnostics, drugs, and vaccines
- Economic evaluation of the health impact of helminthiases and of deployed interventions for cost-effectiveness analysis of control programmes
- In order to increase DEC research output, gain external visibility, and improve success rates in obtaining studentships, fellowships, and research awards in an increasingly competitive environment, capacity building strategies should include formal training in paper-writing, oral presentation skills, and grantsmanship
- Monitoring and evaluation (M&E) instruments should be devised and deployed to assess the effectiveness of research capacity building strategies in the same rigorous way they are applied to quantify the impact of control interventions. This would provide evidence-based arguments for the continuation and improvement of capacity building
Supporting Information
Figure S1.
Concept and Strategy of the Hashimoto Initiative for Global Parasite Control. WB: World Bank; WHO: World Health Organization; MFA: Japan Ministry of Foreign Affairs; MHW: Japan Ministry of Health and Welfare; JICA: Japan International Cooperation Agency; G8: The Group of Eight (Canada, France, Germany, Italy, Japan, Russia, UK, USA); NMIMR: Noguchi Memorial Institute for Medical Research; WACIPAC: West Africa Centre for International Parasite Control; KEMRI: Kenya Medical Research Institute; ESACIPAC: Eastern and Southern Africa Centre of International Parasite Control; ACIPAC: Asian Centre of International Parasite Control (adapted from reference [1] of Text S1).
Table S1.
Examples of Current Research Capacity Building Initiatives in the Area of Health Research, Helminthiases, and other Infectious Diseases of Poverty with Particular Reference to Africa.
Text S1.
Examples of North–South and South–South Research and Capacity Building Initiatives in Helminthiases and other Infectious Diseases of Poverty.
This review was written following the preparation, for the Special Programme for Research and Training in Tropical Diseases (TDR), of a Technical Report Series manuscript by members of the Disease Reference Group on Helminth Infections (DRG4). We thank Andrea Gazzinelli, Héctor Hugo García, Guo-Jing Yang, and Poppy Lamberton for valuable comments on an earlier draft. Jürg Utzinger and Jeffrey Bethony (deputy editors), and three anonymous referees made very helpful suggestions. Simon O'Hanlon redrew Figure 1 from its original version on the Wellcome Trust website. The DRG4 forms part of an independent "think tank" of international experts, established and funded by TDR to identify key research priorities for poverty-related infectious diseases through the review of research evidence and input from stakeholder consultations. The DRG4 thanks Ayoade Oduola, Michael Wilson, Arve Lee Willingham, Deborah W. Kioy, and other TDR staff for facilitation. TDR is a programme executed by the World Health Organization (WHO) and co-sponsored by UNICEF, UNDP, the World Bank, and the WHO. Further information on all the Disease and Thematic Reference Groups, as well as on the related Global Report on Research for Infectious Diseases of Poverty, can be found on the TDR website at http://www.who.int/tdr/stewardship/research-think-tank/en/.
- 1. Boatin BA, Basáñez MG, Prichard RK, Awadzi K, Barakat RM, et al. (2012) A research agenda for helminth diseases of humans: towards control and elimination. PLoS Negl Trop Dis 6: e1547.
- 2. Lustigman S, Prichard RK, Gazzinelli A, Grant WN, Boatin BA, et al. (2012) A research agenda for helminth diseases of humans: the problem of helminthiases. PLoS Negl Trop Dis 6: e1582.
- 3. Prichard RK, Basáñez MG, Boatin BA, McCarthy JS, García HH, et al. (2012) A research agenda for helminth diseases of humans: intervention for control and elimination. PLoS Negl Trop Dis 6: e 1549.
- 4. McCarthy JS, Lustigman S, Yang GJ, Barakat RM, García HH, et al. (2012) A research agenda for helminth diseases of humans: diagnostics for control and elimination programmes. PLoS Negl Trop Dis 6: e1601.
- 5. Gazzinelli A, Correa-Oliveira R, Yang GJ, Boatin BA, Kloos H (2012) A research agenda for helminth diseases of humans: social ecology, environmental determinants, and health systems. PLoS Negl Trop Dis 6: e1603.
- 6. Basáñez MG, McCarthy JS, French MD, Yang GJ, Walker M, et al. (2012) A research agenda for helminth diseases of humans: modelling for control and elimination. PLoS Negl Trop Dis 6: e1548.
