A multi-center, open-labeled, cluster-randomized study of the safety of double and triple drug community mass drug administration for lymphatic filariasis

BackgroundThe Global Programme to Eliminate Lymphatic Filariasis (GPELF) provides antifilarial medications to hundreds of millions of people annually to treat filarial infections and prevent elephantiasis. Recent trials have shown that a single-dose, triple-drug treatment (ivermectin with diethylcarbamazine and albendazole [IDA]) is superior to a two-drug combination (diethylcarbamazine plus albendazole [DA]) that is widely used in LF elimination programs. This study was performed to assess the safety of IDA and DA in a variety of endemic settings.Methods and findingsLarge community studies were conducted in five countries between October 2016 and November 2017. Two studies were performed in areas with no prior mass drug administration (MDA) for filariasis (Papua New Guinea and Indonesia), and three studies were performed in areas with persistent LF despite extensive prior MDA (India, Haiti, and Fiji). Participants were treated with a single oral dose of IDA (ivermectin, 200 μg/kg; diethylcarbamazine, 6 mg/kg; plus albendazole, a fixed dose of 400 mg) or with DA alone. Treatment assignment in each study site was randomized by locality of residence. Treatment was offered to residents who were ≥5 years of age and not pregnant. Adverse events (AEs) were assessed by medical teams with active follow-up for 2 days and passive follow-up for an additional 5 days. A total of 26,836 persons were enrolled (13,535 females and 13,300 males). A total of 12,280 participants were treated with DA, and 14,556 were treated with IDA. On day 1 or 2 after treatment, 97.4% of participants were assessed for AEs. The frequency of all AEs was similar after IDA and DA treatment (12% versus 12.1%, adjusted odds ratio for IDA versus DA 1.15, 95% CI 0.87-1.52, P = 0.316); 10.9% of participants experienced mild (grade 1) AEs, 1% experienced moderate (grade 2) AEs, and 0.1% experienced severe (grade 3) AEs. Rates of serious AEs after DA and IDA treatment were 0.04% (95% CI 0.01%-0.1%) and 0.01% (95% CI 0.00%-0.04%), respectively. Severity of AEs was not significantly different after IDA or DA. Five of six serious AEs reported occurred after DA treatment. The most common AEs reported were headache, dizziness, abdominal pain, fever, nausea, and fatigue. AE frequencies varied by country and were higher in adults and in females. AEs were more common in study participants with microfilaremia (33.4% versus 11.1%, P ConclusionsIn this study, we observed that IDA was well tolerated in LF-endemic populations. Posttreatment AE rates and severity did not differ significantly after IDA or DA treatment. Thus, results of this study suggest that IDA should be as safe as DA for use as a MDA regimen for LF elimination in areas that currently receive DA.Trial registrationClinicaltrials.gov registration number: NCT02899936

Hardware-Software Hybrid Packet Processing for Intrusion Detection Systems

Security is a major issue in today's communication networks. Designing Network Intrusion Detection systems (NIDS) calls for high performance circuits in order to keep up with the rising data rates. Offloading software processing to hardware realizations is not an economically viable solution and hence hardware- software based hybrid solutions for the NIDS scenario are discussed in literature. By deploying processing on both hardware and software cores simultaneously by using a novel Intelligent Rule Parsing algorithm, we aim to minimize the number of packets whose waiting time is greater than a predefined threshold. This fairness criterion implicitly ensures in obtaining a higher throughput as depicted by our results

Advance Access publication on March 13, 2007 doi:10.1093/comjnl/bxm005 Context-aware Timely Information Delivery in Mobile Environments

In mobile environments, transmitting information relevant to an event along with notification of the event has been proven to be an effective means of providing revenue enhancing services. For example, a relevant advertisement can be displayed just before event notification; for instance, a product promotion by Beckham can be shown just before the notification of a goal scored by him. Challenges in achieving real-time search and delivery of information relevant to events as they occur include: (i) predicting the next event so that the appropriate information can be kept ready; (ii) finding information relevant to the context and content of the event; (iii) searching for and bringing the potentially needed information closer to the user location; and (iv) disseminating and displaying relevant information just before the actual event is notified to the user. In this paper, we propose a real-time information delivery system based on an event’s context and content. The key features of our system are: (i) representing domains with event-based scenarios using statecharts; (ii) using a novel combination of history information and state transitions to predict events; and (iii) real-time delivery of information relevant to an event by prefetching and caching information based on the events predicted to occur in the near future. To illustrate our approach, we focus on the delivery of advertisements relevant to notified events as a specific cas