Efficacy and effectiveness of dihydroartemisinin-piperaquine versus artesunate-mefloquine in falciparum malaria: an open-label randomised comparison.

BACKGROUND: Artemisinin-based combinations are judged the best treatments for multidrug-resistant Plasmodium falciparum malaria. Artesunate-mefloquine is widely recommended in southeast Asia, but its high cost and tolerability profile remain obstacles to widespread deployment. To assess whether dihydroartemisinin-piperaquine is a suitable alternative to artesunate-mefloquine, we compared the safety, tolerability, efficacy, and effectiveness of the two regimens for the treatment of uncomplicated falciparum in western Myanmar (Burma). METHODS: We did an open randomised comparison of 3-day regimens of artesunate-mefloquine (12/25 mg/kg) versus dihydroartemisinin-piperaquine (6.3/50 mg/kg) for the treatment of children aged 1 year or older and in adults with uncomplicated falciparum malaria in Rakhine State, western Myanmar. Within each group, patients were randomly assigned supervised or non-supervised treatment. The primary endpoint was the PCR-confirmed parasitological failure rate by day 42. Failure rates at day 42 were estimated by Kaplan-Meier survival analysis. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN27914471. FINDINGS: Of 652 patients enrolled, 327 were assigned dihydroartemisinin-piperaquine (156 supervised and 171 not supervised), and 325 artesunate-mefloquine (162 and 163, respectively). 16 patients were lost to follow-up, and one patient died 22 days after receiving dihydroartemisinin-piperaquine. Recrudescent parasitaemias were confirmed in only two patients; the day 42 failure rate was 0.6% (95% CI 0.2-2.5) for dihydroartemisinin-piperaquine and 0 (0-1.2) for artesunate-mefloquine. Whole-blood piperaquine concentrations at day 7 were similar for patients with observed and non-observed dihydroartemisinin-piperaquine treatment. Gametocytaemia developed more frequently in patients who had received dihydroartemisinin-piperaquine than in those on artesunate-mefloquine: day 7, 18 (10%) of 188 versus five (2%) of 218; relative risk 4.2 (1.6-11.0) p=0.011. INTERPRETATION: Dihydroartemisinin-piperaquine is a highly efficacious and inexpensive treatment of multidrug-resistant falciparum malaria and is well tolerated by all age groups. The effectiveness of the unsupervised treatment, as in the usual context of use, equalled its supervised efficacy, indicating good adherence without supervision. Dihydroartemisinin-piperaquine is a good alternative to artesunate-mefloquine

Optimization of Phosphorus Fertilizer in Supplemental Feed‐Fed Based Nile Tilapia (Oreochromis niloticus) Ponds

An experiment was conducted in earthen ponds at the Asian Institute of Technology, Thailand to determine different phosphorus fertilizer dose effects on Nile tilapia production, water quality variables, nutrient utilization and cost‐benefit under supplemental feeding. Five phosphorus fertilization rates were used as treatments e.g. 100%, 75%, 50%, 25% and 0% of 7 kg P ha week−1. Nitrogen fertilization rate was fixed at 28 kg N ha week−1 for all the treatments. Sex‐reversed Nile tilapia were stocked at 3 fish m−2, and 30% CP floating feed fed at 50% satiation feeding rate. Nutrient budget showed higher phosphorus fertilizer input resulted in higher phosphorus sink in the sediment. Mean weight, mean weight gain, daily weight gain and net yield were not significantly different among treatments (P > 0.05). Total Kjeldahl nitrogen, total phosphorus and soluble reactive phosphorus were significantly different among treatments. Economic analysis showed phosphorus fertilization resulted in positive net returns. Though the gross income was not affected by different fertilization rates, significantly lowest cost was found in the treatment using 25% phosphorus fertilizer. It can be concluded from the research that 25% phosphorus fertilization might be used as an alternative strategy of Nile tilapia pond culture in terms of economic return and nutrient loss in sediment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115936/1/are12444.pd

Longitudinal Reproducibility of Neurite Orientation Dispersion and Density Imaging (NODDI) Derived Metrics in the White Matter

