Risk factors for mortality from imported falciparum malaria in the United Kingdom over 20 years: an observational study

Objectives To determine which travellers with malaria are at greatest risk of dying, highlighting factors which can be used to target health messages to travellers. Design Observational study based on 20 years of UK national data. Setting National register of malaria cases. Participants 25 054 patients notified with Plasmodium falciparum malaria, of whom 184 died, between 1987 and 2006. Main outcome measures Comparison between those with falciparum malaria who died and non-fatal cases, including age, reason for travel, country of birth, time of year diagnosed, malaria prophylaxis used. Results Mortality increased steadily with age, with a case fatality of 25/548 (4.6%) in people aged >65 years, adjusted odds ratio 10.68 (95% confidence interval 6.4 to 17.8), P<0.001 compared with 18–35 year olds. There were no deaths in the ≤5 year age group. Case fatality was 3.0% (81/2740 cases) in tourists compared with 0.32% (26/8077) in travellers visiting friends and relatives (adjusted odds ratio 8.2 (5.1 to 13.3), P<0.001). Those born in African countries with endemic malaria had a case fatality of 0.4% (36/8937) compared with 2.4% (142/5849) in others (adjusted odds ratio 4.6 (3.1 to 9.9), P<0.001). Case fatality was particularly high from the Gambia. There was an inverse correlation in mortality between region of presentation and number of cases seen in the region (R2=0.72, P<0.001). Most delay in fatal cases was in seeking care. Conclusions Most travellers acquiring malaria are of African heritage visiting friends and relatives. In contrast the risks of dying from malaria once acquired are highest in the elderly, tourists, and those presenting in areas in which malaria is seldom seen. Doctors often do not think of these as high risk groups for malaria; for this reason they are important groups to target in pre-travel advice

Complexity of Bradley-Manna-Sipma Lexicographic Ranking Functions

In this paper we turn the spotlight on a class of lexicographic ranking functions introduced by Bradley, Manna and Sipma in a seminal CAV 2005 paper, and establish for the first time the complexity of some problems involving the inference of such functions for linear-constraint loops (without precondition). We show that finding such a function, if one exists, can be done in polynomial time in a way which is sound and complete when the variables range over the rationals (or reals). We show that when variables range over the integers, the problem is harder -- deciding the existence of a ranking function is coNP-complete. Next, we study the problem of minimizing the number of components in the ranking function (a.k.a. the dimension). This number is interesting in contexts like computing iteration bounds and loop parallelization. Surprisingly, and unlike the situation for some other classes of lexicographic ranking functions, we find that even deciding whether a two-component ranking function exists is harder than the unrestricted problem: NP-complete over the rationals and $\Sigma^P_2$-complete over the integers.Comment: Technical report for a corresponding CAV'15 pape

On Multiphase-Linear Ranking Functions

Multiphase ranking functions ($\mathit{M{\Phi}RFs}$) were proposed as a means to prove the termination of a loop in which the computation progresses through a number of "phases", and the progress of each phase is described by a different linear ranking function. Our work provides new insights regarding such functions for loops described by a conjunction of linear constraints (single-path loops). We provide a complete polynomial-time solution to the problem of existence and of synthesis of $\mathit{M{\Phi}RF}$ of bounded depth (number of phases), when variables range over rational or real numbers; a complete solution for the (harder) case that variables are integer, with a matching lower-bound proof, showing that the problem is coNP-complete; and a new theorem which bounds the number of iterations for loops with $\mathit{M{\Phi}RFs}$. Surprisingly, the bound is linear, even when the variables involved change in non-linear way. We also consider a type of lexicographic ranking functions, $\mathit{LLRFs}$, more expressive than types of lexicographic functions for which complete solutions have been given so far. We prove that for the above type of loops, lexicographic functions can be reduced to $\mathit{M{\Phi}RFs}$, and thus the questions of complexity of detection and synthesis, and of resulting iteration bounds, are also answered for this class.Comment: typos correcte

Selecting electrical billing attributes: big data preprocessing improvements

The attribute selection is a very relevant activity of data preprocessing when discovering knowledge on databases. Its main objective is to eliminate irrelevant and/or redundant attributes to obtain computationally treatable issues, without affecting the quality of the solution. Various techniques are proposed, mainly from two approaches: wrapper and ranking. This article evaluates a novel approach proposed by Bradley and Mangasarian (Machine learning ICML. Morgan Kaufmann, Sn Fco, CA, pp. 82–90, 1998 [1]) which uses concave programming for minimizing the classification error and the number of attributes required to perform the task. The technique is evaluated using the electric service billing database in Colombia. The results are compared against traditional techniques for evaluating: attribute reduction, processing time, discovered knowledge size, and solution quality

Tuberculosis treatment success among rural and urban Ugandans living with HIV: a retrospective study.

