Assessment of the efficacy of antimalarial drugs recommended by the National Malaria Control Programme in Madagascar: Up-dated baseline data from randomized and multi-site clinical trials

<p>Abstract</p> <p>Background</p> <p>In order to improve the monitoring of the antimalarial drug resistance in Madagascar, a new national network based on eight sentinel sites was set up. In 2006/2007, a multi-site randomized clinical trial was designed to assess the therapeutic efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP), amodiaquine (AQ) and artesunate plus amodiaquine combination (ASAQ), the antimalarial therapies recommended by the National Malaria Control Programme (NMCP).</p> <p>Methods</p> <p>Children between six months and 15 years of age, with uncomplicated falciparum malaria, were enrolled. Primary endpoints were the day-14 and day-28 risks of parasitological failure, either unadjusted or adjusted by genotyping. Risks of clinical and parasitological treatment failure after adjustment by genotyping were estimated using Kaplan-Meier survival analysis. Secondary outcomes included fever clearance, parasite clearance, change in haemoglobin levels between Day 0 and the last day of follow-up, and the incidence of adverse events.</p> <p>Results</p> <p>A total of 1,347 of 1,434 patients (93.9%) completed treatment and follow-up to day 28. All treatment regimens, except for the chloroquine (CQ) treatment group, resulted in clinical cure rates above 97.6% by day-14 and 96.7% by day-28 (adjusted by genotyping). Parasite and fever clearance was more rapid with artesunate plus amodiaquine, but the extent of haematological recovery on day-28 did not differ significantly between the four groups. No severe side-effects were observed during the follow-up period.</p> <p>Conclusion</p> <p>These findings (i) constitute an up-dated baseline data on the efficacy of antimalarial drugs recommended by the NMCP, (ii) show that antimalarial drug resistance remains low in Madagascar, except for CQ, compared to the bordering countries in the Indian Ocean region such as the Comoros Archipelago and (iii) support the current policy of ASAQ as the first-line treatment in uncomplicated falciparum malaria.</p

2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative

Objective The 1987 American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticized for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA. Methods A joint working group from the ACR and the European League Against Rheumatism developed, in 3 phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease—this being the appropriate current paradigm underlying the disease construct “rheumatoid arthritis.” Results In the new criteria set, classification as “definite RA” is based on the confirmed presence of synovitis in at least 1 joint, absence of an alternative diagnosis that better explains the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in 4 domains: number and site of involved joints (score range 0–5), serologic abnormality (score range 0–3), elevated acute-phase response (score range 0–1), and symptom duration (2 levels; range 0–1). Conclusion This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimize the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct “rheumatoid arthritis.”Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78045/1/27584_ftp.pd

Squeezing or cuddling? The impact of economic crises on management control and stakeholder management

This paper analyzes the effects of economic crises on firms' use of management control mechanisms and on their management of stakeholder relations. Moreover, the association between stakeholder management and management control system use is analyzed. In the wake of the economic crisis of 2008/2009, many firms were faced with severe threats that called for immediate short-term action to ensure firm survival. However, short-term action like massive cost-cutting and cash generation often are blamed for going at the expense of long-term health as key stakeholder relations may be irreversibly harmed. Hence, three interrelated questions are addressed theoretically and empirically: First, we analyze the impact of the recent economic crisis on firms' control strategies. More specifically, we investigate whether a high crisis impact on firms is associated with a shortening of reporting cycles, a more interactive use of control-relevant information, restriction of employee autonomy and a focus on liquidity and cost-cutting. Second, we examine from the viewpoint of stakeholder theory how firms can make use of active stakeholder management for crisis management. Third, we explore whether firms can take short-term measures for ensuring liquidity and cutting costs and at the same time pursue a stakeholder strategy aiming at the long-term survival of the firm. Using survey data from 204 major Austrian corporations, we provide evidence that firms significantly adjusted their control systems as a response to the economic crisis. Our data do not indicate an immanent contradiction between a "short-term finance focus" and the pursuit of a sustainable stakeholder strategy

New constraints on the disk characteristics and companion candidates around T Chamaeleontis with VLT/SPHERE

International audienceContext. The transition disk around the T Tauri star T Cha possesses a large gap, making it a prime target for high‐resolution imaging in the context of planet formation. Aims. We aim to find signs of disk evolutionary processes by studying the disk geometry and the dust grain properties at its surface, and to search for companion candidates. Methods. We analyze a set of VLT/SPHERE data at near‐infrared and optical wavelengths. We performed polarimetric imaging of T Cha with IRDIS (1.6 mu m) and ZIMPOL (0.5‐0.9 mu m), and obtained intensity images from IRDIS dual‐band imaging with simultaneous spectro‐imaging with IFS (0.9‐1.3 mu m). Results. The disk around T Cha is detected in all observing modes and its outer disk is resolved in scattered light with unprecedented angular resolution and signal‐to‐noise. The images reveal a highly inclined disk with a noticeable east‐west brightness asymmetry. The significant amount of non‐azimuthal polarization signal in the U‐phi images, with a U‐phi/Q(phi) peak‐to‐peak value of 14%, is in accordance with theoretical studies on multiple scattering in an inclined disk. Our optimal axisymmetric radiative transfer model considers two coplanar inner and outer disks, separated by a gap of 0.'' 28 (similar to 30 au) in size, which is larger than previously thought. We derive a disk inclination of similar to 69 deg and PA of similar to 114 deg. In order to self‐consistently reproduce the intensity and polarimetric images, the dust grains, responsible for the scattered light, need to be dominated by sizes of around ten microns. A point source is detected at an angular distance of 3.5 `' from the central star. It is, however, found not to be co‐moving. Conclusions. We confirm that the dominant source of emission is forward scattered light from the near edge of the outer disk. Our point source analysis rules out the presence of a companion with mass larger than similar to 8.5 M‐jup between 0.'' 1 and 0.'' 3. The detection limit decreases to similar to 2 M‐jup for 0.'' 3 to 4.0 `'

Polarimetric imaging mode of VLT/SPHERE/IRDIS: II. Characterization and correction of instrumental polarization effects

International audienc