A Multi-Center Randomised Controlled Trial of Gatifloxacin versus Azithromycin for the Treatment of Uncomplicated Typhoid Fever in Children and Adults in Vietnam

BACKGROUND: Drug resistant typhoid fever is a major clinical problem globally. Many of the first line antibiotics, including the older generation fluoroquinolones, ciprofloxacin and ofloxacin, are failing. OBJECTIVES: We performed a randomised controlled trial to compare the efficacy and safety of gatifloxacin (10 mg/kg/day) versus azithromycin (20 mg/kg/day) as a once daily oral dose for 7 days for the treatment of uncomplicated typhoid fever in children and adults in Vietnam. METHODS: An open-label multi-centre randomised trial with pre-specified per protocol analysis and intention to treat analysis was conducted. The primary outcome was fever clearance time, the secondary outcome was overall treatment failure (clinical or microbiological failure, development of typhoid fever-related complications, relapse or faecal carriage of S. typhi). PRINCIPAL FINDINGS: We enrolled 358 children and adults with suspected typhoid fever. There was no death in the study. 287 patients had blood culture confirmed typhoid fever, 145 patients received gatifloxacin and 142 patients received azithromycin. The median FCT was 106 hours in both treatment arms (95% Confidence Interval [CI]; 94-118 hours for gatifloxacin versus 88-112 hours for azithromycin), (logrank test p = 0.984, HR [95% CI] = 1.0 [0.80-1.26]). Overall treatment failure occurred in 13/145 (9%) patients in the gatifloxacin group and 13/140 (9.3%) patients in the azithromycin group, (logrank test p = 0.854, HR [95% CI] = 0.93 [0.43-2.0]). 96% (254/263) of the Salmonella enterica serovar Typhi isolates were resistant to nalidixic acid and 58% (153/263) were multidrug resistant. CONCLUSIONS: Both antibiotics showed an excellent efficacy and safety profile. Both gatifloxacin and azithromycin can be recommended for the treatment of typhoid fever particularly in regions with high rates of multidrug and nalidixic acid resistance. The cost of a 7-day treatment course of gatifloxacin is approximately one third of the cost of azithromycin in Vietnam. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN67946944

Development of a cognitive robotic system for simple surgical tasks

The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR). The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms) for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Vernacular solutions for small houses in Ha Tinh City towards sustainable and adaptation to climate change

Geographically located on the central coastal plain of Vietnam, with low, flat topography, Ha Tinh City has an urban architecture which interwoven closely with very characteristic rural areas. In 2017-2021, we conducted a research project on building a system of green architecture criteria and proposed architectural design solutions for sustainable small-scale housing in Ha Tinh City in the context of climate change. The research project has conducted surveys, interviews and measurements of climate data at 195 representative houses in 4 typical urban areas of the city. Based on very detailed survey results, combined with the traditional vernacular experience gained from local experts and residents, we have gradually analyzed and assessed the effects of climate change on houses and human activities, from which to build a set of criteria to guide people to build or renovate their homes in the direction of green vernacular architecture which is more sustainable and better adapt to climate change in Ha Tinh

Evaluation of Urban Design Qualities across Five Urban Typologies in Hanoi

Urban design has been shown to play a vital role in promoting the health and wellbeing of urban citizens. However, studies of microscale urban design are underrepresented in comparison with macroscale urban design, especially from low- and middle-income countries in Asia, where urban forms are traditionally compact, complex and with multiple layers and varied urban typologies. The study evaluated microscale urban design qualities of streets (n = 40) across five urban typologies in Hanoi—a typical city in a low- and middle-income country in Asia. The study found that urban typologies and their characteristics have particular impacts on urban design qualities. Old and high-density urban typologies tend to report higher urban design qualities than modern and low-density typologies. Urban design qualities are also significantly associated with the number of pedestrians on the streets. Compared to Western cities, the urban design qualities in Hanoi are substantially different, especially in terms of imageability and complexity, reflecting the differences in urban design and cultural context between cities from various regions. Overall, the study contributes to our understanding of urban design circumstances in Hanoi, providing policymakers, planners, urban designers and architects with important insights for sustainable urban design policies, strategies and interventions

A DCM Based Orientation Estimation Algorithm with an Inertial Measurement Unit and a Magnetic Compass

