Effect of pulsed methylprednisolone on pain, in patients with HTLV-1-associated myelopathy

HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is an immune mediated myelopathy caused by the human T-lymphotropic virus type 1 (HTLV-1). The efficacy of treatments used for patients with HAM/TSP is uncertain. The aim of this study is to document the efficacy of pulsed methylprednisolone in patients with HAM/TSP. Data from an open cohort of 26 patients with HAM/TSP was retrospectively analysed. 1g IV methylprednisolone was infused on three consecutive days. The outcomes were pain, gait, urinary frequency and nocturia, a range of inflammatory markers and HTLV-1 proviral load. Treatment was well tolerated in all but one patient. Significant improvements in pain were: observed immediately, unrelated to duration of disease and maintained for three months. Improvement in gait was only seen on Day 3 of treatment. Baseline cytokine concentrations did not correlate to baseline pain or gait impairment but a decrease in tumour necrosis factor-alpha (TNF-α) concentration after pulsed methylprednisolone was associated with improvements in both. Until compared with placebo, treatment with pulsed methylprednisolone should be offered to patients with HAM/TSP for the treatment of pain present despite regular analgesia

Metrics to evaluate research performance in academic institutions: A critique of ERA 2010 as applied in forestry and the indirect H2 index as a possible alternative

Excellence for Research in Australia (ERA) is an attempt by the Australian Research Council to rate Australian universities on a 5-point scale within 180 Fields of Research using metrics and peer evaluation by an evaluation committee. Some of the bibliometric data contributing to this ranking suffer statistical issues associated with skewed distributions. Other data are standardised year-by-year, placing undue emphasis on the most recent publications which may not yet have reliable citation patterns. The bibliometric data offered to the evaluation committees is extensive, but lacks effective syntheses such as the h-index and its variants. The indirect H2 index is objective, can be computed automatically and efficiently, is resistant to manipulation, and a good indicator of impact to assist the ERA evaluation committees and to similar evaluations internationally.Comment: 19 pages, 6 figures, 7 tables, appendice

Ricci Collineations for type B warped space-times

We present the general structure of proper Ricci Collineations (RC) for type B warped space-times. Within this framework, we give a detailed description of the most general proper RC for spherically symmetric metrics. As examples, static spherically symmetric and Friedmann-Robertson-Walker space-times are considered.Comment: 18 pages, Latex, To appear in GR

Geometric Interpretation of the Mixed Invariants of the Riemann Spinor

Mixed invariants are used to classify the Riemann spinor in the case of Einstein-Maxwell fields and perfect fluids. In the Einstein-Maxwell case these mixed invariants provide information as to the relative orientation of the gravitational and electromagnetic principal null directions. Consideration of the perfect fluid case leads to some results about the behaviour of the Bel-Robinson tensor regarded as a quartic form on unit timelike vectors.Comment: 31 pages, AMS-LaTe

The Incidence Risk, Clustering, and Clinical Presentation of La Crosse Virus Infections in the Eastern United States, 2003–2007

BACKGROUND:Although La Crosse virus (LACV) is one of the most common causes of pediatric arboviral infections in the United States, little has been done to assess its geographic distribution, identify areas of higher risk of disease, and to provide a national picture of its clinical presentation. Therefore, the objective of this study was to investigate the geographic distribution of LACV infections reported in the United States, to identify hot-spots of infection, and to present its clinical picture. METHODS AND FINDINGS:Descriptive and cluster analyses were performed on probable and confirmed cases of LACV infections reported to the Centers for Disease Control and Prevention from 2003-2007. A total of 282 patients had reported confirmed LACV infections during the study period. Of these cases the majority (81 percent) presented during the summer, occurred in children 15 years and younger (83.3 percent), and were found in male children (64.9 percent). Clinically, the infections presented as meningioencephalitis (56.3 percent), encephalitis (20.7 percent), meningitis (17.2 percent), or uncomplicated fever (5 percent). Deaths occurred in 1.9 percent of confirmed cases, and in 8.6 percent of patients suffering from encephalitis. The majority of these deaths were in patients 15 years and younger. The county-level incidence risk among counties (n = 136) reporting both probable and confirmed cases for children 15 years and younger (n = 355) ranged from 0.2 to 228.7 per 100,000 persons. The southern United States experienced a significantly higher (p<0.05) incidence risk during the months of June, July, August, and October then the northern United States. There was significant (p<0.05) clustering of high risk in several geographic regions with three deaths attributed to complications from LAC encephalitis occurring in two of these hot-spots of infections. CONCLUSIONS:Both the incidence risk and case fatality rates were found to be higher than previously reported. We detected clustering in four geographic regions, a shift from the prior geographic distributions, and developed maps identifying high-risk areas. These findings are useful for raising awareness among health care providers regarding areas at a high risk of infections and for guiding targeted multifaceted interventions by public health officials

A rebellious past : history, theatre and the England riots

Alain Badiou has argued that the England riots of 2011, in dialogue with societal upheavals around the world that same year, demonstrated fundamental crises in our governing social, economic and political discourses. Whilst institutional responses to the riots treated them as an aberration, Badiou believes them to be symptomatic of a broader rebirth of ‘history’ – the coalescing of past and present events into a congruent trajectory with powerful implications for the future. Using Badiou’s argument as a starting point, this article considers two theatrical responses to the riots – Nicholas Kent’s premiere of Gillian Slovo’s The Riots at the Tricycle, and Sean Holmes’ revival of Edward Bond’s Saved at the Lyric Hammersmith. By looking at the ways in which the productions sought to historicise the riots, I unpick both their interpretations of these events, and the contributions they were able to make to the urgent and ongoing discussions that the riots have generated.PostprintPeer reviewe

Performance evaluation of automated urine microscopy as a rapid, non-invasive approach for the diagnosis of non-gonococcal urethritis.

