An approach to hygiene education among rural Indian school going children

Objectives: To find out the prevalence of intestinal parasites and its epidemiological correlates among rural Indian school going (6-14 years) children and to study the effect of focused, need based child to child hygiene education on personal hygiene of school children. Materials and Methods: In September 2007, the present participatory action research was undertaken at a feasibly selected village Dhotra (Kasar) in Wardha district of central India. A triangulated research design of quantitative (survey) and qualitative (transect walk & pile sorting) methods was used for the needs assessment before initiating formal hygiene education. Out of enlisted 172 children, data of 118 children with complete information was used for final analysis. The quantitative and qualitative data was entered and analyzed using the Epi Info 6.04 software and Anthropac 4.98.1/X software package respectively. School based participatory life skills based child to child hygiene education was undertaken for message dissemination and behavior change. The effect of this hygiene education on identified key behaviors was assessed after one month Results: Out of the 118 (50 male and 68 female) subjects examined 21 (17.8%, 95%CI, 11.4 – 25.9%) had intestinal parasite infection. The prevalence of intestinal parasitic infection was significantly high among children having dirty untrimmed nails (47.4%, 95%CI, 30.9 – 64.1%) followed by those having poor hand washing practices (37.2%, 95%CI, 22.9 – 53.2%). One month after hygiene education, the proportion of children having practice of hand washing with soap after defecation significantly improved from 63.6 % to 78%. The proportion of clean and cut nails also improved from 67.8% to 80 % (p<0.05). Conclusions: The need based, focused, life skills based child to child hygiene education was effective for behavior change. An integrated approach of drug treatment and focused participatory hygiene education is required to control parasite load among rural Indian school going children

Discrete Convex Functions on Graphs and Their Algorithmic Applications

The present article is an exposition of a theory of discrete convex functions on certain graph structures, developed by the author in recent years. This theory is a spin-off of discrete convex analysis by Murota, and is motivated by combinatorial dualities in multiflow problems and the complexity classification of facility location problems on graphs. We outline the theory and algorithmic applications in combinatorial optimization problems

Signaling through IL-17C/IL-17RE Is Dispensable for Immunity to Systemic, Oral and Cutaneous Candidiasis

Candida albicans is a commensal fungal microbe of the human orogastrointestinal tract and skin. C . albicans causes multiple forms of disease in immunocompromised patients, including oral, vaginal, dermal and disseminated candidiasis. The cytokine IL-17 (IL-17A) and its receptor subunits, IL-17RA and IL-17RC, are required for protection to most forms of candidiasis. The importance of the IL-17R pathway has been observed not only in knockout mouse models, but also in humans with rare genetic mutations that impact generation of Th17 cells or the IL-17 signaling pathway, including Hyper-IgE Syndrome (STAT3 or TYK2 mutations) or IL17RA or ACT1 gene deficiency. The IL-17 family of cytokines is a distinct subclass of cytokines with unique structural and signaling properties. IL-17A is the bestcharacterized member of the IL-17 family to date, but far less is known about other IL-17-related cytokines. In this study, we sought to determine the role of a related IL-17 cytokine, IL-17C, in protection against oral, dermal and disseminated forms of C . albicans infection. IL-17C signals through a heterodimeric receptor composed of the IL-17RA and IL-17RE subunits. We observed that IL-17C mRNA was induced following oral C. albicans infection. However, mice lacking IL-17C or IL-17RE cleared C. albicans infections in the oral mucosa, skin and bloodstream at rates similar to WT littermate controls. Moreover, these mice demonstrated similar gene transcription profiles and recovery kinetics as WT animals. These findings indicate that IL-17C and IL-17RE are dispensable for immunity to the forms of candidiasis evaluated, and illustrate a surprisingly limited specificity of the IL-17 family of cytokines with respect to systemic, oral and cutaneous Candida infections

Differentiating lower motor neuron syndromes

Lower motor neuron (LMN) syndromes typically present with muscle wasting and weakness and may arise from pathology affecting the distal motor nerve up to the level of the anterior horn cell. A variety of hereditary causes are recognised, including spinal muscular atrophy, distal hereditary motor neuropathy and LMN variants of familial motor neuron disease. Recent genetic advances have resulted in the identification of a variety of disease-causing mutations. Immune-mediated disorders, including multifocal motor neuropathy and variants of chronic inflammatory demyelinating polyneuropathy, account for a proportion of LMN presentations and are important to recognise, as effective treatments are available. The present review will outline the spectrum of LMN syndromes that may develop in adulthood and provide a framework for the clinician assessing a patient presenting with predominantly LMN features

Phase 3 Multicenter Study of Revusiran in Patients with Hereditary Transthyretin-Mediated (hATTR) Amyloidosis with Cardiomyopathy (ENDEAVOUR)

