WorldWideScience

Sample records for children receiving artemether-lumefantrine

  1. Clinical Efficacy of Artemether-Lumefantrine in Congolese Children with Acute Uncomplicated Falciparum Malaria in Brazzaville

    Directory of Open Access Journals (Sweden)

    Mathieu Ndounga

    2012-01-01

    Full Text Available The Republic of the Congo adopted artemisinin-based combination therapies (ACTs in 2006: artesunate-amodiaquine and artemether-lumefantrine as the first-line and second-line drugs, respectively. The baseline efficacy of artemether-lumefantrine was evaluated between March and July 2006 in Brazzaville, the capital city of Congo. Seventy-seven children aged between 6 months and 10 years were enrolled in a nonrandomized study. The children were treated under supervision with 6 doses of artemether-lumefantrine and followed up for 28 days in accordance with the 2003 World Health Organization guideline. Pretreatment (i.e., day 0 and recrudescent Plasmodium falciparum isolates between day 14 and day 28 were compared by the polymerase chain reaction to distinguish between true recrudescence and reinfection. The overall cure rate on day 28 was 96.9% after PCR correction. Reported adverse effects included pruritus and dizziness. Artemether-lumefantrine was highly efficacious in Brazzaville.

  2. Pyronaridine-artesunate granules versus artemether-lumefantrine crushed tablets in children with Plasmodium falciparum malaria: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Kayentao Kassoum

    2012-10-01

    Full Text Available Abstract Background Children are most vulnerable to malaria. A pyronaridine-artesunate pediatric granule formulation is being developed for the treatment of uncomplicated Plasmodium falciparum malaria. Methods This phase III, multi-center, comparative, open-label, parallel-group, controlled clinical trial included patients aged ≤12 years, bodyweight ≥5 to P. falciparum malaria. Patients were randomized (2:1 to pyronaridine-artesunate granules (60/20 mg once daily or artemether-lumefantrine crushed tablets (20/120 mg twice daily, both dosed by bodyweight, orally (liquid suspension for three days. Results Of 535 patients randomized, 355 received pyronaridine-artesunate and 180 received artemether-lumefantrine. Day-28 adequate clinical and parasitological response (ACPR, corrected for re-infection using polymerase chain reaction (PCR genotyping (per-protocol population was 97.1% (329/339; 95% CI 94.6, 98.6 for pyronaridine-artesunate; 98.8% (165/167; 95% CI 95.7, 99.9 for artemether-lumefantrine. The primary endpoint was achieved: pyronaridine-artesunate PCR-corrected day-28 ACPR was statistically significantly >90% (P 3 times the upper limit of normal (ULN and peak total bilirubin >2xULN (i.e. within the Hy’s law definition. Conclusions The pyronaridine-artesunate pediatric granule formulation was efficacious and was non-inferior to artemether-lumefantrine. The adverse event profile was similar for the two comparators. Pyronaridine-artesunate should be considered for inclusion in paediatric malaria treatment programmes. Trial registration ClinicalTrials.gov: identifier NCT00541385

  3. Dispersible formulation of artemether/lumefantrine: specifically developed for infants and young children

    Directory of Open Access Journals (Sweden)

    Sagara Issaka

    2009-10-01

    Full Text Available Abstract Infants and children under five years of age are the most vulnerable to malaria with over 1,700 deaths per day from malaria in this group. However, until recently, there were no WHO-endorsed paediatric anti-malarial formulations available. Artemisinin-based combination therapy is the current standard of care for patients with uncomplicated falciparum malaria in Africa. Artemether/lumefantrine (AL meets WHO pre-qualification criteria for efficacy, safety and quality. Coartem®, a fixed dose combination of artemether and lumefantrine, has consistently achieved cure rates of >95% in clinical trials. However, AL tablets are inconvenient for caregivers to administer as they need to be crushed and mixed with water or food for infants and young children. Further, in common with other anti-malarials, they have a bitter taste, which may result in children spitting the medicine out and not receiving the full therapeutic dose. There was a clear unmet medical need for a formulation of AL specifically designed for children. Ahead of a call from WHO for child-friendly medicines, Novartis, working in partnership with Medicines for Malaria Venture (MMV, started the development of a new formulation of AL for infants and young children: Coartem® Dispersible. The excellent efficacy, safety and tolerability already demonstrated by AL tablets were confirmed with dispersible AL in a large trial comparing the crushed tablets with dispersible tablets in 899 African children with falciparum malaria. In the evaluable population, 28-day PCR-corrected cure rates of >96% were achieved. Further, its sweet taste means that it is palatable for children, and the dispersible formulation makes it easier for caregivers to administer than bitter crushed tablets. Easing administration may foster compliance, hence improving therapeutic outcomes in infants and young children and helping to preserve the efficacy of ACT.

  4. Artemether-lumefantrine: an oral antimalarial for uncomplicated malaria in children

    DEFF Research Database (Denmark)

    Adjei, George O; Goka, Bamenla Q; Binka, Fred

    2009-01-01

    Artemether-lumefantrine (AL; Coartem, Riamet) is the first fixed-dose artemisinin combination therapy (ACT) regimen to be manufactured under Good Manufacturing Practice conditions, and is the most widely adopted ACT regimen used in malaria control programs. AL is approved for the treatment...... of uncomplicated malaria in adults, children and infants, and as treatment of uncomplicated malaria in nonimmune travelers returning from malarious areas. AL is efficacious for treating uncomplicated malaria in children and the frequency of associated adverse events is not higher than other available ACT regimens....... In this review, available evidence on efficacy and safety of AL in the treatment of uncomplicated malaria, with emphasis on children where appropriate, and focusing on characteristics that are potentially important for malaria control policy decisions, are presented and discussed....

  5. Oral artesunate-amodiaquine and artemether-lumefantrine in the treatment of uncomplicated hyperparasitaemic Plasmodium falciparum malaria in children.

    Science.gov (United States)

    Gbotosho, Grace O; Sowunmi, Akintunde; Okuboyejo, Titilope M; Happi, Christian T

    2012-04-01

    The therapeutic efficacy, changes in haematocrit and declines in parasitaemias were evaluated in 56 children with uncomplicated falciparum hyperparasitaemia after oral artesunate-amodiaquine or artemether-lumefantrine. All children recovered clinically within 2 days and without progression to severe malaria. Falls in haematocrit in the first 3 days after treatment began were similar and <5%. Declines in parasitaemias were monoexponential with both treatments with an estimated half-life of 1 h.

  6. Detection of persistent Plasmodium spp. infections in Ugandan children after artemether-lumefantrine treatment.

    Science.gov (United States)

    Betson, Martha; Sousa-Figueiredo, José C; Atuhaire, Aaron; Arinaitwe, Moses; Adriko, Moses; Mwesigwa, Gerald; Nabonge, Juma; Kabatereine, Narcis B; Sutherland, Colin J; Stothard, J Russell

    2014-12-01

    During a longitudinal study investigating the dynamics of malaria in Ugandan lakeshore communities, a consistently high malaria prevalence was observed in young children despite regular treatment. To explore the short-term performance of artemether-lumefantrine (AL), a pilot investigation into parasite carriage after treatment(s) was conducted in Bukoba village. A total of 163 children (aged 2-7 years) with a positive blood film and rapid antigen test were treated with AL; only 8.7% of these had elevated axillary temperatures. On day 7 and then on day 17, 40 children (26.3%) and 33 (22.3%) were positive by microscopy, respectively. Real-time PCR analysis demonstrated that multi-species Plasmodium infections were common at baseline, with 41.1% of children positive for Plasmodium falciparum/Plasmodium malariae, 9.2% for P. falciparum/ Plasmodium ovale spp. and 8.0% for all three species. Moreover, on day 17, 39.9% of children infected with falciparum malaria at baseline were again positive for the same species, and 9.2% of those infected with P. malariae at baseline were positive for P. malariae. Here, chronic multi-species malaria infections persisted in children after AL treatment(s). Better point-of-care diagnostics for non-falciparum infections are needed, as well as further investigation of AL performance in asymptomatic individuals.

  7. Electrocardiographic study in Ghanaian children with uncomplicated malaria, treated with artesunate-amodiaquine or artemether-lumefantrine

    Directory of Open Access Journals (Sweden)

    Adjei George O

    2012-12-01

    Full Text Available Abstract Background Several anti-malarial drugs are associated with adverse cardiovascular effects. These effects may be exacerbated when different anti-malarials are used in combination. There has been no report yet on the potential cardiac effects of the combination artesunate-amodiaquine. Methods Electrocardiographic (ECG intervals in Ghanaian children with uncomplicated malaria treated with artesunate-amodiaquine (n=47, were compared with that of children treated with artemether-lumefantrine (n=30. The ECG measurements were repeated one, two, three, seven and 28 days after treatment. The ECG intervals of artesunate-amodiaquine treated subjects were correlated with plasma concentrations of desethylamodiaquine (DEAQ, the main metabolite of amodiaquine. Results The mean ECG intervals were similar in both groups before treatment. After treatment (day 3, ECG intervals changed significantly from baseline in all subjects, but there were no differences between the two treatment groups. A significantly higher proportion of children treated with artesunate-amodiaquine developed sinus bradycardia compared with artemether-lumefantrine treated subjects (7/47 vs 0/30; χ2 p=0.03. Subjects who developed bradycardia were significantly older, and had higher DEAQ concentrations than those who did not develop bradycardia. The proportion of subjects with QTc interval prolongations did not differ significantly between the groups, and no relationship between prolonged QTc intervals and DEAQ levels were observed. No clinically significant rhythm disturbances were observed in any of the subjects. Conclusion Artesunate-amodiaquine treatment resulted in a higher incidence of sinus bradycardia than artemether-lumefantrine treatment in children with uncomplicated malaria, but no clinically significant rhythm disturbances were induced by combining artesunate with amodiaquine. These findings, although reassuring, may imply that non-amodiaquine based artemisinin

  8. Surveillance of the efficacy of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum among children under five in Togo, 2005-2009

    Directory of Open Access Journals (Sweden)

    Dorkenoo Monique A

    2012-10-01

    Full Text Available Abstract Background Malaria remains a major public health problem in Togo. The national malaria control programme in Togo changed the anti-malarial treatment policy from monotherapy to artemisinin combination therapy in 2004. This study reports the results of therapeutic efficacy studies conducted on artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Togo, between 2005 and 2009. Methods Children between 6 and 59 months of age, who were symptomatically infected with P. falciparum, were treated with either artemether-lumefantrine or artesunate-amodiaquine. The primary end-point was the 28-day cure rate, PCR-corrected for reinfection and recrudescence. Studies were conducted according to the standardized WHO protocol for the assessment of the efficacy of anti-malarial treatment. Differences between categorical data were compared using the chi-square test or the Fisher’s exact test where cell counts were ≤ 5. Differences in continuous data were compared using a t-test. Results A total of 16 studies were conducted in five sentinel sites, with 459, 505 and 332 children included in 2005, 2007 and 2009, respectively. The PCR-corrected 28-day cure rates using the per-protocol analysis were between 96%-100% for artemether-lumefantrine and 94%-100% for artesunate-amodiaquine. Conclusions Both formulations of artemisinin-based combination therapy were effective over time and no severe adverse events related to the treatment were reported during the studies.

  9. Safety and tolerability of artemether-lumefantrine versus dihydroartemisinin-piperaquine for malaria in young HIV-infected and uninfected children

    Directory of Open Access Journals (Sweden)

    Kamya Moses

    2009-01-01

    Full Text Available Abstract Background Artemisinin combination therapy has become the standard of care for uncomplicated malaria in most of Africa. However, there is limited data on the safety and tolerability of these drugs, especially in young children and patients co-infected with HIV. Methods A longitudinal, randomized controlled trial was conducted in a cohort of HIV-infected and uninfected children aged 4-22 months in Tororo, Uganda. Participants were randomized to treatment with artemether-lumefantrine (AL or dihydroartemisinin-piperaquine (DP upon diagnosis of their first episode of uncomplicated malaria and received the same regimen for all subsequent episodes. Participants were actively monitored for adverse events for 28 days and then passively for up to 63 days after treatment. This study was registered in ClinicalTrials.gov (registration # NCT00527800. Results A total of 122 children were randomized to AL and 124 to DP, resulting in 412 and 425 treatments, respectively. Most adverse events were rare, with only cough, diarrhoea, vomiting, and anaemia occurring in more than 1% of treatments. There were no differences in the risk of these events between treatment groups. Younger age was associated with an increased risk of diarrhoea in both the AL and DP treatment arms. Retreatment for malaria within 17-28 days was associated with an increased risk of vomiting in the DP treatment arm (HR = 6.47, 95% CI 2.31-18.1, p < 0.001. There was no increase in the risk of diarrhoea or vomiting for children who were HIV-infected or on concomitant therapy with antiretrovirals or trimethoprim-sulphamethoxazole prophylaxis. Conclusion Both AL and DP were safe and well tolerated for the treatment of uncomplicated malaria in young HIV-infected and uninfected children. Trial Registration ClinicalTrials.gov: NCT00527800; http://clinicaltrials.gov/ct2/show/NCT00527800

  10. Therapeutic efficacy and effects of artemether-lumefantrine and artesunate-amodiaquine coformulated or copackaged on malaria-associated anemia in children with uncomplicated Plasmodium falciparum malaria in Southwest Nigeria.

    Science.gov (United States)

    Gbotosho, Grace O; Sowunmi, Akintunde; Okuboyejo, Titilope M; Happi, Christian T; Folarin, Onikepe A; Michael, Obaro S; Adewoye, Elsie O

    2011-05-01

    The therapeutic efficacy and effects of artemether-lumefantrine (AL) and artesunate-amodiaquine co-formulated (AAcf) or co-packaged (AAcp) on malaria-associated anemia (MAA) were evaluated in 285 children < 12 years of age with uncomplicated Plasmodium falciparum malaria randomized to receive one of the three drug combinations. Fever and parasite clearance times were similar in all treatment groups. Mean drug-attributable fall in hematocrit (DAFH), defined as difference between hematocrit values pre- and 3 d post-initiation of treatment, was low (< 4.5%) and rates of recovery from MAA were similar with all treatments. Mean areas under curve (AUCs) of the plot of deficit in hematocrit levels from 30% versus time in anemic children were similar in all groups. All regimens were well tolerated. AL, AAcf and AAcp cleared fever and parasitemia rapidly and had similar rates of resolution of MAA after treatment in malarious Nigerian children.

  11. A randomized trial on effectiveness of artemether-lumefantrine versus artesunate plus amodiaquine for unsupervised treatment of uncomplicated Plasmodium falciparum malaria in Ghanaian children

    Directory of Open Access Journals (Sweden)

    Hogan Benedikt

    2008-12-01

    Full Text Available Abstract Background Numerous trials have demonstrated high efficacy and safety of artemisinin-based combination therapy (ACT under supervised treatment. In contrast, effectiveness studies comparing different types of ACT applied unsupervised are scarce. The aim of this study was to compare effectiveness, tolerability and acceptance of artesunate plus amodiaquine (ASAQ against that of artemether-lumefantrine (AL in Ghanaian children with uncomplicated Plasmodium falciparum malaria. Methods A randomized open-label trial was conducted at two district hospitals in the Ashanti region, Ghana, an area of intense malaria transmission. A total of 246 children under five years of age were randomly assigned to either ASAQ (Arsucam® or AL (Coartem®. Study participants received their first weight-adjusted dose under supervision. After the parent/guardian was advised of times and mode of administration the respective three-day treatment course was completed unobserved at home. Follow-up visits were performed on days 3, 7, 14 and 28 to evaluate clinical and parasitological outcomes, adverse events, and haematological recovery. Length polymorphisms of variable regions of msp1 and msp2 were determined to differentiate recrudescences from reinfections. Acceptance levels of both treatment regimens were assessed by means of standardized interviews. Results Adequate clinical and parasitological responses after AL and ASAQ treatment were similar (88.3% and 91.7%, respectively. Interestingly, more late clinical failures until day 28 occurred in AL-treated children than in those who received ASAQ (17.5% and 7.3%, respectively; Hazard Ratio 2.41, 95% CI 1.00–5.79, p Haematological recovery and drug tolerability were not found to be significantly different in both study arms. The acceptance of treatment with ASAQ was higher than that with AL (rank-scores 10.6 and 10.3, respectively; p Conclusion Unobserved AL and ASAQ treatment showed high adequate clinical and

  12. The impact of retail-sector delivery of artemether-lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Beth P Kangwana

    2011-05-01

    Full Text Available BACKGROUND: It has been proposed that artemisinin-based combination therapy (ACT be subsidised in the private sector in order to improve affordability and access. This study in western Kenya aimed to evaluate the impact of providing subsidized artemether-lumefantrine (AL through retail providers on the coverage of prompt, effective antimalarial treatment for febrile children aged 3-59 months. METHODS AND FINDINGS: We used a cluster-randomized, controlled design with nine control and nine intervention sublocations, equally distributed across three districts in western Kenya. Cross-sectional household surveys were conducted before and after the delivery of the intervention. The intervention comprised provision of subsidized packs of paediatric ACT to retail outlets, training of retail outlet staff, and community awareness activities. The primary outcome was defined as the proportion of children aged 3-59 months reporting fever in the past 2 weeks who started treatment with AL on the same day or following day of fever onset. Data were collected using structured questionnaires and analyzed based on cluster-level summaries, comparing control to intervention arms, while adjusting for other covariates. Data were collected on 2,749 children in the target age group at baseline and 2,662 at follow-up. 29% of children experienced fever within 2 weeks before the interview. At follow-up, the percentage of children receiving AL on the day of fever or the following day had risen by 14.6% points in the control arm (from 5.3% [standard deviation (SD: 3.2%] to 19.9% [SD: 10.0%] and 40.2% points in the intervention arm (from 4.7% [SD: 3.4%] to 44.9% [SD: 11.7%]. The percentage of children receiving AL was significantly greater in the intervention arm at follow-up, with a difference between the arms of 25.0% points (95% confidence interval [CI]: 14.1%, 35.9%; unadjusted p = 0.0002, adjusted p = 0.0001. No significant differences were observed between arms in the

  13. Therapeutic efficacy of artemether-lumefantrine combination in the treatment of uncomplicated malaria among children under five years of age in three ecological zones in Ghana

    Directory of Open Access Journals (Sweden)

    Abuaku Benjamin

    2012-11-01

    Full Text Available Abstract Background In 2008, artemether - lumefantrine (AL and dihydroartemisinin - piperaquine (DHAP were added to artesunate - amodiaquine (AS-AQ as first-line drugs for uncomplicated malaria in Ghana. The introduction of new drugs calls for continuous monitoring of these drugs to provide timely information on trends of their efficacy and safety to enhance timely evidence-based decision making by the National Malaria Control Programme. In this regard, the therapeutic efficacy of AL was monitored from September 2010 to April 2011 in four sentinel sites representing the three main ecological zones of the country. Methods The study was a one-arm prospective evaluation of clinical and parasitological responses to directly observed treatment for uncomplicated malaria among children aged 6 months to 59 months using the 2009 WHO protocol for surveillance of anti-malarial drug efficacy. Children recruited into the study received weight-based 20/120 mg AL at 0, 8, 24, 36, 48, and 60 hrs. Parasitaemia levels were assessed on days 2, 3, 7, 14, 21, 28, and at any time a study child was brought to the clinic with fever. Results A total of 175 children were enrolled into the study: 56 in the savanna zone, 78 in the forest zone and 41 in the coastal zone. Per-protocol analysis showed that the overall PCR-corrected cure rates on day 14 and day 28 were 96.5% (95% CI: 92.1, 98.6 and 95.4% (95% CI: 90.3, 98.0, respectively, with statistically significant differences between the ecological zones. The 90.4% day-28 cure rate observed in the savannah zone (95% CI: 78.2, 96.4 was significantly the lowest compared with 100% (95% CI: 93.2, 99.9 in the forest zone and 93.8% (95% CI: 77.8, 98.9 in the coastal zone (P = 0.017. Fever and parasite clearance were slower among children enrolled in the savannah zone. Gametocytaemia after day-3 post-treatment was rare in all the zones. Conclusions The study has shown that AL remains efficacious in Ghana with

  14. A simple dose regimen of artesunate and amodiaquine based on age or body weight range for uncomplicated falciparum malaria in children: comparison of therapeutic efficacy with standard dose regimen of artesunate and amodiaquine and artemether-lumefantrine.

    Science.gov (United States)

    Gbotosho, Grace O; Sowunmi, Akintunde; Okuboyejo, Titilope M; Happi, Christian T; Folarin, Onikepe O; Adewoye, Elsie O

    2012-07-01

    A new dose regimen of artesunate and amodiaquine (NDRAA) based on age or body weight range was compared with standard dose regimen of artesunate and amodiaquine (SDRAA) calculated according to body weight and with fixed-dose artesunate-amodiaquine (FDAA) and artemether-lumefantrine (AL) in 304 children afflicted by malaria aged 15 years or younger. In initial comparison (n = 208), children on NDRAA received 1-3 times amodiaquine per kilogram of body weight and 1-1.5 times of artesunate per kilogram of body weight compared with those receiving SDRAA. Parasite but not fever clearance was significantly faster in children who received NDRAA (19.4 ± 8.4 hours vs. 24.6 ± 15.5 hours, P = 0.003). Polymerase chain reaction-uncorrected cure rates on days 28-42 were also significantly higher in children who received NDRAA (P < 0.02 in all cases). Therapeutic responses in children younger than 5 years (n = 96) treated with NDRAA, FDAA, and AL were similar. Changes in hematocrit values and reported adverse events after commencing therapy were similar in those who received NDRAA and SDRAA. All drug regimens were well tolerated. NDRAA based on age or body weight range is simple, is therapeutically superior to SDRAA calculated according to body weight, and is as efficacious as AL in children younger than 5 years.

  15. A comparative, randomized clinical trial of artemisinin/naphtoquine twice daily one day versus artemether/lumefantrine six doses regimen in children and adults with uncomplicated falciparum malaria in Côte d'Ivoire

    Directory of Open Access Journals (Sweden)

    Toure Walamtchin

    2009-07-01

    Full Text Available Abstract Background Drug resistance in Plasmodium falciparum poses a major threat to malaria control. Combination anti-malarial therapy, including artemisinins, has been advocated to improve efficacy and limit the spread of resistance. The fixed combination of oral artemether-lumefantrine (AL is highly effective and well-tolerated. Artemisinin/naphtoquine (AN is a fixed-dose ACT that has recently become available in Africa. The objectives of the study were to compare the efficacy and safety of AN and AL for the treatment of uncomplicated falciparum malaria in a high transmission-intensity site in Ivory Coast. Methods We enrolled 122 participants aged 6 months or more with uncomplicated falciparum malaria. Participants were randomized to receive either artemisinin/naphtoquine or artemether/lumefantrine with variable dose according to their weight. Primary endpoints were the risks of treatment failure within 28 days, either unadjusted or adjusted by genotyping to distinguish recrudescence from new infection. Results Among 125 participants enrolled, 123 (98.4% completed follow-up. Clinical evaluation of the 123 participants showed that cumulative PCR-uncorrected cure rate on day 28 was 100% for artemisinin/naphtoquine and 98.4% for artemether/lumefantrine. Both artemisinin-based combinations effected rapid fever and parasite clearance. Interpretation These data suggest that Arco® could prove to be suitable for use as combination antimalarial therapy. Meanwhile, pharmacokinetic studies and further efficacy assessment should be conducted before its widespread use can be supported.

  16. Efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for treatment of uncomplicated malaria in children in Zaire and Uíge Provinces, angola.

    Science.gov (United States)

    Plucinski, Mateusz M; Talundzic, Eldin; Morton, Lindsay; Dimbu, Pedro Rafael; Macaia, Aleixo Panzo; Fortes, Filomeno; Goldman, Ira; Lucchi, Naomi; Stennies, Gail; MacArthur, John R; Udhayakumar, Venkatachalam

    2015-01-01

    The development of resistance to antimalarials is a major challenge for global malaria control. Artemisinin-based combination therapies, the newest class of antimalarials, are used worldwide but there have been reports of artemisinin resistance in Southeast Asia. In February through May 2013, we conducted open-label, nonrandomized therapeutic efficacy studies of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) in Zaire and Uíge Provinces in northern Angola. The parasitological and clinical responses to treatment in children with uncomplicated Plasmodium falciparum monoinfection were measured over 28 days, and the main outcome was a PCR-corrected adequate clinical and parasitological response (ACPR) proportion on day 28. Parasites from treatment failures were analyzed for the presence of putative molecular markers of resistance to lumefantrine and artemisinins, including the recently identified mutations in the K13 propeller gene. In the 320 children finishing the study, 25 treatment failures were observed: 24 in the AL arms and 1 in the DP arm. The PCR-corrected ACPR proportions on day 28 for AL were 88% (95% confidence interval [CI], 78 to 95%) in Zaire and 97% (91 to 100%) in Uíge. For DP, the proportions were 100% (95 to 100%) in Zaire, and 100% (96 to 100%) in Uíge. None of the treatment failures had molecular evidence of artemisinin resistance. In contrast, 91% of AL late-treatment failures had markers associated with lumefantrine resistance on the day of failure. The absence of molecular markers for artemisinin resistance and the observed efficacies of both drug combinations suggest no evidence of artemisinin resistance in northern Angola. There is evidence of increased lumefantrine resistance in Zaire, which should continue to be monitored.

  17. Efficacy and safety of fixed-dose artesunate-amodiaquine vs. artemether-lumefantrine for repeated treatment of uncomplicated malaria in Ugandan children.

    Directory of Open Access Journals (Sweden)

    Adoke Yeka

    Full Text Available The safety and efficacy of the two most widely used fixed-dose artemisinin-based combination therapies (ACT, artesunate-amodiaquine (ASAQ and artemether-lumefantrine (AL are well established for single episodes of uncomplicated Plasmodium falciparum malaria, but the effects of repeated, long-term use are not well documented. We conducted a 2-year randomized, open-label, longitudinal, phase IV clinical trial comparing the efficacy and safety of fixed-dose ASAQ and AL for repeated treatment of uncomplicated malaria in children under 5 years at Nagongera Health Centre, Uganda. Participants were randomized to ASAQ or AL and all subsequent malaria episodes were treated with the same regimen. 413 children were enrolled and experienced a total of 6027 malaria episodes (mean 15; range, 1-26. For the first malaria episode, the PCR-corrected-cure rate for ASAQ (97.5% was non-inferior to that for AL (97.0%; 95% CI [-0.028; 0.037]. PCR-corrected cure rates for subsequent malaria episodes that had over 100 cases (episodes 2-18, ranged from 88.1% to 98.9% per episode, with no clear difference between the treatment arms. Parasites were completely cleared by day 3 for all malaria episodes and gametocyte carriage was less than 1% by day 21. Fever clearance was faster in the ASAQ group for the first episode. Treatment compliance for subsequent episodes (only first dose administration observed was close to 100%. Adverse events though common were similar between treatment arms and mostly related to the disease. Serious adverse events were uncommon, comparable between treatment arms and resolved spontaneously. Anemia and neutropenia occurred in <0.5% of cases per episode, abnormal liver function tests occurred in 0.3% to 1.4% of cases. Both regimens were safe and effective for repeated treatment of malaria.Current Controlled Trials NCT00699920.

  18. Artemether-lumefantrine versus artesunate plus amodiaquine for treating uncomplicated childhood malaria in Nigeria: randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Nwachukwu Chukwuemeka

    2006-05-01

    Full Text Available Abstract Background The therapeutic efficacy of artesunate plus amodiaquine and artemether/lumefantrine were assessed in an area of Nigeria with high levels of Plasmodium falciparum resistance to chloroquine and sulphadoxine-pyrimethamine. Participants Children aged 6 to 59 months with uncomplicated P. falciparum infection and parasite density 1,000 to 200,000 parasites/μL enrolled following informed consent by parents. Methods Eligible children were randomly assigned to receive either a 3-day course of artesunate (4 mg/kg plus amodiaquine (10 mg/kg or 6-dose course of artemether/lumefantrine (20/120 mg tablets over three days. Patients were followed up with clinical and laboratory assessments until day 14 using standard WHO in-vivo antimalarial drug test protocol. Results A total 119 eligible children were enrolled but 111 completed the study. Adequate clinical and parasitological response (ACPR was 47 (87.0% and 47 (82.5% for artemether-lumefantrine (AL and artesunate+amodiaquine (AAMQ respectively (OR 0.7, 95% confidence interval 0.22 to 2.22. Early treatment failure (ETF occurred in one participant (1.8% treated with AAQ but in none of those with AL. Two (3.7% patients in the AL group and none in the AAQ group had late clinical failure. Late parasitological failure was observed in 9 (15.8 and 5 (9.3% of patients treated with AAQ and AL respectively. None of participants had a serious adverse event. Conclusion Artemether-lumenfantrine and artesunate plus amodiaquine have high and comparable cure rates and tolerability among under-five children in Calabar, Nigeria.

  19. Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania: an open label prospective study

    Directory of Open Access Journals (Sweden)

    Blessborn Daniel

    2011-03-01

    Full Text Available Abstract Background Home-management of malaria (HMM strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL, presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs and administered unsupervised by parents or guardians at home. Methods An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. Results A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5% patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%. The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10 compared with reinfections (205 ng/mL [114-390]; n = 92, or no parasite reappearance (217 [121-374] ng/mL; n = 70; p ≤ 0.046. Conclusions Provision of AL by CHWs for unsupervised malaria treatment at home

  20. Chlorproguanil-dapsone-artesunate versus artemether-lumefantrine: a randomized, double-blind phase III trial in African children and adolescents with uncomplicated Plasmodium falciparum malaria.