- 7. Lustigman S, Geldhof P, Grant WN, Osei-Atweneboana MY, Sripa B, et al. (2012) A research agenda for helminth diseases of humans: basic research and enabling technologies to support control and elimination of helminthiases. PLoS Negl Trop Dis 6: e1445.
- 8. Volmink J, Dare L (2005) Addressing inequalities in research capacity in Africa. BMJ 331: 705–706.
- 9.
Wagner CS, Brahmakulam I, Jackson B, Wong A, Yoda T (2001) Science and technology collaboration: building capacity in developing countries? Available: http://www.rand.org/content/dam/rand/pubs/monograph_reports/2005/MR1357.0.pdf. Accessed 10 April 2012.
- 10.
Chauhan R (2005) Lack of research impetus in Africa: a way forward. Reply to reference [8]. Rapid responses. BMJ. 331. : 705–706.
- 11. Colley DG, LoVerde PT, Savioli L (2001) Medical helminthology in the 21st century. Science 293: 1437–1438.
- 12. Conteh L, Engels T, Molyneux DH (2010) Socioeconomic aspects of neglected tropical diseases. Lancet 375: 239–247.
- 13.
[No authors listed] (2004) The Mexico statement on health research. Knowledge for better health: strengthening health systems. From the Ministerial Summit on Health Research. Mexico City, November 16–20, 2004. Available: http://www.who.int/rpc/summit/agenda/en/mexico_statement_on_health_research.pdf. Accessed 10 April 2012.
- 14.
[No authors listed] (2006) Health research for disease control and development. High-level ministerial meeting convened by the Ministry of Health, Ghana and the Federal Ministry of Health, Nigeria, with technical and financial assistance from the World Health Organization (WHO) through the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). Accra, Ghana, June 15–17, 2006. Available: http://www.who.int/tdr/stewardship/Accra_Communique_Signed.pdf. Accessed 10 April 2012.
- 15.
Global Ministerial Forum on Research for Health (2008) The Bamako call to action on research for health. Strengthening research for health, development, and equity. Bamako, Mali, November 17–19, 2008. Available: http://www.who.int/rpc/news/BAMAKOCALLTOACTIONFinalNov24.pdf. Accessed 10 April 2012.
- 16.
Third High Level Forum on Aid Effectiveness (2008) Accra agenda for action. Accra, Ghana, September 2–4, 2008. Available: http://siteresources.worldbank.org/ACCRAEXT/Resources/4700790-1217425866038/AAA-4-SEPTEMBER-FINAL-16h00.pdf. Accessed 10 April 2012.
- 17. Savino W, Jani IV, Fumane J, Buss PM, Leal M do C (2008) Local generation of high-quality human resources for health research. Bull World Health Organ 86: 910, A.
- 18. Almeida C, de Campos RP, Buss P, Ferreira JR, Fonseca LE (2010) Brazil's conception of South-South "structural cooperation" in health. R Eletr Com Inf Inov Saúde, Rio de Janeiro 4: 23–32. Available: http://www.reciis.cict.fiocruz.br/index.php/reciis/article/download/343/528. Accessed 10 April 2012.
- 19.
Moran M, Guzman J, Henderson K, Ropars A-L, McDonald A, et al. (2009) Neglected disease research and development: new times, new trends. G-FINDER 2009. Sydney: Health Policy Division, The George Institute for International Health. Available: http://www.policycures.org/downloads/G-FINDER_survey_of_global_R&D_funding_for_Neglected_diseases_2009.pdf. Accessed 10 April 2012.
- 20.
Moran M, Guzman J, Henderson K, Abela-Oversteegen L, Wu L, et al. (2011) Neglected disease research and development: is the global financial crisis changing R&D? G-FINDER 2010. Health Policy Division, The George Institute for International Health. Available: http://www.policycures.org/downloads/g-finder_2010.pdf. Accessed 10 April 2012.
- 21.
The World Bank (2005) Capacity building in Africa. An OED evaluation of World Bank support. Operations Evaluation Department. Washington (D.C.): The World Bank. Available: http://www.worldbank.org/oed/africa_capacity_building/. Accessed 10 April 2012.
- 22.
Healthlink (2006) Exchange Findings 5: Communicating health research: how should evidence affect policy and practice? Available: http://www.healthlink.org.uk/PDFs/findings_research.pdf. Accessed 10 April 2012.
