26 research outputs found
The influence of pregnancy on the pharmacokinetic properties of artemisinin combination therapy (ACT): a systematic review
Pregnancy has been reported to alter the pharmacokinetic properties of anti-malarial drugs, including the different components of artemisinin-based combination therapy (ACT). However, small sample sizes make it difficult to draw strong conclusions based on individual pharmacokinetic studies. The aim of this review is to summarize the evidence of the influence of pregnancy on the pharmacokinetic properties of different artemisinin-based combinations. A PROSPERO-registered systematic review to identify clinical trials that investigated the influence of pregnancy on the pharmacokinetic properties of different forms of ACT was conducted, following PRISMA guidelines. Without language restrictions, Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus were searched for studies published up to November 2015. The following components of ACT that are currently recommend by the World Health Organization as first-line treatment of malaria in pregnancy were reviewed: artemisinin, artesunate, dihydroartemisinin, lumefantrine, amodiaquine, mefloquine, sulfadoxine, pyrimethamine, piperaquine, atovaquone and proguanil. The literature search identified 121 reports, 27 original studies were included. 829 pregnant women were included in the analysis. Comparison of the available studies showed lower maximum concentrations (Cmax) and exposure (AUC) of dihydroartemisinin, the active metabolite of all artemisinin derivatives, after oral administration of artemether, artesunate and dihydroartemisinin in pregnant women. Low day 7 concentrations were commonly seen in lumefantrine studies, indicating a low exposure and possibly reduced efficacy. The influence of pregnancy on amodiaquine and piperaquine seemed not to be clinically relevant. Sulfadoxine plasma concentration was significantly reduced and clearance rates were higher in pregnancy, while pyrimethamine and mefloquine need more research as no general conclusion can be drawn based on the available evidence. For atovaquone, the available data showed a lower maximum concentration and exposure. Finally, the maximum concentration of cycloguanil, the active metabolite of proguanil, was significantly lower, possibly compromising the efficacy. These findings suggest that reassessment of the dose of the artemisinin derivate and some components of ACT are necessary to ensure the highest possible efficacy of malaria treatment in pregnant women. However, for most components of ACT, data were insufficient and extensive research with larger sample sizes will be necessary to identify the exact influences of pregnancy on the pharmacokinetic properties of different artemisinin-based combinations. In addition, different clinical studies used diverse study designs with various reported relevant outcomes. Future pharmacokinetic studies could benefit from more uniform designs, in order to increase quality, robustness and effectiveness. CRD42015023756 (PROSPERO
The Atacama Cosmology Telescope: Cosmological parameters from three seasons of data
We present constraints on cosmological and astrophysical parameters from
high-resolution microwave background maps at 148 GHz and 218 GHz made by the
Atacama Cosmology Telescope (ACT) in three seasons of observations from 2008 to
2010. A model of primary cosmological and secondary foreground parameters is
fit to the map power spectra and lensing deflection power spectrum, including
contributions from both the thermal Sunyaev-Zeldovich (tSZ) effect and the
kinematic Sunyaev-Zeldovich (kSZ) effect, Poisson and correlated anisotropy
from unresolved infrared sources, radio sources, and the correlation between
the tSZ effect and infrared sources. The power ell^2 C_ell/2pi of the thermal
SZ power spectrum at 148 GHz is measured to be 3.4 +\- 1.4 muK^2 at ell=3000,
while the corresponding amplitude of the kinematic SZ power spectrum has a 95%
confidence level upper limit of 8.6 muK^2. Combining ACT power spectra with the
WMAP 7-year temperature and polarization power spectra, we find excellent
consistency with the LCDM model. We constrain the number of effective
relativistic degrees of freedom in the early universe to be Neff=2.79 +\- 0.56,
