Pre-hospital risk factors for inpatient death from severe febrile illness in Malian children.

BACKGROUND: Inpatient case fatality from severe malaria remains high in much of sub-Saharan Africa. The majority of these deaths occur within 24 hours of admission, suggesting that pre-hospital management may have an impact on the risk of case fatality. METHODS: Prospective cohort study, including questionnaire about pre-hospital treatment, of all 437 patients admitted with severe febrile illness (presumed to be severe malaria) to the paediatric ward in Sikasso Regional Hospital, Mali, in a two-month period. FINDINGS: The case fatality rate was 17.4%. Coma, hypoglycaemia and respiratory distress at admission were associated with significantly higher mortality. In multiple logistic regression models and in a survival analysis to examine pre-admission risk factors for case fatality, the only consistent and significant risk factor was sex. Girls were twice as likely to die as boys (AOR 2.00, 95% CI 1.08-3.70). There was a wide variety of pre-hospital treatments used, both modern and traditional. None had a consistent impact on the risk of death across different analyses. Reported use of traditional treatments was not associated with post-admission outcome. INTERPRETATION: Aside from well-recognised markers of severity, the main risk factor for death in this study was female sex, but this study cannot determine the reason why. Differences in pre-hospital treatments were not associated with case fatality

Do ethnobotanical and laboratory data predict clinical safety and efficacy of anti-malarial plants?

<p>Abstract</p> <p>Background</p> <p>Over 1200 plant species are reported in ethnobotanical studies for the treatment of malaria and fevers, so it is important to prioritize plants for further development of anti-malarials.</p> <p>Methods</p> <p>The “RITAM score” was designed to combine information from systematic literature searches of published ethnobotanical studies and laboratory pharmacological studies of efficacy and safety, in order to prioritize plants for further research. It was evaluated by correlating it with the results of clinical trials.</p> <p>Results and discussion</p> <p>The laboratory efficacy score correlated with clinical parasite clearance (r_s=0.7). The ethnobotanical component correlated weakly with clinical symptom clearance but not with parasite clearance. The safety component was difficult to validate as all plants entering clinical trials were generally considered safe, so there was no clinical data on toxic plants.</p> <p>Conclusion</p> <p>The RITAM score (especially the efficacy and safety components) can be used as part of the selection process for prioritising plants for further research as anti-malarial drug candidates. The validation in this study was limited by the very small number of available clinical studies, and the heterogeneity of patients included.</p

The TFOS International Workshop on Contact Lens Discomfort: Introduction

Nichols, J. J., Jones, L., Nelson, J. D., Stapleton, F., Sullivan, D. A., & Willcox, M. D. P. (2013). The TFOS International Workshop on Contact Lens Discomfort: Introduction. Investigative Opthalmology & Visual Science, 54(11), TFOS1. https://doi.org/10.1167/iovs.13-13195For many years, the contact lens field had focused on safety associated with contact lens wear—and for good reason, given the lack of understanding of the risk factors and etiology of serious complications such as microbial keratitis. However, as knowledge came to light on these complications through the 1980s and 1990s, it allowed for practitioners to become more comfortable managing these complications, along with the introduction of products that helped reduce or prevent some of these problems. It was during this time, beginning in the mid-1980s, that the field itself became cognizant of the issues associated with comfort, or discomfort, during contact lens wear. Since that time, we have witnessed the field (and industry) shift its attention toward understanding the issue of contact lens discomfort (CLD). Contact lens discomfort is a substantial and burdensome problem experienced frequently by contact lens wearers. It is well established that most contact lens wearers experience CLD, at least occasionally, although many experience CLD to such a severity that they feel compelled to alter their wearing habits. Common, although palliative at best, treatments include the periodic use of rewetting drops, contact lens removal, contact lens refitting (using different lens designs or materials or replacement schedules), and changes in the contact lens care solutions or regimens, in addition to other less commonly used approaches including topical or systemic medications, alterations in diet, and punctal plugs. Ultimately, CLD is the primary factor associated with permanent discontinuation from contact lens wear. Given the importance of the issue of CLD to both patients and practitioners alike, the time was right to move the field forward by taking steps to bring global consensus to our current understanding of this condition.Supported by unrestricted financial support from Alcon (title sponsor), Allergan, Bausch & Lomb, Santen, Menicon, Vistakon, Laboratoires Théa, Optima, Oculus, CooperVision, and Contact Lens Spectrum

Microbial contamination of hydrogel contact lenses

Bacterial contamination of contact lenses (CLs) may contribute to CL-related corneal infection and inflammation. This study reports CL biota over time during daily and extended wear. Microbial contamination of a 58% water, ionic hydrogel CL and a 38% water, non-ionic hydrogel CL was evaluated in an Australian and an Indian population. Fifty wearers were repeatedly sampled over 18 months. Overnight CL use did not alter the frequency of positive cultures, nor the spectrum of organisms compared with daily CL wear. There were no differences in type and frequency of CL contamination between the CL types. Positive cultures were more frequently recovered from the Indian population compared with the Australian population. Streptococcus spp. and Propionibacterium spp. were more frequently isolated from the Australian population. Fungi and Bacillus spp. were more frequently isolated from the Indian population. Normal CL biota alone cannot explain the increased rate of infection and inflammation in extended wear

Doublet structures in quantum well absorption spectra due to Fano-related interference

In this theoretical investigation we predict an unusual interaction between a discrete state and a continuum of states, which is closely related to the case of Fano-interference. It occurs in a GaAs/AlxGa1-xAs quantum well between the lowest light-hole exciton and the continuum of the second heavy-hole exciton. Unlike the typical case for Fano-resonance, the discrete state here is outside the continuum; we use uniaxial stress to tune its position with respect to the onset of the continuum. State-of-the art calculations of absorption spectra show that as the discrete state approaches the continuum, a doublet structure forms which reveals anticrossing behaviour. The minimum separation energy of the anticrossing depends characteristically on the well width and is unusually large for narrow wells. This offers striking evidence for the strong underlying valence-band mixing. Moreover, it proves that previous explanations of similar doublets in experimental data, employing simple two-state models, are incomplete.Comment: 21 pages, 5 figures and 5 equations. Accepted for publication in Physical Review

Pre-agricultural plant management in the uplands of the central Zagros: the archaeobotanical evidence from Sheikh-e Abad

Prior to the emergence of agriculture in southwest Asia, sedentarising human communities were experimenting with a diverse range of wild plant species over a prolonged period. In some cases, this involved the cultivation of species that would go on to be domesticated and form the foundation of future agricultural economies. However, many forms of plant use did not follow this trajectory, and in multiple places farming was only taken up later as an established ‘package’. In this paper, we present new archaeobotanical evidence from the Early Neolithic site of Sheikh-e Abad in the central Zagros of western Iran. Sheikh-e Abad is unique in being the only settlement known to date within southwest Asia that lies at an altitude above 1000m and which has occupation spanning the agricultural transition. Thus, it provides a rare opportunity to examine pre-agricultural plant management strategies in an upland zone. Our analyses of the plant remains from Sheikh-e Abad suggest that from its earliest occupation inhabitants were unconsciously ‘auditioning’ a suite of locally available wild grasses which ultimately were never domesticated. We discuss the possible reasons for this from a socio-ecological perspective, considering both the biology and ecology of the plant species in question, as well as the ways in which they were potentially managed