Access to diagnosis and treatment of Chagas disease/infection in endemic and non-endemic countries in the XXI century.

In this article, Médicos Sin Fronteras (MSF) Spain faces the challenge of selecting, piecing together, and conveying in the clearest possible way, the main lessons learnt over the course of the last seven years in the world of medical care for Chagas disease. More than two thousand children under the age of 14 have been treated; the majority of whom come from rural Latin American areas with difficult access. It is based on these lessons learnt, through mistakes and successes, that MSF advocates that medical care for patients with Chagas disease be a reality, in a manner which is inclusive (not exclusive), integrated (with medical, psychological, social, and educational components), and in which the patient is actively followed. This must be a multi-disease approach with permanent quality controls in place based on primary health care (PHC). Rapid diagnostic tests and new medications should be available, as well as therapeutic plans and patient management (including side effects) with standardised flows for medical care for patients within PHC in relation to secondary and tertiary level, inclusive of epidemiological surveillance systems

Form factors and decoupling of matter fields in four-dimensional gravity

We extend previous calculations of the non-local form factors of semiclassical gravity in 4D to include the Einstein–Hilbert term. The quantized fields are massive scalar, fermion and vector fields. The non-local form factor in this case can be seen as the sum of a power series of total derivatives, but it enables us to derive the beta function of Newton's constant and formally evaluate the decoupling law in the new sector, which turns out to be the standard quadratic one

Whistler Waves Driven by Anisotropic Strahl Velocity Distributions: Cluster Observations

Observed properties of the strahl using high resolution 3D electron velocity distribution data obtained from the Cluster/PEACE experiment are used to investigate its linear stability. An automated method to isolate the strahl is used to allow its moments to be computed independent of the solar wind core+halo. Results show that the strahl can have a high temperature anisotropy (T(perpindicular)/T(parallell) approximately > 2). This anisotropy is shown to be an important free energy source for the excitation of high frequency whistler waves. The analysis suggests that the resultant whistler waves are strong enough to regulate the electron velocity distributions in the solar wind through pitch-angle scatterin

Randomized non-inferiority trial to compare trimethoprim/sulfamethoxazole plus rifampicin versus linezolid for the treatment of MRSA infection

Objectives The therapeutic arsenal for MRSA infections is limited. The aim of this study was to assess the non-inferiority of a combination of trimethoprim/sulfamethoxazole plus rifampicin versus linezolid alone for the treatment of MRSA infection. Methods We conducted a randomized, open-label, single-centre, non-inferiority trial comparing trimethoprim/sulfamethoxazole (160 mg/800 mg three times daily) plus rifampicin (600 mg once a day) versus linezolid (600 mg twice a day) alone in adult patients with various types of MRSA infection. Patients were allocated 1: 1 to either regimen. The primary outcome was clinical cure at 6 weeks after the end of treatment (non-inferiority margin 20%) assessed by both ITT and PP analyses. Secondary outcomes included the microbiologically documented persistence of MRSA in clinical cultures, mortality and adverse events. The study protocol has been registered with ClinicalTrials.gov (NCT00711854). Results Overall, 150 patients were randomized to one of the two treatment arms between January 2009 and December 2013 and were included in the ITT analysis. Of these 56/75 (74.7%) in the linezolid group and 59/75 (78.7%) in the trimethoprim/sulfamethoxazole and rifampicin group experienced clinical success (risk difference 4%, 95% CI −9.7% to 17.6%). The results were confirmed by the PP analysis, with 54/66 (81.8%) cured patients in the linezolid group versus 52/59 (88.1%) in the trimethoprim/sulfamethoxazole and rifampicin group (risk difference 6.3%, 95% CI −6.8% to 19.2%). There were no statistically significant differences between the two groups in any of the secondary outcomes, including microbiologically documented failure. Four adverse drug reactions attributed to the study medication occurred in the linezolid group versus nine in the trimethoprim/sulfamethoxazole and rifampicin group. Conclusions Compared with linezolid, trimethoprim/sulfamethoxazole and rifampicin seems to be non-inferior in the treatment of MRSA infectio

Comparing the cost-effectiveness of linezolid to trimethoprim/sulfamethoxazole plus rifampicin for the treatment of MRSA infection: a health-care system perspective