in agreement with the canonical value of Neff=3.046 for three massless
neutrinos. We constrain the sum of the neutrino masses to be Sigma m_nu < 0.39
eV at 95% confidence when combining ACT and WMAP 7-year data with BAO and
Hubble constant measurements. We constrain the amount of primordial helium to
be Yp = 0.225 +\- 0.034, and measure no variation in the fine structure
constant alpha since recombination, with alpha/alpha0 = 1.004 +/- 0.005. We
also find no evidence for any running of the scalar spectral index, dns/dlnk =
-0.004 +\- 0.012.Comment: 26 pages, 22 figures. This paper is a companion to Das et al. (2013)
and Dunkley et al. (2013). Matches published JCAP versio
The Atacama Cosmology Telescope: Data Characterization and Map Making
We present a description of the data reduction and mapmaking pipeline used
for the 2008 observing season of the Atacama Cosmology Telescope (ACT). The
data presented here at 148 GHz represent 12% of the 90 TB collected by ACT from
2007 to 2010. In 2008 we observed for 136 days, producing a total of 1423 hours
of data (11 TB for the 148 GHz band only), with a daily average of 10.5 hours
of observation. From these, 1085 hours were devoted to a 850 deg^2 stripe (11.2
hours by 9.1 deg) centered on a declination of -52.7 deg, while 175 hours were
devoted to a 280 deg^2 stripe (4.5 hours by 4.8 deg) centered at the celestial
equator. We discuss sources of statistical and systematic noise, calibration,
telescope pointing, and data selection. Out of 1260 survey hours and 1024
detectors per array, 816 hours and 593 effective detectors remain after data
selection for this frequency band, yielding a 38% survey efficiency. The total
sensitivity in 2008, determined from the noise level between 5 Hz and 20 Hz in
the time-ordered data stream (TOD), is 32 micro-Kelvin sqrt{s} in CMB units.
Atmospheric brightness fluctuations constitute the main contaminant in the data
and dominate the detector noise covariance at low frequencies in the TOD. The
maps were made by solving the least-squares problem using the Preconditioned
Conjugate Gradient method, incorporating the details of the detector and noise
correlations. Cross-correlation with WMAP sky maps, as well as analysis from
simulations, reveal that our maps are unbiased at multipoles ell > 300. This
paper accompanies the public release of the 148 GHz southern stripe maps from
2008. The techniques described here will be applied to future maps and data
releases.Comment: 20 pages, 18 figures, 6 tables, an ACT Collaboration pape
The Atacama Cosmology Telescope: Sunyaev Zel'dovich Selected Galaxy Clusters at 148 GHz in the 2008 Survey
We report on twenty-three clusters detected blindly as Sunyaev-Zel'dovich
(SZ) decrements in a 148 GHz, 455 square-degree map of the southern sky made
with data from the Atacama Cosmology Telescope 2008 observing season. All SZ
detections announced in this work have confirmed optical counterparts. Ten of
the clusters are new discoveries. One newly discovered cluster, ACT-CL
J0102-4915, with a redshift of 0.75 (photometric), has an SZ decrement
comparable to the most massive systems at lower redshifts. Simulations of the
cluster recovery method reproduce the sample purity measured by optical
follow-up. In particular, for clusters detected with a signal-to-noise ratio
greater than six, simulations are consistent with optical follow-up that
demonstrated this subsample is 100% pure. The simulations further imply that
the total sample is 80% complete for clusters with mass in excess of 6x10^14
solar masses referenced to the cluster volume characterized by five hundred
times the critical density. The Compton y -- X-ray luminosity mass comparison
for the eleven best detected clusters visually agrees with both self-similar
and non-adiabatic, simulation-derived scaling laws.Comment: 13 pages, 7 figures, Accepted for publication in Ap
The Atacama Cosmology Telescope: Extragalactic Sources at 148 GHz in the 2008 Survey
We report on extragalactic sources detected in a 455 square-degree map of the
southern sky made with data at a frequency of 148 GHz from the Atacama
Cosmology Telescope 2008 observing season. We provide a catalog of 157 sources
with flux densities spanning two orders of magnitude: from 15 to 1500 mJy.