Setting: Government health centres and hospitals (six urban and 20 rural) providing tuberculosis (TB) treatment for people living with the human immunodeficiency virus (PLHIV) in central and western Uganda. Objective: To identify and quantify modifiable factors that limit TB treatment success among PLHIV in rural Uganda. Design: A retrospective cross-sectional review of routine Uganda National Tuberculosis and Leprosy Programme clinic registers and patient files of HIV-positive patients who received anti-tuberculosis treatment in 2014. Results: Of 191 rural patients, 66.7% achieved treatment success compared to 81.1% of 213 urban patients. Adjusted analysis revealed higher average treatment success in urban patients than in rural patients (OR 3.95, 95%CI 2.70-5.78, P < 0.01, generalised estimating equation model). Loss to follow-up was higher and follow-up sputum smear results were less frequently recorded in TB clinic registers among rural patients. Patients receiving treatment at higher-level facilities in rural settings had greater odds of treatment success, while patients receiving treatment at facilities where drug stock-outs had occurred had lower odds of treatment success. Conclusion: Lower reported treatment success in rural settings is mainly attributed to clinic-centred factors such as treatment monitoring procedures. We recommend strengthening treatment monitoring and delivery

Multiyear social stability and social information use in reef sharks with diel fission–fusion dynamics

Animals across vertebrate taxa form social communities and often exist as fission–fusion groups. Central place foragers (CPF) may form groups from which they will predictably disperse to forage, either individually or in smaller groups, before returning to fuse with the larger group. However, the function and stability of social associations in predatory fish acting as CPFs is unknown, as individuals do not need to return to a shelter yet show fidelity to core areas. Using dynamic social networks generated from acoustic tracking data, we document spatially structured sociality in CPF grey reef sharks at a Pacific Ocean atoll. We show that sharks form stable social groups over multiyear periods, with some dyadic associations consistent for up to 4 years. Groups primarily formed during the day, increasing in size throughout the morning before sharks dispersed from the reef at night. Our simulations suggest that multiple individuals sharing a central place and using social information while foraging (i.e. local enhancement) will outperform non-CPF social foragers. We show multiyear social stability in sharks and suggest that social foraging with information transfer could provide a generalizable mechanism for the emergence of sociality with group central place foraging

Microbial and Biogeochemical Dynamics in Glacier Forefields Are Sensitive to Century-Scale Climate and Anthropogenic Change

The recent retreat of glaciers and ice sheets as a result of global warming exposes forefield soils that are rapidly colonized by microbes. These ecosystems are dominant in high-latitude carbon and nutrient cycles as microbial activity drives biogeochemical transformations within these newly exposed soils. Despite this, little is known about the response of these emerging ecosystems and associated biogeochemical cycles to projected changes in environmental factors due to human impacts. Here, we applied the model SHIMMER to quantitatively explore the sensitivity of biogeochemical dynamics in the forefield of Midtre Lovénbreen, Svalbard, to future changes in climate and anthropogenic forcings including soil temperature, snow cover, and nutrient and organic substrate deposition. Model results indicated that the rapid warming of the Arctic, as well as an increased deposition of organic carbon and nutrients, may impact primary microbial colonizers in Arctic soils. Warming and increased snow-free conditions resulted in enhanced bacterial production and an accumulation of biomass that was sustained throughout 200 years of soil development. Nitrogen deposition stimulated growth during the first 50 years of soil development following exposure. Increased deposition of organic carbon sustained higher rates of bacterial production and heterotrophic respiration leading to decreases in net ecosystem production and thus net CO2 efflux from soils. Pioneer microbial communities were particularly susceptible to future changes. All future climate simulations encouraged a switch from allochthonously-dominated young soils (<40 years) to microbially-dominated older soils, due to enhanced heterotrophic degradation of organic matter. Critically, this drove remineralisation and increased nutrient availability. Overall, we show that human activity, especially the burning of fossil fuels and the enhanced deposition of nitrogen and organic carbon, has the potential to considerably affect the biogeochemical development of recently exposed Arctic soils in the present day and for centuries into the future. These effects must be acknowledged when attempting to make accurate predictions of the future fate of Arctic soils that are exposed over large expanses of presently ice-covered regions.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Psychological type and attitude towards Celtic Christianity among committed Churchgoers in the United Kingdom: an empirical study