    Directory of Open Access Journals (Sweden)

    Zul Premji

    Full Text Available BACKGROUND: Chlorproguanil-dapsone-artesunate (CDA was developed as an affordable, simple, fixed-dose artemisinin-based combination therapy for use in Africa. This trial was a randomized parallel-group, double-blind, double-dummy study to compare CDA and artemether-lumefantrine (AL efficacy in uncomplicated Plasmodium falciparum malaria and further define the CDA safety profile, particularly its hematological safety in glucose-6-phosphate dehydrogenase (G6PD -deficient patients. METHODS AND FINDINGS: The trial was conducted at medical centers at 11 sites in five African countries between June 2006 and August 2007. 1372 patients (> or =1 to <15 years old, median age 3 years with acute uncomplicated P. falciparum malaria were randomized (2:1 to receive CDA 2/2.5/4 mg/kg once daily for three days (N = 914 or six-doses of AL over three days (N = 458. Non-inferiority of CDA versus AL for efficacy was evaluated in the Day 28 per-protocol (PP population using parasitological cure (polymerase chain reaction [PCR]-corrected. Cure rates were 94.1% (703/747 for CDA and 97.4% (369/379 for AL (treatment difference -3.3%, 95%CI -5.6, -0.9. CDA was non-inferior to AL, but there was simultaneous superiority of AL (upper 95%CI limit <0. Adequate clinical and parasitological response at Day 28 (uncorrected for reinfection was 79% (604/765 with CDA and 83% (315/381 with AL. In patients with a G6PD-deficient genotype (94/603 [16%] hemizygous males, 22/598 [4%] homozygous females, CDA had the propensity to cause severe and clinically concerning hemoglobin decreases: the mean hemoglobin nadir was 75 g/L (95%CI 71, 79 at Day 7 versus 97 g/L (95%CI 91, 102 for AL. There were three deaths, unrelated to study medication (two with CDA, one with AL. CONCLUSIONS: Although parasitologically effective at Day 28, the hemolytic potential of CDA in G6PD-deficient patients makes it unsuitable for use in a public health setting in Africa. TRIAL REGISTRATION: ClinicalTrials.Gov NCT

  1. Artemether-lumefantrine treatment of uncomplicated Plasmodium falciparum malaria

    DEFF Research Database (Denmark)

    Kofoed, Poul-Erik

    2015-01-01

    BACKGROUND: Achieving adequate antimalarial drug exposure is essential for curing malaria. Day 7 blood or plasma lumefantrine concentrations provide a simple measure of drug exposure that correlates well with artemether-lumefantrine efficacy. However, the 'therapeutic' day 7 lumefantrine concentr......BACKGROUND: Achieving adequate antimalarial drug exposure is essential for curing malaria. Day 7 blood or plasma lumefantrine concentrations provide a simple measure of drug exposure that correlates well with artemether-lumefantrine efficacy. However, the 'therapeutic' day 7 lumefantrine......-lumefantrine for uncomplicated Plasmodium falciparum malaria, to define therapeutic day 7 lumefantrine concentrations and identify patient factors that substantially alter these concentrations. A systematic review of PubMed, Embase, Google Scholar, ClinicalTrials.gov and conference proceedings identified all relevant studies...... lumefantrine concentrations ≥200 ng/ml and high cure rates in most uncomplicated malaria patients. Three groups are at increased risk of treatment failure: very young children (particularly those underweight-for-age); patients with high parasitemias; and patients in very low transmission intensity areas...

  2. Pyronaridine-artesunate granules versus artemether-lumefantrine crushed tablets in children with Plasmodium falciparum malaria: a randomized controlled trial

    OpenAIRE

    Kayentao Kassoum; Doumbo Ogobara K; Pénali Louis K; Offianan André T; Bhatt Kirana M; Kimani Joshua; Tshefu Antoinette K; Kokolomami Jack HT; Ramharter Michael; de Salazar Pablo Martinez; Tiono Alfred B; Ouédraogo Alphonse; Bustos Maria Dorina G; Quicho Frederick; Borghini-Fuhrer Isabelle

    2012-01-01

    Abstract Background Children are most vulnerable to malaria. A pyronaridine-artesunate pediatric granule formulation is being developed for the treatment of uncomplicated Plasmodium falciparum malaria. Methods This phase III, multi-center, comparative, open-label, parallel-group, controlled clinical trial included patients aged ≤12 years, bodyweight ≥5 to 90% (P 3 times the upper limit of normal (ULN) and peak total bilirubin >2xULN (i.e. within the Hy’s law definition). Conclusions The pyron...

  3. Amodiaquine-Artesunate versus Artemether-Lumefantrine against Uncomplicated Malaria in Children Less Than 14 Years in Ngaoundere, North Cameroon: Efficacy, Safety, and Baseline Drug Resistant Mutations in pfcrt, pfmdr1, and pfdhfr Genes.

    Science.gov (United States)

    Ali, Innocent M; Netongo, Palmer M; Atogho-Tiedeu, Barbara; Ngongang, Eric-Olivier; Ajua, Anthony; Achidi, Eric A; Mbacham, Wilfred F

    2013-01-01

    Background. In Cameroon, both Artesunate-amodiaquine (AS/AQ) and artemether-lumefantrine (AL) are used as first-line treatment against uncomplicated malaria in line with the WHO recommendations. We compared the efficacy and safety of both therapeutic combinations and determined the prevalence of drug resistance conferring mutations in three parasite genes. Methods. One hundred and fifty acute malaria patients between six months and 14 years of age were randomized to receive standard doses of either AS/AQ (73) or AL (77) and followedup for 28 days. Outcome of treatment was according to the standard WHO classification. DNA samples from pretreatment parasite isolates were used to determine the prevalence of resistant mutations in the pfcrt, pfmdr1, and dhfr genes. Results. Both drug combinations induced rapid clearance of parasites and malaria symptoms. PCR-corrected cure rates were 100% and 96.4% for AL. The combinations were well tolerated. Major haplotypes included CVIET (71%), CVMNT (25%) for the pfcrt; SND (100%) for the pfmdr1; IRN (79, 8%), NCS (8.8%), and mixed haplotype (11, 8%) for the dhfr. Conclusion. Both AS/AQ and AL were highly effective and well tolerated for the treatment of uncomplicated falciparum malaria in Ngaoundere, Cameroon. High prevalence of mutant pfcrt alleles confirms earlier observations. Long-term monitoring of safety and efficacy and molecular markers is highly solicited.

  4. Amodiaquine-Artesunate versus Artemether-Lumefantrine against Uncomplicated Malaria in Children Less Than 14 Years in Ngaoundere, North Cameroon: Efficacy, Safety, and Baseline Drug Resistant Mutations in pfcrt, pfmdr1, and pfdhfr Genes

    Directory of Open Access Journals (Sweden)

    Innocent M. Ali

    2013-01-01

    Full Text Available Background. In Cameroon, both Artesunate-amodiaquine (AS/AQ and artemether-lumefantrine (AL are used as first-line treatment against uncomplicated malaria in line with the WHO recommendations. We compared the efficacy and safety of both therapeutic combinations and determined the prevalence of drug resistance conferring mutations in three parasite genes. Methods. One hundred and fifty acute malaria patients between six months and 14 years of age were randomized to receive standard doses of either AS/AQ (73 or AL (77 and followedup for 28 days. Outcome of treatment was according to the standard WHO classification. DNA samples from pretreatment parasite isolates were used to determine the prevalence of resistant mutations in the pfcrt, pfmdr1, and dhfr genes. Results. Both drug combinations induced rapid clearance of parasites and malaria symptoms. PCR-corrected cure rates were 100% and 96.4% for AL. The combinations were well tolerated. Major haplotypes included CVIET (71%, CVMNT (25% for the pfcrt; SND (100% for the pfmdr1; IRN (79, 8%, NCS (8.8%, and mixed haplotype (11, 8% for the dhfr. Conclusion. Both AS/AQ and AL were highly effective and well tolerated for the treatment of uncomplicated falciparum malaria in Ngaoundere, Cameroon. High prevalence of mutant pfcrt alleles confirms earlier observations. Long-term monitoring of safety and efficacy and molecular markers is highly solicited.

  5. Efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Northeast Ethiopia

    Directory of Open Access Journals (Sweden)

    Assefa Mulu

    2015-06-01

    Conclusions: In general, this study discovered good clinical and parasitological response of P. falciparum to artemether/lumefantrine. Further polymeric chain reaction and plasma drug concentration based effectiveness study of artemether/lumefantrine should be conducted throughout the country. [Int J Basic Clin Pharmacol 2015; 4(3.000: 492-496

  6. Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treatment of Uncomplicated Plasmodium falciparum Malaria in Children Aged Less than 15 Years in Guinea-Bissau - An Open-Label Non-Inferiority Randomised Clinical Trial

    DEFF Research Database (Denmark)

    Ursing, Johan; Rombo, Lars; Rodrigues, Amabelia;

    2016-01-01

    BACKGROUND: Artemether-lumefantrine (AL) was introduced for treatment of uncomplicated malaria in Guinea-Bissau in 2008. Malaria then resurged and recurrent malaria after treatment with AL and stock-outs of AL were common. This study therefore aimed to assess the efficacy of AL and identify...... an alternative second line antimalarial. Dihydroartemisinin-piperaquine (DP) was chosen as it has been shown to be safe and efficacious and to reduce the incidence of recurrent malaria. METHODS AND FINDINGS: In a multicentre randomised open-label non-inferiority clinical trial, AL or DP were given over 3 days.......022. In a modified intention to treat analysis in which treatment failures day 0 and reinfections were also considered as treatment failures adequate clinical and parasitological responses were 94% and 97% (OR 0.42 [95% CI, 0.13-1.38], p = 0.15). Parasite clearance and symptom resolution were similar with both...

  7. Quality Assessment of Artemether-Lumefantrine Samples and Artemether Injections Sold in the Cape Coast Metropolis

    Directory of Open Access Journals (Sweden)

    James Prah

    2016-01-01

    Full Text Available Most prescribers and patients in Ghana now opt for the relatively expensive artemether/lumefantrine rather than artesunate-amodiaquine due to undesirable side effects in the treatment of uncomplicated malaria. The study sought to determine the existence of substandard and/or counterfeit artemether-lumefantrine tablets and suspension as well as artemether injection on the market in Cape Coast. Six brands of artemether-lumefantrine tablets, two brands of artemether-lumefantrine suspensions, and two brands of artemether injections were purchased from pharmacies in Cape Coast for the study. The mechanical properties of the tablets were evaluated. The samples were then analyzed for the content of active ingredients using High Performance Liquid Chromatography with a variable wavelength detector. None of the samples was found to be counterfeit. However, the artemether content of the samples was variable (93.22%−104.70% of stated content by manufacturer. The lumefantrine content of the artemether/lumefantrine samples was also variable (98.70%–111.87%. Seven of the artemether-lumefantrine brands passed whilst one failed the International Pharmacopoeia content requirements. All brands of artemether injections sampled met the International Pharmacopoeia content requirement. The presence of a substandard artemether-lumefantrine suspension in the market should alert regulatory bodies to be more vigilant and totally flush out counterfeit and substandard drugs from the Ghanaian market.

  8. Efficacy of artemether-lumefantrine as a treatment for uncomplicated Plasmodium vivax malaria in eastern Sudan

    Directory of Open Access Journals (Sweden)

    Abdallah Tajeldin M

    2012-12-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT is the treatment of choice for uncomplicated Plasmodium falciparum malaria in most areas of the world, where malaria is endemic, including Sudan. However, few published data are available on the use of ACT for treatment of P. vivax malaria. Methods This study was conducted at a health centre in Kassala, eastern Sudan, from October to December 2011. Patients with uncomplicated P. vivax malaria received artemether-lumefantrine (AL tablets (containing 20mg artemether and 120 mg lumefantrine and were monitored for 28 days. Results Out of the 43 cases enrolled in this study, 38 completed the 28-day follow-up. Their mean age was 25.1 years (SD: 1.5. On day 3 following AL treatment, all of the patients were afebrile and aparasitaemic. By day 28, all 38 patients exhibited adequate clinical and parasitological responses to AL treatment. The cure rate was 100% and 88.4% for the per protocol analysis andfor the intention to treat analysis, respectively. Mild adverse effects (nausea, vomiting, abdominal pain, dizziness and/or rash that resolved spontaneously were observed in four (10.5% of the patients. Conclusion AL combination therapy was fully effective for treatment of P. vivax malaria in the study in eastern Sudan. Trial registration Trial. Gov: NCT01625871

  9. Possible clinical failure of artemether-lumefantrine in an italian traveler with uncomplicated falciparum malaria.

    Science.gov (United States)

    Repetto, Ernestina C; Traverso, Antonio; Giacomazzi, Claudio G

    2011-01-01

    Artemisinin-combination therapies (ACTs) are recommended for the treatment of uncomplicated malaria in endemic areas with multidrug resistant Plasmodium falciparum. We report a case of possible artemether-lumefantrine clinical failure in an Italian traveler with uncomplicated P. falciparum malaria imported from Democratic Republic of Congo.

  10. Possible treatment failure of artemether-lumefantrine in an Italian traveler with uncomplicated falciparum malaria.

    Directory of Open Access Journals (Sweden)

    Ernestina Carla Repetto

    2011-10-01

    Full Text Available Artemisinin-combination therapies (ACTs are recommended for the treatment of uncomplicated malaria in endemic areas with multidrug resistant Plasmodium falciparum. We report a case of possible artemether-lumefantrine failure in an Italian traveler with uncomplicated P. falciparum malaria imported from Democratic Republic of Congo.

  11. Therapeutic efficacy of artemether-lumefantrine for Plasmodium vivax infections in a prospective study in Guyana

    Directory of Open Access Journals (Sweden)

    Eibach Daniel

    2012-10-01

    Full Text Available Abstract Background In Guyana, chloroquine + primaquine is used for the treatment of vivax malaria. A worldwide increase of chloroquine resistance in Plasmodium vivax led to questioning of the current malaria treatment guidelines. A therapeutic efficacy study was conducted using artemether-lumefantrine + primaquine against P. vivax to evaluate a treatment alternative for chloroquine. Methods From 2009 to 2010, a non-controlled study in two hospitals in Guyana was conducted. A total 61 patients with P. vivax infection were treated with artemether-lumefantrine as a six-dose regimen twice a day for three days with additional 0.25 mg/kg/d primaquine at day 0 for 14 days. Clinical and parasitological parameters were followed on days 0,1,2,3,7,14 and 28 in agreement with WHO guidelines. Plasmodium vivax DNA from eight patients was analysed for pvmdr1, molecular marker of resistance. Results Artemether-lumefantrine cleared 100% of parasites on day 1, but two patients (3% had recurrence of parasites on day 28, suggesting relapse. No pvmdr1 Y976F polymorphism was detected. The treatment regimen was well tolerated. Conclusions In Guyana, artemether-lumefantrine represents an adequate treatment option against P. vivax when combined with primaquine. Availability of this alternative will be of great importance in case of emerging chloroquine resistance against P. vivax.

  12. Possible Clinical Failure of Artemether-Lumefantrine in an Italian Traveler with Uncomplicated Falciparum Malaria.

    Science.gov (United States)

    Repetto, Ernestina C.; Traverso, Antonio; Giacomazzi, Claudio G.

    2011-01-01

    Artemisinin-combination therapies (ACTs) are recommended for the treatment of uncomplicated malaria in endemic areas with multidrug resistant Plasmodium falciparum. We report a case of possible artemether-lumefantrine clinical failure in an Italian traveler with uncomplicated P. falciparum malaria imported from Democratic Republic of Congo. PMID:22084655

  13. Haemolytic anaemia in an HIV-infected patient with severe falciparum malaria after treatment with oral artemether-lumefantrine

    Directory of Open Access Journals (Sweden)

    Corpolongo Angela

    2012-03-01

    Full Text Available Abstract Intravenous (i.v. artesunate is now the recommended first-line treatment of severe falciparum malaria in adults and children by WHO guidelines. Nevertheless, several cases of haemolytic anaemia due to i.v. artesunate treatment have been reported. This paper describes the case of an HIV-infected patient with severe falciparum malaria who was diagnosed with haemolytic anaemia after treatment with oral artemether-lumefantrine. The patient presented with fever, headache, and arthromyalgia after returning from Central African Republic where he had been working. The blood examination revealed acute renal failure, thrombocytopaenia and hypoxia. Blood for malaria parasites indicated hyperparasitaemia (6% and Plasmodium falciparum infection was confirmed by nested-PCR. Severe malaria according to the laboratory WHO criteria was diagnosed. A treatment with quinine and doxycycline for the first 12 hours was initially administered, followed by arthemeter/lumefantrine (Riamet® for a further three days. At day 10, a diagnosis of severe haemolytic anaemia was made (Hb 6.9 g/dl, LDH 2071 U/l. Hereditary and autoimmune disorders and other infections were excluded through bone marrow aspiration, total body TC scan and a wide panel of molecular and serologic assays. The patient was treated by transfusion of six units of packed blood red cell. He was discharged after complete remission at day 25. At present, the patient is in a good clinical condition and there is no evidence of haemolytic anaemia recurrence. This is the first report of haemolytic anaemia probably associated with oral artemether/lumefantrine. Further research is warranted to better define the adverse events occurring during combination therapy with artemisinin derivatives.

  14. Quality and stability of artemether-lumefantrine stored under ambient conditions in rural Mali

    OpenAIRE

    Gitua, John; Beck, Aaron; Rovers, John

    2014-01-01

    Background The quality and stability of anti-malarial drugs in the Global South has long been of significant concern. Drug quality can be affected by poor or fraudulent manufacturing processes, while drug stability is affected by temperature and humidity. Knowledge of drug quality and stability is often the unique contribution of pharmacists volunteering on short-term medical mission trips. Objective To determine the quality and stability of artemether-lumefantrine 20/120 mg under ambient sto...

  15. Implementation of artemether-lumefantrine treatment policy for malaria at health facilities in Tanzania

    Directory of Open Access Journals (Sweden)

    Mugoyela V

    2011-09-01

    Full Text Available V Mugoyela1, O Minzi21Department of Medicinal Chemistry, 2Unit of Pharmacology and Therapeutics, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, TanzaniaBackground: The purpose of this study was to compare knowledge on the part of health workers in public and private health facilities about prescribing and dispensing of an artemether-lumefantrine combination, 3 years after moving from sulfadoxine-pyrimethamine to artemether-lumefantrine as a first-line treatment for nonsevere malaria in Tanzania.Methods: A cross-sectional survey of a convenience sample of 306 dispensaries and pharmacies was conducted in Dar Es Salaam and the Coast region of Tanzania. Of these, 122 were community pharmacies, 143 were private dispensaries, and 41 were public dispensaries. Specific outcome measures were health workers’ knowledge of the new malaria treatment guidelines, recommended doses of artemether-lumefantrine, and food requirements.Results: A total of 489 health workers were included in the study. The respondents were prescribers in private dispensaries, public dispensaries, and community pharmacies. Participants included medical officers (3.7%, clinical officers (38%, pharmacists (5.7%, and pharmaceutical technicians (3.9%. Nearly all workers in the public dispensaries and about 50% of workers in private dispensaries and community pharmacies were aware of recommended first-line malaria treatment. The difference in the proportion of health workers with adequate knowledge about the new recommended antimalarial medicine in public and private dispensaries was statistically significant (P < 0.0001. There was a higher proportion of workers in public dispensaries who had adequate knowledge about doses of artemether-lumefantrine for adults compared with workers in private dispensaries (P = 0.001. Only 58.0% of respondents were able to state correctly the recommended doses in private dispensaries as compared with 77.0% in public

  16. A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia

    Directory of Open Access Journals (Sweden)

    Hawela Moonga

    2007-02-01

    Full Text Available Abstract Background Malaria remains a leading cause of morbidity, mortality and non-fatal disability in Zambia, especially among children, pregnant women and the poor. Data gathered by the National Malaria Control Centre has shown that recently observed widespread treatment failure of SP and chloroquine precipitated a surge in malaria-related morbidity and mortality. As a result, the Government has recently replaced chloroquine and SP with combination therapy as first-line treatment for malaria. Despite the acclaimed therapeutic advantages of ACTs over monotherapies with SP and CQ, the cost of ACTs is much greater, raising concerns about affordability in many poor countries such as Zambia. This study evaluates the cost-effectiveness analysis of artemether-lumefantrine, a version of ACTs adopted in Zambia in mid 2004. Methods Using data gathered from patients presenting at public health facilities with suspected malaria, the costs and effects of using ACTs versus SP as first-line treatment for malaria were estimated. The study was conducted in six district sites. Treatment success and reduction in demand for second line treatment constituted the main effectiveness outcomes. The study gathered data on the efficacy of, and compliance to, AL and SP treatment from a random sample of patients. Costs are based on estimated drug, labour, operational and capital inputs. Drug costs were based on dosages and unit prices provided by the Ministry of Health and the manufacturer (Norvatis. Findings The results suggest that AL produces successful treatment at less cost than SP, implying that AL is more cost-effective. While it is acknowledged that implementing national ACT program will require considerable resources, the study demonstrates that the health gains (treatment success from every dollar spent are significantly greater if AL is used rather than SP. The incremental cost-effectiveness ratio is estimated to be US$4.10. When the costs of second line

  17. Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether-Lumefantrine?: A Randomized Controlled Trial in Uganda.

    Science.gov (United States)

    Saran, Indrani; Yavuz, Elif; Kasozi, Howard; Cohen, Jessica

    2016-04-01

    Most patients with suspected malaria do not receive diagnostic confirmation before beginning antimalarial treatment. We investigated the extent to which uncertainty about malaria diagnosis contributes to patient nonadherence to artemether-lumefantrine (AL) treatment through a randomized controlled trial in central Uganda. Among 1,525 patients purchasing a course of AL at private drug shops, we randomly offered 37.6% a free malaria rapid diagnostic test (RDT) and then assessed adherence through home visits 3 days later. Of these subjects, 68.4% tested positive for malaria and 65.8% adhered overall. Patients who tested positive did not have significantly higher odds of adherence than those who were not offered the test (adjusted odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.734-1.57,P= 0.719). Patients who received a positive malaria test had 0.488 fewer pills remaining than those not offered the test (95% CI: -1.02 to 0.043,P= 0.072). We found that patients who felt relatively healthy by the second day of treatment had lower odds of completing treatment (adjusted OR: 0.532, 95% CI: 0.394-0.719,Psymptoms have resolved.

  18. The effect of dose on the antimalarial efficacy of artemether-lumefantrine

    DEFF Research Database (Denmark)

    Anstey, N. M.; Davis, T. M E; Karunajeewa, H. A.

    2015-01-01

    -endemic settings. Methods: We searched PubMed for clinical trials that enrolled and treated patients with artemether-lumefantrine and were published from 1960 to December, 2012. We merged individual patient data from these trials by use of standardised methods. The primary endpoint was the PCR-adjusted risk...... of Plasmodium falciparum recrudescence by day 28. Secondary endpoints consisted of the PCR-adjusted risk of P falciparum recurrence by day 42, PCR-unadjusted risk of P falciparum recurrence by day 42, early parasite clearance, and gametocyte carriage. Risk factors for PCR-adjusted recrudescence were identified...

  19. Surveillance of artemether-lumefantrine associated Plasmodium falciparum multidrug resistance protein-1 gene polymorphisms in Tanzania

    DEFF Research Database (Denmark)

    Kavishe, Reginald A; Paulo, Petro; Kaaya, Robert D;

    2014-01-01

    BACKGROUND: Resistance to anti-malarials is a major public health problem worldwide. After deployment of artemisinin-based combination therapy (ACT) there have been reports of reduced sensitivity to ACT by malarial parasites in South-East Asia. In Tanzania, artemether-lumefantrine (ALu) is the re......BACKGROUND: Resistance to anti-malarials is a major public health problem worldwide. After deployment of artemisinin-based combination therapy (ACT) there have been reports of reduced sensitivity to ACT by malarial parasites in South-East Asia. In Tanzania, artemether-lumefantrine (ALu...... falciparum positive dried blood spots on filter paper and rapid diagnostic test strips collected by finger pricks from patients attending health facilities in six regions of Tanzania mainland between June 2010 and August 2011 were used. Polymerase chain reaction-restriction fragment length polymorphism (PCR......-RFLP) technique was used to detect Pfmdr1 SNPs N86Y, Y184F and D1246Y. RESULTS: There were variations in the distribution of Pfmdr1 polymorphisms among regions. Tanga region had exceptionally high prevalence of mutant alleles, while Mbeya had the highest prevalence of wild type alleles. The haplotype YFY...

  20. The content of African diets is adequate to achieve optimal efficacy with fixed-dose artemether-lumefantrine: a review of the evidence

    Directory of Open Access Journals (Sweden)

    Sagara Issaka

    2008-11-01

    Full Text Available Abstract A fixed-dose combination of artemether-lumefantrine (AL, Coartem® has shown high efficacy, good tolerability and cost-effectiveness in adults and children with uncomplicated malaria caused by Plasmodium falciparum. Lumefantrine bioavailability is enhanced by food, particularly fat. As the fat content of sub-Saharan African meals is approximately a third that of Western countries, it raises the question of whether fat consumption by African patients is sufficient for good efficacy. Data from healthy volunteers have indicated that drinking 36 mL soya milk (containing only 1.2 g of fat results in 90% of the lumefantrine absorption obtained with 500 mL milk (16 g fat. African diets are typically based on a carbohydrate staple (starchy root vegetables, fruit [plantain] or cereals supplemented by soups, relishes and sauces derived from vegetables, pulses, nuts or fish. The most important sources of dietary fat in African countries are oil crops (e.g. peanuts, soya beans and cooking oils as red palm, peanut, coconut and sesame oils. Total fat intake in the majority of subSaharan countries is estimated to be in the range 30–60 g/person/day across the whole population (average 43 g/person/day. Breast-feeding of infants up to two years of age is standard, with one study estimating a fat intake of 15–30 g fat/day from breast milk up to the age of 18 months. Weaning foods typically contain low levels of fat, and the transition from breast milk to complete weaning is associated with a marked reduction in dietary fat. Nevertheless, fat intake >10 g/day has been reported in young children post-weaning. A randomized trial in Uganda reported no difference in the efficacy of AL between patients receiving supervised meals with a fixed fat content (~23 g fat or taking AL unsupervised, suggesting that fat intake at home was sufficient for optimal efficacy. Moreover, randomized trials in African children aged 5–59 months have shown similar high cure

  1. Provider knowledge of treatment policy and dosing regimen with artemether-lumefantrine and quinine in malaria-endemic areas of western Kenya

    Directory of Open Access Journals (Sweden)

    Watsierah Carren A

    2012-12-01

    Full Text Available Abstract Background Due to widespread anti-malarial drug resistance in many countries, Kenya included, artemisinin-based Combination Therapy (ACT has been adopted as the most effective treatment option against malaria. Artemether-lumefantrine (AL is the first-line ACT for treatment of uncomplicated malaria in Kenya, while quinine is preferred for complicated and severe malaria. Information on the providers’ knowledge and practices prior to or during AL and quinine implementation is scanty. The current study evaluated providers’ knowledge and practices of treatment policy and dosing regimens with AL and quinine in the public, private and not-for-profit drug outlets. Methods A cross-sectional survey using three-stage sampling of 288 (126 public, 96 private and 66 not-for-profits providers in drug outlets was conducted in western Kenya in two Plasmodium falciparum-endemic regions with varying malarial risk. Information on provider in-service training, knowledge (qualification, treatment policy, dosing regimen, recently banned anti-malarials and on practices (request for written prescription, prescription of AL, selling partial packs and advice given to patients after prescription, was collected. Results Only 15.6% of providers in private outlets had received any in-service training on AL use. All (100% in public and majority (98.4% in not-for-profit outlets mentioned AL as first line-treatment drug. Quinine was mentioned as second-line drug by 47.9% in private outlets. A total of 92.0% in public, 57.3% in private and 78.8% in not-for-profit outlets stated correct AL dose for adults. A total of 85.7% of providers in public, 30.2% in private and 41.0% in not-for-profit outlets were aware that SP recommendations changed from treatment for mild malaria to IPTp in high risk areas. In-service training influenced treatment regimen for uncomplicated malaria (P = 0.039 and P = 0.039 and severe malaria (P P = 0.002 in children and adults

  2. Randomized comparison of the efficacies and tolerabilities of three artemisinin-based combination treatments for children with acute Plasmodium falciparum malaria in the Democratic Republic of the Congo.

    Science.gov (United States)

    Onyamboko, M A; Fanello, C I; Wongsaen, K; Tarning, J; Cheah, P Y; Tshefu, K A; Dondorp, A M; Nosten, F; White, N J; Day, N P J

    2014-09-01

    An open-label, randomized controlled trial was carried out in 2011-2012 in the Democratic Republic of the Congo to test the efficacy, safety, and tolerability of the artemisinin-based combination treatments dihydroartemisinin-piperaquine, amodiaquine-artesunate, and artemether-lumefantrine. Six hundred eighty-four children aged 3 to 59 months with uncomplicated Plasmodium falciparum malaria were randomly allocated to each study arm. Children were hospitalized for 3 days, given supervised treatment, and followed up weekly for 42 days. All regimens were well tolerated and rapidly effective. The median parasitemia clearance half-life was 2.2 h, and half-lives were similar between arms (P=0.19). The PCR-uncorrected cure rates by day 42 were 73.0% for amodiaquine-artesunate, 70.2% for artemether-lumefantrine, and 86.3% for dihydroartemisinin-piperaquine (P=0.001). Early treatment failure occurred in three patients (0.5%), one in each arm. The PCR-corrected cure rates were 93.4% for amodiaquine-artesunate, 92.7% for artemether-lumefantrine, and 94.3% for dihydroartemisinin-piperaquine (P=0.78). The last provided a longer posttreatment prophylactic effect than did the other two treatments. The day 7 plasma concentration of piperaquine was below 30 ng/ml in 47% of the children treated with dihydroartemisinin-piperaquine, and the day 7 lumefantrine concentration was below 280 ng/ml in 37.0% of children who received artemether-lumefantrine. Thus, although cure rates were all satisfactory, they could be improved by increasing the dose. (This study has been registered with the International Standard Randomized Controlled Trial Number Register [www.isrctn.org] under registration no. ISRCTN20984426.).

  3. Early clinical development of artemether-lumefantrine dispersible tablet: palatability of three flavours and bioavailability in healthy subjects

    Directory of Open Access Journals (Sweden)

    Abdulla Salim

    2010-09-01

    Full Text Available Abstract Background Efforts to ease administration and enhance acceptability of the oral anti-malarial artemether-lumefantrine (A-L crushed tablet to infants and children triggered the development of a novel dispersible tablet of A-L. During early development of this new formulation, two studies were performed in healthy subjects, one to evaluate the palatability of three flavours of A-L, and a second one to compare the bioavailability of active principles between the dispersible tablet and the tablet (administered crushed and intact. Methods Study 1 was performed in 48 healthy schoolchildren in Tanzania. Within 1 day, all subjects tasted a strawberry-, orange- and cherry-flavoured oral A-L suspension for 10 seconds (without swallowing in a randomized, single-blind, crossover fashion. The palatability of each formulation was rated using a visual analogue scale (VAS. Study 2 was an open, randomized crossover trial in 48 healthy adults given single doses of A-L (80 mg artemether + 480 mg lumefantrine with food. The objectives were to compare the bioavailability of artemether, dihydroartemisinin (DHA and lumefantrine between the dispersible tablet and the tablet administered crushed (primary objective and intact (secondary objective. Results Study 1 showed no statistically significant difference in VAS scores between the three flavours but cherry had the highest score in several ratings (particularly for overall liking. Study 2 demonstrated that the dispersible and crushed tablets delivered bioequivalent artemether, DHA and lumefantrine systemic exposure (area under the curve [AUC]; mean ± SD AUC0-tlast were 208 ± 113 vs 195 ± 93 h.ng/ml for artemether, 206 ± 81 vs 199 ± 84 h.ng/ml for DHA and 262 ± 107 vs 291 ± 106 h.μg/ml for lumefantrine. Bioequivalence was also shown for peak plasma concentrations (Cmax of DHA and lumefantrine. Compared with the intact tablet, the dispersible tablet resulted in bioequivalent lumefantrine exposure, but

  4. Artesunate + amodiaquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in the Colombian Pacific region: a noninferiority trial

    Directory of Open Access Journals (Sweden)

    Fernando De la Hoz Restrepo

    2012-12-01

    Full Text Available INTRODUCTION: In Colombia, there are no published studies for the treatment of uncomplicated Plasmodium falciparum malaria comparing artemisinin combination therapies. Hence, it is intended to demonstrate the non-inferior efficacy/safety profiles of artesunate + amodiaquine versus artemether-lumefantrine treatments. METHODS: A randomized, controlled, open-label, noninferiority (Δ≤5% clinical trial was performed in adults with uncomplicated P. falciparum malaria using the 28‑day World Health Organization validated design/definitions. Patients were randomized 1:1 to either oral artesunate + amodiaquine or artemether-lumefantrine. The primary efficacy endpoint: adequate clinical and parasitological response; secondary endpoints: - treatment failures defined per the World Health Organization. Safety: assessed through adverse events. RESULTS: A total of 105 patients was included in each group: zero censored observations. Mean (95%CI - Confidence interval adequate clinical and parasitological response rates: 100% for artesunate + amodiaquine and 99% for artemether-lumefantrine; the noninferiority criteria was met (Δ=1.7%. There was one late parasitological therapeutic failure (1%; artemether-lumefantrine group, typified by polymerase chain reaction as the MAD20 MSP1 allele. The fever clearance time (artesunate + amodiaquine group was significantly shorter (p=0.002. Respectively, abdominal pain for artesunate + amodiaquine and artemether-lumefantrine was 1.9% and 3.8% at baseline (p=0.68 and 1% and 13.3% after treatment (p<0.001. CONCLUSIONS: Uncomplicated P. falciparum malaria treatment with artesunate + amodiaquine is noninferior to the artemether-lumefantrine standard treatment. The efficacy/safety profiles grant further studies in this and similar populations.