Comparison to other catalogs shows that 98% of the ACT detections correspond to
sources detected at lower radio frequencies. Three of the sources appear to be
associated with the brightest cluster galaxies of low redshift X-ray selected
galaxy clusters. Estimates of the radio to mm-wave spectral indices and
differential counts of the sources further bolster the hypothesis that they are
nearly all radio sources, and that their emission is not dominated by
re-emission from warm dust. In a bright (>50 mJy) 148 GHz-selected sample with
complete cross-identifications from the Australia Telescope 20 GHz survey, we
observe an average steepening of the spectra between 5, 20, and 148 GHz with
median spectral indices of , , and . When the
measured spectral indices are taken into account, the 148 GHz differential
source counts are consistent with previous measurements at 30 GHz in the
context of a source count model dominated by radio sources. Extrapolating with
an appropriately rescaled model for the radio source counts, the Poisson
contribution to the spatial power spectrum from synchrotron-dominated sources
with flux density less than 20 mJy is C^{\rm Sync} = (2.8 \pm 0.3) \times
10^{-6} \micro\kelvin^2.Comment: Accepted to Ap
The Atacama Cosmology Telescope: A Measurement of the Cosmic Microwave Background Power Spectrum at 148 and 218 GHz from the 2008 Southern Survey
We present measurements of the cosmic microwave background (CMB) power
spectrum made by the Atacama Cosmology Telescope at 148 GHz and 218 GHz, as
well as the cross-frequency spectrum between the two channels. Our results
clearly show the second through the seventh acoustic peaks in the CMB power
spectrum. The measurements of these higher-order peaks provide an additional
test of the {\Lambda}CDM cosmological model. At l > 3000, we detect power in
excess of the primary anisotropy spectrum of the CMB. At lower multipoles 500 <
l < 3000, we find evidence for gravitational lensing of the CMB in the power
spectrum at the 2.8{\sigma} level. We also detect a low level of Galactic dust
in our maps, which demonstrates that we can recover known faint, diffuse
signals.Comment: 19 pages, 13 figures. Submitted to ApJ. This paper is a companion to
Hajian et al. (2010) and Dunkley et al. (2010
The Atacama Cosmology Telescope: Cosmology from Galaxy Clusters Detected via the Sunyaev-Zel'dovich Effect
We present constraints on cosmological parameters based on a sample of
Sunyaev-Zel'dovich-selected galaxy clusters detected in a millimeter-wave
survey by the Atacama Cosmology Telescope. The cluster sample used in this
analysis consists of 9 optically-confirmed high-mass clusters comprising the
high-significance end of the total cluster sample identified in 455 square
degrees of sky surveyed during 2008 at 148 GHz. We focus on the most massive
systems to reduce the degeneracy between unknown cluster astrophysics and
cosmology derived from SZ surveys. We describe the scaling relation between
cluster mass and SZ signal with a 4-parameter fit. Marginalizing over the
values of the parameters in this fit with conservative priors gives sigma_8 =
0.851 +/- 0.115 and w = -1.14 +/- 0.35 for a spatially-flat wCDM cosmological
model with WMAP 7-year priors on cosmological parameters. This gives a modest
improvement in statistical uncertainty over WMAP 7-year constraints alone.
Fixing the scaling relation between cluster mass and SZ signal to a fiducial
relation obtained from numerical simulations and calibrated by X-ray
observations, we find sigma_8 = 0.821 +/- 0.044 and w = -1.05 +/- 0.20. These
results are consistent with constraints from WMAP 7 plus baryon acoustic
oscillations plus type Ia supernoava which give sigma_8 = 0.802 +/- 0.038 and w
= -0.98 +/- 0.053. A stacking analysis of the clusters in this sample compared
to clusters simulated assuming the fiducial model also shows good agreement.
These results suggest that, given the sample of clusters used here, both the
astrophysics of massive clusters and the cosmological parameters derived from
them are broadly consistent with current models.Comment: 12 pages, 7 figures. Submitted to Ap
The influence of pregnancy on the pharmacokinetic properties of artemisinin combination therapy (ACT): a systematic review
Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world
Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic.
Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality.
Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States.
Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis.
Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection