Evaluation of Convalescent Plasma for Ebola Virus Disease in Guinea

: In the wake of the recent outbreak of Ebola virus disease (EVD) in several African countries, the World Health Organization prioritized the evaluation of treatment with convalescent plasma derived from patients who have recovered from the disease. We evaluated the safety and efficacy of convalescent plasma for the treatment of EVD in Guinea. : In this nonrandomized, comparative study, 99 patients of various ages (including pregnant women) with confirmed EVD received two consecutive transfusions of 200 to 250 ml of ABO-compatible convalescent plasma, with each unit of plasma obtained from a separate convalescent donor. The transfusions were initiated on the day of diagnosis or up to 2 days later. The level of neutralizing antibodies against Ebola virus in the plasma was unknown at the time of administration. The control group was 418 patients who had been treated at the same center during the previous 5 months. The primary outcome was the risk of death during the period from 3 to 16 days after diagnosis with adjustments for age and the baseline cycle-threshold value on polymerase-chain-reaction assay; patients who had died before day 3 were excluded. The clinically important difference was defined as an absolute reduction in mortality of 20 percentage points in the convalescent-plasma group as compared with the control group. : A total of 84 patients who were treated with plasma were included in the primary analysis. At baseline, the convalescent-plasma group had slightly higher cycle-threshold values and a shorter duration of symptoms than did the control group, along with a higher frequency of eye redness and difficulty in swallowing. From day 3 to day 16 after diagnosis, the risk of death was 31% in the convalescent-plasma group and 38% in the control group (risk difference, -7 percentage points; 95% confidence interval [CI], -18 to 4). The difference was reduced after adjustment for age and cycle-threshold value (adjusted risk difference, -3 percentage points; 95% CI, -13 to 8). No serious adverse reactions associated with the use of convalescent plasma were observed. : The transfusion of up to 500 ml of convalescent plasma with unknown levels of neutralizing antibodies in 84 patients with confirmed EVD was not associated with a significant improvement in survival. (Funded by the European Union's Horizon 2020 Research and Innovation Program and others; ClinicalTrials.gov number, NCT02342171.).<br/

Humanidades médicas no Reino Unido: uma tendência mundial em educação médica hoje

This editorial aims to present a critical analysis of the state-of-the-art literature on the initiative of introduction of the Medical Humanities into Medical Education in the United Kingdom,as well as the perceptions and attitudes of medical students, scholars and researchers in this field. For such purpose, a critical literature review was performed at the online bases Ovid-SP and Scopus for the keywords in the English language ‘medical humanities’, ‘medical education’, ‘humanities’, ‘humanisation’, ‘physicians’, ‘patients’, ‘medical students’, ‘British’, ‘England’, during the period from 2000 to 2011, also collecting publications by cross-referencing. This search produced a result of 34 papers, from which 29 were directly referenced in this work that shows the way through which the Medical Humanities became a flourishing discipline to be introduced in Medical Schools from the 1950’s on, simultaneously in the US and the UK. At this panorama, we historicised the origins of the dissolution process of the ‘good doctor’ and delineated the pathway by which the UK has become the focus of a worldwide trend in humanisation of the health care. As such, raising the world debate with the British both wide and effective experience of introduction of the Medical Humanities, firstly as an instrument for the ethical education in health, then, more recently, as a research strength to investigate the observed effects of the integrity in the education od doctors produced by its several formats implementation across the Medical Schools in the UK, after the publication of Tomorrow’s Doctors by the General Medical Council in 1995, whose main aim was to “rescue” the ‘good doctor’ back into the healthcare.Este artigo tem por objetivo apresentar uma análise crítica do estado-da-arte da literatura sobre o movimento de introdução das Humanidades Médicas em Educação Médica no Reino Unido, assim como as percepções e atitudes de estudantesde Medicina, acadêmicos e pesquisadores na área. Para tal foi realizada uma revisão crítica de literatura nas bases Ovid-SP e Scopus para os descritores na língua inglesa ‘medical humanities’, ‘medical education’, ‘humanities’, ‘humanisation’, ‘physicians’, ‘patients’, ‘medical students’, ‘British’, ‘England’, no período de 2000 a 2011, com publicações em língua inglesa e por referência cruzada. Tal pesquisa gerou um resultado de 34 artigos, dos quais 29 encontram-se diretamente referenciados neste texto que mostra a maneira como as Humanidades Médicaspassaram a ser uma florescente disciplina a ser introduzida em Escolas Médicas a partir da década de 1950, paralelamente entre E.U.A. e Reino Unido. Neste panorama, historicizamos as origens do processo de dissolução do ‘bom médico’ e delineamoso caminho por meio do qual o Reino Unido configurou-se como o berço da atual tendência mundial de humanização dos cuidados em saúde. Desta maneira, o Reino Unido tem liderado o debate mundial com sua ampla experiência nas Humanidades em Saúde, primeiramente como instrumento de formação ética em saúde e, mais recentemente, como linha de pesquisa para investigar os efeitos observados na integralidade da formação de médicos produzidos pelos variados modelos de sua implementaçãoem suas Escolas Médicas após a publicação dos Médicos de Amanhã pelo General Medical Council em 1995, cujo objetivo é o de resgatar o ‘good doctor’, o ‘bom médico’, para a prática clínica

