Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data.

BACKGROUND: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). METHODS: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. RESULTS: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P <0.001); fever (>37.5 °C) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). CONCLUSIONS: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility.

Association between parental history and genetic risk scores for coronary heart disease prediction: The population-based CoLaus study.

BACKGROUND AND AIMS: Parental history (PH) and genetic risk scores (GRSs) are separately associated with coronary heart disease (CHD), but evidence regarding their combined effects is lacking. We aimed to evaluate the joint associations and predictive ability of PH and GRSs for incident CHD. METHODS: Data for 4283 Caucasians were obtained from the population-based CoLaus Study, over median follow-up time of 5.6 years. CHD was defined as incident myocardial infarction, angina, percutaneous coronary revascularization or bypass grafting. Single nucleotide polymorphisms for CHD identified by genome-wide association studies were used to construct unweighted and weighted versions of three GRSs, comprising of 38, 53 and 153 SNPs respectively. RESULTS: PH was associated with higher values of all weighted GRSs. After adjustment for age, sex, smoking, diabetes, systolic blood pressure, low and high density lipoprotein cholesterol, PH was significantly associated with CHD [HR 2.61, 95% CI (1.47-4.66)] and further adjustment for GRSs did not change this estimate. Similarly, one standard deviation change of the weighted 153-SNPs GRS was significantly associated with CHD [HR 1.50, 95% CI (1.26-1.80)] and remained so, after further adjustment for PH. The weighted, 153-SNPs GRS, but not PH, modestly improved discrimination [(C-index improvement, 0.016), p = 0.048] and reclassification [(NRI improvement, 8.6%), p = 0.027] beyond cardiovascular risk factors. After including both the GRS and PH, model performance improved further [(C-index improvement, 0.022), p = 0.006]. CONCLUSION: After adjustment for cardiovascular risk factors, PH and a weighted, polygenic GRS were jointly associated with CHD and provided additive information for coronary events prediction.

Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis.

BACKGROUND: Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. METHODS: MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. FINDINGS: We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). INTERPRETATION: AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption.

Rendu-Osler-Weber syndrome: what radiologists should know. Literature review and three cases report

Rendu-Osler-Weber syndrome or hereditary hemorrhagic telangiectasia is an autosomal dominant vascular disease involving multiple systems whose main pathological change is the presence of abnormal arteriovenous communications. Most common symptoms include skin and mucosal telangiectasias, epistaxis, gastrointestinal, pulmonary and intracerebral bleeding. The key imaging finding is the presence of visceral arteriovenous malformations. The diagnosis is based on clinical criteria and can be confirmed by molecular biology techniques. Treatment includes measures for management of epistaxis, as well as surgical excision, radiotherapy and embolization of arteriovenous malformations, with emphasis on endovascular treatment. The present pictorial essay includes a report of three typical cases of this entity and a literature review.

Bias in dissemination of clinical research findings: structured OPEN framework of what, who and why, based on literature review and expert consensus.

OBJECTIVE: The aim of this study is to review highly cited articles that focus on non-publication of studies, and to develop a consistent and comprehensive approach to defining (non-) dissemination of research findings. SETTING: We performed a scoping review of definitions of the term 'publication bias' in highly cited publications. PARTICIPANTS: Ideas and experiences of a core group of authors were collected in a draft document, which was complemented by the findings from our literature search. INTERVENTIONS: The draft document including findings from the literature search was circulated to an international group of experts and revised until no additional ideas emerged and consensus was reached. PRIMARY OUTCOMES: We propose a new approach to the comprehensive conceptualisation of (non-) dissemination of research. SECONDARY OUTCOMES: Our 'What, Who and Why?' approach includes issues that need to be considered when disseminating research findings (What?), the different players who should assume responsibility during the various stages of conducting a clinical trial and disseminating clinical trial documents (Who?), and motivations that might lead the various players to disseminate findings selectively, thereby introducing bias in the dissemination process (Why?). CONCLUSIONS: Our comprehensive framework of (non-) dissemination of research findings, based on the results of a scoping literature search and expert consensus will facilitate the development of future policies and guidelines regarding the multifaceted issue of selective publication, historically referred to as 'publication bias'.

An Overview Of British Automotive Industry: Implications From History and Recommendations for Future

This thesis is a literary research, which aims to uncover reasons for the downfall of automotive industry in the United Kingdom in the late 20th century. First, there is a short review on the history of the industry in the UK and then there are more present cases presented in the form of BMW-Rover and Tata-Jaguar Land Rover. Finally, the thesis suggests some ideas to which the UK should work towards in order to ensure future competitiveness. The automotive industry in the United Kingdom is one of the oldest in the world, but as the end of last millennium was approaching it was not doing too well. Industry that was still flourishing in the mid-century was soon heading down river and by the end of the century all large English car manufacturers had either closed down or were forced under foreign ownership. The thesis suggests possible targets for future prospects from the literary review and from the conclusions made. These are to ensure the continuity of the industry and the competitiveness on an international level. The suggestions are for long term and are mainly focused around research and development of renewable energy forms.