Diffusion-weighted magnetic resonance imaging (DWI) is undergoing constant evolution with the ambitious goal of developing in-vivo histology of the brain. A recent methodological advancement is Neurite Orientation Dispersion and Density Imaging (NODDI), a histologically validated multi-compartment model to yield microstructural features of brain tissue such as geometric complexity and neurite packing density, which are especially useful in imaging the white matter. Since NODDI is increasingly popular in clinical research and fields such as developmental neuroscience and neuroplasticity, it is of vast importance to characterize its reproducibility (or reliability). We acquired multi-shell DWI data in 29 healthy young subjects twice over a rescan interval of 4 weeks to assess the within-subject coefficient of variation (CVWS), between-subject coefficient of variation (CVBS) and the intraclass correlation coefficient (ICC), respectively. Using these metrics, we compared regional and voxel-by-voxel reproducibility of the most common image analysis approaches (tract-based spatial statistics [TBSS], voxel-based analysis with different extents of smoothing [“VBM-style”], ROI-based analysis). We observed high test–retest reproducibility for the orientation dispersion index (ODI) and slightly worse results for the neurite density index (NDI). Our findings also suggest that the choice of analysis approach might have significant consequences for the results of a study. Collectively, the voxel-based approach with Gaussian smoothing kernels of ≥4 mm FWHM and ROI-averaging yielded the highest reproducibility across NDI and ODI maps (CVWS mostly ≤3%, ICC mostly ≥0.8), respectively, whilst smaller kernels and TBSS performed consistently worse. Furthermore, we demonstrate that image quality (signal-to-noise ratio [SNR]) is an important determinant of NODDI metric reproducibility. We discuss the implications of these results for longitudinal and cross-sectional research designs commonly employed in the neuroimaging field

Differences in decision-making behavior between elite and amateur team-handball players in a near-game test situation

Athletic features distinguishing experts from non-experts in team sports are relevant for performance analyses, talent identification and successful training. In this respect, perceptual-cognitive factors like decision making have been proposed to be important predictor of talent but, however, assessing decision making in team sports remains a challenging endeavor. In particular, it is now known that decisions expressed by verbal reports or micro-movements in the laboratory differ from those actually made in on-field situations in play. To address this point, our study compared elite and amateur players' decision-making behavior in a near-game test environment including sport-specific sensorimotor responses. Team-handball players (N = 44) were asked to respond as quickly as possible to representative, temporally occluded attack sequences in a team-handball specific defense environment on a contact plate system. Specifically, participants had to choose and perform the most appropriate out of four prespecified, defense response actions. The frequency of responses and decision time were used as dependent variables representing decision-making behavior. We found that elite players responded significantly more often with offensive responses (p < 0.05, odds ratios: 2.76-3.00) in left-handed attack sequences. Decision time decreased with increasing visual information, but no expertise effect was found. We suppose that expertise-related knowledge and processing of kinematic information led to distinct decision-making behavior between elite and amateur players, evoked in a domain-specific and near-game test setting. Results also indicate that the quality of a decision might be of higher relevance than the required time to decide. Findings illustrate application opportunities in the context of performance analyses and talent identification processes

Detection of asymptomatic malaria in Asian countries: a meta-analysis of diagnostic accuracy

Background: Achieving malaria elimination requires the targeting of the human reservoir of infection, including those patients with asymptomatic infection. The objective was to synthesise evidence on the accuracy of the rapid- onsite diagnostic tests (RDTs) and microscopy for the detection of asymptomatic malaria as part of the surveillance activities in Asian countries. Methods: This was a meta-analysis of diagnostic test accuracy. Relevant studies that evaluated the diagnostic per- formance of RDTs and microscopy for detection of asymptomatic malaria were searched in health-related electronic databases. The methodological quality of the studies included was assessed using the QUADAS-2 tool. Results: Ten studies assessing RDT and/or microscopy were identified. The diagnostic accuracies in all these stud- ies were verified by PCR. Overall, the pooled sensitivities of RDT, as well as microscopy for detection of any malaria parasites in asymptomatic participants, were low, while their pooled specificities were almost ideal. For the detection of Plasmodium falciparum, pooled sensitivity by RDT (59%, 95%CI:16-91%) or microscopy (55%, 95%CI: 25-82%) were almost comparable. For detection of Plasmodium vivax, pooled sensitivity of RDT (51%, 95% CI:7-94%) had also the comparable accuracy of microscopy (54%, 95%CI,11-92%). Of note are the wide range of sensitivity and specificity. Conclusion: The findings of this meta-analysis suggest that RDTs and microscopy have limited sensitivity and are inappropriate for the detection of asymptomatic Plasmodium infections. Other methods including a combination of PCR-based strategies, Loop-Mediated Isothermal Amplification (LAMP) technique must be considered to target these infections, in order to achieve malaria elimination. However, more data is needed for the wide acceptance and feasi- bility of these approaches. Studies to explore the role of asymptomatic and sub-patent infections in the transmission of malaria are of critical importance and are recommend

