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Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear.
To describe the emergency department presentation patterns of a help-seeking youth mental health cohort.
Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12–30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other).
During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86–0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086–1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation.
Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.
The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients.
FAST includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST).
A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted
The internal consistency (Cronbach’s alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p < 0.001). The K-FAST exhibited significant correlations with GAF (r=-0.771), WHOQOL-BREF (r=-0.326), YMRS (r=0.509) and BDRS (r=0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed 4 factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI=0.925; TLI=0.912; RMSEA=0.078).Table.
Model fit index of confirmatory factor analysis (n=209)
Measure of fit
RMSEA (90% CI)
χ2, chi-square; df, degrees of freedom; RMSEA, root mean square error of approximation; CFI, comparative fit index; TLI, Tucker-Lewis index.
The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.
Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies.
To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality.
State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident.
There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6–2.6) but higher for males (5.3, 95% CI 3.8–7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13–9.09) and psychiatric admission (HR 4.01, 95% CI 1.81–8.88) were the strongest predictors of mortality.
Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.
Three-dimensional elastic turbulence in Taylor–Couette flows of dilute polymer solutions has been realized and thoroughly investigated via direct numerical simulations. A novel flow transition pathway from elastically dominated turbulence to solitary vortex pairs (or diwhirls) and eventually to elastic turbulence is observed by decreasing the fluid inertia ($Re$) over seven orders of magnitude, i.e. from $Re=1000$ to $0.0001$. The dominant spatio-temporal flow features in the elastic turbulence regime are those of large-scale unsteady diwhirls and small-scale axial and azimuthal travelling waves in the outer and inner halves of the gap, respectively. Moreover, it is conclusively shown that production of turbulent kinetic energy in purely elastic turbulence solely arises due to the stochastic nature of polymer stretch/relaxation. Overall, based on this comprehensive numerical investigation, the differences in the underlying fluid physics that give rise to turbulent fluctuations in elastically dominated and purely elastic turbulence have been delineated.
Jeju Island, designated by UNESCO as a world heritage site, continues to face the anthropogenic pressures of reckless development for regional tourism and economic revitalization purposes. Because land use/land cover (LULC) affects ecosystem services and human well-being, it is crucial to comprehensively identify the causes of changes in LULC based on long-term analyses. This study examined LULC changes on Jeju Island over 47 years from 1973 to 2019 and quantified changes in four ecosystem services: habitat quality, carbon stock, water yield and cumulative viewshed. From 1973 to 1998, forest land increased from 22% to 56%, but these restoration efforts were conducted in grassland, reducing that land type from 42% to 17%. This process increased the areas of highest habitat quality from 68% to 73%, and carbon stock increased from 20 to 30 million tonnes. Between 1998 and 2009, the area of cropland more than doubled from 21% to 44%. As a result, the areas of highest habitat quality decreased from 73% to 49%, and carbon stock decreased from 3.0 million tonnes to 2.3 million tonnes. Our analysis could help stakeholders and policymakers to develop their management planning and improve ecosystem services through restoration and conservation policies on Jeju Island.
Many waterflooding oil fields, injecting water into an oil-bearing reservoir for pressure maintenance, are in their middle to late stages of development. To explore the geological conditions and improve oilfield recovery of the most important well group of the Hu 136 block, located on the border areas of three provinces (Henan, Shandong, and Hebei), Zhongyuan Oilfield, Sinopec, central China, a 14C cross-well tracer monitoring technology was developed and applied in monitoring the development status and recognize the heterogeneity of oil reservoirs. The tracer response in the production well was tracked, and the water drive speed, swept volume of the injection fluid were obtained. Finally, the reservoir heterogeneity characteristics, such as the dilution coefficient, porosity, permeability, and average pore-throat radius, were fitted according to the mathematical model of the heterogeneous multi-layer inter-well theory. The 14C-AMS technique developed in this work is expected to be a potential analytical method for evaluating underground reservoir characteristics and providing crucial scientific guidance for the mid to late oil field recovery process.