Ion energy distribution functions behind the sheaths of magnetized and non magnetized radio frequency discharges

The effect of a magnetic field on the characteristics of capacitively coupled radio frequency discharges is investigated and found to be substantial. A one-dimensional particle-in-cell simulation shows that geometrically symmetric discharges can be asymmetrized by applying a spatially inhomogeneous magnetic field. This effect is similar to the recently discovered electrical asymmetry effect. Both effects act independently, they can work in the same direction or compensate each other. Also the ion energy distribution functions at the electrodes are strongly affected by the magnetic field, although only indirectly. The field influences not the dynamics of the sheath itself but rather its operating conditions, i.e., the ion flux through it and voltage drop across it. To support this interpretation, the particle-in-cell results are compared with the outcome of the recently proposed ensemble-in-spacetime algorithm. Although that scheme resolves only the sheath and neglects magnetization, it is able to reproduce the ion energy distribution functions with very good accuracy, regardless of whether the discharge is magnetized or not

Determinants of serum concentrations of organochlorine compounds in Swedish pregnant women: a cross-sectional study

BACKGROUND: We performed a cross-sectional study of associations between personal characteristics and lipid-adjusted serum concentrations of certain PCB congeners and chlorinated pesticides/metabolites among 323 pregnant primiparous women from Uppsala County (age 18–41 years) sampled 1996–1999. METHODS: Extensive personal interviews and questionnaires about personal characteristics were performed both during and after pregnancy. Concentrations of organochlorine compounds in serum lipids in late pregnancy were analysed by gas chromatography. Associations between personal characteristics and serum levels of organochlorine compounds were analysed by multiple linear regression. RESULTS: Participation rate was 82% (325 of 395 women). Serum concentrations of PCB congeners IUPAC no. 28, 52, 101, 105 and 167, and o, p'-DDT and -DDE, p, p'-DDT and -DDD, oxychlordane, and γ- and α-HCH were in many cases below the limit of quantification (LOQ). No statistical analysis of associations with personal characteristics could be performed for these substances. Concentrations of PCB congeners IUPAC no. 118, 138, 153, 156 and 180, HCB, β-HCH, trans-nonachlor and p, p'-DDE increased with increased age and were highest in women sampled early during the 4 year study period. This shows that older women and women sampled early in the study had experienced the highest life-time exposure levels, probably mainly during childhood and adolescence. The importance of early exposures was supported by lower PCB concentrations and higher β-HCH and p, p'-DDE concentrations among women born in non-Nordic countries. Moreover, serum concentrations of certain PCBs and pesticide/metabolites were positively associated with consumption of fatty fish during adolescence, and concentrations of CB 156, CB 180 and p, p'-DDE increased significantly with number of months women had been breast-fed during infancy. Short-term changes in bodily constitution may, however, also influence serum concentrations, as suggested by negative associations between concentrations of organochlorine compounds and BMI before pregnancy and weight change during pregnancy. CONCLUSION: Although some of the associations could be caused by unknown personal characteristics confounding the results, our findings suggest that exposures to organochlorine compounds during childhood and adolescence influence the body burdens of the compounds during pregnancy

Parallel Tree Search in Volunteer Computing: a Case Study

International audienc

High rate of subclinical chikungunya virus infection and association of neutralizing antibody with protection in a prospective cohort in the Philippines.

