Paediatric malaria case-management with artemether-lumefantrine in Zambia: a repeat cross-sectional study

BACKGROUND:Zambia was the first African country to change national antimalarial treatment policy to artemisinin-based combination therapy - artemether-lumefantrine. An evaluation during the early implementation phase revealed low readiness of health facilities and health workers to deliver artemether-lumefantrine, and worryingly suboptimal treatment practices. Improvements in the case-management of uncomplicated malaria two years after the initial evaluation and three years after the change of policy in Zambia are reported.METHODS:Data collected during the health facility surveys undertaken in 2004 and 2006 at all outpatient departments of government and mission facilities in four Zambian districts were analysed. The surveys were cross-sectional, using a range of quality of care assessment methods. The main outcome measures were changes in health facility and health worker readiness to deliver artemether-lumefantrine, and changes in case-management practices for children below five years of age presenting with uncomplicated malaria as defined by national guidelines.RESULTS:In 2004, 94 health facilities, 103 health workers and 944 consultations for children with uncomplicated malaria were evaluated. In 2006, 104 facilities, 135 health workers and 1125 consultations were evaluated using the same criteria of selection. Health facility and health worker readiness improved from 2004 to 2006: availability of artemether-lumefantrine from 51% (48/94) to 60% (62/104), presence of artemether-lumefantrine dosage wall charts from 20% (19/94) to 75% (78/104), possession of guidelines from 58% (60/103) to 92% (124/135), and provision of in-service training from 25% (26/103) to 41% (55/135). The proportions of children with uncomplicated malaria treated with artemether-lumefantrine also increased from 2004 to 2006: from 1% (6/527) to 27% (149/552) in children weighing 5 to 9 kg, and from 11% (42/394) to 42% (231/547) in children weighing 10 kg or more. In both weight groups and both years, 22% (441/2020) of children with uncomplicated malaria were not prescribed any antimalarial drug.CONCLUSION:Although significant improvements in malaria case-management have occurred over two years in Zambia, the quality of treatment provided at the point of care is not yet optimal. Strengthening weak health systems and improving the delivery of effective interventions should remain high priority in all countries implementing new treatment policies for malaria.

GreedyDual-Join: Locality-Aware Buffer Management for Approximate Join Processing Over Data Streams

We investigate adaptive buffer management techniques for approximate evaluation of sliding window joins over multiple data streams. In many applications, data stream processing systems have limited memory or have to deal with very high speed data streams. In both cases, computing the exact results of joins between these streams may not be feasible, mainly because the buffers used to compute the joins contain much smaller number of tuples than the tuples contained in the sliding windows. Therefore, a stream buffer management policy is needed in that case. We show that the buffer replacement policy is an important determinant of the quality of the produced results. To that end, we propose GreedyDual-Join (GDJ) an adaptive and locality-aware buffering technique for managing these buffers. GDJ exploits the temporal correlations (at both long and short time scales), which we found to be prevalent in many real data streams. We note that our algorithm is readily applicable to multiple data streams and multiple joins and requires almost no additional system resources. We report results of an experimental study using both synthetic and real-world data sets. Our results demonstrate the superiority and flexibility of our approach when contrasted to other recently proposed techniques.

Client-based Logging: A New Paradigm of Distributed Transaction Management

The proliferation of inexpensive workstations and networks has created a new era in distributed computing. At the same time, non-traditional applications such as computer-aided design (CAD), computer-aided software engineering (CASE), geographic-information systems (GIS), and office-information systems (OIS) have placed increased demands for high-performance transaction processing on database systems. The combination of these factors gives rise to significant challenges in the design of modern database systems. In this thesis, we propose novel techniques whose aim is to improve the performance and scalability of these new database systems. These techniques exploit client resources through client-based transaction management. Client-based transaction management is realized by providing logging facilities locally even when data is shared in a global environment. This thesis presents several recovery algorithms which utilize client disks for storing recovery related information (i.e., log records). Our algorithms work with both coarse and fine-granularity locking and they do not require the merging of client logs at any time. Moreover, our algorithms support fine-granularity locking with multiple clients permitted to concurrently update different portions of the same database page. The database state is recovered correctly when there is a complex crash as well as when the updates performed by different clients on a page are not present on the disk version of the page, even though some of the updating transactions have committed. This thesis also presents the implementation of the proposed algorithms in a memory-mapped storage manager as well as a detailed performance study of these algorithms using the OO1 database benchmark. The performance results show that client-based logging is superior to traditional server-based logging. This is because client-based logging is an effective way to reduce dependencies on server CPU and disk resources and, thus, prevents the server from becoming a performance bottleneck as quickly when the number of clients accessing the database increases.

Concurrency Admission Control Management in ACCORD

We propose and evaluate admission control mechanisms for ACCORD, an Admission Control and Capacity Overload management Real-time Database framework-an architecture and a transaction model-for hard deadline RTDB systems. The system architecture consists of admission control and scheduling components which provide early notification of failure to submitted transactions that are deemed not valuable or incapable of completing on time. In particular, our Concurrency Admission Control Manager (CACM) ensures that transactions which are admitted do not overburden the system by requiring a level of concurrency that is not sustainable. The transaction model consists of two components: a primary task and a compensating task. The execution requirements of the primary task are not known a priori, whereas those of the compensating task are known a priori. Upon the submission of a transaction, the Admission Control Mechanisms are employed to decide whether to admit or reject that transaction. Once admitted, a transaction is guaranteed to finish executing before its deadline. A transaction is considered to have finished executing if exactly one of two things occur: Either its primary task is completed (successful commitment), or its compensating task is completed (safe termination). Committed transactions bring a profit to the system, whereas a terminated transaction brings no profit. The goal of the admission control and scheduling protocols (e.g., concurrency control, I/O scheduling, memory management) employed in the system is to maximize system profit. In that respect, we describe a number of concurrency admission control strategies and contrast (through simulations) their relative performance.