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.

A chart of the southern part of South America : with the track of the centurion from the island of St. Catherines to the island of Juan Fernandes in which is inserted the variation and soundings observ'd on board her, together with her deviation from her estimated course in passing round Cap Horn, occasiond by the force of the currents / R. W. Seale sculp

Nimeketiedot nimiönkehyksissä

Breastfeeding preterm infant from the delivery ward via nicu to home

The aim of this study was to examine how to support breastfeeding of preterm infants immediately after birth in the delivery ward, during their hospital stay in a neonatal intensive care unit (NICU), and at home after hospital discharge. Specifically, the role of early physical contact, maternal breastfeeding attitude, and an internet-based peer support group were investigated. The delivery ward practices concerning the implementation of early physical contact between a mother and her infant admitted to a NICU were examined by a structured survey in two hospitals. An Internet-based, breastfeeding peer-support intervention for the mothers of preterm infants was developed and tested in a randomized controlled design with one year follow-up. The main outcomes were the duration of exclusive and overall breastfeeding, expressing milk, and maternal attitude. In addition, the perceptions of mothers of preterm infants were investigated by analyzing the peer-support group discussions with a qualitative approach. The implementation of early physical contact was different between the two hospitals studied and was based more on hospital routines than the physiological condition of the infant. Preterm infants, who were born before a gestational age (GA) of 32 weeks, were hardly ever allowed to have early contact with their mothers. Both, a higher GA and early physical contact predicted earlier initiation and increased frequency of breastfeeding in the NICU. A maternal breastfeeding-favorable attitude predicted increased frequency of breastfeeding in the NICU and also a longer duration of overall breastfeeding. The actual duration of breastfeeding was, however, shorter than the mothers intended in advance. The internet-based, peer-support intervention had no effect on the duration of breastfeeding, expressing milk, or maternal attitude. The participating mothers enjoyed the possibility of sharing their experiences of preterm infants with other mothers in similar situations. Some of the mothers also experienced being given useful advice for breastfeeding. Based on the mothers’ discussions, a process of breastfeeding preterm infants was created. This included some paradoxical elements in the NICU where, for example, breast milk was emphasized over breastfeeding and support in the hospital varied. Hospital discharge was a critical point, when the mothers faced breastfeeding in reality. Over time, the mothers assimilated their breastfeeding experience into part of being a mother. The care practices related to early physical contact in delivery wards need to be re-evaluated to allow more infants to have a moment with the mother. Maternal attitude could be screened prenatally and attitude-focused interventions developed. Breastfeeding support in the NICU should be standardized. Internet-based breastfeeding peer-support intervention was feasible but additional research is needed.

O estatuto do corpo em esquisse d'une théorie des émotions, de Jean-Paul Sartre

Neste artigo, pretendo evidenciar algumas dificuldades que cercam a definição do estatuto do corpo em Esquisse d'une théorie des émotions (Esboço de uma teoria das emoções), obra de Jean-Paul Sartre publicada em 1939. Tais dificuldades, fundamentalmente, advêm do primado que a consciência adquire na eidética sartreana da emoção, o qual acaba por condicionar a atividade do corpo à espontaneidade da consciência. Trata-se, portanto, de uma posição teórica que guarda semelhanças com o intelectualismo, o qual, todavia, é objeto das críticas de Sartre desde o início da referida obra. Com o intuito de assinalar essas questões, procuro expor a eidética sartreana da emoção, dando ênfase ao estatuto problemático do corpo nela presente. Contudo, é necessário, antes dessa exposição, retomar o teor da censura às teorias psicológicas da emoção no texto de Sartre, em especial a de William James, bem como recuperar algumas teses centrais do próprio James a respeito da emoção.

William Shakspeare : drame en six actes. [Suivi de] Une minute trop tard : opérette en un acte. Livr. 307 / par Ferdinand Dugué... ; par M. Vernon, musique de M. Villebichot...

Collection : Théâtre contemporain illustré ; 306e et 307e livraisons

William Shakspeare : drame en six actes. [Suivi de] Une minute trop tard : opérette en un acte. Livr. 306 / par Ferdinand Dugué... ; par M. Vernon, musique de M. Villebichot...

Collection : Théâtre contemporain illustré ; 306e et 307e livraisons

W[illiam] Hehir, gagnant [d'une] série [du] 1000 [i. e. 10000] m marche [Jeux olympiques d'Anvers, 17/8/20] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 60596

Feuillet d'une demi-Bible en français ayant appartenu à Jean de Berry

A l'exception des ex-libris et annotations de Jean Flamel, le manuscrit ne contient que la fin du Psautier sur une colonne (f. 4v) : « Sire, delivre nous en l'eure de la mort. / Sire, delivre (a exponctué) nous au jour du jugement ...-.... Sire, oy m'oroison / Et mon cri a toy viengne ». « Dex a qui propre chose est d'avoir merci ...-.... que la grant misericorde de ta pitié nous absoille. Par Crist nostre Seigneur. Ainsi soit il ». « Ci fine le Psautier en françois ». « Ci doit venir aprés le livre des paraboles Salemon ».