  5. Artemether-Lumefantrine Combination Therapy for Treatment of Uncomplicated Malaria: The Potential for Complex Interactions with Antiretroviral Drugs in HIV-Infected Individuals

    Directory of Open Access Journals (Sweden)

    Pauline Byakika-Kibwika

    2011-01-01

    Full Text Available Treatment of malaria in HIV-infected individuals receiving antiretroviral therapy (ART poses significant challenges. Artemether-lumefantrine (AL is one of the artemisisnin-based combination therapies recommended for treatment of malaria. The drug combination is highly efficacious against sensitive and multidrug resistant falciparum malaria. Both artemether and lumefantrine are metabolized by hepatic cytochrome P450 (CYP450 enzymes which metabolize the protease inhibitors (PIs and nonnucleoside reverse transcriptase inhibitors (NNRTIs used for HIV treatment. Coadministration of NNRTIs and PIs with AL could potentially cause complex pharmacokinetic drug interactions. NNRTI by inducing CYP450 3A4 enzyme and PIs by inhibiting CYP450 3A4 enzymes could influence both artemether and lumefantrine concentrations and their active metabolites dihydroartemisinin and desbutyl-lumefantrine, predisposing patients to poor treatment response, toxicity, and risk for development of resistance. There are scanty data on these interactions and their consequences. Pharmacokinetic studies to evaluate these interactions in the target populations are urgently needed.

  6. Adherence to and acceptability of artemether-lumefantrine as first-line anti-malarial treatment: evidence from a rural community in Tanzania

    Directory of Open Access Journals (Sweden)

    Schlienger Raymond

    2010-02-01

    Full Text Available Abstract Background Controlled clinical trials have shown that a six-dose regimen of artemether-lumefantrine (AL therapy for uncomplicated Plasmodium falciparum malaria results in cure rates >95% with good tolerability. Materials and methods A prospective study was carried out to document the adherence to and acceptability of AL administration. This was undertaken in the context of the ALIVE study, a prospective, community-based, observational study in a rural, malaria-endemic area of Tanzania. Following microscopic confirmation of P. falciparum infection, the first AL dose was taken under supervision, with the subsequent five doses taken unsupervised at home. Patients were randomized to receive a home-based assessment close to the scheduled time for one of the unsupervised doses, but were blinded to which follow-up visit they had been allocated. A structured questionnaire was administered by trained staff and AL consumption was confirmed by inspection of blister packs. Results A total of 552 patients were recruited of whom 352 (63.8% were Discussion Factors contributing to adherence were likely to be helpful packaging, pictorial dosing instructions and patients' conviction that AL is effective. Conclusion Adherence to the dosing regimen and timing of AL administration was very good.

  7. Subacute therapeutic dosing of artemether-lumefantrine and artesunate-amodiaquine combination preserves plasma cholesterol, renal antioxidant status, and organ weights in rats.

    Science.gov (United States)

    Otuechere, Chiagoziem A; Edewor, Gloria; Kale, Oluwafemi Ezekiel; Ekor, Martins

    2012-01-01

    Recent instances of breakdowns of malaria control programs and the constant emergence of drug-resistant parasites to monotherapies have shored up the use of artemisinin-based combination therapy (ACT) as the malaria therapy of choice. We evaluated a subacute therapeutic dosing of artemether-lumefantrine and artesunate-amodiaquine on plasma cholesterol, renal antioxidants, and organ weights in rats. Sixteen albino rats were grouped into three. Group A (n = 5) served as the control. Groups B (n = 6) and C (n = 5) were administered, twice daily, oral therapeutic doses of artemether-lumefantrine (1.14/6.86 mg/kg/d) and artesunate-amodiaquine (2.86/8.58 mg/kg/d), respectively, for seven days. From our results, ACTs did not significantly (P > 0.05) alter catalase, superoxide dismutase, glutathione S-transferase, myeloperoxidase, and total glutathione levels when compared with the control. Plasma total cholesterol levels also decreased insignificantly (P > 0.05). Organ-system weights were not significantly (P > 0.05) different from control rats. Artesunate-amodiaquine, but not artemether-lumefantrine, significantly increased (P artesunate-amodiaquine and artemether-lumefantrine may preserve renal antioxidants and organ weights in vivo. However, caution is required above therapeutic indications or in chronic doses as this may predispose to renal oxidative stress.

  8. Similar efficacy and tolerability of double-dose chloroquine and artemether-lumefantrine for treatment of Plasmodium falciparum infection in Guinea-Bissau: a randomized trial

    DEFF Research Database (Denmark)

    Ursing, Johan; Kofoed, Poul-Erik; Rodrigues, Amabelia;

    2011-01-01

    In 2008, Guinea-Bissau introduced artemether-lumefantrine for treatment of uncomplicated malaria. Previously, 3 times the standard dose of chloroquine, that was probably efficacious against Plasmodium falciparum with the resistance-associated chloroquine-resistance transporter (pfcrt) 76T allele...

  9. Therapeutic efficacy of artemether-lumefantrine in uncomplicated falciparum malaria in India

    Directory of Open Access Journals (Sweden)

    Dev Vas

    2009-05-01

    Full Text Available Abstract Background Artemisinin-based combination therapy (ACT is the treatment of choice for uncomplicated falciparum malaria. Artemether-lumefantrine (AL, a fixed dose co-formulation, has recently been approved for marketing in India, although it is not included in the National Drug Policy for treatment of malaria. Efficacy of short course regimen (4 × 4 tablets of 20 mg artemether plus 120 mg lumefantrine over 48 h was demonstrated in India in the year 2000. However, low cure rates in Thailand and better plasma lumefantrine concentration profile with a six-dose regimen over three days, led to the recommendation of higher dose globally. This is the first report on the therapeutic efficacy of the six-dose regimen of AL in Indian uncomplicated falciparum malaria patients. The data generated will help in keeping the alternative ACT ready for use in the National Programme as and when required. Methods One hundred and twenty four subjects between two and fifty-five years of age living in two highly endemic areas of the country (Assam and Orissa were enrolled for single arm, open label prospective study. The standard six-dose regimen of AL was administered over three days and was followed-up with clinical and parasitological evaluations over 28 days. Molecular markers msp-1 and msp-2 were used to differentiate the recrudescence and reinfection among the study subjects. In addition, polymorphism in pfmdr1 was also carried out in the samples obtained from patients before and after the treatment. Results The PCR corrected cure rates were high at both the sites viz. 100% (n = 53 in Assam and 98.6% (n = 71 in Orissa. The only treatment failure case on D7 was a malnourished child. The drug was well tolerated with no adverse events. Patients had pre-treatment carriage of wild type codons at positions 86 (41.7%, n = 91 and 184 (91.3%, n = 91 of pfmdr1 gene. Conclusion AL is safe and effective drug for the treatment of acute uncomplicated falciparum malaria

  10. Physical and chemical stability of expired fixed dose combination artemether-lumefantrine in uncontrolled tropical conditions

    Directory of Open Access Journals (Sweden)

    Hess Kimberly

    2009-02-01

    Full Text Available Abstract Background New artemisinin combination therapies pose difficulties of implementation in developing and tropical settings because they have a short shelf-life (two years relative to the medicines they replace. This limits the reliability and cost of treatment, and the acceptability of this treatment to health care workers. A multi-pronged investigation was made into the chemical and physical stability of fixed dose combination artemether-lumefantrine (FDC-ALU stored under heterogeneous, uncontrolled African conditions, to probe if a shelf-life extension might be possible. Methods Seventy samples of expired FDC-ALU were collected from private pharmacies and malaria researchers in seven African countries. The samples were subjected to thin-layer chromatography (TLC, disintegration testing, and near infrared Raman spectrometry for ascertainment of active ingredients, tablet integrity, and chemical degradation of the tablet formulation including both active ingredients and excipients. Results Seventy samples of FDC-ALU were tested in July 2008, between one and 58 months post-expiry. 68 of 70 (97% samples passed TLC, disintegration and Raman spectrometry testing, including eight samples that were post-expiry by 20 months or longer. A weak linear association (R2 = 0.33 was observed between the age of samples and their state of degradation relative to brand-identical samples on Raman spectrometry. Sixty-eight samples were retested in February 2009 using Raman spectrometry, between eight and 65 months post-expiry. 66 of 68 (97% samples passed Raman spectrometry retesting. An unexpected observation about African drug logistics was made in three batches of FDC-ALU, which had been sold into the public sector at concessional pricing in accordance with a World Health Organization (WHO agreement, and which were illegally diverted to the private sector where they were sold for profit. Conclusion The data indicate that FDC-ALU is chemically and

  11. Subacute Therapeutic Dosing of Artemether-Lumefantrine and Artesunate-Amodiaquine Combination Preserves Plasma Cholesterol, Renal Antioxidant Status, and Organ Weights in Rats

    Directory of Open Access Journals (Sweden)

    Chiagoziem A. Otuechere

    2012-01-01

    Full Text Available Recent instances of breakdowns of malaria control programs and the constant emergence of drug-resistant parasites to monotherapies have shored up the use of artemisinin-based combination therapy (ACT as the malaria therapy of choice. We evaluated a subacute therapeutic dosing of artemether-lumefantrine and artesunate-amodiaquine on plasma cholesterol, renal antioxidants, and organ weights in rats. Sixteen albino rats were grouped into three. Group A (n=5 served as the control. Groups B (n=6 and C (n=5 were administered, twice daily, oral therapeutic doses of artemether-lumefantrine (1.14/6.86 mg/kg/d and artesunate-amodiaquine (2.86/8.58 mg/kg/d, respectively, for seven days. From our results, ACTs did not significantly (P>0.05 alter catalase, superoxide dismutase, glutathione S-transferase, myeloperoxidase, and total glutathione levels when compared with the control. Plasma total cholesterol levels also decreased insignificantly (P>0.05. Organ-system weights were not significantly (P>0.05 different from control rats. Artesunate-amodiaquine, but not artemether-lumefantrine, significantly increased (P<0.05 lactate dehydrogenase activity and also afforded a 27.2% decrease in heart weight when compared with control. Also, both ACTs increased (P<0.05 lipid peroxidation. Overall, artesunate-amodiaquine and artemether-lumefantrine may preserve renal antioxidants and organ weights in vivo. However, caution is required above therapeutic indications or in chronic doses as this may predispose to renal oxidative stress.

  12. Increased pfmdr1 copy number and sequence polymorphisms in Plasmodium falciparum isolates from Sudanese malaria patients treated with artemether-lumefantrine.

    OpenAIRE

    Gadalla, NB; Adam, I.; Elzaki, SE; Bashir, S.; Mukhtar, I; Oguike, M.; Gadalla, A; Mansour, F.; Warhurst,D; El-Sayed, BB; Sutherland, CJ

    2011-01-01

    : Molecular markers for surveillance of Plasmodium falciparum resistance to current antimalarials are sorely needed. A 28-day efficacy study of artemether-lumefantrine in eastern Sudan identified 5 treatment failures among 100 evaluable patients; 9 further individuals were parasite positive by PCR during follow-up. Polymorphisms in pfatpase6 and pfmdr1 were evaluated by DNA sequencing. One individual carried parasites with a novel pfmdr1 polymorphism (F1044L). pfmdr1 gene amplification in par...

  13. Artesunate Plus Amodiaquine (AS+AQ) Versus Artemether -Lumefantrine (AL) for the Treatment of Uncomplicated Plasmodium Falciparum Malaria in Sub-Saharan Africa-A Meta-Analysis

    OpenAIRE

    Bello, Shaibu O; Chika, Aminu; AbdulGafar, Jimoh O

    2010-01-01

    The purpose of this study is to summarize the available data on the efficacy of Artesunate plus Amodiaquine (AS+AQ) versus Artemether -Lumefantrine (AL) for the treatment of uncomplicated Plasmodium falciparum malaria in sub-Saharan Africa using uncorrected parasitaemia as a clinically relevant endpoint. Studies and conference abstracts identified through Pubmed, Medline, Embase, Ansinet, AJOL, Bioline, Cochrane Infectious Diseases Group trials register, The Cochrane Controlled Trials Registe...

  14. Assessment of the therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in northern KwaZulu-Natal: an observational cohort study

    Directory of Open Access Journals (Sweden)

    Vaughan-Williams Charles H

    2012-12-01

    Full Text Available Abstract Background Recent malaria epidemics in KwaZulu-Natal indicate that effective anti-malarial therapy is essential for malaria control. Although artemether-lumefantrine has been used as first-line treatment for uncomplicated Plasmodium falciparum malaria in northern KwaZulu-Natal since 2001, its efficacy has not been assessed since 2002. The objectives of this study were to quantify the proportion of patients treated for uncomplicated P. falciparum malaria with artemether-lumefantrine who failed treatment after 28 days, and to determine the prevalence of molecular markers associated with artemether-lumefantrine and chloroquine resistance. Methods An observational cohort of 49 symptomatic patients, diagnosed with uncomplicated P. falciparum malaria by rapid diagnostic test, had blood taken for malaria blood films and P. falciparum DNA polymerase chain reaction (PCR. Following diagnosis, patients were treated with artemether-lumefantrine (Coartem® and invited to return to the health facility after 28 days for repeat blood film and PCR. All PCR P. falciparum positive samples were analysed for molecular markers of lumefantrine and chloroquine resistance. Results Of 49 patients recruited on the basis of a positive rapid diagnostic test, only 16 were confirmed to have P. falciparum by PCR. At follow-up, 14 were PCR-negative for malaria, one was lost to follow-up and one blood specimen had insufficient blood for a PCR analysis. All 16 with PCR-confirmed malaria carried a single copy of the multi-drug resistant (mdr1 gene, and the wild type asparagine allele mdr1 codon 86 (mdr1 86N. Ten of the 16 samples carried the wild type haplotype (CVMNK at codons 72-76 of the chloroquine resistance transporter gene (pfcrt; three samples carried the resistant CVIET allele; one carried both the resistant and wild type, and in two samples the allele could not be analysed. Conclusions The absence of mdr1 gene copy number variation detected in this study

  15. An open label, randomised trial of artesunate+amodiaquine, artesunate+chlorproguanil-dapsone and artemether-lumefantrine for the treatment of uncomplicated malaria.

    Directory of Open Access Journals (Sweden)

    Seth Owusu-Agyei

    Full Text Available BACKGROUND: Artesunate+amodiaquine (AS+AQ and artemether-lumefantrine (AL are now the most frequently recommended first line treatments for uncomplicated malaria in Africa. Artesunate+chlorproguanil-dapsone (AS+CD was a potential alternative for treatment of uncomplicated malaria. A comparison of the efficacy and safety of these three drug combinations was necessary to make evidence based drug treatment policies. METHODS: Five hundred and thirty-four, glucose-6-phosphate dehydrogenase (G6PD normal children were randomised in blocks of 15 to the AS+AQ, AL or AS+CD groups. Administration of study drugs was supervised by project staff and the children were followed up at r home on days 1,2,3,7,14 and 28 post treatment. Parasitological and clinical failures and adverse events were compared between the study groups. MAIN FINDINGS: In a per-protocol analysis, the parasitological and clinical failure rate at day 28 post treatment (PCF28 was lower in the AS+AQ group compared to the AL or AS+CD groups (corrected for re-infections: 6.6% vs 13.8% and 13.8% respectively, p = 0.08; uncorrected: 14.6% vs 27.6% and 28.1% respectively, p = 0.005. In the intention to treat analysis, the rate of early treatment failure was high in all three groups (AS+AQ 13.3%; AL 15.2%; and AS+CD 9.3%, p = 0.2 primarily due to vomiting. However, the PCF28 corrected for re-infection was lower, though not significantly, in the AS+AQ group compared to the AL or the AS+CD groups (AS+AQ 18.3%; AL 24.2%; AS+CD 20.8%, p = 0.4 The incidence of adverse events was comparable between the groups. CONCLUSIONS: AS+AQ is an appropriate first line treatment for uncomplicated malaria in Ghana and possibly in the neighbouring countries in West Africa. The effectiveness of AL in routine programme conditions needs to be studied further in West Africa. TRIAL REGISTRATION: ClinicalTrials.gov NCT00119145.

  16. Comparative study of the efficacy and tolerability of dihydroartemisinin - piperaquine - trimethoprim versus artemether - lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Cameroon, Ivory Coast and Senegal

    Directory of Open Access Journals (Sweden)

    Yavo William

    2011-07-01

    Full Text Available Abstract Background The ACT recommended by WHO is very effective and well-tolerated. However, these combinations need to be administered for three days, which may limit adherence to treatment. The combination of dihydroartemisinin - piperaquine phosphate - trimethoprim (Artecom®, Odypharm Ltd, which involves treatment over two days, appears to be a good alternative, particularly in malaria-endemic areas. This study intends to compare the efficacy and tolerability of the combination dihydroartemisinin - piperaquine phosphate - trimethoprim (DPT versus artemether - lumefantrine (AL in the treatment of uncomplicated Plasmodium falciparum malaria in Cameroon, Ivory Coast and Senegal. Methods This was a randomized, controlled, open-label clinical trial with a 28-day follow-up period comparing DPT to AL as the reference drug. The study involved patients of at least two years of age, suffering from acute, uncomplicated Plasmodium falciparum malaria with fever. The WHO 2003 protocol was used. Results A total of 418 patients were included in the study and divided into two treatment groups: 212 in the DPT group and 206 in the AL group. The data analysis involved the 403 subjects who correctly followed the protocol (per protocol analysis, i.e. 206 (51.1% in the DPT group and 197 (48.9% in the AL group. The recovery rate at D14 was 100% in both treatment groups. The recovery rate at D28 was 99% in the DPT and AL groups before and after PCR results with one-sided 97.5% Confidence Interval of the rates difference > -1.90%. More than 96% of patients who received DPT were apyrexial 48 hours after treatment compared to 83.5% in the AL group (p Conclusion The overall efficacy and tolerability of DPT are similar to those of AL. The ease of taking DPT and its short treatment course (two days may help to improve adherence to treatment. Taken together, these findings make this medicinal product a treatment of choice for the effective management of malaria in Africa.

  17. Why don't health workers prescribe ACT? A qualitative study of factors affecting the prescription of artemether-lumefantrine

    Directory of Open Access Journals (Sweden)

    Zurovac Dejan

    2008-02-01

    Full Text Available Abstract Background Kenya recently changed its antimalarial drug policy to a specific artemisinin-based combination therapy (ACT, artemether-lumefantrine (AL. New national guidelines on the diagnosis, treatment and prevention were developed and disseminated to health workers together with in-service training. Methods Between January and March 2007, 36 in-depth interviews were conducted in five rural districts with health workers who attended in-service training and were non-adherent to the new guidelines. A further 20 interviews were undertaken with training facilitators and members of District Health Management Teams (DHMTs to explore reasons underlying health workers' non-adherence. Results Health workers generally perceived AL as being tolerable and efficacious as compared to amodiaquine and sulphadoxine-pyremethamine. However, a number of key reasons for non-adherence were identified. Insufficient supply of AL was a major issue and hence fears of stock outs and concern about AL costs was an impediment to AL prescription. Training messages that contradicted the recommended guidelines also led to health worker non-adherence, compounded by a lack of follow-up supervision. In addition, the availability of non-recommended antimalarials such as amodiaquine caused prescription confusion. Some health workers and DHMT members maintained that shortage of staff had resulted in increased patient caseload affecting the delivery of the desirable quality of care and adherence to guidelines. Conclusion The introduction of free efficacious ACTs in the public health sector in Kenya and other countries has major potential public health benefits for Africa. These may not be realized if provider prescription practices do not conform to the recommended treatment guidelines. It is essential that high quality training, drug supply and supervision work synergistically to ensure appropriate case management.

  18. A systematic review of the safety and efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria during pregnancy

    Directory of Open Access Journals (Sweden)

    Manyando Christine

    2012-05-01

    Full Text Available Abstract Malaria during pregnancy, particularly Plasmodium falciparum malaria, has been linked to increased morbidity and mortality, which must be reduced by both preventive measures and effective case management. The World Health Organization (WHO recommends artemisinin-based combination therapy (ACT to treat uncomplicated falciparum malaria during the second and third trimesters of pregnancy, and quinine plus clindamycin during the first trimester. However, the national policies of many African countries currently recommend quinine throughout pregnancy. Therefore, the aim of this article is to provide a summary of the available data on the safety and efficacy of artemether-lumefantrine (AL in pregnancy. An English-language search identified 16 publications from 1989 to October 2011 with reports of artemether or AL exposure in pregnancy, including randomized clinical trials, observational studies and systematic reviews. Overall, there were 1,103 reports of AL use in pregnant women: 890 second/third trimester exposures; 212 first trimester exposures; and one case where the trimester of exposure was not reported. In the second and third trimesters, AL was not associated with increased adverse pregnancy outcomes as compared with quinine or sulphadoxine-pyrimethamine, showed improved tolerability relative to quinine, and its efficacy was non-inferior to quinine. There is evidence to suggest that the pharmacokinetics of anti-malarial drugs may change in pregnancy, although the impact on efficacy and safety needs to be studied further, especially since the majority of studies report high cure rates and adequate tolerability. As there are fewer reports of AL safety in the first trimester, additional data are required to assess the potential to use AL in the first trimester. Though the available safety and efficacy data support the use of AL in the second and third trimesters, there is still a need for further information. These findings reinforce the

  19. Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal, South Africa.

    Directory of Open Access Journals (Sweden)

    Karen I Barnes

    2005-11-01

    Full Text Available BACKGROUND: Between 1995 and 2000, KwaZulu-Natal province, South Africa, experienced a marked increase in Plasmodium falciparum malaria, fuelled by pyrethroid and sulfadoxine-pyrimethamine resistance. In response, vector control was strengthened and artemether-lumefantrine (AL was deployed in the first Ministry of Health artemisinin-based combination treatment policy in Africa. In South Africa, effective vector and parasite control had historically ensured low-intensity malaria transmission. Malaria is diagnosed definitively and treatment is provided free of charge in reasonably accessible public-sector health-care facilities. METHODS AND FINDINGS: We reviewed four years of malaria morbidity and mortality data at four sentinel health-care facilities within KwaZulu-Natal's malaria-endemic area. In the year following improved vector control and implementation of AL treatment, malaria-related admissions and deaths both declined by 89%, and outpatient visits decreased by 85% at the sentinel facilities. By 2003, malaria-related outpatient cases and admissions had fallen by 99%, and malaria-related deaths had decreased by 97%. There was a concomitant marked and sustained decline in notified malaria throughout the province. No serious adverse events were associated causally with AL treatment in an active sentinel pharmacovigilance survey. In a prospective study with 42 d follow up, AL cured 97/98 (99% and prevented gametocyte developing in all patients. Consistent with the findings of focus group discussions, a household survey found self-reported adherence to the six-dose AL regimen was 96%. CONCLUSION: Together with concurrent strengthening of vector control measures, the antimalarial treatment policy change to AL in KwaZulu-Natal contributed to a marked and sustained decrease in malaria cases, admissions, and deaths, by greatly improving clinical and parasitological cure rates and reducing gametocyte carriage.

  20. Safety of artemether-lumefantrine in pregnant women with malaria: results of a prospective cohort study in Zambia

    Directory of Open Access Journals (Sweden)

    Manyando Christine

    2010-09-01

    Full Text Available Abstract Background Safety data regarding exposure to artemisinin-based combination therapy in pregnancy are limited. This prospective cohort study conducted in Zambia evaluated the safety of artemether-lumefantrine (AL in pregnant women with malaria. Methods Pregnant women attending antenatal clinics were assigned to groups based on the drug used to treat their most recent malaria episode (AL vs. sulphadoxine-pyrimethamine, SP. Safety was assessed using standard and pregnancy-specific parameters. Post-delivery follow-up was six weeks for mothers and 12 months for live births. Primary outcome was perinatal mortality (stillbirth or neonatal death within seven days after birth. Results Data from 1,001 pregnant women (AL n = 495; SP n = 506 and 933 newborns (AL n = 466; SP n = 467 showed: perinatal mortality (AL 4.2%; SP 5.0%, comprised of early neonatal mortality (each group 2.3%, stillbirths (AL 1.9%; SP 2.7%; preterm deliveries (AL 14.1%; SP 17.4% of foetuses; and gestational age-adjusted low birth weight (AL 9.0%; SP 7.7%. Infant birth defect incidence was 1.8% AL and 1.6% SP, excluding umbilical hernia. Abortions prior to antenatal care could not be determined: abortion occurred in 4.5% of women treated with AL during their first trimester; none were reported in the 133 women exposed to SP and/or quinine during their first trimester. Overall development (including neurological assessment was similar in both groups. Conclusions These data suggest that exposure to AL in pregnancy, including first trimester, is not associated with particular safety risks in terms of perinatal mortality, malformations, or developmental impairment. However, more data are required on AL use during the first trimester.

  1. Efficacy and safety of the six-dose regimen of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in adolescents and adults: A pooled analysis of individual patient data from randomized clinical trials

    NARCIS (Netherlands)

    E.A. Mueller; M. van Vugt; W. Kirch; K. Andriano; P. Hunt; P.I. de Palacios

    2006-01-01

    To demonstrate the superiority of the six-dose over the four-dose regimen of artemether-lumefantrine (co-artemether, Coartem (R)) in patients > 12 years, data from 11 randomized clinical trials were pooled and analyzed. A total of 1368 patients with uncomplicated Plasinodium falciparum malaria (six-

  2. Artesunate Plus Amodiaquine (AS+AQ) Versus Artemether -Lumefantrine (AL) for the Treatment of Uncomplicated Plasmodium Falciparum Malaria in Sub-Saharan Africa-A Meta-Analysis.

    Science.gov (United States)

    Bello, Shaibu O; Chika, Aminu; Abdulgafar, Jimoh O

    2010-01-01

    The purpose of this study is to summarize the available data on the efficacy of Artesunate plus Amodiaquine (AS+AQ) versus Artemether -Lumefantrine (AL) for the treatment of uncomplicated Plasmodium falciparum malaria in sub-Saharan Africa using uncorrected parasitaemia as a clinically relevant endpoint. Studies and conference abstracts identified through Pubmed, Medline, Embase, Ansinet, AJOL, Bioline, Cochrane Infectious Diseases Group trials register, The Cochrane Controlled Trials Register, Science Citation Index, Lilacs, African Index Medicus, Clusty, Google, Yahoo and Microsoft search engines. Randomized controlled clinical trials comparing Artesunate-Amodiaquine versus Artemether-Lumefantrine, in Sub-Saharan Africa from January 2004 to June 2009, and which had at least 30 patients per study arm. The authors independently applied the inclusion criteria, assessed methodological quality and extracted data into a predesigned form. The outcome of interest was uncorrected day 28 parasitological failure. Data were then checked for agreement and double entered into RevMan version 5 for further analyses. Fifteen trials (4265 participants) met the inclusion criteria. Day 28 parasitological failure was lower for AL (286 of 2201 participants or 13.0 % failures) when compared with AS+AQ (446 of 2424 participants or 18.4% failures). The relative risk of parasitological failure with AS+AQ was higher when compared with AL (RR 1.65, 95% CI, 1.18-2.32). There were significant heterogeneity and inconsistencies in the studies. AL appears more effective at avoiding parasitological failure at days 28 than AS+AQ.

  3. Efficacy of artemisinin-based combination treatments of uncomplicated falciparum malaria in under-five-year-old Nigerian children.

    Science.gov (United States)

    Oguche, Stephen; Okafor, Henrietta U; Watila, Ismaila; Meremikwu, Martin; Agomo, Philip; Ogala, William; Agomo, Chimere; Ntadom, Godwin; Banjo, Olajide; Okuboyejo, Titilope; Ogunrinde, Gboye; Odey, Friday; Aina, Olugbemiga; Sofola, Tolulope; Sowunmi, Akintunde

    2014-11-01

    The efficacy of 3-day regimens of artemether-lumefantrine and artesunate-amodiaquine were evaluated in 747 children artesunate-amodiaquine-compared with artemether-lumefantrine-treated children. Parasite clearance times were similar with both treatments. Overall efficacy was 96.3% (95% confidence interval [CI] 94.5-97.6%), and was similar for both regimens. Polymerase chain reaction-corrected parasitologic cure rates on Day 28 were 96.9% (95% CI 93.9-98.2%) and 98.3% (95% CI 96.1-99.3%) for artemether-lumefantrine and artesunate-amodiaquine, respectively. Gametocyte carriage post treatment was significantly lower than pretreatment (P < 0.0001). In anemic children, mean time to recovery from anemia was 10 days (95% CI 9.04-10.9) and was similar for both regimens. Both treatments were well tolerated and are safe and efficacious treatments of uncomplicated falciparum malaria in young Nigerian children.

  4. Efficacy of fixed-dose combination artesunate-amodiaquine versus artemether-lumefantrine for uncomplicated childhood Plasmodium falciparum malaria in Democratic Republic of Congo: a randomized non-inferiority trial

    Directory of Open Access Journals (Sweden)

    Espié Emmanuelle

    2012-05-01

    Full Text Available Abstract Background In 2005, the Democratic Republic of Congo (DRC adopted artesunate and amodiaquine (ASAQ as first-line anti-malarial treatment. In order to compare the efficacy of the fixed-dose formulation ASAQ versus artemether-lumefantrine (AL, a randomized, non-inferiority open-label trial was conducted in Katanga. Methods Children aged six and 59 months with uncomplicated Plasmodium falciparum malaria were enrolled and randomly allocated into one of the two regimens. The risk of recurrent parasitaemia by day 42, both unadjusted and adjusted by PCR genotyping to distinguish recrudescence from new infection, was analysed. Results Between April 2008 and March 2009, 301 children were included: 156 with ASAQ and 145 with AL. No early treatment failures were reported. Among the 256 patients followed-up at day 42, 32 patients developed late clinical or parasitological failure (9.9% (13/131 in the ASAQ group and 15.2% (19/125 in the AL group. After PCR correction, cure rates were 98.3% (95%CI, 94.1-99.8 in the ASAQ group and 99.1% (95%CI, 94.9-99.9 in the AL group (difference −0.7%, one sided 95% CI −3.1. Kaplan-Meier PCR-adjusted cure rates were similar. Both treatment regimens were generally well tolerated. Conclusion Both ASAQ and AL are highly effective and currently adequate as the first-line treatment of uncomplicated falciparum malaria in this area of Katanga, DRC. However, in a very large country, such as DRC, and because of possible emergence of resistance from other endemic regions, surveillance of efficacy of artemisinin-based combination treatments, including other evaluations of the resistance of ASAQ, need to be done in other provinces. Trial registration The protocol was registered with the clinicaltrials.gov, open clinical trial registry under the identifier number NCT01567423.