Nosocomial transmission of COVID-19 among immunocompromised hosts can have a serious impact on COVID-19 severity, underlying disease progression and SARS-CoV-2 transmission to other patients and healthcare workers within hospitals. We experienced a nosocomial outbreak of COVID-19 in the setting of a daycare unit for paediatric and young adult cancer patients. Between 9 and 18 November 2020, 473 individuals (181 patients, 247 caregivers/siblings and 45 staff members) were exposed to the index case, who was a nursing staff. Among them, three patients and four caregivers were infected. Two 5-year-old cancer patients with COVID-19 were not severely ill, but a 25-year-old cancer patient showed prolonged shedding of SARS-CoV-2 RNA for at least 12 weeks, which probably infected his mother at home approximately 7–8 weeks after the initial diagnosis. Except for this case, no secondary transmission was observed from the confirmed cases in either the hospital or the community. To conclude, in the day care setting of immunocompromised children and young adults, the rate of in-hospital transmission of SARS-CoV-2 was 1.6% when applying the stringent policy of infection prevention and control, including universal mask application and rapid and extensive contact investigation. Severely immunocompromised children/young adults with COVID-19 would have to be carefully managed after the mandatory isolation period while keeping the possibility of prolonged shedding of live virus in mind.
A high-order transition route from inertial to elasticity-dominated turbulence (EDT) in Taylor–Couette flows of polymeric solutions has been discovered via direct numerical simulations. This novel two-step transition route is realized by enhancing the extensional viscosity and hoop stresses of the polymeric solution via increasing the maximum chain extension at a fixed polymer concentration. Specifically, in the first step inertial turbulence is stabilized to a laminar flow much like the modulated wavy vortex flow. The second step destabilizes this laminar flow state to EDT, i.e. a spatially smooth and temporally random flow with a $-3.5$ scaling law of the energy spectrum reminiscent of elastic turbulence. The flow states involved are distinctly different to those observed in the reverse transition route from inertial turbulence via a relaminarization of the flow to elasto-inertial turbulence in parallel shear flows, underscoring the importance of polymer-induced hoop stresses in realizing EDT that are absent in parallel shear flows.
The flow physics of inertio-elastic turbulent Taylor–Couette flow for a radius ratio of $0.5$ in the Reynolds number ($Re$) range of $500$ to $8000$ is investigated via direct numerical simulation. It is shown that as $Re$ is increased the turbulence dynamics can be subdivided into two distinct regimes: (i) a low $Re \leqslant 1000$ regime where the flow physics is essentially dominated by nonlinear elastic forces and the main contribution to transport and mixing of momentum, stress and energy comes from large-scale flow structures in the bulk region and (ii) a high $Re \geqslant 5000$ regime where inertial forces govern the flow physics and the flow dynamics is mainly governed by small-scale flow structures in the near-wall region. Flow–microstructure coupling analysis reveals that the elastic Görtler instability in the near-wall region is triggered via significant polymer extension and commensurately high hoop stresses. This instability gives rise to small-scale elastic vortical structures identified as elastic Görtler vortices which are present at all $Re$ considered. In fact, these vortices develop herringbone streaks near the inner wall that have a longer average life span than their Newtonian counterparts due to their elastic origin. Examination of the budgets of mean streamwise enstrophy, mean kinetic energy, turbulent kinetic energy and Reynolds shear stress demonstrates that increasing fluid inertia hinders the generation of elastic stresses, leading to a monotonic reduction of the elastic-related effects on the flow physics.
Regional planning may help to ensure that the specific measures implemented as part of a national suicide prevention strategy are aligned with the varying needs of local services and communities; however, there are concerns that the reliability of local programme development may be limited in practice.
The potential impacts of independent regional planning on the effectiveness of suicide prevention programmes in the Australian state of New South Wales were quantified using a system dynamics model of mental health services provision and suicidal behaviour in each of the state's ten Primary Health Network (PHN) catchments.
Reductions in projected suicide mortality over the period 2021–2031 were calculated for scenarios in which combinations of four and five suicide prevention and mental health services interventions (selected from 13 possible interventions) are implemented separately in each PHN catchment. State-level impacts were estimated by summing reductions in projected suicide mortality for each intervention combination across PHN catchments.
