Praziquantel coverage in schools and communities targeted for the elimination of urogenital schistosomiasis in Zanzibar: a cross-sectional survey

© 2015 Knopp et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. The attached file is the published version of the article

Randomized, Controlled Trial of the Long Term Safety, Immunogenicity and Efficacy of RTS,S/AS02(D) Malaria Vaccine in Infants Living in a Malaria-Endemic Region.

The RTS,S/AS malaria candidate vaccine is being developed with the intent to be delivered, if approved, through the Expanded Programme on Immunization (EPI) of the World Health Organization. Safety, immunogenicity and efficacy of the RTS,S/AS02(D) vaccine candidate when integrated into a standard EPI schedule for infants have been reported over a nine-month surveillance period. This paper describes results following 20 months of follow up. This Phase IIb, single-centre, randomized controlled trial enrolled 340 infants in Tanzania to receive three doses of RTS,S/AS02(D) or hepatitis B vaccine at 8, 12, and 16 weeks of age. All infants also received DTPw/Hib (diphtheria and tetanus toxoids, whole-cell pertussis vaccine, conjugated Haemophilus influenzae type b vaccine) at the same timepoints. The study was double-blinded to month 9 and single-blinded from months 9 to 20. From month 0 to 20, at least one SAE was reported in 57/170 infants who received RTS,S/AS02(D) (33.5%; 95% confidence interval [CI]: 26.5, 41.2) and 62/170 infants who received hepatitis B vaccine (36.5%; 95% CI: 29.2, 44.2). The SAE profile was similar in both vaccine groups; none were considered to be related to vaccination. At month 20, 18 months after completion of vaccination, 71.8% of recipients of RTS,S/AS02(D) and 3.8% of recipients of hepatitis B vaccine had seropositive titres for anti-CS antibodies; seroprotective levels of anti-HBs antibodies remained in 100% of recipients of RTS,S/AS02(D) and 97.7% recipients of hepatitis B vaccine. Anti-HBs antibody GMTs were higher in the RTS,S/AS02(D) group at all post-vaccination time points compared to control. According to protocol population, vaccine efficacy against multiple episodes of malaria disease was 50.7% (95% CI: -6.5 to 77.1, p = 0.072) and 26.7% (95% CI: -33.1 to 59.6, p = 0.307) over 12 and 18 months post vaccination, respectively. In the Intention to Treat population, over the 20-month follow up, vaccine efficacy against multiple episodes of malaria disease was 14.4% (95% CI: -41.9 to 48.4, p = 0.545). The acceptable safety profile and good tolerability of RTS,S/AS02(D) in combination with EPI vaccines previously reported from month 0 to 9 was confirmed over a 20 month surveillance period in this infant population. Antibodies against both CS and HBsAg in the RTS,S/AS02(D) group remained significantly higher compared to control for the study duration. Over 18 months follow up, RTS,S/AS02(D) prevented approximately a quarter of malaria cases in the study population. CLINICAL TRIALS: Gov identifier: NCT00289185

Effects of Thyroxine Exposure on Osteogenesis in Mouse Calvarial Pre-Osteoblasts

The incidence of craniosynostosis is one in every 1,800-2500 births. The gene-environment model proposes that if a genetic predisposition is coupled with environmental exposures, the effects can be multiplicative resulting in severely abnormal phenotypes. At present, very little is known about the role of gene-environment interactions in modulating craniosynostosis phenotypes, but prior evidence suggests a role for endocrine factors. Here we provide a report of the effects of thyroid hormone exposure on murine calvaria cells. Murine derived calvaria cells were exposed to critical doses of pharmaceutical thyroxine and analyzed after 3 and 7 days of treatment. Endpoint assays were designed to determine the effects of the hormone exposure on markers of osteogenesis and included, proliferation assay, quantitative ALP activity assay, targeted qPCR for mRNA expression of Runx2, Alp, Ocn, and Twist1, genechip array for 28,853 targets, and targeted osteogenic microarray with qPCR confirmations. Exposure to thyroxine stimulated the cells to express ALP in a dose dependent manner. There were no patterns of difference observed for proliferation. Targeted RNA expression data confirmed expression increases for Alp and Ocn at 7 days in culture. The genechip array suggests substantive expression differences for 46 gene targets and the targeted osteogenesis microarray indicated 23 targets with substantive differences. 11 gene targets were chosen for qPCR confirmation because of their known association with bone or craniosynostosis (Col2a1, Dmp1, Fgf1, 2, Igf1, Mmp9, Phex, Tnf, Htra1, Por, and Dcn). We confirmed substantive increases in mRNA for Phex, FGF1, 2, Tnf, Dmp1, Htra1, Por, Igf1 and Mmp9, and substantive decreases for Dcn. It appears thyroid hormone may exert its effects through increasing osteogenesis. Targets isolated suggest a possible interaction for those gene products associated with calvarial suture growth and homeostasis as well as craniosynostosis. © 2013 Cray et al

SEND: a system for electronic notification and documentation of vital sign observations