  5. Efficacy and safety of a fixed dose artesunate-sulphamethoxypyrazine-pyrimethamine compared to artemether-lumefantrine for the treatment of uncomplicated falciparum malaria across Africa: a randomized multi-centre trial

    Directory of Open Access Journals (Sweden)

    Djimdé Abdoulaye

    2009-04-01

    Full Text Available Abstract Background The efficacy of artemisinin-based combination therapy has already been demonstrated in a number of studies all over the world, and some of them can be regarded as comparably effective. Ease of administration of anti-malarial treatments with shorter courses and fewer tablets may be key determinant of compliance. Methods Patients with uncomplicated falciparum malaria and over six months of age were recruited in Cameroon, Mali, Rwanda and Sudan. 1,384 patients were randomly assigned to receive artesunate-sulphamethoxypyrazine-pyrimethamine (AS-SMP three-day (once daily for 3 days regimen (N = 476 or AS-SMP 24-hour (0 h, 12 h, 24 h regimen (N = 458 or artemether-lumefantrine (AL, the regular 6 doses regimen (N = 450. The primary objective was to demonstrate non-inferiority (using a margin of -6% of AS-SMP 24 hours or AS-SMP three days versus AL on the PCR-corrected 28-day cure rate. Results The PCR corrected 28-day cure rate on the intention to treat (ITT analysis population were: 96.0%(457/476 in the AS-SMP three-day group, 93.7%(429/458 in the AS-SMP 24-hour group and 92.0%(414/450 in the AL group. Likewise, the cure rates on the PP analysis population were high: 99.3%(432/437 in the AS-SMP three-day group, 99.5%(416/419 in the AS-SMP 24-hour group and 99.7(391/394% in the AL group. Most common drug-related adverse events were gastrointestinal symptoms (such as vomiting and diarrhea which were slightly higher in the AS-SMP 24-hour group. Conclusion AS-SMP three days or AS-SMP 24 hours are safe, are as efficacious as AL, and are well tolerated. Trial registration NCT00484900 http://www.clinicaltrials.gov.

  6. Treatment of asymptomatic carriers with artemether-lumefantrine: an opportunity to reduce the burden of malaria?

    Directory of Open Access Journals (Sweden)

    Gbadoé Adama

    2010-01-01

    of the hypothesis The treatment of asymptomatic carriers with ACT is an innovative and essential tool for breaking the cycle of infection in some transmission settings. Safe and effective medicines can save the lives of children, but the reprieve is only temporary so long as the mosquitoes can become re-infected from the asymptomatic carriers. With improvements in rapid diagnostic tests that allow easier identification of asymptomatic carriers, the elimination of the pool of parasites is within reach.

  7. Does the Use of Dihydroartemisinin-Piperaquine in Treating Patients with Uncomplicated falciparum Malaria Reduce the Risk for Recurrent New falciparum Infection More Than Artemether-Lumefantrine?

    Directory of Open Access Journals (Sweden)

    Wisdom Akpaloo

    2014-01-01

    Full Text Available Malaria contributes significantly to the global disease burden. The World Health Organization recommended the use of artemisinin-based combination therapies (ACTs for treatment of uncomplicated falciparum malaria a decade ago in response to problems of drug resistance. This review compared two of the ACTs—Dihydroartemisinin-Piperaquine (DP and Artemether-Lumefantrine (AL to provide evidence which one has the ability to offer superior posttreatment prophylaxis at 28 and 42 days posttreatment. Four databases (MEDLINE, EMBASE, Cochrane Database and Global Health were searched on June 2, 2013 and a total of seven randomized controlled trials conducted in sub-Sahara Africa were included. Results involving 2, 340 participants indicates that reduction in risk for recurrent new falciparum infections (RNIs was 79% at day 28 in favour of DP [RR, 0.21; 95% CI: 0.14 to 0.32, P<0.001], and at day 42 was 44% favouring DP [RR, 0.56; 95% CI: 0.34 to 0.90; P=0.02]. No significant difference was seen in treatment failure rates between the two drugs at days 28 and 42. It is concluded that use of DP offers superior posttreatment prophylaxis compared to AL in the study areas. Hence DP can help reduce malaria cases in such areas more than AL.

  8. Supervised versus unsupervised antimalarial treatment with six-dose artemether-lumefantrine: pharmacokinetic and dosage-related findings from a clinical trial in Uganda

    Directory of Open Access Journals (Sweden)

    Ruzagira Eugene

    2006-07-01

    Full Text Available Abstract Background A six-dose antimalarial regimen of artemether-lumefantrine (A/L may soon become one of the most widely used drug combination in Africa, despite possible constraints with adherence and poor absorption due to inadequate nutrition, and a lack of pharmacokinetic and effectiveness data. Methods Within a trial of supervised versus unsupervised A/L treatment in a stable Ugandan Plasmodium falciparum transmission setting, plasma lumefantrine concentrations were measured in a subset of patients on day 3 (C [lum]day3 and day 7 (C [lum]day7 post-inclusion. Predictors of lumefantrine concentrations were analysed to show how both C [lum]day7 and the weight-adjusted lumefantrine dose affect 28-day recrudescence and re-infection risks. The implications of these novel findings are discussed in terms of the emergence of lumefantrine-resistant strains in Africa. Results C [lum]day3 and C [lum]day7 distributions among 241 supervised and 238 unsupervised patients were positively skewed. Unsupervised treatment and decreasing weight-adjusted lumefantrine dose were negatively associated with C [lum]day3. Unsupervised treatment and decreasing age showed strong negative associations with C [lum]day7. Both models were poorly predictive (R-squared day7 below 400 ng/mL (p Conclusion Maintaining the present six-dose regimen and ensuring high adherence and intake are essential to maximize the public health benefits of this valuable drug combination.

  9. Artemether-lumefantrine to treat malaria in pregnancy is associated with reduced placental haemozoin deposition compared to quinine in a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Muehlenbachs Atis

    2012-05-01

    Full Text Available Abstract Background Data on efficacy of artemisinin-based combination therapy (ACT to treat Plasmodium falciparum during pregnancy in sub-Saharan Africa is scarce. A recent open label, randomized controlled trial in Mbarara, Uganda demonstrated that artemether-lumefantrine (AL is not inferior to quinine to treat uncomplicated malaria in pregnancy. Haemozoin can persist in the placenta following clearance of parasites, however there is no data whether ACT can influence the amount of haemozoin or the dynamics of haemozoin clearance. Methods Women attending antenatal clinics with weekly screening and positive blood smears by microscopy were eligible to participate in the trial and were followed to delivery. Placental haemozoin deposition and inflammation were assessed by histology. To determine whether AL was associated with increased haemozoin clearance, population haemozoin clearance curves were calculated based on the longitudinal data. Results Of 152 women enrolled in each arm, there were 97 and 98 placental biopsies obtained in the AL and quinine arms, respectively. AL was associated with decreased rates of moderate to high grade haemozoin deposition (13.3% versus 25.8%, which remained significant after correcting for gravidity, time of infection, re-infection, and parasitaemia. The amount of haemozoin proportionately decreased with the duration of time between treatment and delivery and this decline was greater in the AL arm. Haemozoin was not detected in one third of biopsies and the prevalence of inflammation was low, reflecting the efficacy of antenatal care with early detection and prompt treatment of malaria. Conclusions Placental haemozoin deposition was decreased in the AL arm demonstrating a relationship between pharmacological properties of drug to treat antenatal malaria and placental pathology at delivery. Histology may be considered an informative outcome for clinical trials to evaluate malaria control in pregnancy. Trial

  10. Electrocardiographic study in Ghanaian children with uncomplicated malaria, treated with artesunate-amodiaquine or artemether-lumefantrine

    DEFF Research Database (Denmark)

    Adjei, George O; Oduro-Boatey, Collins; Rodrigues, Onike P;

    2012-01-01

    Several anti-malarial drugs are associated with adverse cardiovascular effects. These effects may be exacerbated when different anti-malarials are used in combination. There has been no report yet on the potential cardiac effects of the combination artesunate-amodiaquine.......Several anti-malarial drugs are associated with adverse cardiovascular effects. These effects may be exacerbated when different anti-malarials are used in combination. There has been no report yet on the potential cardiac effects of the combination artesunate-amodiaquine....

  11. Community screening and treatment of asymptomatic carriers of Plasmodium falciparum with artemether-lumefantrine to reduce malaria disease burden: a modelling and simulation analysis

    Directory of Open Access Journals (Sweden)

    Ubben David

    2011-07-01

    Full Text Available Abstract Background Asymptomatic carriers of Plasmodium falciparum serve as a reservoir of parasites for malaria transmission. Identification and treatment of asymptomatic carriers within a region may reduce the parasite reservoir and influence malaria transmission in that area. Methods Using computer simulation, this analysis explored the impact of community screening campaigns (CSC followed by systematic treatment of P. falciparum asymptomatic carriers (AC with artemether-lumefantrine (AL on disease transmission. The model created by Okell et al (originally designed to explore the impact of the introduction of treatment with artemisinin-based combination therapy on malaria endemicity was modified to represent CSC and treatment of AC with AL, with the addition of malaria vector seasonality. The age grouping, relative distribution of age in a region, and degree of heterogeneity in disease transmission were maintained. The number and frequency of CSC and their relative timing were explored in terms of their effect on malaria incidence. A sensitivity analysis was conducted to determine the factors with the greatest impact on the model predictions. Results The simulation showed that the intervention that had the largest effect was performed in an area with high endemicity (entomological inoculation rate, EIR > 200; however, the rate of infection returned to its normal level in the subsequent year, unless the intervention was repeated. In areas with low disease burden (EIR Conclusions Community screening and treatment of asymptomatic carriers with AL may reduce malaria transmission significantly. The initial level of disease intensity has the greatest impact on the potential magnitude and duration of malaria reduction. When combined with other interventions (e.g. long-lasting insecticide-treated nets, rapid diagnostic tests, prompt diagnosis and treatment, and, where appropriate, indoor residual spraying the effect of this intervention can be

  12. Temporal trends in prevalence of Plasmodium falciparum molecular markers selected for by artemether-lumefantrine treatment in pre-ACT and post-ACT parasites in western Kenya.

    Science.gov (United States)

    Achieng, Angela O; Muiruri, Peninah; Ingasia, Luicer A; Opot, Benjamin H; Juma, Dennis W; Yeda, Redemptah; Ngalah, Bidii S; Ogutu, Bernhards R; Andagalu, Ben; Akala, Hoseah M; Kamau, Edwin

    2015-12-01

    Artemether-lumefantrine (AL) became the first-line treatment for uncomplicated malaria in Kenya in 2006. Studies have shown AL selects for SNPs in pfcrt and pfmdr1 genes in recurring parasites compared to the baseline infections. The genotypes associated with AL selection are K76 in pfcrt and N86, 184F and D1246 in pfmdr1. To assess the temporal change of these genotypes in western Kenya, 47 parasite isolates collected before (pre-ACT; 1995-2003) and 745 after (post-ACT; 2008-2014) introduction of AL were analyzed. In addition, the associations of parasite haplotype against the IC50 of artemether and lumefantrine, and clearance rates were determined. Parasite genomic DNA collected between 1995 and 2014 was analyzed by sequencing or PCR-based single-base extension on Sequenom MassARRAY. IC50s were determined for a subset of the samples. One hundred eighteen samples from 2013 to 2014 were from an efficacy trial of which 68 had clearance half-lives. Data revealed there were significant differences between pre-ACT and post-ACT genotypes at the four codons (chi-square analysis; p < 0.0001). The prevalence of pfcrt K76 and N86 increased from 6.4% in 1995-1996 to 93.2% in 2014 and 0.0% in 2002-2003 to 92.4% in 2014 respectively. Analysis of parasites carrying pure alleles of K + NFD or T + YYY haplotypes revealed that 100.0% of the pre-ACT parasites carried T + YYY and 99.3% of post-ACT parasites carried K + NFD. There was significant correlation (p = 0.04) between lumefantrine IC50 and polymorphism at pfmdr1 codon 184. There was no difference in parasite clearance half-lives based on genetic haplotype profiles. This study shows there is a significant change in parasite genotype, with key molecular determinants of AL selection almost reaching saturation. The implications of these findings are not clear since AL remains highly efficacious. However, there is need to closely monitor parasite genotypic, phenotypic and clinical dynamics in response to continued use

  13. Open-label trial on efficacy of artemether/lumefantrine against the uncomplicated Plasmodium falciparum malaria in Metema district, Northwestern Ethiopia

    Science.gov (United States)

    Wudneh, Feven; Assefa, Ashenafi; Nega, Desalegn; Mohammed, Hussien; Solomon, Hiwot; Kebede, Tadesse; Woyessa, Adugna; Assefa, Yibeltal; Kebede, Amha; Kassa, Moges

    2016-01-01

    Purpose Following the increased Plasmodium falciparum resistance to chloroquine and sulfadoxine/pyrimethamine, Ethiopia adopted artemether/lumefantrine (AL) as the first-line treatment for uncomplicated P. falciparum in 2004. According to the recommendation of the World Health Organization, this study was carried out for regular monitoring of the efficacy of AL in treating the uncomplicated P. falciparum malaria in Metema district, Gondar Zone, Northwest Ethiopia. Patients and methods This is a one-arm prospective 28-day in vivo therapeutic efficacy study among the uncomplicated P. falciparum malaria patients aged 6 months and older. The study was conducted from October 2014 to January 2015, based on the revised World Health Organization protocol of 2009 for surveillance of antimalarial drug therapeutic efficacy study. Standard six-dose regimen of AL was given twice daily for 3 days, and then the treatment outcomes were assessed on days 0, 1, 2, 3, 7, 14, 21, 28, and any other unscheduled day for emergency cases. Results There were 91 study subjects enrolled in this study, of whom 80 study subjects completed the full follow-up schedules and showed adequate clinical and parasitological responses on day 28, with no major adverse event. Per protocol analysis, the unadjusted cure rate of Coartem® was 98.8% (95% confidence interval: 93.3%–100%) in the study area. Recurrence of one P. falciparum case was detected on day 28, with a late parasitological failure rate of 1.2%. No early treatment failure occurred. Complete parasite and fever clearance was observed on day 3. Gametocyte carriage was 4.4% at enrollment that cleared on day 21. Although the difference is statistically not significant, a slight increase in the level of mean hemoglobin from baseline to day 28 was observed. Conclusion The study showed high efficacy and tolerability of Coartem® against uncomplicated P. falciparum malaria, suggesting the continuation as a first-line drug in the study district

  14. Prescribing practice for malaria following introduction of artemether-lumefantrine in an urban area with declining endemicity in West Africa

    Directory of Open Access Journals (Sweden)

    Conway David J

    2010-06-01

    Full Text Available Abstract Background The decline in malaria coinciding with the introduction of newer, costly anti-malarials has prompted studies into the overtreatment for malaria mostly in East Africa. The study presented here describes prescribing practices for malaria at health facilities in a West African country. Methods Cross-sectional surveys were carried out in two urban Gambian primary health facilities (PHFs during and outside the malaria transmission season. Facilities were comparable in terms of the staffing compliment and capability to perform slide microscopy. Patients treated for malaria were enrolled after consultations and blood smears collected and read at a reference laboratory. Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined. Results Slide requests were made for 33.2% (173 of those enrolled, being more frequent in children (0-15 yrs than adults during the wet season (p = 0.003. In the same period, requests were commoner in under-fives compared to older children (p = 0.022; however, a positive test result was 4.4 times more likely in the latter group (p = 0.010. Parasitaemia was confirmed for only 4.7% (10/215 and 12.5% (37/297 of patients in the dry and wet seasons, respectively. The negative predictive value of a PHF slide remained above 97% in both seasons. Conclusions The study provides evidence for considerable overtreatment for malaria in a West African setting comparable to reports from areas with similar low malaria transmission in East Africa. The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment. The "peak prevalence" in 5-15 year olds may reflect successful implementation of malaria control interventions in under-fives, but point out the need to extend such interventions to older

  15. Efficacy and Safety of Artesunate-Amodiaquine versus Artemether-Lumefantrine in the Treatment of Uncomplicated Plasmodium falciparum Malaria in Sentinel Sites across Côte d'Ivoire.

    Science.gov (United States)

    Yavo, William; Konaté, Abibatou; Kassi, Fulgence Kondo; Djohan, Vincent; Angora, Etienne Kpongbo; Kiki-Barro, Pulcherie Christiane; Vanga-Bosson, Henriette; Menan, Eby Ignace Hervé

    2015-01-01

    Two years after the introduction of free Artesunate-Amodiaquine (ASAQ) and Artemether-Lumefantrine (AL) for the treatment of uncomplicated malaria in public health facilities in Côte d'Ivoire, we carried out this study to compare their efficacy and tolerability in three surveillance sites. It was a multicentre open randomised clinical trial of 3-day ASAQ treatment against AL for the treatment of 2 parallel groups of patients aged 2 years and above. The endpoints were (1) Adequate Clinical and Parasitological Response (ACPR) at day 28 and (2) the clinical and biological tolerability. Of the 300 patients who were enrolled 289, with 143 (49.5%) and 146 (50.5%) in the ASAQ and AL groups, respectively, correctly followed the WHO 2003 protocol we used. The PCR-corrected ACPR was 99.3% for each group. More than 94% of patients no longer showed signs of fever, 48 hours after treatment. Approximately 78% of the people in the ASAQ group had a parasite clearance time of 48 hours or less compared to 81% in the AL group (p = 0.496). Both drugs were found to be well tolerated by the patients. This study demonstrates the effectiveness and tolerability of ASAQ and AL supporting their continuous use for the treatment of uncomplicated P. falciparum malaria infection in Côte d'Ivoire.

  16. Polymorphisms in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance 1 genes: parasite risk factors that affect treatment outcomes for P. falciparum malaria after artemether-lumefantrine and artesunate-amodiaquine.

    Science.gov (United States)

    Venkatesan, Meera; Gadalla, Nahla B; Stepniewska, Kasia; Dahal, Prabin; Nsanzabana, Christian; Moriera, Clarissa; Price, Ric N; Mårtensson, Andreas; Rosenthal, Philip J; Dorsey, Grant; Sutherland, Colin J; Guérin, Philippe; Davis, Timothy M E; Ménard, Didier; Adam, Ishag; Ademowo, George; Arze, Cesar; Baliraine, Frederick N; Berens-Riha, Nicole; Björkman, Anders; Borrmann, Steffen; Checchi, Francesco; Desai, Meghna; Dhorda, Mehul; Djimdé, Abdoulaye A; El-Sayed, Badria B; Eshetu, Teferi; Eyase, Frederick; Falade, Catherine; Faucher, Jean-François; Fröberg, Gabrielle; Grivoyannis, Anastasia; Hamour, Sally; Houzé, Sandrine; Johnson, Jacob; Kamugisha, Erasmus; Kariuki, Simon; Kiechel, Jean-René; Kironde, Fred; Kofoed, Poul-Erik; LeBras, Jacques; Malmberg, Maja; Mwai, Leah; Ngasala, Billy; Nosten, Francois; Nsobya, Samuel L; Nzila, Alexis; Oguike, Mary; Otienoburu, Sabina Dahlström; Ogutu, Bernhards; Ouédraogo, Jean-Bosco; Piola, Patrice; Rombo, Lars; Schramm, Birgit; Somé, A Fabrice; Thwing, Julie; Ursing, Johan; Wong, Rina P M; Zeynudin, Ahmed; Zongo, Issaka; Plowe, Christopher V; Sibley, Carol Hopkins

    2014-10-01

    Adequate clinical and parasitologic cure by artemisinin combination therapies relies on the artemisinin component and the partner drug. Polymorphisms in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) genes are associated with decreased sensitivity to amodiaquine and lumefantrine, but effects of these polymorphisms on therapeutic responses to artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) have not been clearly defined. Individual patient data from 31 clinical trials were harmonized and pooled by using standardized methods from the WorldWide Antimalarial Resistance Network. Data for more than 7,000 patients were analyzed to assess relationships between parasite polymorphisms in pfcrt and pfmdr1 and clinically relevant outcomes after treatment with AL or ASAQ. Presence of the pfmdr1 gene N86 (adjusted hazards ratio = 4.74, 95% confidence interval = 2.29 - 9.78, P < 0.001) and increased pfmdr1 copy number (adjusted hazards ratio = 6.52, 95% confidence interval = 2.36-17.97, P < 0.001 : were significant independent risk factors for recrudescence in patients treated with AL. AL and ASAQ exerted opposing selective effects on single-nucleotide polymorphisms in pfcrt and pfmdr1. Monitoring selection and responding to emerging signs of drug resistance are critical tools for preserving efficacy of artemisinin combination therapies; determination of the prevalence of at least pfcrt K76T and pfmdr1 N86Y should now be routine.

  17. Efficacy and Safety of Artesunate-Amodiaquine versus Artemether-Lumefantrine in the Treatment of Uncomplicated Plasmodium falciparum Malaria in Sentinel Sites across Côte d'Ivoire

    Science.gov (United States)

    Yavo, William; Konaté, Abibatou; Kassi, Fulgence Kondo; Djohan, Vincent; Angora, Etienne Kpongbo; Kiki-Barro, Pulcherie Christiane; Vanga-Bosson, Henriette; Menan, Eby Ignace Hervé

    2015-01-01

    Two years after the introduction of free Artesunate-Amodiaquine (ASAQ) and Artemether-Lumefantrine (AL) for the treatment of uncomplicated malaria in public health facilities in Côte d'Ivoire, we carried out this study to compare their efficacy and tolerability in three surveillance sites. It was a multicentre open randomised clinical trial of 3-day ASAQ treatment against AL for the treatment of 2 parallel groups of patients aged 2 years and above. The endpoints were (1) Adequate Clinical and Parasitological Response (ACPR) at day 28 and (2) the clinical and biological tolerability. Of the 300 patients who were enrolled 289, with 143 (49.5%) and 146 (50.5%) in the ASAQ and AL groups, respectively, correctly followed the WHO 2003 protocol we used. The PCR-corrected ACPR was 99.3% for each group. More than 94% of patients no longer showed signs of fever, 48 hours after treatment. Approximately 78% of the people in the ASAQ group had a parasite clearance time of 48 hours or less compared to 81% in the AL group (p = 0.496). Both drugs were found to be well tolerated by the patients. This study demonstrates the effectiveness and tolerability of ASAQ and AL supporting their continuous use for the treatment of uncomplicated P. falciparum malaria infection in Côte d'Ivoire. PMID:26347849

  18. Efficacy and Safety of Artesunate-Amodiaquine versus Artemether-Lumefantrine in the Treatment of Uncomplicated Plasmodium falciparum Malaria in Sentinel Sites across Côte d’Ivoire

    Directory of Open Access Journals (Sweden)

    William Yavo

    2015-01-01

    Full Text Available Two years after the introduction of free Artesunate-Amodiaquine (ASAQ and Artemether-Lumefantrine (AL for the treatment of uncomplicated malaria in public health facilities in Côte d’Ivoire, we carried out this study to compare their efficacy and tolerability in three surveillance sites. It was a multicentre open randomised clinical trial of 3-day ASAQ treatment against AL for the treatment of 2 parallel groups of patients aged 2 years and above. The endpoints were (1 Adequate Clinical and Parasitological Response (ACPR at day 28 and (2 the clinical and biological tolerability. Of the 300 patients who were enrolled 289, with 143 (49.5% and 146 (50.5% in the ASAQ and AL groups, respectively, correctly followed the WHO 2003 protocol we used. The PCR-corrected ACPR was 99.3% for each group. More than 94% of patients no longer showed signs of fever, 48 hours after treatment. Approximately 78% of the people in the ASAQ group had a parasite clearance time of 48 hours or less compared to 81% in the AL group (p=0.496. Both drugs were found to be well tolerated by the patients. This study demonstrates the effectiveness and tolerability of ASAQ and AL supporting their continuous use for the treatment of uncomplicated P. falciparum malaria infection in Côte d’Ivoire.

  19. Rapid selection of Plasmodium falciparum chloroquine resistance transporter gene and multidrug resistance gene-1 haplotypes associated with past chloroquine and present artemether-lumefantrine use in Inhambane District, southern Mozambique

    DEFF Research Database (Denmark)

    Thomsen, Thomas T; Madsen, Laura B; Hansson, Helle H;

    2013-01-01

    Chloroquine (CQ) use in Mozambique was stopped in 2002 and artemether-lumefantrine (AL) was implemented in 2008. In light of no use of CQ and extensive use of AL, we determined the frequency of molecular markers of Plasmodium falciparum drug resistance/tolerance to CQ and AL in persons living...... in Linga-Linga, an isolated peninsula and in Furvela village, which is located 8 km inland. The P. falciparum chloroquine resistance transporter gene CVMNK wild type increased in frequency from 43.9% in 2009 to 66.4% in 2010 (P = 0.001), and combined P. falciparum multidrug resistance gene 1 N86-184F-D1246...... haplotype increased significantly between years (P = 0.039). The combination of P. falciparum chloroquine resistance transporter gene CVMNK and P. falciparum multidrug resistance gene NFD increased from 24.3% (2009) to 45.3% in (2010, P = 0.017). The rapid changes observed may largely be caused by decreased...

  20. Randomized trial of safety and effectiveness of chlorproguanil-dapsone and lumefantrine-artemether for uncomplicated malaria in children in the Gambia.

    Directory of Open Access Journals (Sweden)

    Samuel Dunyo

    Full Text Available BACKGROUND: Chlorproguanil-dapsone (Lapdap, developed as a low-cost antimalarial, was withdrawn in 2008 after concerns about safety in G6PD deficient patients. This trial was conducted in 2004 to evaluate the safety and effectiveness of CD and comparison with artemether-lumefantrine (AL under conditions of routine use in G6PD normal and G6PD deficient patients with uncomplicated malaria in The Gambia. We also examined the effects of a common genetic variant that affects chlorproguanil metabolism on risk of treatment failure. METHODS: 1238 children aged 6 months to 10 years with uncomplicated malaria were randomized to receive CD or artemether-lumefantrine (AL and followed for 28 days. The first dose was supervised, subsequent doses given unsupervised at home. G6PD genotype was determined to assess the interaction between treatment and G6PD status in their effects on anaemia. The main endpoints were clinical treatment failure by day 28, incidence of severe anaemia (Hb<5 g/dL, and haemoglobin concentration on day 3. FINDINGS: One third of patients treated with AL, and 6% of patients treated with CD, did not complete their course of medication. 18% (109/595 of children treated with CD and 6.1% (36/587 with AL required rescue medication within 4 weeks, risk difference 12% (95%CI 8.9%-16%. 23 children developed severe anaemia (17 (2.9% treated with CD and 6 (1.0% with AL, risk difference 1.8%, 95%CI 0.3%-3.4%, P = 0.02. Haemoglobin concentration on day 3 was lower among children treated with CD than AL (difference 0.43 g/dL, 95% CI 0.24 to 0.62, and within the CD group was lower among those children who had higher parasite density at enrollment. Only 17 out of 1069 children who were typed were G6PD A- deficient, of these 2/9 treated with CD and 1/8 treated with AL developed severe anaemia. 5/9 treated with CD had a fall of 2 g/dL or more in haemoglobin concentration by day 3. INTERPRETATION: AL was well tolerated and highly effective and when

  1. Amodiaquine-artesunate vs artemether-lumefantrine for uncomplicated malaria in Ghanaian children: a randomized efficacy and safety trial with one year follow-up

    DEFF Research Database (Denmark)

    Adjei, George O; Kurtzhals, Jorgen A L; Rodrigues, Onike P;

    2008-01-01

    subsequent attacks of uncomplicated malaria after 28 days were treated with the same regimen as at randomization. Investigations aimed at determining efficacy and side effects were conducted. RESULTS: Adequate clinical and parasitological response in subjects with evaluable end-points were, 97.1% (100....../103) and 98.2% (107/109) on day 14, and 94.2% (97/103) and 95.3% (102/107) on day 28 in the AM-L and AS+AQ groups, respectively. Similar results were obtained after PCR correction. The incidence of malaria attacks in the year following recruitment was similar between the two treatment groups (p = 0...

  2. Randomized trials of artemisinin-piperaquine, dihydroartemisinin-piperaquine phosphate and artemether-lumefantrine for the treatment of multi-drug resistant falciparum malaria in Cambodia-Thailand border area

    Directory of Open Access Journals (Sweden)

    Song Jianping

    2011-08-01

    Full Text Available Abstract Background Drug resistance of falciparum malaria is a global problem. Sulphadoxine/pyrimethamine-resistant and mefloquine-resistant strains of falciparum malaria have spread in Southeast Asia at lightning speed in 1980s-1990s, and the Cambodia-Thailand border is one of the malaria epidemic areas with the most severe forms of multi-drug resistant falciparum malaria. Methods Artemisinin-piperaquine (AP, dihydroartemisinin-piperaquine phosphate (DHP and artemether-lumefantrine (AL were used to treat 110, 55 and 55 uncomplicated malaria patients, respectively. The total dosage for adults is 1,750 mg (four tablets, twice over 24 hours of AP, 2,880 mg (eight tablets, four times over two days of DHP, and 3,360 mg (24 tablets, six times over three days of AL. The 28-day cure rate, parasite clearance time, fever clearance time, and drug tolerance of patients to the three drugs were compared. All of the above methods were consistent with the current national guidelines. Results The mean parasite clearance time was similar in all three groups (66.7 ± 21.9 hrs, 65.6 ± 27.3 hrs, 65.3 ± 22.5 hrs in AP, DHP and AL groups, respectively, and there was no remarkable difference between them; the fever clearance time was also similar (31.6 ± 17.7 hrs, 34.6 ± 21.8 hrs and 36.9 ± 15.4 hrs, respectively. After following up for 28-days, the cure rate was 95.1%(97/102, 98.2%(54/55 and 82.4%(42/51; and the recrudescence cases was 4.9%(5/102, 1.8%(1/55 and 17.6%(9/51, respectively. Therefore, the statistical data showed that 28-day cure rate in AP and DHP groups was superior to AL group obviously. The patients had good tolerance to all the three drugs, and some side effects (anoxia, nausea, vomiting, headache and dizziness could be found in every group and they were self-limited; patients in control groups also had good tolerance to DHP and AL, there was no remarkable difference in the three groups. Conclusions AP, DHP and AL all remained efficacious

  3. A randomized trial of artesunate-amodiaquine versus artemether-lumefantrine in Ghanaian paediatric sickle cell and non-sickle cell disease patients with acute uncomplicated malaria

    DEFF Research Database (Denmark)

    Adjei, George O; Goka, Bamenla Q; Enweronu-Laryea, Christabel C

    2014-01-01

    BACKGROUND: Sickle cell disease (SCD) is a genetic disorder common in malaria endemic areas. In endemic areas, malaria is a major cause of morbidity and mortality among SCD patients. This suggests the need for prompt initiation of efficacious anti-malarial therapy in SCD patients with acute malaria......-lumefantrine (AL). A comparison group of non-SCD children (HbAA genotype; n = 59) with uncomplicated malaria were also randomized to treatment with AA or AL. Recruited children were followed up and selected investigations were done on days 1, 2, 3, 7, 14, 28, 35, and 42. Selected clinical and laboratory parameters...