- 23. Kariuki T, Phillips R, Njenga S, Olesen OF, Klatser PR, et al. (2011) Research and capacity building for control of neglected tropical diseases: the need for a different approach. PLoS Negl Trop Dis 5: e1020.
- 24. Williams JR, Bórquez A, Basáñez MG (2008) Hispanic Latin America, Spain and the Spanish-speaking Caribbean: a rich source of reference material for public health, epidemiology and tropical medicine. Emerg Themes Epidemiol 5: 17.
- 25.
Global Ministerial Forum on Research for Health (2008) Overview and report from the Algiers preparatory meeting, and report from other preparatory meetings related to the Bamako Call for Action. Available: http://www.tropika.net/svc/specials/bamako2008/session-reports/ministerial-discussions-day-1. Accessed 10 April 2012.
- 26.
Wilder R, Solovy EM (2005) The development of medicines for developing country diseases: the role of intellectual property. Available: http://www.wipo.int/edocs/mdocs/mdocs/en/isipd_05/isipd_05_www_103972.pdf. Accessed 10 April 2012.
- 27.
Civil Society Report on Intellectual Property, Innovation and Health (2006) Civil society report on intellectual property, innovation and health. Available: http://www.policynetwork.net/sites/default/files/Civil_Society_text_web.pdf. Accessed 10 April 2012.
- 28.
Degrave W, Huynh C, Roos D, Oduola A, Morel CM (2002) Bioinformatics for disease endemic countries: opportunities and challenges in science and technology development for health. IUPAC Journal. Available: http://www.ibioseminars.org/roos/TDRbioinformatics.pdf. Accessed 10 April 2012.
- 29. Nashiru O, Huynh C, Doumbia S, Kissinger JC, Isokpehi RD, et al. (2007) Building bioinformatics capacity in West Africa. Afr J Med Med Sci 36: Suppl15–18.
- 30.
World Health Organization (2007) Global plan to combat neglected tropical diseases 2008–2015. Available: http://whqlibdoc.who.int/hq/2007/who_cds_ntd_2007.3_eng.pdf. Accessed 10 April 2012.
- 31. Dujardin JC, Herrera S, do Rosario V, Arevalo J, Boelaert M, et al. (2010) Research priorities for neglected infectious diseases in Latin America and the Caribbean region. PLoS Negl Trop Dis 4: e780.
- 32. Morel CM, Acharya T, Broun D, Dangi A, Elias C, et al. (2005) Health innovation networks to help developing countries address neglected diseases. Science 309: 401–404.
- 33. Hotez PJ, Bethony J, Bottazzi ME, Brooker S, Buss P (2005) Hookworm: "the great infection of mankind". PLoS Med 2: e67.
- 34. Xiao S, Tanner M, N'Goran EK, Utzinger J, Chollet J, et al. (2002) Recent investigations of artemether, a novel agent for the prevention of schistosomiasis japonica, mansoni and haematobia. Acta Trop 82: 175–181.
- 35.
Grace C (2004) The effect of changing intellectual property on pharmaceutical industry prospects in India and China: considerations for access to medicine. Issues Paper, Health Systems Resource Centre. United Kingdom: Department for International Development (DfID). Available: http://www.who.int/hiv/amds/Grace2China.pdf. Accessed 10 April 2012.
- 36.
Neufeld V, Gyapong J, Tan-Torres Edejer T (2003) Coalition for Global Health Research - Canada (CGHRC). South–Canada research partnerships for health and development. Working paper. Cited in: Building respectful and collaborative partnerships for global health research. Canadian Coalition for Global Health Research (CCGHR), Ottawa. Available: http://www.ccghr.ca/Resources/Documents/Resources/LearningResource_BuildingPartnerships.pdf. Accessed 12 April 2012.
- 37. Colley DG, Secor WE (2007) A schistosomiasis research agenda. PLoS Negl Trop Dis 1: e32.
- 38. Tanner M, Kitua A, Degrémont AA (1994) Developing health research capability in Tanzania: from a Swiss Tropical Institute Field Laboratory to the Ifakara Centre of the Tanzanian National Institute of Medical Research. Acta Trop 57: 153–173.
