The effect of dose on the antimalarial efficacy of artemether-lumefantrine: a systematic review and pooled analysis of individual patient data.

BACKGROUND: Artemether-lumefantrine is the most widely used artemisinin-based combination therapy for malaria, although treatment failures occur in some regions. We investigated the effect of dosing strategy on efficacy in a pooled analysis from trials done in a wide range of malaria-endemic settings. METHODS: We searched PubMed for clinical trials that enrolled and treated patients with artemether-lumefantrine and were published from 1960 to December, 2012. We merged individual patient data from these trials by use of standardised methods. The primary endpoint was the PCR-adjusted risk of Plasmodium falciparum recrudescence by day 28. Secondary endpoints consisted of the PCR-adjusted risk of P falciparum recurrence by day 42, PCR-unadjusted risk of P falciparum recurrence by day 42, early parasite clearance, and gametocyte carriage. Risk factors for PCR-adjusted recrudescence were identified using Cox's regression model with frailty shared across the study sites. FINDINGS: We included 61 studies done between January, 1998, and December, 2012, and included 14 327 patients in our analyses. The PCR-adjusted therapeutic efficacy was 97·6% (95% CI 97·4-97·9) at day 28 and 96·0% (95·6-96·5) at day 42. After controlling for age and parasitaemia, patients prescribed a higher dose of artemether had a lower risk of having parasitaemia on day 1 (adjusted odds ratio [OR] 0·92, 95% CI 0·86-0·99 for every 1 mg/kg increase in daily artemether dose; p=0·024), but not on day 2 (p=0·69) or day 3 (0·087). In Asia, children weighing 10-15 kg who received a total lumefantrine dose less than 60 mg/kg had the lowest PCR-adjusted efficacy (91·7%, 95% CI 86·5-96·9). In Africa, the risk of treatment failure was greatest in malnourished children aged 1-3 years (PCR-adjusted efficacy 94·3%, 95% CI 92·3-96·3). A higher artemether dose was associated with a lower gametocyte presence within 14 days of treatment (adjusted OR 0·92, 95% CI 0·85-0·99; p=0·037 for every 1 mg/kg increase in total artemether dose). INTERPRETATION: The recommended dose of artemether-lumefantrine provides reliable efficacy in most patients with uncomplicated malaria. However, therapeutic efficacy was lowest in young children from Asia and young underweight children from Africa; a higher dose regimen should be assessed in these groups. FUNDING: Bill & Melinda Gates Foundation.

Paperikoneen laatusäätöjärjestelmän uusinnan vaikutukset laatusäätöjen suorituskykyyn

Tutkimuksen kohteena olleen UPM-Kymmene Oyj Kajaanin tehtaan PK3:n laatusäätöjärjestelmä ja mittapalkki uusittiin, jolloin haluttiin selvittää uusinnan vaikutuksia laatusäätöjen suorituskykyyn ja paperin laatuun. Työn kirjallisessa osassa perehdyttiin paperinvalmistusprosessin osiin kyseisen sanomalehtipaperikoneen tapauksessa sekä keskeisimpiin paperin laatuominaisuuksiin liittyviin mittaus- ja säätölaitteisiin sekä niiden toimintaan. Seurattaviksi paperin laatusuureiksi valittiin neliömassa, kuivamassa, kosteus ja paksuus, jotka ovat sanomalehtipaperin tärkeimpiä online-mitattavia ominaisuuksia. Paperin laatusuureiden seurantaan käytetään erilaisia tunnuslukuja ja työkaluja, joita on esitelty tässä työssä. Laatusuureiden konesuuntaisen ja poikkisuuntaisen seurannan tunnusluvuksi valittiin yleisesti käytössä oleva 2σ-keskiarvohajonta. Säätöjen suorituskykyä seurattiin suorituskykykolmion ohjausmatkaindeksien (CTI) ja erosuureen integraalien (IAE) avulla. Kokeellisessa osassa kerättiin mittaustietoja sekä vanhan että uuden laatusäätöjärjestelmän aikana. Seurattavat ajotilanteet paperikoneella jaettiin stabiiliin ajoon ja muutostilanteisiin, jotka käsittävät katkot ja lajinvaihtotilanteet. Stabiilin ajon aikana selvitettiin laatusuureiden hajontojen ja säätöjen suorituskykyindeksien normaaleissa tasoissa tapahtuneet muutokset. Muutostilanteiden osalta haluttiin selvittää, nopeuttaako järjestelmäuusinta katkoista toipumista ja lajinvaihtoaikaa. Stabiilin ajon seurannasta saatujen tulosten perusteella neliömassan ja kuivamassan konesuuntaiset hajonnat kasvoivat järjestelmäuusinnan myötä, mutta kosteuden konesuuntaiset hajonnat pienenivät. Laatusuureiden poikkisuuntaisista hajonnoista neliömassan sekä kuivamassan hajonnat kasvoivat ja kosteuden sekä paksuuden hajonnat pienenivät joidenkin lajien osalta. Poikkisuuntaisten laatusuureiden, etenkin paksuuden, toipuminen katkon jälkeen nopeutui. Myös lajinvaihtoon kuluva aika lyheni poikkisuuntaisilla laatusuureilla. Muutostilanteiden konesuuntaisten hajontojen asettumisajat eivät juuri parantuneet.

