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.

Conceitos de química dos ingressantes nos cursos de graduação do Instituto de Química da Universidade de São Paulo

A diagnostic instrument was developed to evaluate the basic chemistry concepts held by freshmen students of the three Chemistry undergraduate courses offered by the University of São Paulo. The instrument minimizes the use of algorithms or memorization by students and values high-order cognitive skills. Analysis of the students' performances reveals systematic use of "displacement reaction" as an algorithm and a mechanical use of Le Chatelier's Principle. Failure in comprehending the chemical equation and chemical language drives students to alternative models for chemical reactions in aqueous solution. For instance, reaction would occur between "ionic pairs" and/or between species situated in separate compartments.

The Constitutional basis of aboriginal rights

Aboriginal rights are rights held by aboriginal peoples, not by virtue of Crown grant, legislation or treaty, but “by reason of the fact that aboriginal peoples were once independent, self-governing entities in possession of most of the lands now making up Canada.” It is, of course, the presence of aboriginal peoples in North America before the arrival of the Europeans that distinguishes them from other minority groups in Canada, and explains why their rights have special legal status. However, the extent to which those rights had survived European settlement was in considerable doubt until as late as 1973, which was when the Supreme Court of Canada decided the Calder case.2 In that case, six of the seven judges held that the Nishga people of British Columbia possessed aboriginal rights to their lands that had survived European settlement. The actual outcome of the case was inconclusive, because the six judges split evenly on the question whether the rights had been validly extinguished or not. However, the recognition of the rights was significant, and caught the attention of the Government of Canada, which began to negotiate treaties (now called land claims agreements) with First Nations in those parts of the country that were without treaties. That resumed a policy that had been abandoned in the 1920s, when the last numbered treaty was entered into.

Revisión sistemática : uso de imágenes por difusión en RMN, para predecir sobrevida en pacientes adultos con diagnostico de glioblastoma multiforme

El Glioblastoma multiforme (GBM), es el tumor cerebral más frecuente, con pronóstico grave y baja sensibilidad al tratamiento inicial. El propósito de este estudio fue evaluar si la Difusión en RM (IDRM), es un biomarcador temprano de respuesta tumoral, útil para tomar decisiones tempranas de tratamiento y para obtener información pronostica. Metodología La búsqueda se realizo en las bases de datos EMBASE, CENTRAL, MEDLINE; las bibliografías también fueron revisadas. Los artículos seleccionados fueron estudios observacionales (casos y controles, cohortes, corte transversal), no se encontró ningún ensayo clínico; todos los participante tenían diagnostico histopatológico de GBM, sometidos a resección quirúrgica y/o radio-quimioterapia y seguimiento de respuesta al tratamiento con IDRM por al menos 6 meses. Los datos extraídos de forma independiente fueron tipo de estudio, participantes, intervenciones, seguimiento, desenlaces (sobrevida, progresión/estabilización de la enfermedad, muerte) Resultados Quince estudios cumplieron los criterios de inclusión. Entre las técnicas empleadas de IDRM para evaluar respuesta radiológica al tratamiento, fueron histogramas del coeficiente aparente de difusion ADC (compararon valores inferiores a la media y el percentil 10 de ADC, con los valores superiores); encontrando en términos generales que un ADC bajo es un fuerte predictor de sobrevida y/o progresión del tumor. (Esto fue significativo en 5 estudios); mapas funcionales de difusion (FDM) (midieron el porcentaje de cambio de ADC basal vs pos tratamiento) que mostro ser un fuerte predictor de sobrevida en pacientes con progresión tumoral. DISCUSION Desafortunadamente la calidad de los estudios fue intermedia-baja lo que hace que la aplicabilidad de los estudios sea limitada.

Análisis crítico del concepto de seguridad humana en relación con la actuación de la MINUEE (Misión de Naciones Unidas Para Etiopía y Eritrea). Período 1998-2008

La monografía buscó realizar un análisis crítico del concepto de Seguridad Humana en relación con la actuación de la MINUEE en el período de guerra(1998-2000) y luego del retiro de la Misión (Julio de 2008), para establecer una crítica constructiva al funcionamiento de las OMP de la ONU, determinar los aciertos y desaciertos de la Misión en el uso del concepto de Seguridad Humana y sus múltiples dimensiones definidas en el PNUD(Seguridad: de la comunidad, de la salud, política, alimentaria, ambiental y personal) y comprender por qué la Misión fracasó en su intento de dirimir la crisis humanitaria y dar fin al conflicto.

Mimo : el arte del silencio.