- 39. Ofori-Adjei D (2008) Investing in health research for endemic diseases. Ghana Med J 42: 95.
- 40. Bonfoh B, Raso G, Koné I, Dao D, Girardin O, et al. (2011) Research in a war zone. Nature 474: 569–571.
- 41.
Young J, Kannemeyer N (2001) Building capacity in Southern research: a study to map existing initiatives. Main report. Overseas Development Institute. London: Department for International Development (DfID). Available: http://www.odi.org.uk/resources/download/2845.pdf. Accessed 10 April 2012.
- 42.
Swiss Commission for Research Partnerships with Developing Countries (1998) Guidelines for research in partnership with developing countries. 11 principles. KFPE. Berne: Swiss Academy of Sciences. [Translated from German original by JM Jenkins, Swiss Tropical Institute, Basel.] Available: http://www.kfpe.ch/download/Guidelines_e.pdf. Accessed 10 April 2012.
- 43.
Swiss Commission for Research Partnerships with Developing Countries (2000) Guidelines for research in partnership with developing countries: 12 principles. KFPE. Bern: Swiss Academy of Sciences. Cited in [8].
- 44.
Ofori-Adjei D, Gyapong J (2008) A developing country perspective on international research partnerships on health. Available: http://www.nuffic.nl/home/news-events/docs/events/kotm/abstracts-and-papers/International%20Research%20Partnerships%20on%20Health%20Final.pdf. Accessed 10 April 2012.
- 45. Bethony JM, Loukas A (2008) The schistosomiasis research agenda–what now? PLoS Negl Trop Dis 2: e207.
- 46. Binka F (2005) Editorial: North–South research collaborations: a move towards a true partnership? Trop Med Int Health 10: 207–209.
- 47. Traoré S, Wilson MD, Sima A, Barro T, Diallo A, et al. (2009) The elimination of the onchocerciasis vector from the island of Bioko as a result of larviciding by the WHO African Programme for Onchocerciasis Control. Acta Trop 111: 211–218.
- 48. Ozoh GA, Murdoch ME, Bissek AC, Hagan M, Ogbuagu K, et al. (2011) The African Programme for Onchocerciasis Control: impact on onchocercal skin disease. Trop Med Int Health 16: 875–883.


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Did Nostradamus Predict the Sept 11th Tragedy?...
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Did Nostradamus Predict the Sept 11th Tragedy?By Richard Lowe, Jr.
Nostradamus was a French astrologer born in 1503. He published a collection of prophecies in 1555. Each of the four-line verses (called quatrains) is said to foretell a world event at some time in the future.
Of course, ever since that time, the works of this man have been claimed to have foretold just about everything, including wars, the rise and fall of empires, assassinations and disasters, as well as just about anything else.
Anyone who has ever really read these prophecies will immediately realize that they are written in such a vague way that they could mean almost anything. Nostradamus was purposely vague in his writings, as he was constantly being harassed and watched by the church.
Naturally, there are many people who claim right away that Nostradamus predicted the September 11th disasters. In fact, the following "prophecy" circulated within hours of the attack.
Two brothers torn apart by Chaos,
while the fortress endures,
the great leader will succumb,
The third big war will begin when the big city is burning
- Nostradamus 1654
Someone obviously mistook this for a real prophecy and added a few lines of his own.
Two brothers torn apart by Chaos,
while the fortress endures,
the great leader will succumb,
The third big war will begin when the big city is burning
On the 11th day of the 9 month,
From the sky will come a great King of Terror.
The sky will burn at forty-five degrees.
Fire approaches the great new city
In the city of york there will be a great collapse,
Two tall brothers torn apart by chaos,
while the fortress endures, the great leader will succumb,
The third big war will swiftly begin from the city of
burning (Nostradamus 1654)
Will cause the towers around the New City to shake,
Two great rocks for a long time will make war,
And then Arethusa will color a new river red.
will cause trembling around the new city:
Two great rocks will make war for a long time.
Then Arethusa will redden a new river.
Some hoaxer played the numbers game (another favorite pastime of the followers of Nostradamus). The attack is no exception.
The flights that were hijacked were from United and American Airlines, they were numbered as follows: 11, 93, 175, and 77
So what's the bottom line? The prophecies of Nostradamus may or may not be valid. But they have nothing to do with the terrorist attack on September 11th. Nothing at all.