In this paper, Direction Cosine Matrix (DCM) method for attitude and orientation estimation is discussed. DCM method was chosen due to some advantages over the popular methods such as namely Euler Angle, Quaternion in light of reliability, accuracy and computational efforts. Proposed model for each method is developed for methodology comparison. It is shown that normal Kalman Filter in DCM method is better than extended Kalman Filter in Euler and Quaternion based method because it helps avoid the first order approximation error. Methodology errors are verified using Aerospace Blockset of Matlab Simulink

Understanding the startup’s intention of digital marketing’s learners: An application of the theory of planned behavior (TPB) and technology acceptance method (TAM)

AbstractDue to its low entry barrier, minimal overhead, and high return on investment, digital marketing has become more popular among startups, small and medium-sized enterprises as well as all businesses. There is a high need for workers skilled in Digital Marketing, so it is no surprise that schools are vying for students with an interest in this area. In this study, we will look at how students of digital marketing feel about the goals of startups, using data from recent studies to help us draw conclusions. The findings indicate that there is a strong positive relationship between startups’ propensity to use digital marketing tools and their intended behavior, which has a positive effect on their intention to launch a business. The results also support the theoretical hypotheses of the Technology Acceptance Model (TAM), as entrepreneurs’ propensity to use digital marketing tools has a direct impact on their intention to launch a business. Consistent with recent research, these findings indicate that the level of adoption of technological innovations can predict people’s intent to act in particular ways. This study offers insights for entrepreneurs and policymakers seeking to promote entrepreneurship by maximizing the potential of digital marketing tools.Based on theory of planned behavior (TPB) and the technology acceptance model (TAM), this research has also helped bring to light the role of normative influence and behavioral control in shaping entrepreneurs’ intention

A Simple, Rapid, and Cost-Effective PCR Procedure for Detection of NUDT15 Gene Variants in Vietnamese Patients with Acute Lymphoblastic Leukemia

Objective The NUDT15 variants impact thiopurine dose selection in acute lymphoblastic leukemia patients. The ability to rapidly detect variants is important in clinical practice. This study aims to develop a simple polymerase chain reaction (PCR) procedure for detecting NUDT15 variants in Vietnamese patients. Materials and Methods Sanger sequencing was used to determine NUDT15 variants from 200 patients. We designed primers and optimized the PCR procedure for detection of wild-type and variant alleles and compared with Sanger sequencing results. Results The inserted variant c.55_56insGAGTCG was detected by differences in size through conventional PCR. The tetra-primer amplification refractory mutation system PCR was successful in detecting two variations, c.52G > A and c.415C > T. The sensitivity and specificity of PCR procedure achieved 100% when compared to 200 Sanger sequencing results. Conclusion Our PCR procedure is suitable for replacing Sanger sequencing to detect the NUDT15 variants in clinical setting

Mechanical properties of metallic thin films: theoretical approach

The statistical moment method in statistical mechanics was developed to investigate the mechanical properties of free-standing metallic thin films at ambient conditions including the anharmonicity effects of thermal lattice vibrations. Analytical expressions of isothermal areal modulus BT, Young’s modulus E and shear modulus G were derived in terms of the power moments of the atomic displacements. Numerical calculations have been performed for metallic Ni, Au and Al thin films, and compared with those of bulk metals. This method is physically transparent and it successfully described the temperature effects on mechanical properties of metallic thin films

Empirical Examination of Factors Influencing the Adoption of Green Building Technologies: The Perspective of Construction Developers in Developing Economies

This study seeks to better understand the determinants of green building technology (GBT) adoption intention of construction developers in developing countries. In order to address these objectives, this study integrates the Diffusion of Innovation theory, the theory of Resource-based View, and the Resource Dependence Theory to analyze and construct the theoretical model of developers&rsquo; intentions to adopt GBTs from three perspectives, namely, technological, organizational, and environmental. The model was tested using survey data collected from 142 experienced managers in Vietnam. Data analysis was performed by SEM using the partial least squares (PLS) approach. The findings show that perceived GBT advantages, perceived GBT disadvantages, top management leadership, government support, project partners&rsquo; green building readiness, and social demand of green buildings are the significant factors that affect GBT adoption intention by developers. However, organizational GBT resource and GBT market readiness have no significant effect on developers&rsquo; GBT adoption intention. Theoretical and practical implications and limitations of the research are discussed, and suggestions for future research are also proposed