Recovery boilers - history and future

Recovery boilers are built all over the world. The roots of recovery technology are longer than the roots of recovery boilers. But it wasn’t until the invention of recovery boilers before the Second World War that the pulping technology was revolutionalized. This led to long development of essentially the same type of equipment, culminating into units that are largest biofuel boilers in the world. Early recovery technology concentrated on chemical recovery as chemicals cost money and if one could recycle these chemicals then the profitability of pulp manufacture would improve. For pulp mills the significance of electricity generation from the recovery boiler was for long secondary. The most important design criterion for the recovery boiler was a high availability. The electricity generation in recovery boiler process can be increased by elevated main steam pressure and temperature or by higher black liquor dry solids as well as improving its steam cycle. This has been done in the modern Scandinavian units.

Vegetational history and geochronology of several sites in South Southwestern Ontario with discussion on mastodon extinction in Southern Ontario /

This study has three purposes: to establish a chronologically controlled vegetational history for a number of sites in south Southwestern Ontario; to utilize the resulting data to support and/or add to the current understanding of Quaternary geology and stratigraphy, and the glacial and postglacial history of the Great Lakes in south Southwestern Ontario; and to attempt to propose a possible explanation for the extinction of the mastodon in Southern Ontario. Palynological and geochronological analyses were conducted on material collected from eleven sites (east to west): Verbeke Mastodon Site, Woloshko Mastodon Site, Walker Pond II, Pond Mills I, Lake Hunger Bog, Bouckaert Site. Mabee Site, Cornell Bog. Colles Lake I, Folden Mastodon Site and Forest Pond. Individual geochronologically controlled (where possible) vegetational histories were reconstructed for each of the sites investigated. The results of the individual studies, when considered in overview. indicated the existance of an established closed boreal forest throughout south Southwestern Ontario by 10,000 years B.P. This evidence for a significant climatic change coincident throughout south Southwestern Ontario supports the proposed age of 10,000 years B.P. for the Pleistocene/Holocene Boundary (Terasmae, 1972). Remnant patches of 'open spruce parkland' persisted in small local 'wet' areas. It was in these areas that the mastodon was restricted during early Holocene time. With continued encroachment by the surrounding boreal forest, possibly speeded up by this browser's destructive feeding habits, the spruce enclaves shrank and the mastodon became extinct in south Southwestern Ontario. The results of this thesis basically support Dreimanis' (1967, 1968) proposed 'Environmental-Climatic' theory for mastodon extinction. It is suggested that increased dryness during the present interglacial compared to the climate of earlier interglacials may be the key to unravelling the problem of mastodon extinction in eastern North America.

Metal music as critical dystopia : humans, technology and the future in 1990s science fiction metal

Metal Music as Critical Dystopia: Humans, Technology and the Future in 1990s Science Fiction Metal seeks to demonstrate that the dystopian elements in metal music are not merely or necessarily a sonic celebration of disaster. Rather, metal music's fascination with dystopian imagery is often critical in intent, borrowing themes and imagery from other literary and cinematic traditions in an effort to express a form of social commentary. The artists and musical works examined in this thesis maintain strong ties with the science fiction genre, in particular, and tum to science fiction conventions in order to examine the long-term implications of humanity's complex relationship with advanced technology. Situating metal's engagements with science fiction in relation to a broader practice of blending science fiction and popular music and to the technophobic tradition in writing and film, this thesis analyzes the works of two science fiction metal bands, VOlvod and Fear Factory, and provides close readings of four futuristic albums from the mid to late 1990s that address humanity's relationship with advanced technology in musical and visual imagery as well as lyrics. These recorded texts, described here as cyber metal for their preoccupation with technology in subject matter and in sound, represent prime examples of the critical dystopia in metal music. While these albums identify contemporary problems as the root bf devastation yet to come, their musical narratives leave room for the possibility of hope , allowing for the chance that dystopia is not our inevitable future.

Where's Albania? : staking out the politics of the real and reality in documentary cinema

This thesis, entitled, "Where's Albania? Staking Out the Politics of the Real and Reality in Documentary Cinema," charts the documentary tradition's path from its first incarnations, as filmed travelogue or ethnographic study, for example, right through to its development as a form acting as an objective observer, reflexive commentator, and finally, as a postmodern hybrid. This thesis begins by locating the documentary tradition's origins in realism. Foregrounding documentary cinema as a realist style is important in that it is a contention that spans this entire study. After working through the numerous modes of documentary as outlined by Bill Nichols, I suggest the documentary is often best understood as a hybrid form drawing on numerous modes and conventions. This argument permits my study to make a shift into postmodern theory, wherein I examine postmodernism's relationship to the documentary both as being influenced by it, but also as subsequently forcing documentary cinema to look back at itself and reevaluate the claims it has made in the past, and how postmodernism has drawn these claims to the surface of debate. My thesis concludes with a study of the mockumentary. This analysis confirms the link between postmodernism and documentary, but perhaps more importantly, this analysis investigates postmodemism's critique of the image and representation in general, two elements historically linked to documentary cinema's success as "truth teller."