Additional InformationNostradamus FAQ
Good information about Nostradamus. Excellent resource.
About Urban Legends
Nostradamus Homepage
Article by Richard Lowe Jr. Richard is the webmaster of Internet Tips And Secrets. This web-site includes over 1,000 free articles to improve your internet profits, enjoyment and knowledge. Subscribe to his Daily Tips Newsletter by sending a blank email to email@example.com or by going to Internet-tips.net
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#Netflix The Christmas Chronicles: Movie Review
All in all, I love how Christmas-y the entire movie was. It manages to embody everything that people love about the holidays and it even got me tearing up through the corniest and cheesiest of dialogues simply because it taps into audiences' soft spot for family and love. The elves are super cute, especially Lars and Bjorn who can't get enough of candy canes. I loved Santa's Fast and the Furious moment, his hatred for his commercial depictions, his brutal frankness and his musical number and the reveal on who Mrs. Claus was. It was fun and entertaining yet it was funny and dramatic at the same time and that's a plus and a plus on my book. Personally, I think this could work perfectly as a standalone but I wouldn't mind sitting through a sequel if Netflix decides to greenlight a follow up movie for next year. Thumbs up to the entire team behind this movie!
PS. By the way, my nephew sat through the entire movie and this is the first time he has completed watching an entire full feature film and remained interested throughout. If that isn't a shining endorsement, I don't know what is. Thank you or this gem, Netflix!


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At The Drisco, intimate meetings and events can be held in a variety of historic spaces that have undergone a very authentic respectful restoration for more than a decade. We offer a selection of charming unique spaces and venues carefully designed to secure successful and exciting events.
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- The private beer room suitable for up to 10 people.
- Our stunning garden suite can be converted into a spacious meeting room, offering 2 outdoors spaces, accommodating 18 guests.
- The roof terrace overlooking the views of the Mediterranean and Tel Aviv is ideal for cocktail parties for 25-50 guests.
- Product launches, fashion shows, company parties, private brunch, cocktails, press conferences, lectures, music recitals, photoshoots, and family events can be held in the historic Drisco Bar, built in 1866 and flaunting early 20th century sophistication.
The Drisco hotel offers the ease of hosting 2 to 80 participants in conference rooms equipped with auxiliary supporting services such as: coffee corner, free high-speed wireless internet, valet parking, epicurean food and beverage, proposing a unique luxury service culture of the highest standards distinctive and exclusive to the Leading Hotels of the World properties.
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please call us at 03-7410000 or email email@example.com


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Pinar Tarhan has some quality insights into writing:
How to Handle Rejection (and When It Might Be A Good Thing) – by Pinar Tarhan
Writers are constantly exposed to a form of rejection. Well, no one likes to be rejected in any area, but we writers need to face the music more often than others. We apply to a lot of writing gigs both online and offline, try to get our stories/novels published, and/ or get our scripts read by producers/agents. And it doesn't always matter whether we targeted the right market or abided by the guidelines. It doesn't always make a difference that our writing is good, or the query letters rocked. John Grisham got rejected. J.K. Rowling got rejected. Do I really need to give more examples?
And having been writing full time since late 2009, I can say that I am pretty much at the start of the rejection cycle. Because although I have been writing since I was basically a preteen, I had never sent my writing to anyone besides my friends. I loved being read and I enjoyed a loyal following that loved what story I would come up with next.
But we all grew up and our lives became much more hectic than just going to school, socializing or dating. We were distracted by our career and family plans. That's when I finally decided that I was not satisfied with writing just for me and my friends. I also wasn't going to settle for some job I didn't want because the economy sucked. It was time to follow my. So I dove straight into heavy research. I studied how magazine queries were made, how articles were formatted. I read about how you could sell your screenplays even if you lived a world away from Hollywood.
I read about blogging and writing, and applied what I learned. In addition to running several blogs, I got some decent gigs and continue to have them. I also keep getting rejected. Here is what I've learned so far:
Yes, we understand that anyone who uses the phrase "quality insights into writing" probably should hang up his keyboard. That's us, not Tarhan, but we're going to keep at this writing thing till we get it – at least – almost right.


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At the foot of Buachaille Etive Mòr, this lass was kind enough to pose for a portrait. Much to my embarrassment I admit to shooting this from the passenger seat of my Sisters car, despite chastising her up about the same thing earlier on our journey. At least I was professional enough to wind the window down.