  4. Reversible audiometric threshold changes in children with uncomplicated malaria

    DEFF Research Database (Denmark)

    Adjei, George O; Goka, Bamenla Q; Kitcher, Emmanuel

    2013-01-01

    Background. Plasmodium falciparum malaria, as well as certain antimalarial drugs, is associated with hearing impairment in adults. There is little information, however, on the extent, if any, of this effect in children, and the evidence linking artemisinin combination therapies (ACTs) with hearing...... is inconclusive. Methods. Audiometry was conducted in children with uncomplicated malaria treated with artesunate-amodiaquine (n = 37), artemether-lumefantrine (n = 35), or amodiaquine (n = 8) in Accra, Ghana. Audiometry was repeated 3, 7, and 28 days later and after 9 months. Audiometric thresholds were compared...... evident between treated children and controls after 9 months. The hearing thresholds of children treated with the two ACT regimens were comparable but lower than those of amodiaquine-treated children during acute illness. Interpretation. Malaria is the likely cause of the elevated hearing threshold levels...

  5. A qualitative study of the feasibility and community perception on the effectiveness of artemether-lumefantrine use in the context of home management of malaria in south-west Nigeria

    Directory of Open Access Journals (Sweden)

    Happi Christian

    2008-06-01

    Full Text Available Abstract Background In Nigeria ACT use at the community level has not been evaluated and the use of antimalarial drugs (commonly chloroquine (CQ at home has been shown to be largely incorrect. The treatment regimen of ACT is however more complicated than that of CQ. There is thus a need to determine the feasibility of using ACT at the home level and determine community perception on its use. Methods A before and after qualitative study using key informant interviews (KII and focus group discussions (FGDs was conducted in selected villages in Ona-Ara local government area. At baseline, 14 FGDs and 14 KIIs were conducted. Thereafter, community medicine distributors (CMDs were trained in each village to dispense artemeter-lumenfantrine (AL to febrile children aged 6–59 months presumed to have uncomplicated malaria. After one year of drug distribution, nine KIIs and 10 FGDs were conducted. Participants and key informants were mothers and fathers with children under five years, traditional heads of communities, opinion leaders and health workers. Results None of the participants have heard of AL prior to study. Participants were favourably disposed to introduction of AL into the community. Mothers/caregivers were said to have used AL in place of the orthodox drugs and herbs reported commonly used prior to study after commencement of AL distribution. The use of CMDs for drug distribution was acceptable to the participants and they were judged to be efficient as they were readily available, distributed correct dose of AL and mobilised the community effectively. AL was perceived to be very effective and no significant adverse event was reported. Major concerns to the sustainability of the program were the negative attitudes of health workers towards discharge of their duties, support to the CMDs and the need to provide CMDs incentives. In addition regular supply of drugs and adequate supervision of CMDs were advised. Conclusion Our findings showed

  6. Safety and tolerability of combination antimalarial therapies for uncomplicated falciparum malaria in Ugandan children

    Directory of Open Access Journals (Sweden)

    Kamya Moses R

    2008-06-01

    Full Text Available Abstract Background Combination antimalarial therapy is recommended for the treatment of uncomplicated falciparum malaria in Africa; however, some concerns about the safety and tolerability of new regimens remain. This study compared the safety and tolerability of three combination antimalarial regimens in a cohort of Ugandan children. Methods A longitudinal, single-blind, randomized clinical trial of children was conducted between November 2004 and May 2007 in Kampala, Uganda. Upon diagnosis of the first episode of uncomplicated malaria, participants were randomized to treatment with amodiaquine + sulphadoxine-pyrimethamine (AQ+SP, artesunate + amodiaquine (AS+AQ, or artemether-lumefantrine (AL. Once randomized, participants received the same regimen for all subsequent episodes of uncomplicated malaria. Participants were actively monitored for adverse events for the first 14 days after each treatment, and then passively followed until their next study medication treatment, or withdrawal from study. Outcome measures included the risk of adverse events at 14 and 42 days after treatment. Results Of 601 enrolled children, 382 were diagnosed with at least one episode of uncomplicated malaria and were treated with study medications. The median age at treatment was 6.3 years (range 1.1 – 12.3 years. At 14 days of follow-up, AQ+SP treatment was associated with a higher risk of anorexia, weakness, and subjective fever than treatment with AL, and a higher risk of weakness, and subjective fever than treatment with AS+AQ. Treatment with AL was associated with a higher risk of elevated temperature. Repeated episodes of neutropaenia associated with AS+AQ were detected in one participant. Considering only children less than five years, those who received AQ+SP were at higher risk of developing moderate or severe anorexia and weakness than those treated with AL (anorexia: RR 3.82, 95% CI 1.59 – 9.17; weakness: RR 5.40, 95% CI 1.86 – 15.7, or AS

  7. Availability and utilization of the WHO recommended priority lifesaving medicines for under five-year old children in public health facilities in Uganda

    DEFF Research Database (Denmark)

    Nsabagasani, Xavier; Ogwal-Okeng, Jasper; Mbonye, Anthony;

    2015-01-01

    priority medicines for diarrhea, sepsis, pneumonia and malaria. 81 health workers from the facilities reported what they prescribed for children with the above diseases. RESULTS: Oral rehydration salt (ORS) and zinc sulphate dispersible tablets for diarrhea were available in all HC IIs and IIIs and in only......OBJECTIVES: To explore the availability and utilization of the World Health Organization (WHO) recommended priority life-saving medicines for children under five in public health facilities in Uganda. METHODS: We conducted a cross sectional survey in 32 lower level public facilities in Jinja...... of the health workers reported prescribing zinc sulphate and ORS for diarrhea, 86% reported procaine benzyl penicillin injection powder for sepsis, and 57% reported amoxicillin dispersible tablets for pneumonia. None reported prescribing Artemether lumefantrine dispersible tablets and rectal artesunate...

  8. Adherence of community caretakers of children to pre-packaged antimalarial medicines (HOMAPAK® among internally displaced people in Gulu district, Uganda

    Directory of Open Access Journals (Sweden)

    Opwonya John

    2006-05-01

    Full Text Available Abstract Background In 2002, home-based management of fever (HBMF was introduced in Uganda, to improve access to prompt, effective antimalarial treatment of all fevers in children under 5 years. Implementation is through community drug distributors (CDDs who distribute pre-packaged chloroquine plus sulfadoxine-pyrimethamine (HOMAPAK® free of charge to caretakers of febrile children. Adherence of caretakers to this regimen has not been studied. Methods A questionnaire-based survey combined with inspection of blister packaging was conducted to investigate caretakers' adherence to HOMAPAK®. The population surveyed consisted of internally displaced people (IDPs from eight camps. Results A total of 241 caretakers were interviewed. 95.0% (CI: 93.3% – 98.4% of their children had received the correct dose for their age and 52.3% of caretakers had retained the blister pack. Assuming correct self-reporting, the overall adherence was 96.3% (CI: 93.9% – 98.7%. The nine caretakers who had not adhered had done so because the child had improved, had vomited, did not like the taste of the tablets, or because they forgot to administer the treatment. For 85.5% of cases treatment had been sought within 24 hours. Blister packaging was considered useful by virtually all respondents, mainly because it kept the drugs clean and dry. Information provided on, and inside, the package was of limited use, because most respondents were illiterate. However, CDDs had often told caretakers how to administer the treatment. For 39.4% of respondents consultation with the CDD was their reported first action when their child has fever and 52.7% stated that they consult her/him if the child does not get better. Conclusion In IDP camps, the HBMF strategy forms an important component of medical care for young children. In case of febrile illness, most caretakers obtain prompt and adequate antimalarial treatment, and adhere to it. A large proportion of malaria episodes are thus

  9. Impact of combined intermittent preventive treatment of malaria and helminths on anaemia, sustained attention, and recall in Northern Ghanaian schoolchildren

    DEFF Research Database (Denmark)

    Opoku, Ernest Cudjoe; Olsen, Annette; Browne, Edmund

    2016-01-01

    BACKGROUND: The benefits of integrated control of malaria, schistosomiasis, and soil-transmitted helminth infections have not been fully explored in Ghanaian schoolchildren. OBJECTIVE: To assess the impact of co-administered artemether-lumefantrine plus albendazole, and artemether-lumefantrine plus......-administered to 131 schoolchildren in Study Arm 1; artemether-lumefantrine, albendazole, and praziquantel to 90 children in Study Arm 2 versus albendazole and praziquantel to 127 children in Control Arm 3. Medicines were administered to all children at least 30 min after a meal. A HemoCue(®) photometer was used...

  10. Reasons Parents Exempt Children from Receiving Immunizations

    Science.gov (United States)

    Luthy, Karlen E.; Beckstrand, Renea L.; Callister, Lynn C.; Cahoon, Spencer

    2012-01-01

    School nurses are on the front lines of educational efforts to promote childhood vaccinations. However, some parents still choose to exempt their children from receiving vaccinations for personal reasons. Studying the beliefs of parents who exempt vaccinations allows health care workers, including school nurses, to better understand parental…

  11. Reversible Audiometric Threshold Changes in Children with Uncomplicated Malaria

    Directory of Open Access Journals (Sweden)

    George O. Adjei

    2013-01-01

    Full Text Available Background. Plasmodium falciparum malaria, as well as certain antimalarial drugs, is associated with hearing impairment in adults. There is little information, however, on the extent, if any, of this effect in children, and the evidence linking artemisinin combination therapies (ACTs with hearing is inconclusive. Methods. Audiometry was conducted in children with uncomplicated malaria treated with artesunate-amodiaquine (n=37, artemether-lumefantrine (n=35, or amodiaquine (n=8 in Accra, Ghana. Audiometry was repeated 3, 7, and 28 days later and after 9 months. Audiometric thresholds were compared with those of a control group of children (n=57 from the same area. Findings. During the acute stage, hearing threshold levels of treated children were significantly elevated compared with controls (P<0.001. The threshold elevations persisted up to 28 days, but no differences in hearing thresholds were evident between treated children and controls after 9 months. The hearing thresholds of children treated with the two ACT regimens were comparable but lower than those of amodiaquine-treated children during acute illness. Interpretation. Malaria is the likely cause of the elevated hearing threshold levels during the acute illness, a finding that has implications for learning and development in areas of intense transmission, as well as for evaluating potential ototoxicity of new antimalarial drugs.

  12. Plasmodium falciparum gametocyte carriage, sex ratios and asexual parasite rates in Nigerian children before and after a treatment protocol policy change instituting the use of artemisinin-based combination therapies

    Directory of Open Access Journals (Sweden)

    Grace Olusola Gbotosho

    2011-09-01

    Full Text Available The effects of artemisinin-based combination therapies (ACTs on transmission of Plasmodium falciparum were evaluated after a policy change instituting the use of ACTs in an endemic area. P. falciparum gametocyte carriage, sex ratios and inbreeding rates were examined in 2,585 children at presentation with acute falciparum malaria during a 10-year period from 2001-2010. Asexual parasite rates were also evaluated from 2003-2010 in 10,615 children before and after the policy change. Gametocyte carriage declined significantly from 12.4% in 2001 to 3.6% in 2010 (@@χ2 for trend = 44.3, p < 0.0001, but sex ratios and inbreeding rates remained unchanged. Additionally, overall parasite rates remained unchanged before and after the policy change (47.2% vs. 45.4%, but these rates declined significantly from 2003-2010 (@@χ2 for trend 35.4, p < 0.0001. Chloroquine (CQ and artemether-lumefantrine (AL were used as prototype drugs before and after the policy change, respectively. AL significantly shortened the duration of male gametocyte carriage in individual patients after treatment began compared with CQ (log rank statistic = 7.92, p = 0.005. ACTs reduced the rate of gametocyte carriage in children with acute falciparum infections at presentation and shortened the duration of male gametocyte carriage after treatment. However, parasite population sex ratios, inbreeding rates and overall parasite rate were unaffected.

  13. Factors Associated with Use of Guideline in Home Management of Malaria among Children in Rural South West Nigeria

    Science.gov (United States)

    Akerele, Adekunle; Yusuf, Oyindamola B.; Falade, Catherine O.; Ajayi, Ikeoluwapo O.; Pagnoni, Franco

    2011-01-01

    The dosage regimen for artemether-lumefantrine which is the standard of care for malaria in most of Sub-Saharan countries requires use of treatment guidelines and instructions to enhance caregivers' performance in the treatment of malaria. As part of a larger study evaluating its effectiveness in a rural local government area in southwestern Nigeria, 552 caregivers whose children had fever two weeks preceeding the survey were recruited. Information was collected with interviewer administered questionnaire. A multilevel logistic regression model was fitted using the gllamm approach in Stata to determine the factors associated with use of guideline. Age and educational background of caregiver were significantly associated with guideline use. Caregivers aged 26–30 years were 4 times more likely to use guideline than those aged >40 years. Caregivers with primary education were 4 times more likely to use guideline compared with caregivers with no formal education. Between-village variance was 0.00092 ± 0.3084. Guideline use reduced with increasing age and lower education. PMID:22312572

  14. Factors Associated with Use of Guideline in Home Management of Malaria among Children in Rural South West Nigeria

    Directory of Open Access Journals (Sweden)

    Adekunle Akerele

    2011-01-01

    Full Text Available The dosage regimen for artemether-lumefantrine which is the standard of care for malaria in most of Sub-Saharan countries requires use of treatment guidelines and instructions to enhance caregivers' performance in the treatment of malaria. As part of a larger study evaluating its effectiveness in a rural local government area in southwestern Nigeria, 552 caregivers whose children had fever two weeks preceeding the survey were recruited. Information was collected with interviewer administered questionnaire. A multilevel logistic regression model was fitted using the gllamm approach in Stata to determine the factors associated with use of guideline. Age and educational background of caregiver were significantly associated with guideline use. Caregivers aged 26–30 years were 4 times more likely to use guideline than those aged >40 years. Caregivers with primary education were 4 times more likely to use guideline compared with caregivers with no formal education. Between-village variance was 0.00092 ± 0.3084. Guideline use reduced with increasing age and lower education.

  15. Field-adapted sampling of whole blood to determine the levels of amodiaquine and its metabolite in children with uncomplicated malaria treated with amodiaquine plus artesunate combination

    Directory of Open Access Journals (Sweden)

    Gustafsson Lars L

    2009-03-01

    Full Text Available Abstract Background Artemisinin combination therapy (ACT has been widely adopted as first-line treatment for uncomplicated falciparum malaria. In Uganda, amodiaquine plus artesunate (AQ+AS, is the alternative first-line regimen to Coartem® (artemether + lumefantrine for the treatment of uncomplicated falciparum malaria. Currently, there are few field-adapted analytical techniques for monitoring amodiaquine utilization in patients. This study evaluates the field applicability of a new method to determine amodiaquine and its metabolite concentrations in whole blood dried on filter paper. Methods Twelve patients aged between 1.5 to 8 years with uncomplicated malaria received three standard oral doses of AQ+AS. Filter paper blood samples were collected before drug intake and at six different time points over 28 days period. A new field-adapted sampling procedure and liquid chromatographic method was used for quantitative determination of amodiaquine and its metabolite in whole blood. Results The sampling procedure was successively applied in the field. Amodiaquine could be quantified for at least three days and the metabolite up to 28 days. All parasites in all the 12 patients cleared within the first three days of treatment and no adverse drug effects were observed. Conclusion The methodology is suitable for field studies. The possibility to determine the concentration of the active metabolite of amodiaquine up to 28 days suggested that the method is sensitive enough to monitor amodiaquine utilization in patients. Amodiaquine plus artesunate seems effective for treatment of falciparum malaria.

  16. Improving child support enforcement for children receiving SSI.

    Science.gov (United States)

    Wilschke, S

    Less than half of all children who receive Supplemental Security Income (SSI) benefits and live in a single-parent home receive child support services. Although filing for child support is a condition of eligibility for income assistance programs such as Temporary Assistance for Needy Families (TANF), it is not a condition of eligibility for SSI benefits. Requiring single custodial parents applying for SSI on behalf of their children to pursue child support payments might result in more children on SSI receiving child support, and since the Social Security Administration (SSA) excludes one-third of child support when determining benefit amounts, increased receipt of child support would enhance the financial well-being of SSI children. Improving access to data on child support would enhance the integrity of the SSI program by reducing overpayments to children receiving child support. This article looks at the child support provisions in SSI and other means-tested programs and discusses policy options for improving receipt of child support and access to related data. Requiring cooperation with child support enforcement agencies would be consistent with the philosophy that the SSI program should serve as a program of last resort. Whenever possible, both parents should take primary responsibility for their children. While such a requirement has the potential to improve the financial status of children receiving SSI, factors such as their low-income status and their involvement with the TANF program raise questions about how much those children will actually benefit from such a requirement. Even if many additional children do not receive child support, the requirement demonstrates SSA's dedication to the stewardship of the SSI program. However, if custodial parents fail to comply with the requirement, children may be worse off as a result of the requirement. SSA should carefully pursue a requirement to induce cooperation while protecting children to the greatest extent

  17. Early Intervention for Children with Hearing Loss: Information Parents Receive about Supporting Children's Language

    Science.gov (United States)

    Decker, Kalli B.; Vallotton, Claire D.

    2016-01-01

    Family-centered early intervention for children with hearing loss is intended to strengthen families' interactions with their children to support children's language development, and should include providing parents with information they can use as part of their everyday routines. However, little is known about the information received by families…

  18. Should children with inherited metabolic disorders receive varicella vaccination?

    LENUS (Irish Health Repository)

    Varghese, M

    2011-01-01

    The aim was to determine the rate of varicella infection and complications in children with disorders of intermediary metabolism (IEM) between the ages of 1 and 16 years attending our national metabolic referral centre. Of 126 children identified, a response was received from 122. A history of previous varicella infection was identified in 64 cases (53%) and of varicella vaccination in 5 (4%). Fifty-three (43%) patients apparently did not have a history of clinical varicella infection. Of the 64 children with a history of varicella infection, five required hospitalisation for complications, including life-threatening lactic acidosis in one patient with mitochondrial disease and metabolic decompensation in four patients. In conclusion, varicella infection may cause an increased risk of metabolic decompensation in patients with IEMs. We propose that a trial of varicella vaccination be considered for this cohort of patients with monitoring of its safety and efficacy.

  19. Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children.

    Directory of Open Access Journals (Sweden)

    Tamara D Clark

    Full Text Available BACKGROUND: Combination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda. METHODOLOGY/PRINCIPAL FINDINGS: Children aged 1-10 years were enrolled from randomly selected households in 2004-05 and 2007, and were followed at least monthly through 2008. Insecticide-treated bednets (ITNs were provided in 2006. Children were randomized upon their first episode, and then treated for all episodes of uncomplicated malaria with amodiaquine/sulfadoxine-pyrimethamine (AQ/SP, artesunate/amodiaquine (AS/AQ, or artemether/lumefantrine (AL. Risks of parasitological failure were determined for each episode of uncomplicated malaria and clinical parameters were followed. A total of 690 children experienced 1464 episodes of malaria. 96% of these episodes were uncomplicated malaria and treated with study drugs; 94% were due to Plasmodium falciparum. The rank order of treatment efficacy was AL > AS/AQ > AQ/SP. Failure rates increased over time for AQ/SP, but not the artemisinin-based regimens. Over the 4-year course of the study the prevalence of asymptomatic parasitemia decreased from 11.8% to 1.4%, the incidence of malaria decreased from 1.55 to 0.32 per person year, and the prevalence of anemia (hemoglobin <10 gm/dL decreased from 5.9% to 1.0%. No episodes of severe malaria (based on WHO criteria and no deaths were seen. CONCLUSIONS/SIGNIFICANCE: With ready access to combination therapies and distribution of ITNs, responses were excellent for artemisinin-containing regimens, severe malaria was not seen, and the incidence of malaria and prevalence of parasitemia and anemia decreased steadily over time. TRIAL REGISTRATION: isrctn.org ISRCTN37517549.

  20. 25 CFR 20.400 - Who should receive Services to Children, Elderly, and Families?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Who should receive Services to Children, Elderly, and... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Services to Children, Elderly, and Families § 20.400 Who should receive Services to Children, Elderly, and Families? Services to Children, Elderly, and...

  1. Serum Thyroid Hormone Levels in Epileptic Children Receiving Anticonvulsive Drugs

    Directory of Open Access Journals (Sweden)

    Abolfazl MAHYAR

    2011-12-01

    Full Text Available How to Cite this Article: Mahyar A, Ayazi P, Dalirani R, Hosseini SM, Daneshi Kohan MM. Serum Thyroid Hormone Levels in Epileptic Children Receiving AnticonvulsiveDrugs. Iranian Journal of Child Neurology 2011;5(4:21-24.ObjectiveThe aim of this study was to investigate serum thyroid hormone levels in epileptic children receiving anticonvulsive drugs.Materials & MethodsIn this case- control study, 30 epileptic children who were receiving anticonvulsive drugs (case group were compared with 30 healthy children (control group. This study was carried out in the Qazvin Children's Hospital (Qazvin, Iran from October to December 2007. Both groups were matched for age and sex. Thyroid hormone levels were measured using a radioimmunoassay and immunoradiometric assay. Data were analyzed using Chi-square and Student's t-tests.ResultsThe mean serum T3 and T4 levels in the case group were 2.36 ± 0.73 nmol/L and 95.96 ± 27.01 nmol/L, respectively, and the corresponding values in the control group were 1.88 ± 0.93 nmol/L and 147.46 ± 35.77 nmol/L, respectively. The mean serum thyroid-stimulating hormone (TSH levels in the case and control groups were 2.73±0.73 mIU/mL and 2.49 ± 2.17mIU/mL, respectively.ConclusionThis study revealed that long-term consumption of anticonvulsive drugs resulted in a decline in serum T4 levels and an increase in serum T3 levels, but had no effect on TSH levels. 1. Johnston M. Neurodegenerative disorders of childhood;Spingolipidoses. Nelson textbook of pediatrics, 17th edPhiladelphia: Saunders; 2004.P.2031-2.2. Sankar R, Koh S, Wu J, Menkes J. Paroxysmal disorders.In(eds: Menkes JH, Sarnat HB, Maria BL. ChildNeurology; 2006.P.7:877.3. Shiva S, Ashrafi M, Mostafavi F, Abasi F, RahbariA, Shabanian R. Effects of anticonvulsant drugs onthyroid function tests. Iranian Journal of pediatrics2003;13(02:101.4. Kimura M, Yoshino K, Suzuki N, Maeoka Y. Effect ofantiepileptic drugs on thyroid function. Psychiatry andclinical neurosciences

  2. Artesunate-Amodiaquine and Artemether-Lumefantrine Therapies and Selection of Pfcrt and Pfmdr1 Alleles in Nanoro, Burkina Faso.

    Science.gov (United States)

    Sondo, Paul; Derra, Karim; Diallo Nakanabo, Seydou; Tarnagda, Zekiba; Kazienga, Adama; Zampa, Odile; Valéa, Innocent; Sorgho, Hermann; Owusu-Dabo, Ellis; Ouédraogo, Jean-Bosco; Guiguemdé, Tinga Robert; Tinto, Halidou

    2016-01-01

    The adoption of Artemisinin based combination therapies (ACT) constitutes a basic strategy for malaria control in sub-Saharan Africa. Moreover, since cases of ACT resistance have been reported in South-East Asia, the need to understand P. falciparum resistance mechanism to ACT has become a global research goal. The selective pressure of ACT and the possibility that some specific Pfcrt and Pfmdr1 alleles are associated with treatment failures was assessed in a clinical trial comparing ASAQ to AL in Nanoro. Dried blood spots collected on Day 0 and on the day of recurrent parasitaemia during the 28-day follow-up were analyzed using the restriction fragments length polymorphism (PCR-RFLP) method to detect single nucleotide polymorphisms (SNPs) in Pfcrt (codon76) and Pfmdr1 (codons 86, 184, 1034, 1042, and 1246) genes. Multivariate analysis of the relationship between the presence of Pfcrt and Pfmdr1 alleles and treatment outcome was performed. AL and ASAQ exerted opposite trends in selecting Pfcrt K76T and Pfmdr1-N86Y alleles, raising the potential beneficial effect of using diverse ACT at the same time as first line treatments to reduce the selective pressure by each treatment regimen. No clear association between the presence of Pfcrt and Pfmdr1 alleles carried at baseline and treatment failure was observed.

  3. Artesunate-Amodiaquine and Artemether-Lumefantrine Therapies and Selection of Pfcrt and Pfmdr1 Alleles in Nanoro, Burkina Faso.

    Directory of Open Access Journals (Sweden)

    Paul Sondo

    Full Text Available The adoption of Artemisinin based combination therapies (ACT constitutes a basic strategy for malaria control in sub-Saharan Africa. Moreover, since cases of ACT resistance have been reported in South-East Asia, the need to understand P. falciparum resistance mechanism to ACT has become a global research goal. The selective pressure of ACT and the possibility that some specific Pfcrt and Pfmdr1 alleles are associated with treatment failures was assessed in a clinical trial comparing ASAQ to AL in Nanoro. Dried blood spots collected on Day 0 and on the day of recurrent parasitaemia during the 28-day follow-up were analyzed using the restriction fragments length polymorphism (PCR-RFLP method to detect single nucleotide polymorphisms (SNPs in Pfcrt (codon76 and Pfmdr1 (codons 86, 184, 1034, 1042, and 1246 genes. Multivariate analysis of the relationship between the presence of Pfcrt and Pfmdr1 alleles and treatment outcome was performed. AL and ASAQ exerted opposite trends in selecting Pfcrt K76T and Pfmdr1-N86Y alleles, raising the potential beneficial effect of using diverse ACT at the same time as first line treatments to reduce the selective pressure by each treatment regimen. No clear association between the presence of Pfcrt and Pfmdr1 alleles carried at baseline and treatment failure was observed.

  4. Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

    Directory of Open Access Journals (Sweden)

    Sykes Alma

    2011-10-01

    Full Text Available Abstract Background WHO guidelines for the treatment of young children with suspected malaria have recently changed from presumptive treatment to anti-malarial treatment guided by a blood slide or malaria rapid diagnostic test (RDT. However, there is limited evidence of the safety of this policy in routine outpatient settings in Africa. Methods Children 3-59 months of age with a non-severe febrile illness and no obvious cause were enrolled over a period of one year in a malaria endemic area of Tanzania. Treatment was determined by the results of a clinical examination and RDT result, and blood culture and serum lactate were also collected. RDT-negative children were followed up over 14 days. Results Over the course of one year, 965 children were enrolled; 158 (16.4% were RDT-positive and treated with artemether-lumefantrine and 807 (83.4% were RDT-negative and treated with non-anti-malarial medicines. Compared with RDT-positives, RDT-negative children were on average younger with a lower axillary temperature and more likely to have a history of cough or difficulty in breathing. Six (0.6% children became RDT-positive after enrolment, all of whom were PCR-negative for Plasmodium falciparum DNA at enrolment. In addition, 12 (1.2% children were admitted to hospital, one with possible malaria, none of whom died. A bacterial pathogen was identified in 9/965 (0.9% children, eight of whom were RDT-negative and one was RDT-positive, but slide-negative. Excluding three children with Salmonella typhi, all of the children with bacteraemia were ≤12 months of age. Compared to double-read research slide results RDTs had a sensitivity of 97.8% (95%CI 96.9-98.7 and specificity of 96.3% (95%CI 96.3-98.4. Conclusions Use of RDTs to direct the use of anti-malarial drugs in young children did not result in any missed diagnoses of malaria although new infections soon after a consultation with a negative RDT result may undermine confidence in results. Invasive

  5. Cognitive and neuropsychological characteristics of attention deficit hyperactivity disorder children receiving stimulant medications.

    Science.gov (United States)

    Risser, M G; Bowers, T G

    1993-12-01

    10 children receiving stimulant medication for Attention Deficit Hyperactivity Disorder were compared to normal children on cognitive and neuropsychological dimensions in a pilot study. When compared with 10 normal children the ADHD children showed significant differences on cognitive measures, including the Wechsler Developmental Index, the Bender Visual-motor Gestalt Test, and the Benton Revised Visual Retention Test. Elevated levels of polyspike EEG activity were also noted for these children. Analysis suggested that ADHD children receiving stimulant medications may have persisting neuropsychological difficulty. Further research on the neuropsychological correlates of ADHD seems warranted.

  6. Differences in health-related quality of life in children with sickle cell disease receiving hydroxyurea.

    Science.gov (United States)

    Thornburg, Courtney D; Calatroni, Agustin; Panepinto, Julie A

    2011-05-01

    Hydroxyurea is a safe and efficacious medication for children with sickle cell disease (SCD). Our objective was to compare health-related quality of life (HRQL) between children taking hydroxyurea and those not taking hydroxyurea. We conducted a retrospective cohort study of children with SCD who had completed the PedsQL 4.0 at Duke University Medical Center or the Midwest Sickle Cell Center. Our primary outcome was HRQL in children receiving hydroxyurea therapy compared with those not receiving hydroxyurea. One hundred and ninety-one children with SCD were included in the study. Children in the hydroxyurea group had higher self-reported Total PedsQL median scores than children in the no hydroxyurea group (P=0.04). Child self-reported physical functioning scores were significantly higher for children in the hydroxyurea group (P=0.01). In conclusion, children with SCD who received hydroxyurea therapy reported better overall HRQL and better physical HRQL than children who did not receive this therapy despite disease severity. Further research assessing the impact of hydroxyurea therapy on HRQL, such as prospective assessment over time, would aid in our understanding of the effectiveness of hydroxyurea for individual children. Ultimately, this may aid in decreasing the barriers to the use of hydroxyurea.

  7. Impact of intermittent screening and treatment for malaria among school children in Kenya: a cluster randomised trial.