The most effective state-level combinations of four and five interventions prevent, respectively, 20.3% and 22.9% of 10 312 suicides projected under a business-as-usual scenario (i.e. no new policies or programmes, constant services capacity growth). Projected numbers of suicides under the optimal intervention scenarios for each PHN are up to 6% lower than corresponding numbers of suicides projected for the optimal state-level intervention combinations.
Regional suicide prevention planning may contribute to significant reductions in suicide mortality where local health authorities are provided with the necessary resources and tools to support reliable, evidence-based decision-making.
The aim of this study was to explore the effects and mechanisms of different starvation treatments on the compensatory growth of Acipenser dabryanus. A total of 120 fish (60·532 (sem 0·284) g) were randomly assigned to four groups (fasting 0, 3, 7 or 14 d and then refed for 14 d). During fasting, middle body weight decreased significantly with prolonged starvation. The whole-body and muscle composition, serum biochemical indexes, visceral indexes and digestive enzyme activities had been effected with varying degrees of changes. The growth hormone (GH) level in serum was significantly increased in 14D; however, insulin-like growth factor-1 (IGF-1) showed the opposite trend. The neuropeptide Y (npy) mRNA level in brain was significantly improved in 7D; peptide YY (pyy) mRNA level in intestine was significantly decreased during fasting. After refeeding, the final body weight, percentage weight gain, specific growth rate, feed intake, feed efficiency and protein efficiency ratio showed no difference between 0D and 3D. The changes of whole-body and muscle composition, serum biochemical indexes, visceral indexes and digestive enzyme activities had taken place in varying degrees. GH levels in 3D and 7D were significantly higher than those in the 0D; the IGF-1 content decreased significantly during refeeding. There was no significant difference in npy and pyy mRNA levels. These results indicated that short-term fasting followed by refeeding resulted in full compensation and the physiological and biochemical effects on A. dabryanus were the lowest after 3 d of starvation and 14 d of refeeding. Additionally, compensation in A. dabryanus may be mediated by appetite genes and GH, and the degree of compensation is also affected by the duration of starvation.
Predictors of compliance with aspirin in children following cardiac catheterisation have not been identified. The aim of this study is to identify the caregivers’ knowledge, compliance with aspirin medication, and predictors of compliance with aspirin in children with Congenital Heart Disease (CHD) post-percutaneous transcatheter occlusion.
A cross-sectional explorative design was adopted using a self-administered questionnaire and conducted between May 2017 and May 2018. Recruited were 220 caregivers of children with CHD post-percutaneous transcatheter occlusion. Questionnaires included child and caregivers’ characteristics, a self-designed and tested knowledge about aspirin scale (scoring scale 0–2), and the 8-item Morisky Medication Adherence Scale (scoring scale 0–8). Data were analysed using multivariate binary logistic regression analysis to identify predictors of compliance with aspirin.
Of the 220 eligible children and caregivers, 210 (95.5%) responded and 209 surveys were included in the analysis. The mean score of knowledge was 7.25 (standard deviation 2.27). The mean score of compliance was 5.65 (standard deviation 1.36). Child’s age, length of aspirin use, health insurance policies, relationship to child, monthly income, and knowledge about aspirin of caregivers were independent predictors of compliance with aspirin (p < 0.05).
Caregivers of children with CHD had an adequate level of knowledge about aspirin. Compliance to aspirin medication reported by caregivers was low. Predictors of medium to high compliance with aspirin were related to the child’s age and socio-economic reasons. Further studies are needed to identify effective strategies to improve knowledge, compliance with medication, and long-term outcomes of children with CHD.
We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.
A 635-bed, tertiary-care hospital in Daegu, South Korea.
To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.
From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).
Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
To identify the association of the glucokinase gene (GCK) rs4607517 polymorphism with gestational diabetes mellitus (GDM) and determine whether sweets consumption could interact with the polymorphism on GDM in Chinese women.