OBJECTIVES: Gram-stained urethral smear (GSUS), the standard point-of-care test for non-gonococcal urethritis (NGU) is operator dependent and poorly specific. The performance of rapid automated urine flow cytometry (AUFC) of first void urine (FVU) white cell counts (UWCC) for predicting Mycoplasma genitalium and Chlamydia trachomatis urethral infections was assessed and its application to asymptomatic infection was evaluated. METHODS: Receiver operating characteristic curve analysis, determining FVU-UWCC threshold for predicting M. genitalium or C. trachomatis infection was performed on 208 'training' samples from symptomatic patients and subsequently validated using 228 additional FVUs obtained from prospective unselected patients. RESULTS: An optimal diagnostic threshold of >29 UWC/µL gave sensitivities and specificities for either infection of 81.5% (95% CI 65.1% to 91.6%) and 85.8% (79.5% to 90.4%), respectively, compared with 86.8% (71.1% to 95%) and 64.7% (56.9% to 71.7%), respectively, for GSUS, using the training set samples. FVU-UWCC demonstrated sensitivities and specificities of 69.2% (95% CI 48.1% to 84.9%) and 92% (87.2% to 95.2%), respectively, when using validation samples. In asymptomatic patients where GSUS was not used, AUFC would have enabled more infections to be detected compared with clinical considerations only (71.4% vs 28.6%; p=0.03). The correlation between UWCC and bacterial load was stronger for M. genitalium compared with C. trachomatis (τ=0.426, p≤0.001 vs τ=0.295, p=0.022, respectively). CONCLUSIONS: AUFC offers improved specificity over microscopy for predicting C. trachomatis or M. genitalium infection. Universal AUFC may enable non-invasive diagnosis of asymptomatic NGU at the PoC. The degree of urethral inflammation exhibits a stronger association with pathogen load for M. genitalium compared with C. trachomatis

Energetics of the Einstein-Rosen spacetime

A study covering some aspects of the Einstein--Rosen metric is presented. The electric and magnetic parts of the Weyl tensor are calculated. It is shown that there are no purely magnetic E--R spacetimes, and also that a purely electric E--R spacetime is necessarily static. The geodesics equations are found and circular ones are analyzed in detail. The super--Poynting and the ``Lagrangian'' Poynting vectors are calculated and their expressions are found for two specific examples. It is shown that for a pulse--type solution, both expressions describe an inward radially directed flow of energy, far behind the wave front. The physical significance of such an effect is discussed.Comment: 19 pages Latex.References added and updated.To appear in Int.J.Theor.Phy

Geographic Coincidence of Increased Malaria Transmission Hazard and Vulnerability Occurring at the Periphery of two Tanzanian Villages.

The goal of malaria elimination necessitates an improved understanding of any fine-scale geographic variations in transmission risk so that complementary vector control tools can be integrated into current vector control programmes as supplementary measures that are spatially targeted to maximize impact upon residual transmission. This study examines the distribution of host-seeking malaria vectors at households within two villages in rural Tanzania. Host-seeking mosquitoes were sampled from 72 randomly selected households in two villages on a monthly basis throughout 2008 using CDC light-traps placed beside occupied nets. Spatial autocorrelation in the dataset was examined using the Moran's I statistic and the location of any clusters was identified using the Getis-Ord Gi* statistic. Statistical associations between the household characteristics and clusters of mosquitoes were assessed using a generalized linear model for each species. For both Anopheles gambiae sensu lato and Anopheles funestus, the density of host-seeking females was spatially autocorrelated, or clustered. For both species, houses with low densities were clustered in the semi-urban village centre while houses with high densities were clustered in the periphery of the villages. Clusters of houses with low or high densities of An. gambiae s.l. were influenced by the number of residents in nearby houses. The occurrence of high-density clusters of An. gambiae s.l. was associated with lower elevations while An. funestus was also associated with higher elevations. Distance from the village centre was also positively correlated with the number of household occupants and having houses constructed with open eaves. The results of the current study highlight that complementary vector control tools could be most effectively targeted to the periphery of villages where the households potentially have a higher hazard (mosquito densities) and vulnerability (open eaves and larger households) to malaria infection

Incidence and predictors of immune reconstitution inflammatory syndrome in a rural area of Mozambique.

There is limited data on the epidemiology of Immune Reconstitution Inflammatory Syndrome (IRIS) in rural sub-Saharan Africa. A prospective observational cohort study was conducted to assess the incidence, clinical characteristics, outcome and predictors of IRIS in rural Mozambique