To date few industry-independent studies were conducted to compare the relative costs and benefits of drugs to treat MRSA infection. We performed a stochastic cost-effectiveness analysis comparing two treatment strategies -- linezolid versus trimethoprim-sulfamethoxazole plus rifampicin -- for the treatment of MRSA infection

Acceleration of Solar Wind Ions by Nearby Interplanetary Shocks: Comparison of Monte Carlo Simulations with Ulysses Observations

The most stringent test of theoretical models of the first-order Fermi mechanism at collisionless astrophysical shocks is a comparison of the theoretical predictions with observational data on particle populations. Such comparisons have yielded good agreement between observations at the quasi-parallel portion of the Earth's bow shock and three theoretical approaches, including Monte Carlo kinetic simulations. This paper extends such model testing to the realm of oblique interplanetary shocks: here observations of proton and alpha particle distributions made by the SWICS ion mass spectrometer on Ulysses at nearby interplanetary shocks are compared with test particle Monte Carlo simulation predictions of accelerated populations. The plasma parameters used in the simulation are obtained from measurements of solar wind particles and the magnetic field upstream of individual shocks. Good agreement between downstream spectral measurements and the simulation predictions are obtained for two shocks by allowing the the ratio of the mean-free scattering length to the ionic gyroradius, to vary in an optimization of the fit to the data. Generally small values of this ratio are obtained, corresponding to the case of strong scattering. The acceleration process appears to be roughly independent of the mass or charge of the species.Comment: 26 pages, 6 figures, AASTeX format, to appear in the Astrophysical Journal, February 20, 199

MMS Measurements of the Vlasov Equation: Probing the Electron Pressure Divergence Within Thin Current Sheets

We investigate the kinetic structure of electron‐scale current sheets found in the vicinity of the magnetopause and embedded in the magnetosheath within the reconnection exhaust. A new technique for computing terms of the Vlasov equation using Magnetospheric Multiscale (MMS) measurements is presented and applied to study phase space density gradients and the kinetic origins of the electron pressure divergence found within these current sheets. Crescent‐shaped structures in ∇⊥2fe give rise to bipolar and quadrupolar signatures in v·∇fe measured near the maximum ∇·Pe inside the current layers. The current density perpendicular to the magnetic field is strong (J⊥∼2 μA/m2), and the thickness of the current layers ranges from 3 to 5 electron inertial lengths. The electron flows supporting the current layers mainly result from the combination of E×B and diamagnetic drifts. We find nonzero J·E′ within the current sheets even though they are observed apart from typical diffusion region signatures.publishedVersio

Kinetic Interaction of Cold and Hot Protons With an Oblique EMIC Wave Near the Dayside Reconnecting Magnetopause

We report observations of the ion dynamics inside an Alfvén branch wave that propagates near the reconnecting dayside magnetopause. The measured frequency, wave normal angle and polarization are consistent with the predictions of a dispersion solver. The magnetospheric plasma contains hot protons (keV), cold protons (eV), plus some heavy ions. While the cold protons follow the magnetic field fluctuations and remain frozen-in, the hot protons are at the limit of magnetization. The cold protons exchange energy back and forth, adiabatically, with the wave fields. The cold proton velocity fluctuations contribute to balance the Hall term fluctuations in Ohm's law, and the wave E field has small ellipticity and right-handed polarization. The dispersion solver indicates that increasing the cold proton density facilitates propagation and amplification of these waves at oblique angles, as for the observed wave

Evaluation of Commercial Probiotic Products

Although there is a vast number of probiotic products commercially available due to their acceptability and increasing usage, their quality control has continuously been a major concern. This study aimed to assess some commercially available probiotics on the UK market for content in relation to their label claim. Seven products were used for the study. The bacteria content were isolated, identified and enumerated on selective media. The results revealed that all products evaluated contained viable probiotic bacteria but only three out of the seven products (43%) contained the claimed culture concentration or more. None of the multispecies product contained all the labelled probiotic bacteria. Misidentification of some species occurred. The results concurred with previous studies and showed that quality issues with commercial probiotics remain. Since probiotic activity is linked with probiotic concentration and is strain specific, the need exist for a global comprehensive legislation to control the quality of probiotics whose market is gaining huge momentum