    Directory of Open Access Journals (Sweden)

    Katherine E Halliday

    2014-01-01

    Full Text Available BACKGROUND: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence of the benefits of alternative school-based malaria interventions or how the impacts of interventions vary according to intensity of malaria transmission. We investigated the effect of intermittent screening and treatment (IST for malaria on the health and education of school children in an area of low to moderate malaria transmission. METHODS AND FINDINGS: A cluster randomised trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010-2012. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up for 24 months. Once a school term, children were screened by public health workers using malaria rapid diagnostic tests (RDTs, and children (with or without malaria symptoms found to be RDT-positive were treated with a six dose regimen of artemether-lumefantrine (AL. Given the nature of the intervention, the trial was not blinded. The primary outcomes were anaemia and sustained attention. Secondary outcomes were malaria parasitaemia and educational achievement. Data were analysed on an intention-to-treat basis. During the intervention period, an average of 88.3% children in intervention schools were screened at each round, of whom 17.5% were RDT-positive. 80.3% of children in the control and 80.2% in the intervention group were followed-up at 24 months. No impact of the malaria IST intervention was observed for prevalence of anaemia at either 12 or 24 months (adjusted risk ratio [Adj.RR]: 1.03, 95% CI 0.93-1.13, p = 0.621 and Adj.RR: 1.00, 95% CI 0.90-1.11, p = 0.953 respectively, or on prevalence of P. falciparum infection or scores of classroom attention. No effect of IST was observed on educational achievement in the older class, but an apparent negative

  8. NIH Research: Children Research Volunteers Receive Care and Help Advance Knowledge | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... Children Research Volunteers Receive Care and Help Advance Knowledge Past Issues / Winter 2012 Table of Contents Dr. ... Children research volunteers receive care and help advance knowledge I f one smile can light up a ...

  9. Giving toys to children reduces their anxiety about receiving premedication for surgery.

    Science.gov (United States)

    Golden, Leonard; Pagala, Murali; Sukhavasi, Sujatha; Nagpal, Dheeraj; Ahmad, Ayeesha; Mahanta, Aruna

    2006-04-01

    Children have increased anxiety during the preoperative period. The administration of oral premedication to children is often met with apprehension, reluctance, or refusal. We sought to determine whether giving a small toy to the children would decrease the anxiety associated with taking oral premedication. This was a prospective study involving 100 children 3-6 yr of age randomized into two equal groups. The anxiety of each child was assessed using the Modified Yale Preoperative Anxiety Scale. The results showed significantly less anxiety in children who received a toy before oral administration of midazolam.

  10. The majority of sick children receive paracetamol during the winter

    DEFF Research Database (Denmark)

    Ertmann, Ruth Kirk; Møller, Janne Julie; Waldorff, Frans Boch

    2012-01-01

    INTRODUCTION: Even though fever is a common symptom in childhood, it often worries parents and they may try to reduce discomfort by giving the child paracetamol, which is currently the most commonly sold over-the-counter medicine. The objective of this study was to investigate parent-administered......INTRODUCTION: Even though fever is a common symptom in childhood, it often worries parents and they may try to reduce discomfort by giving the child paracetamol, which is currently the most commonly sold over-the-counter medicine. The objective of this study was to investigate parent......-administered paracetamol in toddlers during a winter-period in relation to symptoms, doctor contacts and severity-rated illness. MATERIAL AND METHODS: The study was conducted as a prospective diary study covering a three-month winter-period. It comprised a cohort of 183 infants born in February 2001 in a district...... of the capital area in Denmark. RESULTS: According to the parents, a total of 119 toddlers (65%) received paracetamol at least once during the study period; 9.3% of the toddlers received paracetamol for more than ten days. The administration of paracetamol rose as the number of symptoms increased. Paracetamol...

  11. Progress and Outcomes for Children with Autism Receiving Parent-Managed Intensive Interventions.

    Science.gov (United States)

    Eikeseth, Svein; Martin, Neil T.; Mudford, Oliver C.; Reeves, David

    2001-01-01

    Data were analyzed from 66 young children with autism served by 25 different early intervention consultants and receiving parent-managed interventions. Parent-managed intensive interventions resulted in progress for 60 children for mental age, adaptive behavior, and language skills. Interventions did not reproduce results from clinic-based…

  12. Abnormal Myocardial Strain Indices in Children Receiving Anthracycline Chemotherapy.

    Science.gov (United States)

    Pignatelli, Ricardo H; Ghazi, Payam; Reddy, S Chandra-Bose; Thompson, Patrick; Cui, Qiqiong; Castro, Jacqueline; Okcu, Mehmet F; Jefferies, John Lynn

    2015-12-01

    Anthracycline chemotherapy (AC) is associated with impaired left ventricular (LV) systolic function. LV ejection fraction (EF %) obtained by two-dimensional echocardiography is the current gold standard for detection and monitoring of LV systolic function. However, dependence on LVEF has been shown to be unreliable due to its inherent limitations. Speckle tracking echocardiography (STE) measures myocardial strain and is a sensitive method to detect LV systolic dysfunction with demonstrated utility in such detection in adult and pediatric cohort studies. Compare myocardial strain indices derived by STE with LVEF to detect ACT-induced LV systolic dysfunction. Prospective, cross-sectional measurements of LV myocardial strain indices derived from STE with LVEF. Pediatric cohort of 25 patients (pts): 17 females, eight males with a mean age 9.8 ± 5.8 years, who received anthracyclines (AC); median cumulative dose ≥150 ± 124.4 mg/m(2), range 60-450 mg/m(2) showing normal LV end-diastolic diameter (mm) and normal LVEF (≥55 %) underwent STE to obtain LV myocardial strain indices: strain and strain rate. The inter- and intraobserver variability for the strain indices was 5 %. Fifteen of 25 pts (60 %) showed abnormal global longitudinal peak systolic strain (GLPSS) and 19/25 pts (76 %) showed abnormal peak circumferential strain (PCS) compared to age-matched controls (p = 0.005). In contrast, no significant differences was observed in either indices with the dose of AC. Likewise, no significant changes in the systolic or diastolic strain rate were noted with the dose of AC (r (2) = 0.0076 for peak E, r (2) = 0.072 for peak A, p = NS). GLPSS and PCS were diminished and, however, correlated poorly with the cumulative dose of AC. These observations indicate an early onset of LV systolic dysfunction by the strain indices in pts who continue to show a normal LVEF implying presence of occult LV systolic dysfunction. These novel strain indices may assist in

  13. Contrasting two models of academic self-efficacy--domain-specific versus cross-domain--in children receiving and not receiving special instruction in mathematics.

    Science.gov (United States)

    Jungert, Tomas; Hesser, Hugo; Träff, Ulf

    2014-10-01

    In social cognitive theory, self-efficacy is domain-specific. An alternative model, the cross-domain influence model, would predict that self-efficacy beliefs in one domain might influence performance in other domains. Research has also found that children who receive special instruction are not good at estimating their performance. The aim was to test two models of how self-efficacy beliefs influence achievement, and to contrast children receiving special instruction in mathematics with normally-achieving children. The participants were 73 fifth-grade children who receive special instruction and 70 children who do not receive any special instruction. In year four and five, the children's skills in mathematics and reading were assessed by national curriculum tests, and in their fifth year, self-efficacy in mathematics and reading were measured. Structural equation modeling showed that in domains where children do not receive special instruction in mathematics, self-efficacy is a mediating variable between earlier and later achievement in the same domain. Achievement in mathematics was not mediated by self-efficacy in mathematics for children who receive special instruction. For normal achieving children, earlier achievement in the language domain had an influence on later self-efficacy in the mathematics domain, and self-efficacy beliefs in different domains were correlated. Self-efficacy is mostly domain specific, but may play a different role in academic performance depending on whether children receive special instruction. The results of the present study provided some support of the Cross-Domain Influence Model for normal achieving children.

  14. Sleep habits and fatigue of children receiving maintenance chemotherapy for ALL and their parents.

    Science.gov (United States)

    Zupanec, Sue; Jones, Heather; Stremler, Robyn

    2010-01-01

    The study of potential contributors to fatigue, such as sleep disturbance, has been identified as a research priority in pediatric cancer. The primary objective of this descriptive study was to explore relationships between sleep habits, sleep disturbance, and fatigue for children receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL). This study also described sleep habits, sleep disturbance, and fatigue of parents of children and adolescents with ALL and determined if relationships existed between parent and child sleep disturbance and fatigue. Using a descriptive, cross-sectional design, children aged 4-18 years receiving maintenance chemotherapy for ALL and their parents completed questionnaires about their sleep and fatigue. Sleep disturbance was common in both children (87%) and parents (48%) and sleep disturbance scores were positively correlated with fatigue scores. From qualitative written responses to open-ended questions, 9 themes emerged related to sleep for children undergoing maintenance chemotherapy for ALL. Sleep differences noted since diagnosis included (1) sleep is disturbed, (2) sleep habits have changed, and (3) sleep is unchanged or improved. Things that got in the way of children sleeping well included (4) side effects of medication, especially dexamethasone; and (5) medication schedules. Things that helped children get sleep at night were (6) sleeping with someone, (7) comforting activities or routine, (8) medications, and (9) food and drink. Sleep disturbance in children on ALL maintenance and their parents is common and likely contributes to increased fatigue and is a potential target for nursing interventions.

  15. The effect of chewing gum on oral mucositis in children receiving chemotherapy

    OpenAIRE

    Ocakcı, Ayşe Ferda; Ayverdi, Didem; Ekim, Ayfer

    2014-01-01

    Abstract Background: Oral mucositis is an important clinical problem, resulting in significant patient morbidity, a change in health-related quality of life, and supportive care. The purpose of this study was to assess the efficiency of chewing gum on children, who are receiving chemotherapy regimens, for prevention and treatment of oral mucositis. Method and Material: The study sample consisted of 60 children (30 study group-30 control group) between the ages 6-...

  16. Dominican Children with HIV Not Receiving Antiretrovirals: Massage Therapy Influences their Behavior and Development

    Directory of Open Access Journals (Sweden)

    Maria Hernandez-Reif

    2008-01-01

    Full Text Available Forty-eight children (M age = 4.8 years infected with HIV/AIDS and living in the Dominican Republic were randomly assigned to a massage therapy or a play session control group. The children in the massage therapy group received two weekly 20-min massages for 12 weeks; the children in the control group participated in a play session (coloring, playing with blocks for the same duration and length as the massage therapy group. Overall, the children in the massage therapy group improved in self-help abilities and communication, suggesting that massage therapy may enhance daily functioning for children with HIV/AIDS. Moreover, the HIV infected children who were six or older also showed a decrease in internalizing behaviors; specifically depressive/anxious behaviors and negative thoughts were reduced. Additionally, baseline assessments revealed IQ equivalence below normal functioning for 70% of the HIV infected children and very high incidences of mood problems (depression, withdrawn for 40% of the children and anxiety problems for 20% of the children, suggesting the need for better monitoring and alternative interventions in countries with limited resources to improve cognition and the mental health status of children infected with HIV/AIDS.

  17. Risk factors for Plasmodium falciparum and Plasmodium vivax gametocyte carriage in Papua New Guinean children with uncomplicated malaria.

    Science.gov (United States)

    Karl, Stephan; Laman, Moses; Moore, Brioni R; Benjamin, John M; Salib, Mary; Lorry, Lina; Maripal, Samuel; Siba, Peter; Robinson, Leanne J; Mueller, Ivo; Davis, Timothy M E

    2016-08-01

    There are limited data on gametocytaemia risk factors before/after treatment with artemisinin combination therapy in children from areas with transmission of multiple Plasmodium species. We utilised data from a randomised trial comparing artemether-lumefantrine (AL) and artemisinin-naphthoquine (AN) in 230 Papua New Guinean children aged 0.5-5 years with uncomplicated malaria in whom determinants of gametocytaemia by light microscopy were assessed at baseline using logistic regression and during follow-up using multilevel mixed effects modelling. Seventy-four (32%) and 18 (8%) children presented with P. falciparum and P. vivax gametocytaemia, respectively. Baseline P. falciparum gametocytaemia was associated with Hackett spleen grade 1 (odds ratio (95% CI) 4.01 (1.60-10.05) vs grade 0; P<0.001) and haemoglobin (0.95 (0.92-0.97) per 1g/L increase; P<0.001), and P. falciparum asexual parasitaemia in slide-positive cases (0.36 (0.19-0.68) for a 10-fold increase; P=0.002). Baseline P. vivax gametocytaemia was associated with Hackett grade 2 (12.66 (1.31-122.56); P=0.028), mixed P. falciparum/vivax infection (0.16 (0.03-1.00); P=0.050), P. vivax asexual parasitaemia (5.68 (0.98-33.04); P=0.053) and haemoglobin (0.94 (0.88-1.00); P=0.056). For post-treatment P. falciparum gametocytaemia, independent predictors were AN vs AL treatment (4.09 (1.43-11.65)), haemoglobin (0.95 (0.93-0.97)), presence/absence of P. falciparum asexual forms (3.40 (1.66-0.68)) and day post-treatment (0.086 (0.82-0.90)) (P<0.001). Post-treatment P. vivax gametocytaemia was predicted by presence of P. vivax asexual forms (596 (12-28,433); P<0.001). Consistent with slow P. falciparum gametocyte maturation, low haemoglobin, low asexual parasite density and higher spleen grading, markers of increased prior infection exposure/immunity, were strong associates of pre-treatment gametocyte positivity. The persistent inverse association between P. falciparum gametocytaemia and haemoglobin during follow

  18. Oral health assessment and mouth care for children and young people receiving palliative care. Part one.

    Science.gov (United States)

    Sargeant, Stephanie; Chamley, Carol

    2013-03-01

    This is the first part of two articles exploring oral health problems and treatments for children receiving palliative care, successful management of which can improve considerably the quality of life for this group of children and young people. Part one includes an adapted oral health assessment tool for use in children and young people with complex and palliative healthcare needs that has the potential to help nurses identify and monitor oral health problems and prevent or minimise oral problems from developing. Part two--to be published next month--focuses on basic oral hygiene and the management of specific oral health problems.

  19. Temporal and seasonal changes of genetic polymorphisms associated with altered drug susceptibility to chloroquine, lumefantrine and quinine in Guinea-Bissau between 2003 and 2012

    DEFF Research Database (Denmark)

    Jovel, Irina Tatiana; Kofoed, Poul-Erik; Rombo, Lars;

    2015-01-01

    BACKGROUND: Guinea-Bissau, West-Africa introduced artemether-lumefantrine in 2008 but quinine has also been commonly prescribed for treatment of uncomplicated Plasmodium falciparum malaria. An efficacious high-dose chloroquine treatment regimen was used previously. Temporal and seasonal changes...... of genetic polymorphisms associated with altered drug susceptibility to chloroquine, lumefantrine and quinine are described. METHODS: Pfcrt K76T, pfmdr1 gene copy numbers, N86Y, Y184F and 1034-1246 sequences were determined using PCR-based methods. Blood samples came from virtually all (n=1806) children aged.......001). CONCLUSIONS: Following the discontinuation of an effective chloroquine regimen highly artemether-lumefantrine susceptible P. falciparum (with pfcrt 76T) accumulated possibly due to suboptimal use of quinine and despite a fitness cost linked to 76T....

  20. Impact of combining intermittent preventive treatment with home management of malaria in children less than 10 years in a rural area of Senegal: a cluster randomized trial

    Directory of Open Access Journals (Sweden)

    Tine Roger CK

    2011-12-01

    Full Text Available Abstract Background Current malaria control strategies recommend (i early case detection using rapid diagnostic tests (RDT and treatment with artemisinin combination therapy (ACT, (ii pre-referral rectal artesunate, (iii intermittent preventive treatment and (iv impregnated bed nets. However, these individual malaria control interventions provide only partial protection in most epidemiological situations. Therefore, there is a need to investigate the potential benefits of integrating several malaria interventions to reduce malaria prevalence and morbidity. Methods A randomized controlled trial was carried out to assess the impact of combining seasonal intermittent preventive treatment in children (IPTc with home-based management of malaria (HMM by community health workers (CHWs in Senegal. Eight CHWs in eight villages covered by the Bonconto health post, (South Eastern part of Senegal were trained to diagnose malaria using RDT, provide prompt treatment with artemether-lumefantrine for uncomplicated malaria cases and pre-referral rectal artesunate for complicated malaria occurring in children under 10 years. Four CHWs were randomized to also administer monthly IPTc as single dose of sulphadoxine-pyrimethamine (SP plus three doses of amodiaquine (AQ in the malaria transmission season, October and November 2010. Primary end point was incidence of single episode of malaria attacks over 8 weeks of follow up. Secondary end points included prevalence of malaria parasitaemia, and prevalence of anaemia at the end of the transmission season. Primary analysis was by intention to treat. The study protocol was approved by the Senegalese National Ethical Committee (approval 0027/MSP/DS/CNRS, 18/03/2010. Results A total of 1,000 children were enrolled. The incidence of malaria episodes was 7.1/100 child months at risk [95% CI (3.7-13.7] in communities with IPTc + HMM compared to 35.6/100 child months at risk [95% CI (26.7-47.4] in communities with only HMM (a

  1. Dyslipidemia in a cohort of HIV-infected Latin American children receiving highly active antiretroviral therapy.

    Science.gov (United States)

    Brewinski, Margaret; Megazzini, Karen; Hance, Laura Freimanis; Cruz, Miguel Cashat; Pavia-Ruz, Noris; Della Negra, Marinella; Ferreira, Flavia Gomes Faleiro; Marques, Heloisa; Hazra, Rohan

    2011-10-01

    In order to describe the prevalence of hypercholesterolemia and hypertriglyceridemia in a cohort of HIV-infected children and adolescents in Latin America and to determine associations with highly active antiretroviral therapy (HAART), we performed this cross-sectional analysis within the NICHD International Site Development Initiative pediatric cohort study. Eligible children had to be at least 2 years of age and be on HAART. Among the 477 eligible HIV-infected youth, 98 (20.5%) had hypercholesterolemia and 140 (29.4%) had hypertriglyceridemia. In multivariable analyses, children receiving protease inhibitor (PI)-containing HAART were at increased risk for hypercholesterolemia [adjusted odds ratio (AOR) =  2.7, 95% confidence interval (CI) 1.3-5.6] and hypertriglyceridemia (AOR = 3.5, 95% CI 1.9-6.4) compared with children receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing HAART. In conclusion, HIV-infected youth receiving PI-containing HAART in this Latin American cohort were at increased risk for hypercholesterolemia and hypertriglyceridemia compared with those receiving NNRTI-containing HAART.

  2. Nutritional status changes in HIV-infected children receiving combined antiretroviral therapy including protease inhibitors.

    Science.gov (United States)

    Fiore, P; Donelli, E; Boni, S; Pontali, E; Tramalloni, R; Bassetti, D

    2000-11-01

    Maintaining linear growth and weight gain in HIV-infected children is often difficult. Nutritional evaluation and support are recognised as important factors to improve their quality of life. Combination antiretroviral therapy including protease inhibitors (HAART) reduces HIV-viral load and improves survival, quality of life and nutritional status. Our study aimed to determine changes in nutrional status based on body weight, height and nutritional habits, of HIV-infected children receiving HAART. Possible side effects of lipid metabolism were also studied. Twenty five children, 13 treated with HAART (group B) were followed up for 12 months. We did not observe statistically significant differences in nutritional status over that time or between groups A and B. Inadequate energy intake was more common in patients with advanced HIV-disease. Hyperlipidemia was found in 70% of children receiving ritonavir and in approximately 50% of children receiving nelfinavir. We observed an important although not statistically significative modification in the height of those in group B.

  3. Children's spontaneous emotional expressions while receiving (un)wanted prizes in the presence of peers.

    Science.gov (United States)

    Visser, Mandy; Krahmer, Emiel; Swerts, Marc

    2015-01-01

    Although current emotion theories emphasize the importance of contextual factors for emotional expressive behavior, developmental studies that examine such factors are currently thin on the ground. In this research, we studied the course of emotional expressions of 8- and 11-year-old children after winning a (large) first prize or a (substantially smaller) consolation prize, while playing a game competing against the computer or a physically co-present peer. We analyzed their emotional reactions by conducting two perception tests in which participants rated children's level of happiness. Results showed that co-presence positively affected children's happiness only when receiving the first prize. Moreover, for children who were in the presence of a peer, we found that eye contact affected children's expressions of happiness, but that the effect was different for different age groups: 8-year-old children were negatively affected, and 11-year-old children positively. Overall, we can conclude that as children grow older and their social awareness increases, the presence of a peer affects their non-verbal expressions, regardless of their appreciation of their prize.

  4. Factors related to the institutionalization of children and adolescents received in the district of Uberaba - MG

    Directory of Open Access Journals (Sweden)

    Daniela Tavares Gontijo

    2012-06-01

    Full Text Available Objective: To describe the socio-demographic profile and factors related to the institutionalization of children and adolescents received in the District of Uberaba in 2009. Methods: Descriptive, documental, retrospective study, which included all children and adolescents who have been housed, by judicial decision, in the District of Uberaba-MG, Brazil, in 2009. Data collected from the judicial proceedings was analyzed using descriptive statistics. Results: Of 169 children and adolescents received in 2009, 82 (51.47% were female. Ages between 4 and 6 (33 - 19.53% and between 13 to 15 (30 - 17.75% were the most prevalent age groups. Among school-age children, only 41(24.26% had education level appropriate to age. In 109 (65.08% of cases, the father figure was not identified as present within the family composition. The main reasons for institutional sheltering were negligence, socio-economic conditions of the family, use of alcohol and drugs by those responsible, abuse, abandonment, physical violence and sexual violence. Conclusions: Data point to the process of social vulnerability experienced by families, which raises the articulation and strengthening of policies and intersectoral actions, with active partipation of the society, seeking the promotion of better living and health conditions for children and adolescents.

  5. Comparable lumefantrine oral bioavailability when co-administered with oil-fortified maize porridge or milk in healthy volunteers.

    Science.gov (United States)

    Mwebaza, Norah; Jerling, Markus; Gustafsson, Lars L; Obua, Celestino; Waako, Paul; Mahindi, Margarita; Ntale, Muhammad; Beck, Olof; Hellgren, Urban

    2013-07-01

    Co-administration of artemether-lumefantrine with milk is recommended to improve lumefantrine (L) absorption but milk may not be available in resource-limited settings. This study explored the effects of cheap local food in Uganda on oral bioavailability of lumefantrine relative to milk. In an open-label, four-period crossover study, 13 healthy adult volunteers were randomized to receive a single oral dose of artemether-lumefantrine (80 mg artemether/480 mg lumefantrine) with water, milk, maize porridge or maize porridge with oil on separate occasions. Plasma lumefantrine was assayed using high-performance liquid chromatography with ultraviolet detection. Pharmacokinetic exposure parameters were determined by non-compartmental methods using WinNonlin. Peak concentrations (Cmax ) and area under concentration-time curve restricted to 48 hr after single dosing (AUC(0-48) ) were selected for relative bioavailability evaluations using confidence interval approach for average bioequivalence. Lumefantrine exposure was comparable in milk and maize porridge plus oil study groups. When artemether-lumefantrine was administered with maize porridge plus oil, average bioequivalence ranges (means ratios 90% CI, 0.84-1.88 and 0.85-1.69 for Cmax and AUC(0-48) , respectively) were within and exceeded acceptance ranges relative to milk (90% CI, 0.80-1.25). Both fasted and maize porridge groups demonstrated similarly much lower ranges of lumefantrine exposures (bioinequivalence) relative to milk. If milk is not available, it is thus possible to recommend fortification of carbohydrate-rich food with little fat (maize porridge plus vegetable oil) to achieve similarly optimal absorption of lumefantrine after artemether-lumefantrine administration.

  6. Assessment of antibody titers and immunity to Hepatitis B in children receiving chemotherapy

    Science.gov (United States)

    Shams Shahemabadi, A; Salehi, F; Hashemi, A; Vakili, M; Zare, F; Esphandyari, N; Kashanian, S

    2012-01-01

    Background There is a decrease in vaccine-specific antibody to certain vaccine-preventable diseases in children after chemotherapy, but the frequency of non-immune patients is not clear. In the present case-control study, was taken under investigation protection level to Hepatitis B infection in children 6 months after completing chemotherapy. Materials and Methods In this study 68 patients with cancer and 68 healthy children were enrolled. Patients were 1.5 -12 years old with completed standard chemotherapy at least for 6 months. All the patients and healthy children were negative for HBsAg and HBeAg and had received Hepatitis B vaccination. IgG antibody concentrations against Hepatitis B Virus (HBV) were determined in the patients receiving chemotrapy and healthy subjects serum by ELISA method. IgG antibody titer > 10 mIU/ml was considered as baseline protective titer for preventing HBV infection. Results Anti-HBs antibody titer in 19.12% of patients was less than 10 mIU/ml and 11.76% of the patients had borderline antibody titer (10-20 mIU/ml). In healthy subjects, 2.94% and 5.88% had antibody titer < 10 mIU/ml and 10-20 mIU/ml, respectively. According to statistical analysis, frequency of non immune subjects in children with cancer was significantly higher than those in healthy children (P-value=0.024). Conclusion HBV vaccination post-intensive chemotherapy in the children with cancer is strongly recommended. PMID:24575253

  7. Transient occult cardiotoxicity in children receiving continuous beta-agonist therapy

    Institute of Scientific and Technical Information of China (English)

    Christopher L Carroll; Melinda Coro; Allison Cowl; Kathleen A Sala; Craig M Schramm

    2014-01-01

    Background: Continuous beta-agonist therapy, typically in the form of inhaled albuterol, is the first line therapy for the treatment of acute and severe bronchospasm in children. Although this treatment is commonly used, concerns about cardiotoxicity have been raised. We aimed to investigate the cardiotoxic effects of continuous beta-agonist therapy in children. Methods: We conducted a retrospective review of children admitted to the intensive care unit (ICU) between May 2008 and April 2009, who were treated with continuous beta-agonist therapy (intravenous and nebulized). Results: Twenty of the 36 children treated with continuous albuterol had repeated serum troponin-T and lactate levels measured. Eleven patients (55%) were also treated with continuous intravenous terbutaline. Elevated levels of troponin-T levels were found in 25% of children, and elevated lactate levels were found in 60%. However, all returned to normal levels within 48 hours of ICU admission, despite continued beta-agonist therapy. No children experienced arrhythmias during therapy. There was no association between intravenous terbutaline use and elevated troponin-T [odds ratio (OR), 1.3; 95% CI, 0.2-10.3] or with elevated serum lactate (OR, 0.6; 95% CI, 0.1-3.7). There was also no association between elevated troponin-T or lactate and ICU or hospital length of stay. Conclusions: In this small study, a significant proportion of children had elevated serum troponin-T and lactate levels while receiving inhaled continuous beta-agonist therapy, irrespective of intravenous therapy. However, these abnormal values all returned to normal within 48 hours of ICU admission and were not associated with increased duration of hospitalization.

  8. Reducing the Digital Divide among Children Who Received Desktop or Hybrid Computers for the Home

    Directory of Open Access Journals (Sweden)

    Gila Cohen Zilka

    2016-06-01

    Full Text Available Researchers and policy makers have been exploring ways to reduce the digital divide. Parameters commonly used to examine the digital divide worldwide, as well as in this study, are: (a the digital divide in the accessibility and mobility of the ICT infrastructure and of the content infrastructure (e.g., sites used in school; and (b the digital divide in literacy skills. In the present study we examined the degree of effectiveness of receiving a desktop or hybrid computer for the home in reducing the digital divide among children of low socio-economic status aged 8-12 from various localities across Israel. The sample consisted of 1,248 respondents assessed in two measurements. As part of the mixed-method study, 128 children were also interviewed. Findings indicate that after the children received desktop or hybrid computers, changes occurred in their frequency of access, mobility, and computer literacy. Differences were found between the groups: hybrid computers reduce disparities and promote work with the computer and surfing the Internet more than do desktop computers. Narrowing the digital divide for this age group has many implications for the acquisition of skills and study habits, and consequently, for the realization of individual potential. The children spoke about self improvement as a result of exposure to the digital environment, about a sense of empowerment and of improvement in their advantage in the social fabric. Many children expressed a desire to continue their education and expand their knowledge of computer applications, the use of software, of games, and more. Therefore, if there is no computer in the home and it is necessary to decide between a desktop and a hybrid computer, a hybrid computer is preferable.

  9. Low blood and plasma carnitine levels in children receiving long-term parenteral nutrition.

    Science.gov (United States)

    Dahlström, K A; Ament, M E; Moukarzel, A; Vinton, N E; Cederblad, G

    1990-10-01

    Total and free carnitine and acylcarnitine concentrations were analyzed in whole blood and plasma in 12 children with a mean age of 68.4 +/- 42.9 months who had received carnitine-free total parenteral nutrition (TPN) for an average of 4 years. The purpose of the study was to see if the children had become carnitine deficient and, if so, whether this correlated with poor lipid clearance. Compared to controls, the TPN-dependent children had significantly decreased concentrations of total and free carnitine in blood (26.6 +/- 9.4 (SD) mumols/L vs. 43.3 +/- 9.1 mumols/L, p less than 0.001, and 17.1 +/- 7.7 mumols/L vs. 35.2 +/- 8.1 mumols/L, p less than 0.001, respectively). Similar results were found in plasma (total carnitine of 19.0 +/- 8.0 mumols/L vs. 41.9 +/- 5.2 mumols/L, p less than 0.001, and free carnitine of 15.7 +/- 7.3 mumols/L vs. 36.1 +/- 5.2 mumols/L, p less than 0.001, respectively). The acylcarnitine concentration in plasma was decreased in the TPN children (3.3 +/- 1.5 mumols/L vs. 5.8 +/- 3.0 mumols/L, p less than 0.01) compared to controls. Despite the low carnitine concentrations, serum triglyceride levels and serum free fatty acid levels were within the normal range. There was no correlation between carnitine concentrations in plasma and serum triglyceride and free fatty acid levels. Our data show that children receiving carnitine-free TPN for many years developed markedly decreased concentrations of carnitine in blood and plasma. However, no adverse effects of the low carnitine levels were found on triglyceride and free fatty acid metabolism under stable conditions.

  10. Impaired Phenotype and Function of T Follicular Helper Cells in HIV-1-Infected Children Receiving ART.

    Science.gov (United States)

    Bekele, Yonas; Amu, Sylvie; Bobosha, Kidist; Lantto, Rebecka; Nilsson, Anna; Endale, Birtukan; Gebre, Meseret; Aseffa, Abraham; Rethi, Bence; Howe, Rawleigh; Chiodi, Francesca

    2015-07-01

    T follicular helper (Tfh) cells are important components in development of specific humoral immune responses; whether the number and biology of Tfh cells is impaired in HIV-1-infected children is not yet studied.The frequency, phenotype, and function of Tfh cells and B cells were determined in blood of HIV-1-infected children receiving antiretroviral therapy (ART) and age-matched controls. Flow cytometry was used to characterize the frequency of Tfh cells and B cell subsets. Cytokine expression was measured after in vitro activation of Tfh cells.A reduced frequency of memory Tfh cells (P < 0.001) was identified in HIV-1-infected children and, on these cells, a reduced expression of programmed death-1 (PD-1) and inducible T cell costimulator (ICOS) (P < 0.001 and P < 0.01). Upon activation, the capacity of Tfh cells to express IL-4, an important cytokine for B cell function, was impaired in HIV-1-infected children.B cell subpopulations in HIV-1-infected children displayed significant differences from the control group: the frequency of resting memory (RM) B cells was reduced (P < 0.01) whereas the frequency of exhausted memory B cells increased (P < 0.001). Interestingly, the decline of RM cells correlated with the reduction of memory Tfh cells (P = 0.02).Our study shows that function and phenotype of Tfh cells, pivotal cells for establishment of adaptive B cell responses, are impaired during HIV-1 infection in children. A consistent reduction of memory Tfh cells is associated with declined frequencies of RM B cells, creating a novel link between dysfunctional features of these cell types, major players in establishment of humoral immunity.