BACKGROUND: Chikungunya virus (CHIKV) is a globally re-emerging arbovirus for which previous studies have indicated the majority of infections result in symptomatic febrile illness. We sought to characterize the proportion of subclinical and symptomatic CHIKV infections in a prospective cohort study in a country with known CHIKV circulation. METHODS/FINDINGS: A prospective longitudinal cohort of subjects ≥6 months old underwent community-based active surveillance for acute febrile illness in Cebu City, Philippines from 2012-13. Subjects with fever history were clinically evaluated at acute, 2, 5, and 8 day visits, and at a 3-week convalescent visit. Blood was collected at the acute and 3-week convalescent visits. Symptomatic CHIKV infections were identified by positive CHIKV PCR in acute blood samples and/or CHIKV IgM/IgG ELISA seroconversion in paired acute/convalescent samples. Enrollment and 12-month blood samples underwent plaque reduction neutralization test (PRNT) using CHIKV attenuated strain 181/clone25. Subclinical CHIKV infections were identified by ≥8-fold rise from a baseline enrollment PRNT titer 50 years old. Baseline CHIKV PRNT titer ≥10 was associated with 100% (95%CI: 46.1, 100.0) protection from symptomatic CHIKV infection. Phylogenetic analysis demonstrated Asian genotype closely related to strains from Asia and the Caribbean. CONCLUSIONS: Subclinical infections accounted for a majority of total CHIKV infections. A positive baseline CHIKV PRNT titer was associated with protection from symptomatic CHIKV infection. These findings have implications for assessing disease burden, understanding virus transmission, and supporting vaccine development

A focus on selected perspectives of the NUMEN project

The use of double charge exchange reactions is discussed in view of their application to extract information that may be helpful to determinate the nuclear matrix elements entering in the expression of neutrinoless double beta decay half-life. The strategy adopted in the experimental campaigns performed at INFN - Laboratori Nazionali del Sud and in the analysis methods within the NUMEN project is briefly described, emphasizing the advantages of the multi-channel approach to nuclear reaction data analysis. An overview on the research and development activities on the MAGNEX magnetic spectrometer is also given, with a focus on the chosen technological solutions for the focal plane detector which will guarantee the performances at high-rate conditions

Percepção de médicos e enfermeiros de unidades de assistência médica ambulatorial sobre humanização nos serviços de saúde1

O conceito de humanização é amplo e abrange um conjunto de conhecimentos, práticas, atitudes e relações. Envolve a efetiva participação de profissionais, gestores, usuários e movimentos sociais para que as experiências compartilhadas possam proporcionar melhorias na qualidade do atendimento de saúde. O objetivo deste estudo foi analisar a percepção de médicos e enfermeiros de unidades de assistência médica ambulatorial (AMA) sobre humanização nos serviços de saúde. Trata-se de pesquisa qualitativa, de corte transversal, realizada mediante entrevistas semiestruturadas, de outubro de 2010 a maio de 2011, e o critério de representatividade da amostra para o encerramento da coleta de dados foi a saturação do discurso. Constatou-se que a percepção dos profissionais sobre humanização tem distintos sentidos e significados variados, possibilitando a construção de categorias empíricas: a preocupação com o outro – alteridade, direitos dos usuários, informação e autonomia dos usuários e avaliação de risco. Situações comuns e particulares vivenciadas no cotidiano das unidades AMA, como o contato direto com problemas de saúde que envolvem maiores riscos aos usuários, parecem influenciar a percepção dos profissionais sobre humanização, podendo afetar a preservação dos direitos e as relações estabelecidas entre os profissionais e os usuários

Escola médica e Sistema Único de Saúde (SUS): criação do curso de medicina da Universidade Federal de São Carlos, SP, Brasil (UFSCar) sob perspectiva de docentes e estudantes

A Universidade Federal de São Carlos (UFSCar) implantou seu curso de Medicina em 2006, com currículo baseado em competências e aprendizado prático integrado ao SUS. O objetivo deste trabalho é apresentar uma pesquisa com docentes e graduandos da Primeira Turma da Medicina-UFSCar, realizada por meio da metodologia da História Oral de Vida. As narrativas indicam que o currículo favoreceu o desenvolvimento de competências como: capacidade de busca, pensamento crítico-reflexivo e autogerenciamento do aprendizado, apesar de relatos sobre deficiências em infraestrutura. A prática integrada ao SUS, especialmente nas Unidades de Saúde da Família, aprimorou as dimensões intelectivas, relacionais e afetivas do cuidado, favorecendo a autonomia profissional

GloPID-R report on chikungunya, o'nyong-nyong and Mayaro virus, part 2: Epidemiological distribution of o'nyong-nyong virus

The GloPID-R (Global Research Collaboration for Infectious Disease Preparedness) chikungunya (CHIKV), o'nyong-nyong (ONNV) and Mayaro virus (MAYV) Working Group has been established to identify gaps of knowledge about the natural history, epidemiology and medical management of infection by these viruses, and to provide adapted recommendations for future investigations. Here, we present a report dedicated to ONNV epidemiological distribution. Two large-scale ONNV outbreaks have been identified in Africa in the last 60 years, interspersed with sporadic serosurveys and case reports of returning travelers. The assessment of the real scale of ONNV circulation in Africa remains a difficult task and surveillance studies are necessary to fill this gap. The identification of ONNV etiology is made complicated by the absence of multiplex tools in co-circulati