PURPOSE: The Phase 3 ENDEAVOUR study evaluated revusiran, an investigational RNA interference therapeutic targeting hepatic transthyretin (TTR) production, for treating cardiomyopathy caused by hereditary transthyretin-mediated (hATTR) amyloidosis. / METHODS: Patients with hATTR amyloidosis with cardiomyopathy were randomized 2:1 to receive subcutaneous daily revusiran 500 mg (n = 140) or placebo (n = 66) for 5 days over a week followed by weekly doses. Co-primary endpoints were 6-min walk test distance and serum TTR reduction. / RESULTS: Revusiran treatment was stopped after a median of 6.71 months; the study Sponsor prematurely discontinued dosing due to an observed mortality imbalance between treatment arms. Eighteen (12.9%) patients on revusiran and 2 (3.0%) on placebo died during the on-treatment period. Most deaths in both treatment arms were adjudicated as cardiovascular due to heart failure (HF), consistent with the natural history of the disease. A post hoc safety investigation of patients treated with revusiran found that, at baseline, a greater proportion of those who died were ≥ 75 years and showed clinical evidence of more advanced HF compared with those who were alive throughout treatment. Revusiran pharmacokinetic exposures and TTR lowering did not show meaningful differences between patients who died and who were alive. Revusiran did not deleteriously affect echocardiographic parameters, cardiac biomarkers, or frequency of cardiovascular and HF hospitalization events. / CONCLUSIONS: Causes for the observed mortality imbalance associated with revusiran were thoroughly investigated and no clear causative mechanism could be identified. Although the results suggest similar progression of cardiac parameters in both treatment arms, a role for revusiran cannot be excluded. / CLINICAL TRIAL REGISTRATION: NCT02319005

Supporting Users in Cloud Plan Selection

Cloud computing is a key technology for outsourcing data and applications to external providers. The current cloud market offers a multitude of solutions (plans) differing from one another in terms of their characteristics. In this context, the selection of the right plan for outsourcing is of paramount importance for users wishing to move their data/applications to the cloud. The scientific community has then developed different models and tools for capturing users\u2019 requirements and evaluating candidate plans to determine the extent to which each of them satisfies such requirements. In this chapter, we illustrate some of the existing solutions proposed for cloud plan selection and for supporting users in the specification of their (crisp and/or fuzzy) needs

Motor unit remodelling in multifocal motor neuropathy: The importance of axonal loss

OBJECTIVE: To estimate the degree of axonal loss in patients diagnosed with multifocal motor neuropathy (MMN) using a novel assessment of motor unit numbers and size. METHODS: Automated motor unit number estimation using a compound muscle action potential (CMAP) scan was undertaken in median nerves with conduction block. Results were compared with 30 age-matched healthy controls. RESULTS: Compared with healthy controls, MMN patients had fewer motor units (MMN: 33±11vs HC: 93±36 [mean±SD]; p<0.0001) and larger 'size of the largest unit' (MMN: 1.2±0.5mVvs HC: 0.4±0.1mV; p<0.0001), despite having normal distal CMAP amplitudes (MMN: 7.6±1.8mVvs HC: 8.7±2.5mV; p=0.24). CONCLUSIONS: MMN is associated with marked axonal loss which may be masked by striking re-innervation resulting in preservation of distal CMAP amplitudes. SIGNIFICANCE: Assessment of motor unit properties should be incorporated into assessment of disease progression in MMN, given that nerve conduction studies are insensitive to motor unit remodelling

Multi-objective Optimization of Zero Propellant Spacecraft Attitude Maneuvers

The zero propellant maneuver (ZPM) is an advanced space station, large angle attitude maneuver technique, using only control momentum gyroscopes (CMGs). Path planning is the key to success, and this paper studies the associated multi-objective optimization problem. Three types of maneuver optimal control problem are formulated: (i) momentum-optimal, (ii) time-optimal, and (iii) energy-optimal. A sensitivity analysis approach is used to study the Pareto optimal front and allows the tradeoffs between the performance indices to be investigated. For example, it is proved that the minimum peak momentum decreases as the maneuver time increases, and the minimum maneuver energy decreases if a larger momentum is available from the CMGs. The analysis is verified and complemented by the numerical computations. Among the three types of ZPM paths, the momentum-optimal solution and the time-optimal solution generally possess the same structure, and they are singular. The energy-optimal solution saves significant energy, while generally maintaining a smooth control profile. © 2014 Springer Science+Business Media New York

Evidence for Composite Cost Functions in Arm Movement Planning: An Inverse Optimal Control Approach

An important issue in motor control is understanding the basic principles underlying the accomplishment of natural movements. According to optimal control theory, the problem can be stated in these terms: what cost function do we optimize to coordinate the many more degrees of freedom than necessary to fulfill a specific motor goal? This question has not received a final answer yet, since what is optimized partly depends on the requirements of the task. Many cost functions were proposed in the past, and most of them were found to be in agreement with experimental data. Therefore, the actual principles on which the brain relies to achieve a certain motor behavior are still unclear. Existing results might suggest that movements are not the results of the minimization of single but rather of composite cost functions. In order to better clarify this last point, we consider an innovative experimental paradigm characterized by arm reaching with target redundancy. Within this framework, we make use of an inverse optimal control technique to automatically infer the (combination of) optimality criteria that best fit the experimental data. Results show that the subjects exhibited a consistent behavior during each experimental condition, even though the target point was not prescribed in advance. Inverse and direct optimal control together reveal that the average arm trajectories were best replicated when optimizing the combination of two cost functions, nominally a mix between the absolute work of torques and the integrated squared joint acceleration. Our results thus support the cost combination hypothesis and demonstrate that the recorded movements were closely linked to the combination of two complementary functions related to mechanical energy expenditure and joint-level smoothness