  11. Educational clowning – a serious development in the educational work with children receiving inpatient hospital treatment

    Directory of Open Access Journals (Sweden)

    Alexander Wertgen

    2009-06-01

    Full Text Available Children and youth, receiving inpatient hospital treatment, are living under exceptional physical, psychological, and social circumstances. The engagement of clinic clowns has recently been established as an educational outreach program in many hospitals. Clinic clowns are responsive to the special educational needs of young patients and, according to experience, are able to lastingly influence their state of health in a positive way. Based on an anecdote of a visit from a clinic clown, a description of the professional role of a clown, respectively a clinic clown, the effects and the beneficial results of clowns’ work are explained. The article ends with a discussion on how and to what extent educational clowning can be considered as a new discipline in the extracurricular educational work with sick children.

  12. Cortical thickness in children receiving intensive therapy for idiopathic apraxia of speech.

    Science.gov (United States)

    Kadis, Darren S; Goshulak, Debra; Namasivayam, Aravind; Pukonen, Margit; Kroll, Robert; De Nil, Luc F; Pang, Elizabeth W; Lerch, Jason P

    2014-03-01

    Children with idiopathic apraxia experience difficulties planning the movements necessary for intelligible speech. There is increasing evidence that targeted early interventions, such as Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT), can be effective in treating these disorders. In this study, we investigate possible cortical thickness correlates of idiopathic apraxia of speech in childhood, and changes associated with participation in an 8-week block of PROMPT therapy. We found that children with idiopathic apraxia (n = 11), aged 3-6 years, had significantly thicker left supramarginal gyri than a group of typically-developing age-matched controls (n = 11), t(20) = 2.84, p ≤ 0.05. Over the course of therapy, the children with apraxia (n = 9) experienced significant thinning of the left posterior superior temporal gyrus (canonical Wernicke's area), t(8) = 2.42, p ≤ 0.05. This is the first study to demonstrate experience-dependent structural plasticity in children receiving therapy for speech sound disorders.

  13. Oral health assessment and mouth care for children and young people receiving palliative care. Part two.

    Science.gov (United States)

    Sargeant, S; Chamley, C

    2013-04-01

    This is the second part of a two-part article on oral health assessment and mouth care for children and young people receiving palliative care. This article covers basic oral hygiene and management of oral health problems: oral candidiasis, coated tongue/dirty mouth, dry mouth, hypersalivation, ulceration, painful mouth, stomatitis and mucositis. The article also covers treating patients who are immunocompromised and the need to educate families and carers in the basic principles of oral care, including the importance of preventing cross-infection. Part one outlined oral assessment and discussed the adaptation of the Nottingham Oral Health Assessment Tool (Freer 2000).

  14. Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in Côte d'Ivoire

    Directory of Open Access Journals (Sweden)

    Offianan AT

    2011-11-01

    Full Text Available Andre T Offianan1, Serge B Assi2, Aristide MA Coulibaly1, Landry T N'guessan1, Aristide A Ako1, Florence K Kadjo2, Moïse K San2, Louis K Penali2 1Malariology Department, Institut Pasteur de Côte d'Ivoire, Abidjan, Côte d'Ivoire; 2National Malaria Control Programme, Abidjan, Côte d'Ivoire Background: The emergence of artemisinin resistance has raised concerns that the most potent antimalarial drug may be under threat. Artesunate + amodiaquine (ASAQ and artemether-lumefantrine (AL are respectively the first- and second-line treatments for uncomplicated falciparum malaria in Côte d'Ivoire. A comparison of the efficacy and safety of these two drug combinations was necessary to make evidence-based drug treatment policies. Methods: In an open-label, non inferiority, randomized, controlled clinical trial, children aged 6–59 months were randomized to receive ASAQ or AL. Both drug regimens were given for 3 days, and follow-up was for 28 days. The primary endpoint was the 28-day cure rates and was defined as proportion of patients with polymerase chain reaction (PCR-corrected cure rate after 28 days of follow-up. Findings: A total of 251 patients who were attending the Ayame and Dabakala hospitals and presenting with symptomatic acute uncomplicated falciparum malaria were randomized to receive ASAQ (128 and AL (123. The intention-to-treat analysis showed effectiveness rates of 94.5% and 93.5% for ASAQ and AL, respectively on day 28. After adjustment for PCR results, these rates were 96.1% and 96.8%, respectively. On day 28, the per-protocol analysis showed effectiveness rates of 98.4% and 96.6% for ASAQ and AL, respectively. After adjustment by PCR for reinfection, these rates were 100% for each drug, and both regimens were well tolerated. Conclusion: ASAQ and AL remain efficacious treatments of uncomplicated falciparum malaria in Ivorian children 5 years after adoption. The efficacy of ASAQ and AL in Côte d'Ivoire requires, therefore, continuous

  15. Oral Communication Development in Severe to Profound Hearing Impaired Children After Receiving Aural Habilitation

    Directory of Open Access Journals (Sweden)

    Soleimani Farin

    2009-10-01

    Full Text Available Communication, cognition, language, and speech are interrelated and develop together. It should come as no surprise to us that the key to intervention with deaf children is to establish, as early as possible, a functional communication system for the child and the parents. Early intervention programs need to be multidisciplinary, technologically sound and most important, it should take cognizance of the specific context (community, country in which the child and family function. The main aim of this study was to obtain oral communication development regarding current status of the intervention (aural habilitation and speech therapyfor children with severe to profound hearing impairment in Iran. A prospective longitudinal study was undertaken on a consecutive group of children with severe to profound deafness. Nine severe to profound hearing-impaired children out of the primer 42 cases, who were detected below two years old, had been selected in the previous study to receive aural habilitation. The average of their speech intelligibility scores was near 70% at age 6, which was accounted as poor oral communication and only two of them were able to communicate by spoken language. An integrated intervention services continued again for one year and their oral communication skill was assessed by their speech intelligibility. The intelligibility test of children was recorded on audio-tape, when they read 10 questions such as where is your home. This can be answered only in one word. Each tape was presented to10 normal hearing listeners, and their task was to write down, the answers in Persian orthography. At the beginning (at age 6 the average speech intelligibility score of these children was 72% and only two of them had score of 90% and 100%. At age 7, all of the severe groups were over 90%, and only two profound ones achieved the score of 48% and 62%. All of severe groups develop oral communication, but profound ones had a semi-intelligible speech

  16. Sufentanil reduces emergence agitation in children receiving sevoflurane anesthesia for adenotonsillectomy compared with fentanyl

    Institute of Scientific and Technical Information of China (English)

    LI Jun; HUANG Zhi-lian; ZHANG Xu-tong; LUO Ke; ZHANG Zhan-qin; MAO Yi; ZHUANG Xiao-biao; LIAN Qing-quan; CAO Hong

    2011-01-01

    Background Emergence agitation is a common problem in pediatric anesthesia,especially after sevoflurane induction and maintenance anesthesia.The purpose of this study was to investigate the effect of sufentanil to reduce emergence agitation after sevoflurane anesthesia in children undergoing adenotonsillectomy compared with fentanyl.Methods One hundred and five children,aged 3-11 years,were randomly allocated to receive normal saline (control group),sufentanil 0.2 μg/kg (S2) or fentanyl 2 μg/kg (F2) 1 minute after loss of the eyelash reflex.Anesthesia was induced and maintained with sevoflurane.Time to tracheal extubation,recovery time,Paediatric Anesthesia Emergence Delirium (PAED) scale,and emergence behavior were assessed.Results The incidence of severe agitation was significantly lower in S2 and F2 groups vs.the control group,4/32 and 15/34 vs.24/34 respectively,(P=0.002,0.009,respectively).PAED scales were significantly different among three groups (P=0.007),and lower in the S2 and F2 groups than in the control group (P=0.007 and P=0.025,respectively).And the incidence of severe agitation and the PAED scale score was significantly different between the S2 and F2 groups (P=0.007,P=0.019,respectively).Time to tracheal extubation and recovery time were similar in all three groups.Conclusions Administration of sufentanil at 0.2 μg/kg after induction of anesthesia reduced emergence agitation in children receiving sevoflurane anesthesia for adenotonsillectomy compared with fentanyl.This was without delaying the recovery time or causing significant hypotension.

  17. [Motor problems in children with ADHD receive too little attention in clinical practice].

    Science.gov (United States)

    Fliers, Ellen A; Franke, Barbara; Buitelaar, Jan K

    2011-01-01

    Children with attention deficit hyperactivity disorder (ADHD) do not only display hyperactive motor behaviour, but half of them are also clumsy when executing motor skills. Alongside displaying hyperactivity and poor concentration skills, they have difficulty with writing, tying shoelaces, eating properly using fork and knife, and playing games and sports. This is known as dyspraxia or developmental coordination disorder (DCD). Poor performance in sports and games is, just as ADHD, an important negative predictor of a child's popularity within the peer group. Children with a combination of ADHD and poor motor performance are doubly disadvantaged. A dopamine-induced imbalance in the neuronal circuits of the basal ganglia and the cerebellum is a possible cause of ADHD-DCD. On the basis of family and twin studies, there are also indications that ADHD and DCD have a common genetic background. In daily practice, DCD receives too little attention during diagnosis and treatment of ADHD. Screening for motor problems in children with ADHD, followed by referral to a physiotherapist or occupational therapist if necessary, is useful, because treatment with cognitive-oriented and task-oriented physiotherapy can help.

  18. Percentage of Children Aged 5--17 Years Ever Receiving a Diagnosis of Learning Disability, United States, 2007--2009

    Science.gov (United States)

    ... 5--17 Years Ever Receiving a Diagnosis of Learning Disability,* by Race/Ethnicity † and Family Income Group § --- National ... professional ever told you that [child] had a learning disability?" † White and black children are non-Hispanic children ...

  19. Sustained-release liquisolid compact tablets containing artemether-lumefantrine as alternate-day regimen for malaria treatment to improve patient compliance

    Directory of Open Access Journals (Sweden)

    Nnamani PO

    2016-11-01

    Full Text Available Petra Obioma Nnamani,1,2 Agatha Adaora Ugwu,1 Emmanuel Chinedu Ibezim,1 Franklin Chimaobi Kenechukwu,1 Paul Achile Akpa,1 John-Dike Nwabueze Ogbonna,1 Nicholas Chinedu Obitte,3 Amelia Ngozi Odo,4 Maike Windbergs,2 Claus-Michael Lehr,2,5,6 Anthony Amaechi Attama1 1Drug Delivery and Nanomedicines Research Group, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Nigeria; 2Department of Drug Delivery, Helmholtz Institute for Pharmaceutical Research Saarland (HIPS, Helmholtz Centre for Infection Research, Saarland University, Saarbrücken, Germany; 3Department of Pharmaceutical Technology and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, 4Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, Nigeria; 5PharmBioTec GmbH, 6Department of Biopharmaceutics and Pharmaceutical Technology, Saarland University, Saarbrücken, Germany Abstract: The present study aimed to develop low-dose liquisolid tablets of two antimalarial drugs artemether–lumefantrine (AL from a nanostructured lipid carrier (NLC of lumefantrine (LUM and estimate the potential of AL as an oral delivery system in malariogenic Wistar mice. LUM-NLCs were prepared by hot homogenization using Precirol® ATO 5/Transcutol® HP and tallow fat/Transcutol® HP optimized systems containing 3:1 ratios of the lipids, respectively, as the matrices. LUM-NLC characteristics, including morphology, particle size, zeta potential, encapsulation efficiency, yield, pH-dependent stability, and interaction studies, were investigated. Optimized LUM-NLCs were mixed with artemether powder and other dry ingredients and the resultant powder evaluated for micromeritics. Subsequent AL liquisolid tablets were tested for in vitro drug release and in vivo antiplasmodial activity in mice infected with Plasmodium berghei berghei (NK 65. Results showed that optimized LUM-NLC were stable, spherical, polydispersed but nanometric. Percentage yield and encapsulation efficiency were ~92% and 93% for Precirol® ATO 5/Transcutol® HP batch, then 81% and 95% for tallow fat/Transcutol® HP batch while LUM was amorphous in NLC matrix. In vitro AL release from liquisolid compacts revealed initial burst release and subsequent sustained release. Liquisolid tablet compacts formulated with Precirol® ATO 5/Transcutol® HP-AL4 achieved higher LUM release in simulated intestinal fluid (84.32% than tallow fat/Transcutol® HP-BL3 (77.9%. Non-Fickian (anomalous diffusion and super case II transport were the predominant mechanisms of drug release. Equal parasitemia reduction was observed for both batches of tablet compacts (~92%, superior to the reduction obtained with commercial antimalarial formulations: Coartem® tablets (86% and chloroquine phosphate tablets (66%. No significant difference (P<0.05 in parasite reduction between double (4/24 mg/kg and single (2/12 mg/kg strength doses of AL compacts was observed. Our result highlights that AL could be formulated in much lower doses (4/24 mg/kg, for once-in-two days oral administration to improve patient compliance, which is currently not obtainable with conventional AL dosage forms. Keywords: malaria, artemisinin-based combination therapy, antiplasmodial activity, liquisolid compacts, nanostructured lipid carriers

  20. Scores on the eysenck personality questionnaire for a sample of children and adolescents receiving psychological treatment in Puerto Rico.

    Science.gov (United States)

    Porrata, Jose Luis; Rosa, Abraham; Mendez, Viviana

    2003-08-01

    Personality questionnaire scores obtained by children and adolescents (n = 28) receiving psychological treatment at a health facility in Humacao, Puerto Rico were examined. The scores were compared with those of regular school children of the same age, of Gurabo, Puerto Rico, who were not in treatment (n = 30). The children in treatment obtained higher scores on Psychoticism, lower scores on Extraversion, and similar scores on Neuroticism and Dissimulation by comparison with regular students.

  1. Recommendations for the clinical management of children with refractory epilepsy receiving the ketogenic diet.

    Science.gov (United States)

    Alberti, María J; Agustinho, Ariela; Argumedo, Laura; Armeno, Marisa; Blanco, Virginia; Bouquet, Cecilia; Cabrera, Analía; Caraballo, Roberto; Caramuta, Luciana; Cresta, Araceli; de Grandis, Elizabeth S; De Martini, Martha G; Diez, Cecilia; Dlugoszewski, Corina; Escobal, Nidia; Ferrero, Hilario; Galicchio, Santiago; Gambarini, Victoria; Gamboni, Beatriz; Guisande, Silvina; Hassan, Amal; Matarrese, Pablo; Mestre, Graciela; Pesce, Laura; Ríos, Viviana; Sosa, Patricia; Vaccarezza, María; Viollaz, Rocío; Panico, Luis

    2016-02-01

    The ketogenic diet, a non-drug treatment with proven effectiveness, has been the most commonly used therapy in the past decade for the management of refractory epilepsy in the pediatric population. Compared to adding a new drug to a pre-existing treatment, the ketogenic diet is highly effective and reduces the number of seizures by 50-90% in approximately 45-60% of children after six months of treatment. For this reason, the Argentine Society of Pediatric Neurology established the Ketogenic Diet Working Group. It is integrated by pediatric dietitians, pediatricians, pediatric neurologists and B.S. in Nutrition, who developed recommendations for the optimal management of patients receiving the classical ketogenic diet based on expert consensus and scientific publications in this field.

  2. Carnitine status of children receiving long-term total parenteral nutrition: a longitudinal prospective study.

    Science.gov (United States)

    Moukarzel, A A; Dahlstrom, K A; Buchman, A L; Ament, M E

    1992-05-01

    Nine children receiving carnitine-free total parenteral nutrition for 7.2 +/- 2.6 years since birth were prospectively studied for 3 years. Plasma values of total and free carnitine were 50% lower than those of age-matched healthy control subjects (p less than 0.02) but did not decrease further during the 3-year period. No significant abnormalities in free fatty acids, triglycerides, or cholesterol were found. The mean levels of alanine and aspartate aminotransferases and of alkaline phosphatase were slightly increased (p less than 0.02) at the initiation of the study but remained in the same range 3 years later. The low plasma carnitine values appeared to be without clinical consequence after 10 years of carnitine-free total parenteral nutrition.

  3. Thyroid dysfunction and neoplasia in children receiving neck irradiation for cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fleming, I.D.; Black, T.L.; Thompson, E.I.; Pratt, C.; Rao, B.; Hustu, O.

    1985-03-15

    The reported relationship of radiation exposure and thyroid carcinoma stimulated this retrospective study of 298 patients treated at St. Jude Children's Hospital with radiation therapy to the neck for childhood cancer to identify patients who developed subsequent thyroid abnormalities. This series includes 153 patients with Hodgkin's disease, 95 with acute lymphocytic leukemia, 28 with lymphoepithelioma, and 22 with miscellaneous tumors. Inclusion in the study required 5 years of disease-free survival following therapy for their original tumor, which included thyroid irradiation. Follow-up has been 100%. Most patients also received chemotherapy. Seventeen patients were found to have decreased thyroid reserve with normal levels of free triiodothyroxine (T3) or free thyroxin, (T4) and an elevated level of thyroid-stimulating hormone (TSH). In nine patients hypothyroidism developed, with decreased T3 or T4 levels and an elevated level of TSH. One hyperthyroid patient was identified. Two patients had thyroiditis, and seven had thyroid neoplasms: (carcinoma in two, adenoma in two, colloid nodule in one, and undiagnosed nodules in two). This survey has demonstrated an increased incidence of thyroid dysfunction and thyroid neoplasia when compared to the general population. The importance of long-term follow-up for thyroid disease is emphasized in patients who have received thyroid irradiation. The possible role of subclinical hypothyroidism with TSH elevation coupled with radiation damage to the thyroid gland as a model for the development of neoplastic disease is discussed.

  4. Shortcomings of adherence counselling provided to caregivers of children receiving antiretroviral therapy in rural South Africa.

    Science.gov (United States)

    Coetzee, Bronwyne; Kagee, Ashraf; Bland, Ruth

    2016-03-01

    In order to achieve optimal benefits of antiretroviral therapy (ART), caregivers of children receiving ART are required to attend routine clinic visits monthly and administer medication to the child as prescribed. Yet, the level of adherence to these behaviours varies considerably in many settings. As a way to achieve optimal adherence in rural KwaZulu-Natal, caregivers are required to attend routine counselling sessions at HIV treatment clinics that are centred on imparting information, motivation, and behavioural skills related to medication administration. According to the information-motivation-behavioural skills model, information related to adherence, motivation, and behavioural skills are necessary and fundamental determinants of adherence to ART. The purpose of the study was to observe and document the content of adherence counselling sessions that caregivers attending rural clinics in KwaZulu Natal receive. We observed 25 adherence counselling sessions, which lasted on average 8.1 minutes. Counselling typically consisted of counsellors recording patient attendance, reporting CD4 count and viral load results to caregivers, emphasising dose times, and asking caregivers to name their medications and dosage amounts. Patients were seldom asked to demonstrate how they measure the medication. They were also not probed for problems regarding treatment, even when an unsuppressed VL was reported to a caregiver. This paper calls attention to the sub-optimal level of counselling provided to patients on ART and the urgent need to standardise and improve the training, support, and debriefing provided to counsellors.

  5. The Importance of Efficacy: Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits

    Science.gov (United States)

    Askelson, Natoshia M.; Chi, Donald L.; Momany, Elizabeth T.; Kuthy, Raymond A.; Carter, Knute D.; Field, Kathryn; Damiano, Peter C.

    2015-01-01

    Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid. The extended…

  6. Time Spent Caregiving and Help Received by Spouses and Adult Children of Brain-Impaired Adults.

    Science.gov (United States)

    Enright, Robert B., Jr.

    1991-01-01

    Surveyed 233 family caregivers for brain-impaired adults. Spousal caregivers (both husbands and wives) devoted much time to caregiving. Most caregivers received little assistance from other family members and friends, but husbands received more than others. Employed spouses received more paid help than unemployed spouses; employment did not affect…

  7. Accuracy of Knowledge of Child Development in Mothers of Children Receiving Early Intervention Services

    Science.gov (United States)

    Zand, Debra H.; Pierce, Katherine J.; Bultas, Margaret W.; McMillin, Stephen Edward; Gott, Rolanda Maxim; Wilmott, Jennifer

    2015-01-01

    Parents' involvement in early intervention (EI) services fosters positive developmental trajectories in young children. Although EI research on parenting skills has been abundant, fewer data are available on parents' knowledge of normative child development. Sixty-seven mothers of children participating in a Midwestern city's EI program completed…

  8. Asking, Giving, Receiving: Friendship as Survival Strategy among Accra's Street Children

    Science.gov (United States)

    Mizen, Phillip; Ofosu-Kusi, Yaw

    2010-01-01

    This article considers friendship among street children in Accra. Drawing upon the findings of a three-year qualitative research project, the article argues that friendship is a neglected element of research yet cooperation, mutuality and exchange between friends are essential to street children's survival. Living within the extremities of the…

  9. Comparison of Environmental Attitudes and Experiences of Five-Year-Old Children Receiving Preschool Education in the Village and City Centre

    Science.gov (United States)

    Durkan, Nazmi; Güngör, Hande; Fetihi, Leyla; Erol, Ahmet; Gülay Ogelman, Hülya

    2016-01-01

    The purpose of the study is to compare environmental attitudes and experiences of five-year-old children receiving preschool education in the village and city centre. The first group comprised 54 five-year-old children who received preschool education and attended kindergartens of two primary schools in the Karateke and Kocabas villages of Honaz…

  10. Eliciting adaptive emotion in conversations with parents of children receiving therapy for leukemia.

    Science.gov (United States)

    Tremolada, Marta; Bonichini, Sabrina; Pillon, Marta; Schiavo, Simone; Carli, Modesto

    2011-01-01

    Clinician-parent communication may often be difficult, especially soon after the diagnosis. The aims of this article are to identify the communication strategies associated with expressions of adaptive emotions in parents and to explore the effect of the type of leukemia and of parent's gender on parents' expressions of emotions. The data are obtained from 4.622 conversational turns of 20 videotaped interviews with 10 mothers and 10 fathers of children at their first hospitalization for leukemia. A coding scheme for parent emotional expressions was reliably applied by two independent judges. An original self-report questionnaire on parents' emotional states was used before and after the interview. Positive politeness of interviewer elicits adaptive emotional expressions in parents. Mothers of children with acute myeloid leukemia and fathers of children with acute lymphoblastic leukaemia appear more distressed during the interview. This interview can be identified as an innovative technique of communication with parents of children with cancer.

  11. Nurses' uniform color and feelings/emotions in school-aged children receiving health care.

    Science.gov (United States)

    Albert, Nancy M; Burke, Jane; Bena, James F; Morrison, Shannon M; Forney, Jennifer; Krajewski, Susan

    2013-04-01

    Children may fear nurses wearing white uniforms. When emotions and uniform color were studied in 233 children, many positive emotions were most often associated with blue, bold pink-patterned, or yellow-patterned tops (all p ≤ .002). Negative emotions were not associated with uniform top colors (all p color does not matter," 8 negative emotions were most often associated with white uniform color (p emotions were associated with nurse uniform color.

  12. Transient focal liver scan defects in children receiving chemotherapy (pseudometastases): work in progress

    Energy Technology Data Exchange (ETDEWEB)

    Abramson, S.J.; Barash, F.S.; Seldin, D.W.; Berdon, W.E.

    1984-03-01

    Three pediatric patients with tumors (two rhabdomyosarcoma, one Wilms tumor) had significant focal defects on Tc-99m sulfur colloid scans while receiving chemotherapy (all three had received chemotherapy, including actinomycin D, within ten days prior to scanning). In all three, the defects resolved spontaneously; one biopsy showed fibrosis of a mild degree. The finding of defects on liver scans of pediatric patients receiving chemotherapy must not be automatically assumed to be metastatic disease; the changes may relate to hepatic response to recently administered chemotherapy.

  13. Detection of antinuclear and antilaminin antibodies in autistic children who received thimerosal-containing vaccines.

    Science.gov (United States)

    Singh, Vijendra K; Rivas, Wyatt H

    2004-01-01

    Autism, a neurodevelopmental disorder, may involve autoimmune pathogenesis. Since mercury is potentially a risk factor for autoimmunity, we conducted a study of mercury-induced antinuclear and antilaminin antibodies in autistic and normal children who had been pre-administered with thimerosal-containing vaccines. Laboratory analysis by different immunoassays showed that the serum level of these two autoimmune markers did not significantly differ between autistic and normal children. This finding suggests that the mercury as in thimerosal-containing vaccines is likely not related to autoimmune phenomenon in autism.

  14. Impact on parents of receiving individualized feedback of psychological testing conducted with children as part of a research study.

    Science.gov (United States)

    Cox, Kelly; Fernandez, Conrad V; Chambers, Christine T; Bandstra, Nancy F; Parker, Jennifer A

    2011-01-01

    While many researchers accept the principle that participants have a right to receive information learned from their participation in research, there are few studies examining the impact of receiving results on participants. This study was developed to examine the impact on parents of the receipt of individual results of research-based psychological testing of their children. A summary of the child's individual results of standardized measures of language and development was sent by mail with the questionnaire designed to assess the impact of receiving results. Response rate from the mailed questionnaire was 55.6% (n=74/133). Most parents reported the results as helpful and positive. The majority would receive results again. Overall, the sharing of individualized feedback from psychological testing conducted as part of a research study was well accepted by parents. This practice appears ethically permissible with appropriate support options for addressing participant concerns upon receiving the results as well options for clinical follow-up for the child.

  15. Perceptions and Needs of Hispanic and Non-Hispanic Parents of Children Receiving Learning Disabilities Services.

    Science.gov (United States)

    Torres-Burgo, Nydia I.; Reyes-Wasson, Pamela; Brusca-Vega, Rita

    1999-01-01

    A survey of 50 Hispanic and non-Hispanic parents of children with learning disabilities examined treatment of the two groups of parents in the special education process, parents' involvement in the process, and how parental treatment compared to the mandates of the Individuals with Disabilities Act (IDEA). Strategies are suggested to maximize…

  16. Family Perceptions of Participation in Educational Planning for Children Receiving Mental Health Services

    Science.gov (United States)

    Jivanjee, Pauline; Kruzich, Jean M.; Friesen, Barbara J.; Robinson, Adjoa

    2007-01-01

    Family participation in educational planning for children with disabilities is believed to result in plans that are more responsive to the child's needs and that lead to better social, emotional, and educational outcomes. Participation in educational planning is also a fundamental right of parents and a cornerstone of special education…

  17. Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial

    Directory of Open Access Journals (Sweden)

    Ayse Ozcan

    2014-12-01

    Full Text Available Background and objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Results and conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence agitation after

  18. [Dynamics of tooth decay prevalence in children receiving long-term preventive program in school dental facilities].

    Science.gov (United States)

    Avraamova, O G; Kulazhenko, T V; Gabitova, K F

    2016-01-01

    The paper presents the assessment of tooth decay prevalence in clinically homogenous groups of children receiving long-term preventive program (PP) in school dental facilities. Five-years PP were introduced in clinical practice in 2 Moscow schools. Preventive treatment was performed by dental hygienist. The results show that systematic preventive treatment in school dental offices starting from elementary school allows reducing dental caries incidence 46-53% and stabilize the incidence of caries complications. It should be mentioned though that analysis of individualized outcomes proves heterogeneity of study results despite of equal conditions of PP. Potentially significant hence is early diagnostics and treatment of initial caries forms as demineralization foci, especially in children with intensive tooth decay. Optimization of pediatric dentist and dental hygienist activity in school dental facilities is the main factor of caries prevention efficiency.

  19. Retrospective reports of parenting received in their families of origin: relationships to adult attachment in adult children of alcoholics.

    Science.gov (United States)

    Kelley, Michelle L; Nair, Veena; Rawlings, Tanaya; Cash, Thomas F; Steer, Kate; Fals-Stewart, William

    2005-09-01

    The present study examined general and romantic attachment and parenting students received in their families of origin among 401 college students who resided with an alcohol-abusing parent prior to age 16 years as compared to those who did not reside with alcohol-abusing parents. Participants completed the Children's Report of Parent Behavior Instrument [Schludermann, E. and Schludermann, S. (1970). Children's Report of Parent Behavior Inventory (CRPBI). Canada: University of Manitoba], Experiences in Close Relationships--Revised [Fraley, R. C., Waller, N. G., and Brennan, K. G. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365], Relationship Scale Questionnaire [Griffin, D. W. and Bartholomew, K. (1994). Models of the self and other: Fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology, 67, 430-445], and the Children of Alcoholics Screening Test [Jones, J. W. (1983). The Children of Alcoholics Screening Test: Test manual. Chicago: Camelot]. Young adults who met criteria for ACOAs reported more anxious and avoidant behavior in romantic relationships and a more fearful style of general adult attachment. Parenting behavior in one's family of origin predicted anxious behavior in romantic relationships and a fearful overall style of attachment, whereas being an ACOA and parenting in one's family of origin predicted avoidant behavior in romantic relationships.

  20. Protection against gastroenteritis in US households with children who received rotavirus vaccine.

    Science.gov (United States)

    Cortese, Margaret M; Dahl, Rebecca Moritz; Curns, Aaron T; Parashar, Umesh D

    2015-02-15

    We used Truven Health Marketscan claims database (2008-2011) to compare gastroenteritis rates during January-June among households whose child had received rotavirus vaccine with those whose child did not receive vaccine. Statistically significantly lower rates of hospitalization with a rotavirus gastroenteritis or unspecified-gastroenteritis discharge code occurred in vaccinated households among persons 20-29 years and females 20-29 years (2008/2009), and males 30-39 years (2009/2010). Lower emergency department gastroenteritis rates occurred in vaccinated households among females 20-29 years (2009/2010) and individuals 5-19 years (2010/2011). These data suggest rotavirus vaccination of infants provides indirect protection against moderate-to-severe rotavirus disease in young parents and older siblings.

  1. PfHRP2 and PfLDH antigen detection for monitoring the efficacy of artemisinin-based combination therapy (ACT in the treatment of uncomplicated falciparum malaria

    Directory of Open Access Journals (Sweden)

    Deloron Philippe

    2009-09-01

    Full Text Available Abstract Background An assessment of the accuracy of two malaria rapid diagnostic tests (RDT for the detection of Plasmodium falciparum histidine-rich protein 2 (PfHRP2 or Pf lactate dehydrogenase (PfLDH was undertaken in children aged between six and 59 months included in an anti-malarial efficacy study in Benin. Methods In Allada (Benin, 205 children aged 6-59 months with falciparum malaria received either artesunate-amodiaquine (ASAQ, artemether-lumefantrine (AL, or sulphadoxine-pyrimethamine (SP. Children included in the study were simultaneously followed by both RDT and high-quality microscopy for up to 42 days. Results At the time of inclusion, PfHRP2-based tests were positive in 203 children (99% and PfLDH-based tests were positive in 204 (99.5%. During follow-up, independent of the treatment received, only 17.3% (28/162 of children effectively cured were negative with the PfHRP2 RDT at day 3, with a gradual increase in specificity until day 42. The specificity of antigen detection with the PfLDH test was 87% (141/162 on day 3, and between 92% and 100% on days 7 to 42. A statistical difference was observed between the persistence of PfHRP2 and PfLDH antigenaemia during follow-up in children treated with artemisinin-based combination therapy (ACT but not with SP. Conclusion Although both RDTs are as sensitive as microscopy in detecting true malaria cases, the PfHRP2 RDT had very low specificity during follow-up until day 28. On the other hand, the PfLDH test could be used to detect failures and, therefore, to assess anti-malarial efficacy.