Application of nano insulation materials in the sustainable Built environment

Nanotechnology is widely being used in the built environment for its advantages in many improved engineering properties of the nano materials. Nano insulating materials open up new possibilities for ecologically oriented sustainable infrastructure development. The most widely used nano material in built environment is for the purpose of insulation to improve the energy efficiency namely in the buildings and dwellings. Nanotechnology has now provided an effective and affordable means to increase energy efficiency in pre-existing buildings as well as new construction by increasing thermal resistance. The major advantage of nano insulation materials is its benefit of translucent coatings which increase the thermal envelope of a building without reducing the square footage. The intrinsic property of nano insulating material is it can be applied to windows to reduce heat transfer from solar radiation due it its thermal resistant property and the translucent property allows diffusing of day light. The nano insulating material has significant advantage in reducing the operational energy aspects of buildings due to its valuable insulating properties. This paper examines applicable nanotechnology based products that can improve the sustainable development and overall competitiveness of the building industry. The areas of applying nano insulating material in building industry will be mainly focused on the building envelope. The paper also examines the potential advantages of using nanotechnology based insulating material in reducing the life cycle energy, reduction of material usage and enhancing the useable life span. The paper also investigates the operational energy by simulation methodology and compares the reduction of operational energy consumption

Antigen Production of Dengue Type 4 Virus strains in Aedes albopictus clone C6/36 and Vero Cell Cultures

Antigen production of seven dengue type 4 virus strains in Aedes albopictus clone C6/36 cells at 28℃ and in Vero cells at 37℃ was studied. These seven strains could roughly be divided into three different entities according to their pattern of antigen production. The first entity of prototype strain (H-241) produced ELISA antigen in vero cells at 37℃, whereas its antigen production was undetectable in C6/36 cells upto day 11 post infection. The second entity, strain No.17 (1978-Sri Lankan strain) revealed the reverse pattern: high antigen titer in C6/36 cells and undetectable titer in vero cells. The remaining five strains belonged to the third entity, in which viral antigen production was found in both cell lines to similar titers

Design Lessons from Three Australian Dementia Support Facilities

There is a significant increase in the number of people with dementia, and the demand for residential support facilities is expected to increase. Providing an appropriate living environment for residents with dementia, which can cater for their specific needs is crucial. Residential aged care design can impact the quality of life and wellbeing of the residents. In this investigation, three recently constructed dementia support facilities in Victoria, Australia are selected for evaluation. Through fieldwork observation, design evaluation and space syntax analysis, the aim of this investigation is to consider the design of these three facilities in the context of current evidence on how the built environment can best accommodate residents with dementia

Application of IgM-capture ELISA on Myanmar Dengue Patients\u27 Serum Samples Collected in 1994

Seventy serum samples from clinically diagnosed dengue patients admitted to the North Okkalapa General Hospital, Yangon, Union of Myanmar, in 1994, were used to obtain the confirmed virological diagnosis by IgM-capture ELISA using all four types of dengue antigens raised by cell culture method. Sixty-two out of 70 specimens (88.6%) showed positive IgM ELISA titer against one or more assay antigen. Single application of dengue 2 antigen could detect 59 out of 62 positive sera (95.1% of total positives), whereas three more samples could be detected by using other serotypic antigens (either single antigen or double antigens in combination). Ten samples showing positive by single dengue antigen but negative results by the rest could possibly be due to the primary infection which showed serotype specific immune response

Optimization of the Dengue-2 Antigen ELISA Titer for the Positive Case Detection of Dengue Virus Infection by IgM ELISA

We have determined the dengue-2 antigen ELISA titer for the positive case detection of dengue virus infection by IgM ELISA using 33 paired serum samples of dengue patients admitted to the North Okkalapa General Hospital, Yangon, Union of Myanmar, in June and July, 1994. The antigen ELISA titer was found to be over 32 units in order to find out sufficient number of positive cases. This finding can be used as a reference for further experiments and the development of tetravalent dengue antigen for routine serodiagnosis of dengue virus infection