Background: Recognising the limitations of a paper-based approach to documenting vital sign observations and responding to national clinical guidelines, we have explored the use of an electronic solution that could improve the quality and safety of patient care. We have developed a system for recording vital sign observations at the bedside, automatically calculating an Early Warning Score, and saving data such that it is accessible to all relevant clinicians within a hospital trust. We have studied current clinical practice of using paper observation charts, and attempted to streamline the process. We describe our user-focussed design process, and present the key design decisions prior to describing the system in greater detail. Results: The system has been deployed in three pilot clinical areas over a period of 9 months. During this time, vital sign observations were recorded electronically using our system. Analysis of the number of observations recorded (21,316 observations) and the number of active users (111 users) confirmed that the system is being used for routine clinical observations. Feedback from clinical end-users was collected to assess user acceptance of the system. This resulted in a System Usability Scale score of 77.8, indicating high user acceptability. Conclusions: Our system has been successfully piloted, and is in the process of full implementation throughout adult inpatient clinical areas in the Oxford University Hospitals. Whilst our results demonstrate qualitative acceptance of the system, its quantitative effect on clinical care is yet to be evaluated

Perceptions, Experiences and Expectations of Physicians Regarding the Role of the Pharmacist in an Iraqi Hospital Setting

Purpose: To investigate the perceptions, expectations, and experiences of physicians regarding hospital-based pharmacists in some Iraqi government hospitals.Methods: A cross-sectional study was conducted at four government hospitals in Baghdad and Erbil, Iraq from March to July 2012. A validated, self-administered questionnaire was hand-delivered to a random sample of 200 physicians. The questionnaire comprised four sections that probed the physicians' demographic characteristics as well as their perceptions of, expectations of, and experiences with hospital pharmacists.Results: Most participants (69.4 %) reported rarely interacting with pharmacists and that enquiring about the availability of medications was the main purpose (74.9 %) of any interactions. Physicians reported being comfortable with pharmacists preventing prescription error, treating minor illness, and suggesting prescription medication to physicians of 74, 75 and 67 %, respectively, but only 47 % were comfortable with pharmacists providing patient education. The perspective of physicians in Erbil differed from that of physicians in Baghdad (p < 0.05).Conclusion: Interactions between Iraqi physicians and pharmacists are still not optimal. Physicians are much more comfortable with traditional pharmacist functions than with the extended, patient-oriented pharmacy services currently being promoted. Great efforts are needed to enhance the Iraqi physician's attitude regarding the clinical services provided by pharmacists which in turn would result in more collaboration among healthcare professionals.Keywords: Physician, Pharmacist, Perception, Experience, Expectation, Patient-oriented, Pharmacy servic

Comparative Analysis of Loss Functions in TD3 for Autonomous Parking

Autonomous parking is a revolutionary technology that has transformed the automotive industry with the rise of deep reinforcement learning, in particular, the Twin-Delayed Deep Deterministic Policy Gradient Algorithm (TD3). Nonetheless, the robustness of TD3 remains a significant challenge due to bias in Q-value estimates when determining how good an Action, A, taken at a particular state, S. To investigate this gap, this paper analyzes different loss functions in TD3 to better approximate the true Q-value, which is necessary for optimal decision making. Three loss functions are evaluated; Mean Squared Error (MSE), Mean Absolute Error (MAE) and Huber Loss via a simulation experiment for autonomous parking. The results showed that TD3 with Huber Loss has the highest convergence speed with the fastest Actor and Critic loss convergence. The Huber Loss function is found to be more robust and efficient than either loss function such MSE or MAE used in isolation, making it a suitable replacement for existing loss functions in the TD3 algorithm. In the future, TD3 with Huber Loss will be used as the base model to solve overestimation problem in TD3 when the estimated Q-values that represent the expected rewards of taking an action in a particular state, are higher than their true values

Modelling, Identification and Control of A" Magnetic Levitation CE152

43 unstable, it should be linearized at optional operating point and a digital PID controller with a fine tuned parameters is designed to track a small varying input signals. Finally the simulation’s model is validated with the real system, the results show the simulation’s model is adequately represents the real magnetic levitation system

Structural Behaviour and Fire Design of Duplex and Ferritic Stainless Steel CHS Stub Columns

This paper investigates the structural behaviour and design of duplex and ferritic stainless steel stub columns with a circular hollow cross-section (CHS) at elevated temperature. A numerical model is developed to supplement the limited test results on stainless steel CHS stub columns in the literature. Following validation, the numerical approach is employed to gain an understanding of the critical behavioural characteristics which have not previously been studied. In addition, the paper considers and extends the continuous strength method (CSM) to include duplex and ferritic stainless steel for CHS stub columns in fire. The CSM employs a base curve linking the cross-section resistance to its deformation capacity and implements an elastic, linear hardening material model. The cross-sectional resistances obtained from the proposed CSM are compared with those from the numerical analysis, as well as with the standardised procedures in the European, American and Australia/New Zealand design standards. It is demonstrated that CSM can lead to more accurate and less scattered strength predictions than current design codes

Additive Anti-Tumor Effects of Lovastatin and Everolimus In Vitro through Simultaneous Inhibition of Signaling Pathways

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedThis work was supported by a research grant from the Ludwig-Maximilians University of Munich (Förderprogramm für Forschung und Lehre [FöFoLe], grant number 865/829)