Se presentan multitud de ejercicios de mimo de dificultad creciente. Las explicaciones de cada movimiento van introducidas por medio de dibujos muy claros que ayudan a la adquisición de las técnicas propuestas. Se divide en 24 lecciones, todas ellas con una organización similar : calentamiento, entrenamiento y propuesta específica. Va destinado a grupos de teatro, centros culturales y colegios. Es un libro fundamentalmente práctico, aunque también introduce un capítulo con la historia del mimo.

Proyecto 'Mimarte'.

Resumen basado en el de la publicación

Controls on development and diversity of Early Archean stromatolites

The ≈3,450-million-year-old Strelley Pool Formation in Western Australia contains a reef-like assembly of laminated sedimentary accretion structures (stromatolites) that have macroscale characteristics suggestive of biological influence. However, direct microscale evidence of biology—namely, organic microbial remains or biosedimentary fabrics—has to date eluded discovery in the extensively-recrystallized rocks. Recently-identified outcrops with relatively good textural preservation record microscale evidence of primary sedimentary processes, including some that indicate probable microbial mat formation. Furthermore, we find relict fabrics and organic layers that covary with stromatolite morphology, linking morphologic diversity to changes in sedimentation, seafloor mineral precipitation, and inferred microbial mat development. Thus, the most direct and compelling signatures of life in the Strelley Pool Formation are those observed at the microscopic scale. By examining spatiotemporal changes in microscale characteristics it is possible not only to recognize the presence of probable microbial mats during stromatolite development, but also to infer aspects of the biological inputs to stromatolite morphogenesis. The persistence of an inferred biological signal through changing environmental circumstances and stromatolite types indicates that benthic microbial populations adapted to shifting environmental conditions in early oceans.

Rational conversion of substrate and product specificity in a Salvia monoterpene synthase: structural insights into the evolution of terpene synthase function

Terpene synthases are responsible for the biosynthesis of the complex chemical defense arsenal of plants and microorganisms. How do these enzymes, which all appear to share a common terpene synthase fold, specify the many different products made almost entirely from one of only three substrates? Elucidation of the structure of 1,8-cineole synthase from Salvia fruticosa (Sf-CinS1) combined with analysis of functional and phylogenetic relationships of enzymes within Salvia species identified active-site residues responsible for product specificity. Thus, Sf-CinS1 was successfully converted to a sabinene synthase with a minimum number of rationally predicted substitutions, while identification of the Asn side chain essential for water activation introduced 1,8-cineole and alpha-terpineol activity to Salvia pomifera sabinene synthase. A major contribution to product specificity in Sf-CinS1 appears to come from a local deformation within one of the helices forming the active site. This deformation is observed in all other mono- or sesquiterpene structures available, pointing to a conserved mechanism. Moreover, a single amino acid substitution enlarged the active-site cavity enough to accommodate the larger farnesyl pyrophosphate substrate and led to the efficient synthesis of sesquiterpenes, while alternate single substitutions of this critical amino acid yielded five additional terpene synthases.

Evolution of functional diversity in the cupin superfamily

The cupin superfamily of proteins is among the most functionally diverse of any described to date. It was named on the basis of the conserved beta-barrel fold ('cupa' is the Latin term for a small barrel), and comprises both enzymatic and non-enzymatic members, which have either one or two cupin domains. Within the conserved tertiary structure, the variety of biochemical function is provided by minor variation of the residues in the active site and the identity of the bound metal ion. This review discusses the advantages of this particular scaffold and provides an evolutionary analysis of 18 different subclasses within the cupin superfamily.

Identifying human influences on atmospheric temperature

We perform a multimodel detection and attribution study with climate model simulation output and satellite-based measurements of tropospheric and stratospheric temperature change. We use simulation output from 20 climate models participating in phase 5 of the Coupled Model Intercomparison Project. This multimodel archive provides estimates of the signal pattern in response to combined anthropogenic and natural external forcing (the finger-print) and the noise of internally generated variability. Using these estimates, we calculate signal-to-noise (S/N) ratios to quantify the strength of the fingerprint in the observations relative to fingerprint strength in natural climate noise. For changes in lower stratospheric temperature between 1979 and 2011, S/N ratios vary from 26 to 36, depending on the choice of observational dataset. In the lower troposphere, the fingerprint strength in observations is smaller, but S/N ratios are still significant at the 1% level or better, and range from three to eight. We find no evidence that these ratios are spuriously inflated by model variability errors. After removing all global mean signals, model fingerprints remain identifiable in 70% of the tests involving tropospheric temperature changes. Despite such agreement in the large-scale features of model and observed geographical patterns of atmospheric temperature change, most models do not replicate the size of the observed changes. On average, the models analyzed underestimate the observed cooling of the lower stratosphere and overestimate the warming of the troposphere. Although the precise causes of such differences are unclear, model biases in lower stratospheric temperature trends are likely to be reduced by more realistic treatment of stratospheric ozone depletion and volcanic aerosol forcing.