This article takes the burgeoning interest in Celtic Christianity as a key example of the way in which churches may be responding to the changing spiritual and religious landscape in the United Kingdom today and examines the power of psychological type theory to account for variation in the attitude of committed churchgoers to this innovation. Data provided by a sample of 248 Anglican clergy and lay church officers (who completed the Francis Psychological Type Scales together with the Attitude toward Celtic Christianity Scale) demonstrated that intuitive types, feeling types, and perceiving types reported a more positive attitude towards Celtic Christianity than sensing types, thinking types, and judging types. These findings are interpreted to analyse the appeal of Celtic Christianity and to suggest why some committed churchgoers may find this innovation less attractive

Tubular epithelial cells in renal clear cell carcinoma express high RIPK1/3 and show increased susceptibility to TNF receptor 1-induced necroptosis.

We previously reported that renal clear cell carcinoma cells (RCC) express both tumor necrosis factor receptor (TNFR)-1 and -2, but that, in organ culture, a TNF mutein that only engages TNFR1, but not TNFR2, causes extensive cell death. Some RCC died by apoptosis based on detection of cleaved caspase 3 in a minority TUNEL-positive cells but the mechanism of death in the remaining cells was unexplained. Here, we underpin the mechanism of TNFR1-induced cell death in the majority of TUNEL-positive RCC cells, and show that they die by necroptosis. Malignant cells in high-grade tumors displayed threefold to four fold higher expression of both receptor-interacting protein kinase (RIPK)1 and RIPK3 compared with non-tumor kidney tubular epithelium and low-grade tumors, but expression of both enzymes was induced in lower grade tumors in organ culture in response to TNFR1 stimulation. Furthermore, TNFR1 activation induced significant MLKL(Ser358) and Drp1(Ser616) phosphorylation, physical interactions in RCC between RIPK1-RIPK3 and RIPK3-phospho-MLKL(Ser358), and coincidence of phospho-MLKL(ser358) and phospho-Drp1(Ser616) at mitochondria in TUNEL-positive RCC. A caspase inhibitor only partially reduced the extent of cell death following TNFR1 engagement in RCC cells, whereas three inhibitors, each targeting a different step in the necroptotic pathway, were much more protective. Combined inhibition of caspases and necroptosis provided additive protection, implying that different subsets of cells respond differently to TNF-α, the majority dying by necroptosis. We conclude that most high-grade RCC cells express increased amounts of RIPK1 and RIPK3 and are poised to undergo necroptosis in response to TNFR1 signaling.National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre , Kidney Research UK and NIH grant R01-HL36003.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Nature Publishing Group

Water source dynamics influence macroinvertebrate communities across groundwater-fed streams in a glacierized catchment

Groundwater contributions to streamflow significantly influence the structure and function of riverine ecosystems, particularly in glacierized catchments where there are marked differences in water sources and subsurface flow paths. Here, we investigated spatial and temporal variation in relationships between water sources, flow paths, physical and chemical processes, organic matter, microbial biofilms, and macroinvertebrates across groundwater-fed streams in the glacierized Toklat River catchment of Denali National Park, Alaska. Streams fed predominantly by seepage from the valley sides were perennial, whereas streams sustained by glacial meltwater seepage were ephemeral. Differences in environmental conditions between flow regimes appeared to influence spatial and temporal patterns of organic matter, linking to macroinvertebrate community dynamics. Macroinvertebrates in perennial streams were supported by fine particulate organic matter from subsurface flow paths during summer, transitioning to a combination of fine particulate matter and leaf litter in autumn. In comparison, macroinvertebrates inhabiting ephemeral streams, which only flowed during autumn, were supported by leaf litter. Some macroinvertebrate taxa were unaffected by turnover in organic matter, indicating potential plasticity in organic matter resource use. Findings highlight the importance of considering spatial and temporal variation in groundwater-fed streams, considering that projected hydrological changes under a changing climate may have significant implications for these systems