We conducted a case–control study at a hospital including 1015 participants (562 GDM cases and 453 controls). We collected the data of pre-pregnancy BMI, sweets consumption and performed genotyping of the GCK rs4607517 polymorphism. Logistic regression was performed to test the association between the rs4607517 polymorphism and GDM, and the stratified analyses by sweets consumption were conducted, using an additive genetic model.
A case–control study of women at a hospital in Beijing, China.
One thousand and fifteen Chinese women.
The GCK rs4607517 A allele was significantly associated with GDM (OR 1·35, 95 % CI 1·03, 1·77; P = 0·028). Furthermore, stratified analyses showed that the A allele increased the risk of GDM only in women who had a habitual consumption of sweet foods (sweets consumption ≥ once per week) (OR 1·61, 95 % CI 1·17, 2·21; P = 0·003). Significant interaction on GDM was found between the rs4607517 A allele and sweets consumption (P = 0·004).
This study for the first time reported the interaction between the GCK rs4607517 polymorphism and sweets consumption on GDM. The results provided novel evidence for risk assessment and personalised prevention of GDM.
Early consciousness recovery after cardiac arrest (CA) is one of the most explicit and self-evident prognostic factors for clinical outcomes. We aimed to evaluate the prognostic value of electroencephalography (EEG) phenotypes according to the American Clinical Neurophysiology Society’s Critical Care EEG classification for predicting early recovery after CA.
Consecutive patients admitted to the ICU after CA were enrolled. We analyzed Glasgow Coma Scale (GCS) score within 10 days after CA and evaluated mortality within 28 days according to EEG pattern subtype.
Among the total of 71 patients, 9 had periodic discharges (PDs) EEG pattern, 4 had rhythmic delta activity (RDA), 8 had spike-and-wave (SW), 22 had low voltage, 5 had burst suppression, and 23 had other EEG patterns. Initial GCS scores, GCS scores 3 days after CA (or 3 days after targeted temperature management [TTM]), and 10 days after CA (or 10 days after TTM) were significantly different among EEG subtypes (p < 0.001, respectively) (Table 2). GCS scores were significantly higher in RDA and the other EEG group compared to the PDs, SW, low voltage, and burst suppression groups (p < 0.001). Significant group × time interactions were observed for the follow-up period between EEG phenotypes (p < 0.001) demonstrating the most increase in the other EEG pattern group.
Consciousness states were significantly worse in the PDs, SW, burst suppression, and low-voltage groups compared to the RDA and the other EEG pattern within 10 days after CA. The degree of consciousness recovery differed significantly by EEG pattern subtype within 10 days.
We aimed to evaluate the relationship of plasma Mg with the risk of new-onset hyperuricaemia and examine any possible effect modifiers in hypertensive patients. This is a post hoc analysis of the Uric acid (UA) Sub-study of the China Stroke Primary Prevention Trial (CSPPT). A total of 1685 participants were included in the present study. The main outcome was new-onset hyperuricaemia defined as a UA concentration ≥417 μmol/l in men or ≥357 μmol/l in women. The secondary outcome was a change in UA concentration defined as UA at the exit visit minus that at baseline. During a median follow-up duration of 4·3 years, new-onset hyperuricaemia occurred in 290 (17·2 %) participants. There was a significantly inverse relation of plasma Mg with the risk of new-onset hyperuricaemia (per sd increment; OR 0·85; 95 % CI 0·74, 0·99) and change in UA levels (per sd increment; β −3·96 μmol/l; 95 % CI −7·14, −0·79). Consistently, when plasma Mg was analysed as tertiles, a significantly lower risk of new-onset hyperuricaemia (OR 0·67; 95 % CI 0·48, 0·95) and less increase in UA levels (β −8·35 μmol/l; 95 % CI −16·12, −0·58) were found among participants in tertile 3 (≥885·5 μmol/l) compared with those in tertile 1 (<818·9 μmol/l). Similar trends were found in males and females. Higher plasma Mg levels were associated with a decreased risk of new-onset hyperuricaemia in hypertensive adults.