Worldwide Population Structure, Long-Term Demography, and Local Adaptation of Helicobacter pylori.

Helicobacter pylori is an important human pathogen associated with serious gastric diseases. Owing to its medical importance and close relationship with its human host, understanding genomic patterns of global and local adaptation in H. pylori may be of particular significance for both clinical and evolutionary studies. Here we present the first such whole genome analysis of 60 globally distributed strains, from which we inferred worldwide population structure and demographic history and shed light on interesting global and local events of positive selection, with particular emphasis on the evolution of San-associated lineages. Our results indicate a more ancient origin for the association of humans and H. pylori than previously thought. We identify several important perspectives for future clinical research on candidate selected regions that include both previously characterized genes (e.g., transcription elongation factor NusA and tumor necrosis factor alpha-inducing protein Tipα) and hitherto unknown functional genes.

Lidar measurement of surface melt for a temperate Alpine glacier at the seasonal and hourly scales

This study shows how a new generation of terrestrial laser scanners can be used to investigate glacier surface ablation and other elements of glacial hydrodynamics at exceptionally high spatial and temporal resolution. The study area is an Alpine valley glacier, Haut Glacier d'Arolla, Switzerland. Here we use an ultra-long-range lidar RIEGL VZ-6000 scanner, having a laser specifically designed for measurement of snow- and ice-cover surfaces. We focus on two timescales: seasonal and daily. Our results show that a near-infrared scanning laser system can provide high-precision elevation change and ablation data from long ranges, and over relatively large sections of the glacier surface. We use it to quantify spatial variations in the patterns of surface melt at the seasonal scale, as controlled by both aspect and differential debris cover. At the daily scale, we quantify the effects of ogive-related differences in ice surface debris content on spatial patterns of ablation. Daily scale measurements point to possible hydraulic jacking of the glacier associated with short-term water pressure rises. This latter demonstration shows that this type of lidar may be used to address subglacial hydrologic questions, in addition to motion and ablation measurements.

What young people with spina bifida want to know about sex and are not being told.

OBJECTIVE: The aim of this paper was to examine sexual knowledge, concerns and needs of youth with spina bifida (SB) to inform the medical community on ways to better support their sexual health. METHODS: As part of the Video Intervention/Prevention Assessment (VIA) - transitions, a prospective cohort study, 309 h of video data were collected from 14 participants (13-28 years old) with SB. Participants were loaned a video camcorder for 8-12 weeks to shoot visual narratives about any aspects of their lives. V/A visual narratives were analysed with grounded theory using NVivo. RESULTS: Out of 14 participants, 11 (six women) addressed issues surrounding romantic relationships and sexuality in their video clips. Analysis revealed shared concerns, questions and challenges regarding sexuality gathered under four main themes: romantic relationships, sexuality, fertility and parenthood, and need for more talk on sexuality. CONCLUSIONS: Youth with SB reported difficulties in finding answers to questions regarding their sexuality, romantic relationships and fertility. This study revealed a need for help from the medical community to inform and empower youth with SB in the area of sexual health. Through sexual and reproductive health education with patients and parents starting at an early age, medical providers can further encourage healthy emotional and physical development in adolescents transitioning into adulthood.

Design and evaluation of a continuous flow, integrated nebulizer-hydride generator for flame atomic absorption spectrometry

An evaluation of the performance of a continuous flow hydride generator-nebulizer for flame atomic absorption spectrometry was carried out. Optimization of nebulizer gas flow rate, sample acid concentration, sample and tetrahydroborate uptake rates and reductant concentration, on the As and Se absorbance signals was carried out. A hydrogen-argon flame was used. An improvement of the analytical sensitivity relative to the conventional bead nebulizer used in flame AA was obtained (2 (As) and 4.8 (Se) µg L-1). Detection limits (3σb) of 1 (As) and 1.3 (Se) µg L-1 were obtained. Accuracy of the method was checked by analyzing an oyster tissue reference material.

Sistema multicomutado de análise em fluxo para determinação de amônio e monocloramina em águas residuais e produtos de desinfecção

A binary sampling flow analysis system equipped with gas diffusion cell was developed for NH4+ and/or NH2Cl determination in wastewater and disinfection products samples based on the Berthelot reaction of the NH2Cl diffused through the semi-permeable PTFE membrane. The effect of the analytical conditions related to the reaction and flow parameters were evaluated and N-NH4+ and N-NH2Cl were determined in concentration ranges from 0.17 to 5 mg L-1 and from 0.5 to 14.5 mg L-1, respectively. Limits of detection (3σ) of 50 and 140 µg L-1 for N-NH4+ and N-NH2Cl were calculated, respectively, and RSD of 5 and 2% were calculated for 10 consecutive determinations of N-NH4+ (1 and 3 mg L-1) and N-NH2Cl (3 and 9 mg L-1), respectively with 30 determinations h-1.

