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.

The Bonenblust-Hille inequality for homogeneous polynomials is hypercontractive

The Bohnenblust-Hille inequality says that the $\ell^{\frac{2m}{m+1}}$ -norm of the coefficients of an $m$-homogeneous polynomial $P$ on $\Bbb{C}^n$ is bounded by $\| P \|_\infty$ times a constant independent of $n$, where $\|\cdot \|_\infty$ denotes the supremum norm on the polydisc $\mathbb{D}^n$. The main result of this paper is that this inequality is hypercontractive, i.e., the constant can be taken to be $C^m$ for some $C>1$. Combining this improved version of the Bohnenblust-Hille inequality with other results, we obtain the following: The Bohr radius for the polydisc $\mathbb{D}^n$ behaves asymptotically as $\sqrt{(\log n)/n}$ modulo a factor bounded away from 0 and infinity, and the Sidon constant for the set of frequencies $\bigl\{ \log n: n \text{a positive integer} \le N\bigr\}$ is $\sqrt{N}\exp\{(-1/\sqrt{2}+o(1))\sqrt{\log N\log\log N}\}$.

Kvinnor och messiasgestalter i science fiction-film

Recension

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Long recognized as the standard general reference in the field, this completely revised edition of Grainger and Allison's Diagnostic Radiology provides all the information that a trainee needs to master to successfully take their professional certification examinations as well as providing the practicing radiologist with a refresher on topics that may have been forgotten. Organized along an organ and systems basis, this resource covers all diagnostic imaging modalities in an integrated, correlative fashion and focuses on those topics that really matter to a trainee radiologist in the initial years of training

Public Management : Ganzheitliches Know-how zur Sicherstellung eines professionellen Verwaltungsmanagements

Dieses hochwertige Praxishandbuch ermöglicht Personen mit Führungs- und Managementfunktionen in den öffentlichen Verwaltungen des Bundes, der Kantone und der Gemeinden einen raschen Zugang zu allen wichtigen Führungsthemen und enthält praktische Anleitungen zur Bewältigung von Managementproblemen. Über 50 ausgewiesene Fachautoren mit professionellem beruflichen Hintergrund haben die vorliegenden Inhalte entsprechend den heutigen Anforderungen in der öffentlichen Verwaltung erstellt

Ivory vertebra: imaging findings in different diagnoses

Abstract Low back pain is often managed at all levels of healthcare. In general, diagnostic investigation begins with radiography of the lumbar spine. In addition to the most common findings, radiologists can identify increased density of a vertebral body, referred to as ivory vertebra. The objective of this study was to describe the main diseases that can present with this radiologic sign, such as Hodgkin lymphoma, Paget's disease, metastatic prostate cancer, breast cancer, and osteomyelitis. It is extremely important that radiologists be aware of this finding in order to inform the requesting physician of the possible etiologies, given that it can be the initial radiologic presentation for these diseases.

Análise de naftoquinonas em extratos brutos de raízes de Zeyheria montana M. (bolsa-de-pastor)

Four naphthoquinones, lapachol, a-lapachone, dehydro-a-lapachone and 4-hydroxy-a-lapachone were isolated from the ethanol extract of Zeyheria montana M. roots (Bignoniaceae) and were identified by spectroscopic methods. These naphthoquinones, except 4-hydroxy-a-lapachone, were quantified by HPLC, in the crude ethanol extracts of Z. montana roots. The separation of lapachol, a-lapachone and dehydro-a-lapachone was achieved and these compounds were identified in the chromatograms by their retention times and by their on line UV-spectra. The quantification of the three naphthoquinones, in four different samples showed medium contents of 11,0 mg of lapachol, 6,1 mg of a-lapachone and 4,3 mg of dehydro-a-lapachone, in 100 mg of Z.montana roots.

Shout and Act: an Algorithm for Digital Objects Preservation Inspired from Rescue Robots

We adapt the Shout and Act algorithm to Digital Objects Preservation where agents explore file systems looking for digital objects to be preserved (victims). When they find something they “shout” so that agent mates can hear it. The louder the shout, the urgent or most important the finding is. Louder shouts can also refer to closeness. We perform several experiments to show that this system works very scalably, showing that heterogeneous teams of agents outperform homogeneous ones over a wide range of tasks complexity. The target at-risk documents are MS Office documents (including an RTF file) with Excel content or in Excel format. Thus, an interesting conclusion from the experiments is that fewer heterogeneous (varying skills) agents can equal the performance of many homogeneous (combined super-skilled) agents, implying significant performance increases with lower overall cost growth. Our results impact the design of Digital Objects Preservation teams: a properly designed combination of heterogeneous teams is cheaper and more scalable when confronted with uncertain maps of digital objects that need to be preserved. A cost pyramid is proposed for engineers to use for modeling the most effective agent combinations

Obtenção de vanilina: oportunidade biotecnológica

Natural aroma compounds are of major interest to the food and fragrance industry. Vanillin (3-methoxy-4-hydroxybenzaldehyde) was isolated from the vanilla beans in 1816 and its world consumption has reached today about 12000 tons per year. But only approximately 50 tons per year are extracted from vanilla pods (Vanilla planifolia). The remainder is provided by synthetic vanillin. This review is about alternative processes to produce natural vanillin de novo or by biotransformation using biotechnological methods involving enzymes, microorganisms and plant cells.

Hoffmannin kertomukset

Esityskieli: suomi.

De gemino Messia

Invocatio: [hepreaa].

Schedion zoologicum de ira

Invocatio: Divina adfulgente gratia. Ded.: Gustavus Adolphus Humble, Olavus Osander, Andreas Eckerstedt, Peturs Kexerus, Andreas Ståhl, Sveno Fovelin, Samuel Lyseen, Henricus Bereen, Zacharias Tobiis, Lars Eckman [ruots. runo].

De poenis coelibum apud veteres

Invocatio: [Alpha et Omega].