We report direct numerical simulation results that clearly elucidate the mechanism that leads to curvature dependence of drag enhancement (DE) in viscoelastic turbulent Taylor–Couette flow. Change in the angular momentum transport and its inherent link to transitions in vortical flow structures have been explored to depict the influence of the curvature of the flow geometry on DE. Specifically, it has been demonstrated that a transition in vortical structures with increasing radius ratio leads to weakening and elimination of the small-scale Görtler vortices and development and better organization (occupying the entire gap) of large-scale Taylor vortices as also evinced by the patterns of angular momentum current. The commensurate change in DE and its underlying mechanism are examined by contributions of convective flux and polymeric stress to the angular momentum current. The present finding paves the way for capturing highly localized elastic turbulence structures in direct numerical simulation by increasing geometry curvature in traditional turbulent curvilinear flows.
We aimed to investigate the association between plasma retinol and incident cancer among Chinese hypertensive adults. We conducted a nested case–control study, including 231 patients with incident cancer and 231 matched controls during a median 4·5-year follow-up of the China Stroke Primary Prevention Trial. There was a significant, inverse association between retinol levels and digestive system cancer (per 10 μg/dl increases: OR 0·79; 95 % CI 0·69, 0·91). When compared with participants in the first quartile of retinol (< 52·3 μg/dl), a significantly lower cancer risk was found in participants in quartile 2–4 ( ≥ 52·3 μg/dl: OR 0·31; 95 % CI 0·13, 0·71). However, there was a U-shaped association between retinol levels and non-digestive system cancers where the risk of cancers decreased (although not significantly) with each increment of plasma retinol (per 10 μg/dl increases: OR 0·89; 95 % CI 0·60, 1·31) in participants with retinol < 68·2 μg/dl, and then increased significantly with retinol (per 10 μg/dl increase: OR 1·65; 95 % CI 1·12, 2·44) in participants with retinol ≥ 68·2 μg/dl. In conclusion, there was a significant inverse dose–response association between plasma retinol and the risk of digestive system cancers. However, a U-shaped association was observed between plasma retinol and the risk of non-digestive cancers (with a turning point approximately 68·2 μg/dl).
AlMgB14–TiB2 ceramic was successfully brazed to TC4 alloy with inactive AgCu filler alloy. X-ray diffractometer, SEM, and energy-dispersive spectrometer were used to study interfacial microstructure and shear strength of the joints under different brazing temperatures. The results indicated that the typical microstructure of the TC4/AlMgB14–TiB2 joint was TC4/Ti(s.s) + Ti2Cu/Ti2Cu/TiCu/TiCu2Al/Ag(s.s) + Cu(s.s)/TiB whiskers/TiB2 reaction layer/AMBT. By increasing the brazing temperature, the thickness of the TC4 diffusion layer was improved, whereas that of the brazing seam decreased remarkably. When the brazing temperature was increased to 880 °C, the brazing seam was composed of Ti–Cu intermetallic Ag(s.s) with a few Cu(s.s), TiCu2Al distributed. Meanwhile, the formation of a continuous TiB2 reaction layer at the interface of the AMBT and brazing filler facilitated the improvement of joint shear strength. The joint with the maximum shear strength of 46.7 MPa was obtained while brazing at 880 °C for 10 min.
In Democratic People's Republic of Korea, only Plasmodium vivax malaria is prevalent, which is divided into two forms – long incubation form and short form. Among malaria cases reported in a year, long form accounts for 69% and short form 31%. Incubation period of short form ranges from 10 to 29 days (average 17 days) and long from 5·5 to 16 months (average 8–13 months). The most relapses (90%) were reported from May to September – malaria transmission season in the country. Result from preliminary mass chemoprevention in small size of population before transmission season to find appropriate method showed high protective efficacy in two regimens – one regimen given primaquine 0·25 mg base kg−1 day−1 for 14 days (95%) and another 0·5 mg base kg−1 day−1 for 7 days (94%). During the mass chemoprevention with primaquine, some adverse effects were reported but transient. We consider that mass chemoprevention with primaquine before transmission season is of great significance in disturbing the vivax malaria transmission, in which long incubation form is predominant in countries prevailing seasonal malaria.