Preconcentración y atomización con tubo en la llama para la determinación de Cadmio en agua de mar

A flow injection on-line pre-concentration system coupled to thermospray flame furnace atomic absorption spectrometry (TS-FF-AAS) for cadmium determination at sub μg L-1 levels in seawater samples was developed. The on-line system was evaluated by analysing cadmium containing in a synthetic seawater matrix (2.5% m/v NaCl, 0.5% m/v MgCl2 and 0.8% m/v CaCl2). A sample volume of 2 mL allows determining Cd with a detection limits of 30 ng L-1 (3* σblank/slope), pre-concentration factor of 34 and repeatability of 1,8% (calculated as RSD, N=8 and containing 200 ng L-1 of Cd ).

Application of GA-PLS and GA-KPLS calculations for the prediction of the retention indices of essential oils

Genetic algorithm and partial least square (GA-PLS) and kernel PLS (GA-KPLS) techniques were used to investigate the correlation between retention indices (RI) and descriptors for 117 diverse compounds in essential oils from 5 Pimpinella species gathered from central Turkey which were obtained by gas chromatography and gas chromatography-mass spectrometry. The square correlation coefficient leave-group-out cross validation (LGO-CV) (Q²) between experimental and predicted RI for training set by GA-PLS and GA-KPLS was 0.940 and 0.963, respectively. This indicates that GA-KPLS can be used as an alternative modeling tool for quantitative structure-retention relationship (QSRR) studies.

Determinação de Mn e Zn em arroz empregando espectrometria de fluorescência de raios x de energia dispersiva

A simple, fast and inexpensive method was developed to determine essential elements in pellets of rice samples using energy dispersive X-ray fluorescence spectrometry (EDXRF). The accuracy and precision were evaluated using Standard Reference Material (rice flour NIST 1568a), and yielding relative standard deviation below 5%. The paired t-test showed good agreement within 95% confidence values. The detection limits (3σ) of Mn and Zn were 5.1 and 2.2 mg kg-1, respectively. The proposed method proved to be effective when used to determine Mn and Zn in commercial samples of rice without go by stage of decomposition.

L'Univers

1869/12/21 (Numéro 963).

Hiiden linna

Soitinnus: piano.

Induction Motor Drive Energy Efficiency - Simulation and Analysis

A coupled system simulator, based on analytical circuit equations and a finite element method (FEM) model of the motor has been developed and it is used to analyse a frequency-converterfed industrial squirrel-cage induction motor. Two control systems that emulate the behaviour of commercial direct-torque-controlled (DTC) and vector-controlled industrial frequency converters have been studied, implemented in the simulation software and verified by extensive laboratory tests. Numerous factors that affect the operation of a variable speed drive (VSD) and its energy efficiency have been investigated, and their significance in the simulation of the VSD results has been studied. The dependency of the frequency converter, induction motor and system losses on the switching frequency is investigated by simulations and measurements at different speeds for both the vector control and the DTC. Intensive laboratory measurements have been carried out to verify the simulation results.

Atividades amilolítica e pectinolítica de Alternaria solani e a relação com a agressividade em tomateiro

As atividades amilolítica e pectinolítica de 45 isolados de Alternaria solani, provenientes de diferentes hospedeiros, foram estimadas por meio da difusão enzimática em meio sólido específico e mensuração do halo de degradação do substrato. Todos os isolados degradaram pectina. Apenas 17 isolados apresentaram atividade amilolítica, sendo nove isolados provenientes de batateira. Somente o isolado AS18 se destacou como bom produtor de ambas as enzimas. Uma vez que a atividade pectinolítica foi mais evidente, avaliou-se a influência de pectinases na agressividade de A. solani ao tomateiro. Para isso, cinco isolados (2 de berinjela, 2 de tomateiro e 1 de batateira) contrastantes quanto à produção de pectinases foram selecionados para testes em folíolos destacados e plantas inteiras. Quatro isolados foram utilizados no teste em folíolos destacados (AS6, AS7, AS12 e AS26), e constatou-se haver variabilidade patogênica. A correlação obtida entre o tamanho das lesões e a atividade pectinolítica foi de r = 0,963 (P = 0,087). Cinco isolados (AS6, AS7, AS12, AS25 e AS26) foram inoculados em plantas inteiras de tomate. Os isolados não diferiram quanto ao número de lesões/cm² de área foliar, porém variaram em agressividade. Houve correlação (r = 0,916; P = 0,042) entre a atividade de pectinases e o índice de doença, sugerindo possível papel para as enzimas pécticas durante a infecção de A. solani em tomateiro. É provável que as diferenças no perfil enzimático dos isolados estejam associadas ao hospedeiro original de onde os mesmos foram obtidos. Os resultados reforçaram evidências de especificidade por hospedeiro em populações de A. solani.