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The Thunder King
DescriptionAre you aware of recent events in Kun-Lai Summit? The Zandalari have landed on the northern shores in great numbers and have set about renewing old alliances. To that end, they have resurrected The Thunder King.
Even among the mogu, the name of the first emperor commands awe and fear. The Thunder King founded a vast empire of slavery and suffering... but also of power, riches, and splendor.
We will take the fight to him soon. Find me when your faction makes its move.
The Sunreavers and the Kirin-Tor are mounting an assault on the Thunder King's base of operations! My new friend here and I were just discussing the ramifications of their attack.
You and I can stand to benefit from the situation, <name>. I have a few ideas...
You and I can stand to benefit from the situation, <name>. I have a few ideas...
RewardsYou will receive:
GainsUpon completion of this quest you will gain:
- 10 reputation with The Black Prince
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The Wowhead Client is a little application we use to keep our database up to date, and to provide you with some nifty extra functionality on the website!
It serves 2 main purposes:
- It maintains a WoW addon called the Wowhead Looter, which collects data as you play the game!
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You can also use it to keep track of your completed quests, recipes, mounts, companion pets, and titles!
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Originally, I wasn't going to write a review on this book because dun dun dun I couldn't actually finish it. Then I realised that it could be more important to write about the books we don't finish than the ones we can't get enough of. What stopped me? At what point did I realise my time was too precious to waste on this book? This morning I read an article written by Kenny Pieper on a taboo subject for any avid reader: On Not Finishing Books. It is a brilliant read for any book lover with a case of unfinished-book-guilt and it inspired me to write a review on this novel despite only making it halfway through.
First of all, I was so excited to read this. I've read all of Harris' Sookie Stackhouse series and I loved it. Everything about the Stackhouse world drew me in and kept me going for half a dozen books. My expectations for Harris were high. I even included Midnight Crossroad in my Five Books I'm Reading This Summer blog in May. Now I wish I'd reserved that place for something else.
With Charlaine Harris, I expected darkness, mystery and, most of all, I expected sexiness. The Sookie Stackhouse novels are packed with sex appeal. She created one of the sexiest literary characters of all time: Eric Northman. Coming from an ex-vampire fanatic, it does not get any better than Eric Northman. So when I tucked into Midnight Crossroad I was eagerly anticipating another one of Harris' beautiful badass male characters and instead I got Manfred Bernardo (yes, that has to be the unsexiest name of all time) He's a slightly creepy twenty-two year psychic with silver hair and multiple eyebrow piercings. Straight away, I was disappointed. Where was the famous True Blood sex appeal?
So, with a sigh, I told myself it could still be a great murder mystery, just without the seductiveness. 150 pages later: there had been a murder but it was meh and I had not been excited by a single one of Midnight's multiple residents. Even the town vampire, Lemuel, (yet another incredibly unsexy name) was dull. For some reason, Harris wastes page upon page on monotonous detail. In a town with snake-shifters, vampires, witches and psychics, nothing happens. Even the murder is a non-event. It is discovered at a bloomin' community picnic. Ultimately, after reading 150 pages, I knew more about what Fiji and her cat had for lunch every day than anything else.
It is rare that I strongly dislike a book. Studying English & Comparative Literature for four years has given me a profound appreciation of the most mundane books and short stories but this takes banality to a new level. If you haven't already, I strongly recommend you read the Sookie Stackhouse series if you're looking for a meaty mystery novel with all things dark fantasy thrown in but do yourself a favour and give the Midnight Texas series a complete miss.
If you finished this book, what did you think? Did it get any better past the halfway point?


text: Situated in the heart of central Reno this hotel features a full on-site casino spacious accommodations friendly service and all the amenities needed for a relaxing and enjoyable stay.There is also something to do when at the Sands Regency Casino Hotel Reno. With slot machines card games and keno as well as live entertainment and a state-of-the-art fitness centre there is something for everyone.Sands Regency Casino Hotel Reno also provides guests with a variety of modern facilities. The hotel offers an on-site wedding chapel complete with flower arrangements spacious convention and banquet facilities as well as a variety of gourmet restaurants.Reno-Tahoe International Airport is 15 minutes' drive away from Sands Regency Casino Hotel Reno. A free airport transfer service to is available to guests.


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Best of
the Twin Cities
Walk right in and get in line, because this corner coffee shop has climbed from relative obscurity to rampant popularity in practically no time. That's in part due to its Instagram, which provides those scrolling with a feast for the eyes before they ever set foot through the door. Rainbow peppermint lattes—no two alike—are a glowing, candy-colored dream. The oversized marshmallow roasting like a sugary pig on a spit above a swirling s'mores latte is a winking promise that playing with your food is acceptable. But it's not all edible gold and candied violets. One sip of each signature drink—wonderful lavender-matcha-pistachio concoctions and spicy honey-and-cayenne Bee Stings—proves there's more to Astoria than what meets the eye.


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Business Communication Today 14th edition: Guide to Better Business Writing
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We understand that bullying or harassment in the workplace can be very distressing for those at the receiving end of it. We're very experienced at advising people who have this type of grievance against their employer or another employee.
Bullying and harassment is basically any unwanted behaviour that makes you feel intimidated, degraded, humiliated or offended. It can happen between two people or it may involve groups of people. It might be an on-going situation, or a one-off incident. It's not just a face-to-face thing either – it can occur in written communications, email and text or over the phone.
If you feel you've been bullied or harassed at work in any way, our Employment Team are available to help. We'll give you clear, straightforward advice on whether the bullying amounts to discrimination and what options are available to you.
We'll then help you raise and resolve your concerns with your employer. In short, we'll go the extra mile to fight your corner, ensuring the best possible outcome, making sure the whole process is as easy and stress-free as possible for you.


text: Following a brain injury, many of the worries usually include what will happen tomorrow. Going into my sixth year after the TBI, more long term worries have begun to arise, such as driving, which I have written many posts about (today I drove home from the mall), jobs, living alone, etc. Most of these worries … Continue reading TBI Dementia Risk


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I've done a bit of searching and found a fairly well written explanation, but at the end, the author noted that this explanation seems to work fine for a physicist's purposes - but a mathematician would groan at it due to oversimplifications or inaccuracies.
Since I first posted this paper, two different people have emailed me to tell me that Real Mathematicians don't do this. Playing with dx in the ways described in this paper is apparently one of those smarmy tricks that physicists use to give headaches to mathematicians.
I was also confused when reading it because my Calculus prof last semester said that the chain rule
$$\frac{dy}{dz}=\frac{dy}{dx}\cdot \frac{dx}{dz}$$
cannot be treated as fractions, despite the fact that they look like it, and the $dx$ would not cancel out between the two since you can't do that with differentials. But this article said just the opposite.


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Gamelife Sweepstakes!
We want to send you a copy of Gamelife, Michael Clune's memoir, out now from Farrar, Straus and Giroux! Suspended is the first computer game to obsess seven-year-old Michael, to worm into his head and change his sense of reality. Thirty years later he will write: "Computer games have taught me the things you can't learn from people." Gamelife is the memoir of a childhood transformed by technology.


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GOLD Coast's hopes of securing a shock finals berth remain very much alive, with the third-year club facing the easiest run home of any team in the competition.
While fellow top eight contenders West Coast, Port Adelaide and Carlton all have difficult fixtures over the final 10 rounds of the season, the Suns play four of the bottom six teams.
Further, their only clash with a top six team is against Richmond in Cairns, a game they are yet to lose.
Using a formula designating 18 points for a game against the top team, Hawthorn, down to one point for a game against the bottom team, Greater Westerm Sydney, the Suns' total of 75 points ranks 18th in difficulty.
St Kilda faces the toughest fixture, playing all of the top six teams for a total of 127 points over its final 10 matches.
The Eagles, Power and Blues rank second, third and fourth, with 115, 112 and 101 points respectively.
With 11 wins likely to be enough to clinch eighth place, Gold Coast would need to win six matches to put itself in the finals frame.
The Suns' poor percentage, however, may see them needing a seventh win.
Third-placed Fremantle is set to be the other major beneficiary of the fixture over the final 10 rounds.
Ross Lyon's men appear certain to finish in the top four, with only two matches to come against top six opponents, and four against bottom six teams.
Fremantle is also set to welcome back stars Matthew Pavlich and Aaron Sandilands from injury as September draws near.