  2. Impact of varied center volume categories on volume-outcome relationship in children receiving ECMO for heart operations.

    Science.gov (United States)

    Rettiganti, Mallikarjuna; Seib, Paul M; Robertson, Michael J; Wilcox, Andrew; Gupta, Punkaj

    2016-09-01

    To study the volume-outcome relationship among children receiving extracorporeal membrane oxygenation (ECMO), different studies from different databases use different volume categories. The objective of this study was to evaluate if different center volume categories impact the volume-outcome relationship among children receiving ECMO for heart operations. We performed a post hoc analysis of data from an existing national database, the Pediatric Health Information System. Centers were classified into five different volume categories using different cut-offs and different variables. Mortality rates were compared between the varied volume categories using a mixed effects logistic regression model after adjusting for patient- and center-level risk factors. Data collection included demographic information, baseline characteristics, pre-ECMO risk factors, operation details, patient diagnoses, and center data. In unadjusted analysis, there was a significant relationship between center volume and mortality, with low-and medium-volume centers associated with higher mortality rates compared to high-volume centers in all volume categories, except the hierarchical clustering volume category. In contrast, there was no significant association between center-volume and mortality among all volume categories in adjusted analysis. We concluded that high-volume centers were not associated with improved outcomes for the majority of the categorization schemes despite using different cut-offs and different variables for volume categorization.

  3. The Development of Cognitive, Language, and Cultural Skills from Age 3 to 6: A Comparison between Children of Turkish Origin and Children of Native-Born German Parents and the Role of Immigrant Parents' Acculturation to the Receiving Society

    Science.gov (United States)

    Becker, Birgit; Klein, Oliver; Biedinger, Nicole

    2013-01-01

    This article analyzes the longitudinal development of differences in academic skills between children of Turkish origin and children of native-born German parents from age 3 to 6 in Germany with a focus on the role of immigrant parents' acculturation to the receiving society. Growth curve models show that Turkish-origin children start with lower…

  4. Rare severe mycotic infections in children receiving empirical caspofungin treatment for febrile neutropenia

    Directory of Open Access Journals (Sweden)

    Deniz Yilmaz Karapinar

    2015-10-01

    Full Text Available ABSTRACTEmpirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11-19 days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture. Because the patients' clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3-7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely.

  5. Diagnostic accuracy of serum biochemical fibrosis markers in children with chronic hepatitis B evaluated by receiver operating characteristics analysis

    Institute of Scientific and Technical Information of China (English)

    Dariusz Marek Lebensztejn; El(z)bieta Skiba; Jolanta Tobolczyk; Maria El(z)bieta Sobaniec-Lotowska; Maciej Kaczmarski

    2005-01-01

    AIM: To investigate the diagnostic accuracy of potent serum biochemical fibrosis markers in children with chronic hepatitis B evaluated by receiver operating characteristics (ROC) analysis.METHODS: We determined the serum level of apolipoprotein A-I (APO A-I), haptoglobin (HPT) and a-2macroglobulin (A2M) with an automatic nephelometer in 63 children (age range 4-17 years, mean 10 years)with biopsy-verified chronic HBeAg-positive hepatitis B.Fibrosis stage and inflammation grade were assessed in a blinded fashion according to Batts and Ludwig. We defined mild liver fibrosis as a score ≤2 and advanced fibrosis as a score equal to 3. ROC analysis was used to calculate the power of the assays to detect advanced liver fibrosis (AccuROC, Canada).RESULTS: Serum concentrations of APO A-I, HPT and A2M were not significantly different in patients with chronic hepatitis B compared to controls. However, APO A-I level of 1.19 ng/L had a sensitivity of 85.7% and a specificity of 60.7% (AUC = 0.7117, P = 0.035) to predict advanced fibrosis. All other serum biochemical markers and their combination did not allow a useful prediction.None of these markers was a good predictor of histologic inflammation.CONCLUSION: Apolipoprotein A-I may be a suitable serum marker to predict advanced liver fibrosis in children with chronic hepatitis B.

  6. Antibody responses to Hepatitis B and measles-mumps-rubella vaccines in children who received chemotherapy for acute lymphoblastic leukemia

    Directory of Open Access Journals (Sweden)

    Simone Santana Viana

    2012-01-01

    Full Text Available OBJECTIVE: To evaluate viral vaccine antibody levels in children with acute lymphoblastic leukemia after chemotherapy and after vaccine booster doses. METHODS: Antibody levels against hepatitis B, rubella, measles and mumps vaccine antigens were evaluated in 33 children after completing chemotherapy (before and after vaccine booster doses and the results were compared to the data of 33 healthy children matched for gender, age and social class. RESULTS: After chemotherapy, 75.9%, 67.9%, 59.3% and 51.7% of the patients showed low antibody titers that would be unlikely to protect against exposure to measles, rubella, hepatitis B and mumps, respectively. After receiving a vaccine booster dose for these antigens the patients had high antibody levels consistent with potential protection against measles, mumps and hepatitis B, but not against rubella. CONCLUSION: Extra doses of measles-mumps-rubella plus hepatitis B vaccines are recommended in acute lymphoblastic leukemia patients submitted to treatment after hematologic recovery. After this, viral vaccine antibody levels should be verified to define the individual's protective status.

  7. [Estimates of trace elements requirements of children receiving total parenteral nutrition].

    Science.gov (United States)

    Ricour, C; Duhamel, J F; Gros, J; Mazière, B; Comar, D

    1977-01-01

    Ten children on total parenteral nutrition were studied. Plasma copper, zinc, manganese and selenium levels were determined by neutron activation and gamma spectrometry, every 10 days. With a copper intake of 20 microgram/kg/24 h, the average level 120 microgram% (94-144) was normal (N: 118 microgram +/- 11%). With a manganese intake of 40 microgram/kg/24 h, the level increased to 2.6 microgram% (1.3-4.5) (N: 1.1 microgram +/- 0.2%). With a zinc intake of 30 microgram/kg/24 h, the level decreased to 45.9 microgram % (20-63) (N: 83 microgram +/- 28%); with an intake of 50 microgram/kg/24 h the level remained under normal. With a selenium intake of 1 microgram/kg/24 h, the level decreased to 10.6 ng/ml (3.6-21.6) (N: 38.2 ng/ml +/- 11.9), but was normalized with an intake of 3 microgram/kg/24 h. From these results, with all reserves that estimation implies, the authors suggest that the disorders due to deficit or excess of trace elements could be avoided by daily intakes per kg of body weight: copper 20 microgram, zinc 100 microgram, manganese 10 microgram and selenium 3 microgram, with supplementation of iron, iodine and fluoride.

  8. Serum Creatinine Versus Plasma Methotrexate Levels to Predict Toxicities in Children Receiving High-dose Methotrexate.

    Science.gov (United States)

    Tiwari, Priya; Thomas, M K; Pathania, Subha; Dhawan, Deepa; Gupta, Y K; Vishnubhatla, Sreenivas; Bakhshi, Sameer

    2015-01-01

    Facilities for measuring methotrexate (MTX) levels are not available everywhere, potentially limiting administration of high-dose methotrexate (HDMTX). We hypothesized that serum creatinine alteration after HDMTX administration predicts MTX clearance. Overall, 122 cycles in 50 patients of non-Hodgkin lymphoma or acute lymphoblastic leukemia aged ≤18 years receiving HDMTX were enrolled prospectively. Plasma MTX levels were measured at 12, 24, 36, 48, 60, and 72 hours; serum creatinine was measured at baseline, 24, 48, and 72 hours. Correlation of plasma MTX levels with creatinine levels and changes in creatinine from baseline (Δ creatinine) were evaluated. Plasma MTX levels at 72 hours showed positive correlation with serum creatinine at 48 hours (P = .011) and 72 hours (P = .013) as also Δ creatinine at 48 hours (P = .042) and 72 hours (P = .045). However, cut-off value of either creatinine or Δ creatinine could not be established to reliably predict delayed MTX clearance. Greater than 50% Δ creatinine at 48 and 72 hours significantly predicted grade 3/4 leucopenia (P = .036 and P = .001, respectively) and thrombocytopenia (P = .012 and P = .009, respectively) but not mucositis (P = .827 and P = .910, respectively). Delayed MTX elimination did not predict any grade 3/4 toxicity. In spite of demonstration of significant correlation between serum creatinine and Δ creatinine with plasma MTX levels at 72 hours, cut-off value of either variable to predict MTX delay could not be established. Thus, either of these cannot be used as a surrogate for plasma MTX estimation. Interestingly, Δ creatinine effectively predicted hematological toxicities, which were not predicted by delayed MTX clearance.

  9. Incidence of colonization and bloodstream infection with carbapenem-resistant Enterobacteriaceae in children receiving antineoplastic chemotherapy in Italy.

    Science.gov (United States)

    Caselli, Desiree; Cesaro, Simone; Fagioli, Franca; Carraro, Francesca; Ziino, Ottavio; Zanazzo, Giulio; Meazza, Cristina; Colombini, Antonella; Castagnola, Elio

    2016-02-01

    Few data are available on the incidence of carbapenemase-producing Enterobacteriaceae (CPE) infection or colonization in children receiving anticancer chemotherapy. We performed a nationwide survey among centers participating in the pediatric hematology-oncology cooperative study group (Associazione Italiana Ematologia Oncologia Pediatrica, AIEOP). During a 2-year observation period, we observed a threefold increase in the colonization rate, and a fourfold increase of bloodstream infection episodes, caused by CPE, with a 90-day mortality of 14%. This first nationwide Italian pediatric survey shows that the circulation of CPE strains in the pediatric hematology-oncology environment is increasing. Given the mortality rate, which is higher than for other bacterial strains, specific monitoring should be applied and the results should have implications for health-care practice in pediatric hematology-oncology.

  10. Survival of Mexican Children with Acute Myeloid Leukaemia Who Received Early Intensification Chemotherapy and an Autologous Transplant

    Directory of Open Access Journals (Sweden)

    Elva Jiménez-Hernández

    2015-01-01

    Full Text Available Background. In Mexico and other developing countries, few reports of the survival of children with acute leukaemia exist. Objective. We aimed at comparing the disease-free survival of children with acute myeloid leukaemia who, in addition to being treated with the Latin American protocol of chemotherapy and an autologous transplant, either underwent early intensified chemotherapy or did not undergo such treatment. Procedure. This was a cohort study with a historical control group, forty patients, less than 16 years old. Group A (20 patients, diagnosed in the period 2005–2007, was treated with the Latin American protocol of chemotherapy with an autologous transplant plus early intensified chemotherapy: high doses of cytarabine and mitoxantrone. Group B (20 patients, diagnosed in the period 1999–2004, was treated as Group A, but without the early intensified chemotherapy. Results. Relapse-free survival for Group A was 90% whereas that for Group B it was 60% (P=0.041. Overall survival for Group A (18, 90% was higher than that for Group B (60%. Complete remission continued for two years of follow-up. Conclusions. Relapse-free survival for paediatric patients treated with the Latin American protocol of chemotherapy with an autologous transplant plus early intensified chemotherapy was higher than that for those who did not receive early intensified chemotherapy.

  11. Survival of Mexican Children with Acute Myeloid Leukaemia Who Received Early Intensification Chemotherapy and an Autologous Transplant

    Science.gov (United States)

    Jiménez-Hernández, Elva; Dueñas-González, María Teresa; Arellano-Galindo, José; Medrano-Ortíz-De-Zárate, María Elena; Bekker-Méndez, Vilma Carolina; Berges-García, Adolfina; Solís-Labastida, Karina; Sánchez-Jara, Berenice; Tiznado-García, Héctor Manuel; Jaimes-Reyes, Ethel Zulie; García-Jiménez, Xochiketzalli; Espinoza-Hernández, Laura; Núñez-Villegas, Nora Nancy; Franco-Ornelas, Sergio; Pérez-Casillas, Ruy Xavier; Martínez Villegas, Octavio; Palomares, Teresa Marin; Mejía-Aranguré, Juan Manuel

    2015-01-01

    Background. In Mexico and other developing countries, few reports of the survival of children with acute leukaemia exist. Objective. We aimed at comparing the disease-free survival of children with acute myeloid leukaemia who, in addition to being treated with the Latin American protocol of chemotherapy and an autologous transplant, either underwent early intensified chemotherapy or did not undergo such treatment. Procedure. This was a cohort study with a historical control group, forty patients, less than 16 years old. Group A (20 patients), diagnosed in the period 2005–2007, was treated with the Latin American protocol of chemotherapy with an autologous transplant plus early intensified chemotherapy: high doses of cytarabine and mitoxantrone. Group B (20 patients), diagnosed in the period 1999–2004, was treated as Group A, but without the early intensified chemotherapy. Results. Relapse-free survival for Group A was 90% whereas that for Group B it was 60% (P = 0.041). Overall survival for Group A (18, 90%) was higher than that for Group B (60%). Complete remission continued for two years of follow-up. Conclusions. Relapse-free survival for paediatric patients treated with the Latin American protocol of chemotherapy with an autologous transplant plus early intensified chemotherapy was higher than that for those who did not receive early intensified chemotherapy. PMID:25821830

  12. Partially neutralizing potency against emerging genotype I virus among children received formalin-inactivated Japanese encephalitis virus vaccine.

    Directory of Open Access Journals (Sweden)

    Yi-Chin Fan

    Full Text Available BACKGROUND: Genotype I (GI Japanese encephalitis virus (JEV that replaced GIII virus has become the dominant circulating virus in Asia. Currently, all registered live and inactivated JEV vaccines are derived from genotype III viruses. In Taiwan, the compulsory JEV vaccination policy recommends that children receives four doses of formalin-inactivated Nakayama (GIII JEV vaccine. METHODOLOGY/PRINCIPAL FINDINGS: To evaluate the influence of genotype replacement on the post-vaccination viral neutralizing ability by GIII and GI viruses, the small panel of vaccinated-children serum specimens was assembled, and the reciprocal 50% plaque-reduction neutralizing antibody titers (PRNT(50 were measured against Nakayama vaccine strain, CJN GIII human brain isolate and TC2009-1 GI mosquito isolate. The seropositivity rate (PRNT(50 ≥ 1:10 and geometric mean titers (GMT against the TC2009-1 virus were the lowest among the three viruses. The protective threshold against the CJN and TC2009-1 viruses could only be achieved when the GMT against Nakayama virus was ≥ 1:20 or ≥ 1:80, respectively. Using undiluted vaccinees' sera, the enhancement of JEV infection in K562 cells was observed in some low or non-neutralizing serum specimens. CONCLUSIONS/SIGNIFICANCE: Our preliminary study has shown that neutralizing antibodies, elicited by the mouse brain-derived and formalin-inactivated JEV Nakayama vaccine among a limited number of vaccinees, have reduced neutralizing capacity against circulating GI virus, but more detailed studies are needed to address the potential impact on the future vaccine policy.

  13. Caregiver perceptions and motivation for disclosing or concealing the diagnosis of HIV infection to children receiving HIV care in Mbarara, Uganda: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Julius Kiwanuka

    Full Text Available BACKGROUND: Disclosure of the diagnosis of HIV to HIV-infected children is challenging for caregivers. Despite current recommendations, data suggest that levels of disclosure of HIV status to HIV-infected children receiving care in resource-limited settings are very low. Few studies describe the disclosure process for children in these settings, particularly the motivators, antecedent goals, and immediate outcomes of disclosure to HIV-infected children. This study examined caregivers' perception of the disclosure concept prior to disclosure, their motivation towards or away from disclosure, and their short- and long-term intentions for disclosure to their HIV-infected children. METHODS: In-depth interviews were conducted with primary caregivers of 40 HIV-infected children (ages 5-15 years who were receiving HIV care but did not know their HIV status. RESULTS: Caregivers of HIV-infected children mainly perceived disclosure as a single event rather than a process of gradual delivery of information about the child's illness. They viewed disclosure as potentially beneficial both to children and themselves, as well as an opportunity to explain the parents' role in the transmission of HIV to the children. Caregivers desired to personally conduct the disclosure; however, most reported being over-whelmed with fear of negative outcomes and revealed a lack of self-efficacy towards managing the disclosure process. Consequently, most cope by deception to avoid or delay disclosure until they perceive their own readiness to disclose. CONCLUSIONS: Interventions for HIV disclosure should consider that caregivers may desire to be directly responsible for disclosure to children under their care. They, however, need to be empowered with practical skills to recognize opportunities to initiate the disclosure process early, as well as supported to manage it in a phased, developmentally appropriate manner. The potential role for peer counselors in the disclosure

  14. Late relapse of imported Plasmodium ovale malaria: a case report.

    Science.gov (United States)

    Siala, Emna; Gastli, Mondher; Essid, Rym; Jemal, Sana; Ben Abdallah, Rym; Ben Abda, Imène; Aoun, Karim; Bouratbine, Aida

    2015-06-01

    We report the first case of an imported Plasmodium ovale relapse in a Tunisian man who developed malaria three years after leaving sub- Saharan Africa. A 29-year-old Tunisian man consulted in September 2011 because of a fever, myalgia, and headache that had begun eight days earlier and persisted despite treatment with oral antibiotics. On questioning, the patient stated that he had resided three years ago for six months in Ivory Coast, where he acquired malaria. He was treated with artemether-lumefantrine. The patient said he had no recent travel to any other malaria-endemic area and had not received a blood transfusion. A first microscopy of peripheral blood smears was negative for malaria parasites. The diagnosis was established 17 days after onset of symptoms. A repeat microscopic examination of blood smears confirmed the presence of Plasmodium ovale with a parasitemia lower than 0.1%. The patient was treated with artemether lumefantrine, followed by primaquine. This case emphasizes the possibility of relapse of some plasmodial species. It highlights the importance of repeating microscopic examination of blood when the diagnosis of malaria is suspected.

  15. Effects of Cross-Language Transfer on First-Language Phonological Awareness and Literacy Skills in Chinese Children Receiving English Instruction

    Science.gov (United States)

    Chen, Xi; Xu, Fen; Nguyen, Thien-Kim; Hong, Guanglei; Wang, Yun

    2010-01-01

    The present investigation consists of two studies examining the effects of cross-language transfer on the development of phonological awareness and literacy skills among Chinese children who received different amounts of English instruction. Study 1 compared Chinese students in regular English programs (92 first graders and 93 third graders) with…

  16. Benzodiazepine prescribing in children under 15 years of age receiving free medical care on the General Medical Services scheme in Ireland.

    LENUS (Irish Health Repository)

    O'Sullivan, K

    2015-06-01

    To examine the prevalence and secular trends in benzodiazepine (BZD) prescribing in the Irish paediatric population. In addition, we examine coprescribing of antiepileptic, antipsychotic, antidepressant and psychostimulants in children receiving BZD drugs and compare BZD prescribing in Ireland to that in other European countries.

  17. Modeling the financial and clinical implications of malaria rapid diagnostic tests in the case-management of older children and adults in Kenya.

    Science.gov (United States)

    Zurovac, Dejan; Larson, Bruce A; Skarbinski, Jacek; Slutsker, Laurence; Snow, Robert W; Hamel, Mary J

    2008-06-01

    Using data on clinical practices for outpatients 5 years and older, test accuracy, and malaria prevalence, we model financial and clinical implications of malaria rapid diagnostic tests (RDTs) under the new artemether-lumefantrine (AL) treatment policy in one high and one low malaria prevalence district in Kenya. In the high transmission district, RDTs as actually used would improve malaria treatment (61% less over-treatment but 8% more under-treatment) and lower costs (21% less). Nonetheless, the majority of patients with malaria would not be correctly treated with AL. In the low transmission district, especially because the treatment policy was new and AL was not widely used, RDTs as actually used would yield a minor reduction in under-treatment errors (36% less but the base is small) with 41% higher costs. In both districts, adherence to revised clinical practices with RDTs has the potential to further decrease treatment errors with acceptable costs.

  18. The Serum Anti-HBs Level Among Children Who Received Routine Hepatitis B Vaccination During Infancy in Mianyang City, China: A Cross-Sectional Study.

    Science.gov (United States)

    He, Fang; Ma, Yuan-ji; Zhou, Tao-you; Duan, Jin-chao; Wang, Jun-feng; Ji, Yu-lin; Li, Hong; Zhang, Ju-ying; Tang, Hong

    2016-01-01

    Hepatitis B virus (HBV) prevalence has declined remarkably in children due to nationwide universal vaccination program for HBV in China. However, the persistence of immune response against HBV infection and the optimal time point when a booster vaccination should be performed remain to be elucidated. To assess the persistence and level of antibody against hepatitis B surface antigen (anti-HBs) in a representative population of age 15 and younger who received routine hepatitis B vaccination in Mianyang City, China. A cross-sectional study was conducted in 2011. One thousand five hundred twenty-six children of age 15 and younger who received three doses of 5 μg hepatitis B vaccine series during infancy but did not receive a booster vaccination later were enrolled. Of the 1,526 children, the mean age was 8.2 ± 4.1 and 739 children were male. The median anti-HBs level was 23.0 mIU/mL, and the total percentage of anti-HBs levels ≥10 mIU/mL was 60.9%. With an increase of age, median anti-HBs level, percentage of anti-HBs levels ≥10 mIU/mL, and percentage of anti-HBs levels ≥100 mIU/mL declined remarkably in the early period and reached the lowest level at the age of 3 and then remained relatively stable. The median anti-HBs level, the percentage of anti-HBs levels ≥10 mIU/mL, and the percentage of anti-HBs levels ≥100 mIU/mL in 1- and 2-year-old children were much higher than that in children aged 3-15 (p < 0.05, respectively). Immunity against HBV infection gradually decreased in early ages of children of 15 and younger who received three doses of 5 μg hepatitis B vaccine series during infancy in China. Three dosages of 10 μg hepatitis B vaccine for infants and repeated vaccination or additional booster vaccination for some children at or before age 3 should be provided to get much more powerful immunity to HBV.

  19. Comparison of the Efficacy and Safety of Insulin Glargine and Insulin Detemir with NPH Insulin in Children and Adolescents with Type 1 Diabetes Mellitus Receiving Intensive Insulin Therapy

    OpenAIRE

    Dündar, Bumin Nuri; Dündar, Nihal; Eren, Erdal

    2010-01-01

    Objective: The purpose of this study was to compare the efficacy and safety of insulin glargine and detemir with NPH insulin in children and adolescents with type 1 diabetes mellitus (DM). Methods: Thirty four children and adolescents with type 1 DM (mean age 12.7 ± 3.4 years, diabetes duration 5.4 ± 3.0 years) were included in the study. All patients had been receiving intensive insulin therapy with insulin aspart and NPH for at least 6 months before switching from NPH to insulin glargine (G...

  20. Iodine status of young Burkinabe children receiving small-quantity lipid-based nutrient supplements and iodised salt: a cluster-randomised trial.

    Science.gov (United States)

    Hess, Sonja Y; Abbeddou, Souheila; Yakes Jimenez, Elizabeth; Ouédraogo, Jean-Bosco; Brown, Kenneth H

    2015-12-14

    The objective of the present study was to assess the impact of providing small-quantity lipid-based nutrient supplements (SQ-LNS) on the I status of young Burkinabe children. In total, thirty-four communities were assigned to intervention (IC) or non-intervention cohorts (NIC). IC children were randomly assigned to receive 20 g lipid-based nutrient supplements (LNS)/d containing 90 µg I with 0 or 10 mg Zn from 9 to 18 months of age, and NIC children received no SQ-LNS. All the children were exposed to iodised salt through the national salt iodization programme. Spot urinary iodine (UI), thyroid-stimulating hormone (TSH) and total thyroxine (T4) in dried blood spots as well as plasma thyroglobulin (Tg) concentrations were assessed at 9 and 18 months of age among 123 IC and fifty-six NIC children. At baseline and at 18 months, UI, TSH and T4 did not differ between cohorts. Tg concentration was higher in the NIC v. IC at baseline, but this difference did not persist at 18 months of age. In both cohorts combined, the geometric mean of UI was 339·2 (95% CI 298·6, 385·2) µg/l, TSH 0·8 (95% CI 0·7, 0·8) mU/l, T4 118 (95 % CI 114, 122) nmol/l and Tg 26·0 (95% CI 24·3, 27·7) µg/l at 18 months of age. None of the children had elevated TSH at 18 months of age. Marginally more children in NIC (8·9%) had low T4 (15 ppm). A reduction of SQ-LNS I content could be considered in settings with similarly successful salt iodisation programmes.

  1. High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo

    Directory of Open Access Journals (Sweden)

    Mounerou Salou

    2016-04-01

    Full Text Available Introduction: Antiretroviral treatment (ART has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. Methods: HIV viral load (VL testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014. Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA. Genotypic drug resistance was done for all samples with VL>1000 copies/ml. Results and discussion: Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59% were adolescents and 116 (41% were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months. For 228 (80.6%, the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs (zidovudine and lamivudine and one non-nucleoside reverse transcriptase inhibitor (NNRTI (nevirapine or efavirenz. Only 28 (9.9% were on a protease inhibitor (PI-based regimen. VL was below the detection limit (i.e. 40 copies/ml for 102 (36%, between 40 and 1000 copies/ml for 35 (12.4% and above 1000 copies/ml for 146 (51.6%. Genotypic drug-resistance testing was successful for 125/146 (85.6%; 110/125 (88.0% were resistant to both NRTIs and NNRTIs, 1/125 (0.8% to NRTIs only, 4/125 (3.2% to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125 of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in

  2. THE USE OF SUPEROXIDE DISMUTASE IN ACCELERATING SYMPTOM RELIEF IN ASTHMATIC AND HOUSE DUST MITE ALLERGIC CHILDREN RECEIVING HOUSE DUST MITE IMMUNOTHERAPY: DOUBLE BLIND RANDOMIZED CONTROLLED CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    Anang Endaryanto

    2015-09-01

    Full Text Available Objective: To evaluate the efficacy of superoxide dismutase (SOD in lung function (FEV1 reversibility and respiratory symptoms (drug scores, symptoms scores in asthmatic and house dust mite allergic children receiving house dust mites immunotherapy. Methods: Forty subjects aged 6–17 years old with asthma, tested positive for house dust mite allergy on skin prick test, and received immunotherapy were enrolled in this study. All subjects completed clinical based assessments and diary-based assessments for drug and symptom scores. Following a four-week baseline assessment, all subjects were randomized to receive SOD or placebo. Respiratory symptoms (drug and symptoms score and FEV1 were evaluated at the end of the 1st, 2nd, 3rd, and 4th weeks after randomization. Drug score, symptoms score, and FEV1 reversibility test results were analyzed using a Paired t test and repeated measure of ANOVA. Results: There was a significant difference in drug scores, symptoms score, and FEV1 reversibility test outcomes between SOD and placebo. SOD group showed a significant decrease in all outcome measures compared to those in placebo group. Conclusions: The use of SOD as antioxidants is effective in accelerating symptom relief for children with asthma and house dust mite allergy receiving house dust mite immunotherapy.

  3. Enzymatic Activity of Glutathione S-Transferase and Dental Fluorosis Among Children Receiving Two Different Levels of Naturally Fluoridated Water.

    Science.gov (United States)

    Bonola-Gallardo, Irvin; Irigoyen-Camacho, María Esther; Vera-Robles, Liliana; Campero, Antonio; Gómez-Quiroz, Luis

    2017-03-01

    This study was conducted to measure the activity of the enzyme glutathione S-transferase (GST) in saliva and to compare the activity of this enzyme in children with and without dental fluorosis in communities with different concentrations of naturally fluoridated water. A total of 141 schoolchildren participated in this cross-sectional study. Children were selected from two communities: one with a low (0.4 ppm) and the other with a high (1.8 ppm) water fluoride concentration. Dental fluorosis was evaluated by applying the Thylstrup and Fejerskov Index (TFI) criteria. Stimulated saliva was obtained, and fluoride concentration and GST activity were measured. The GST activity was compared among children with different levels of dental fluorosis using multinomial logistic regression models and odds ratios (OR). The mean age of the children was 10.6 (±1.03) years. Approximately half of the children showed dental fluorosis (52.5 %). The average GST activity was 0.5678 (±0.1959) nmol/min/μg. A higher concentration of fluoride in the saliva was detected in children with a higher GST activity (p = 0.039). A multinomial logistic regression model used to evaluate the GST activity and the dental fluorosis score identified a strong association between TFI = 2-3 (OR = 15.44, p = 0.007) and TFI ≥ 4 (OR = 55.40, p = 0.026) and the GST activity level, compared with children showing TFI = 0-1, adjusted for age and sex. Schoolchildren with higher levels of dental fluorosis and a higher fluoride concentration in the saliva showed greater GST activity. The increased GST activity most likely was the result of the body's need to inactivate free radicals produced by exposure to fluoride.

  4. The Importance of Efficacy: Using the Extended Parallel Process Model to Examine Factors Related to Preschool-Age Children Enrolled in Medicaid Receiving Preventive Dental Visits.

    Science.gov (United States)

    Askelson, Natoshia M; Chi, Donald L; Momany, Elizabeth T; Kuthy, Raymond A; Carter, Knute D; Field, Kathryn; Damiano, Peter C

    2015-12-01

    Early preventive dental visits are vital to the oral health of children. Yet many children, especially preschool-age children enrolled in Medicaid, do not receive early visits. This study attempts to uncover factors that can be used to encourage parents to seek preventive dental care for preschool-age children enrolled in Medicaid. The extended parallel process model was used as a theoretical framework for this research. This model suggests that people will act if the perceived threat (severity and susceptibility) is high enough and if efficacy levels (self-efficacy and response efficacy) are likewise high. Following Witte's method of categorizing people's perceptions and emotions into one of four categories based on levels of threat and efficacy, this article describes four groups (high threat/high efficacy, high threat/low efficacy, low threat/high efficacy, and low threat/low efficacy) of parents and how they compare to each other. Using logistic regression to model if a child had a preventive visit, results indicate that parents with low threat/high efficacy and parents with high threat/high efficacy had approximately 2.5 times the odds of having a child with a preventive oral health visit compared to parents with low threat/low efficacy, when controlling for perceived oral health status, health literacy, and child's age. The importance of efficacy needs to be incorporated in interventions aimed at increasing preventive dental visits for young children.

  5. Utilization of formal health services for children aged 1-5 in Aceh after the 2004 tsunami: Which children did not receive the health care they needed? Implications for other natural disaster relief efforts.

    Science.gov (United States)

    Rassekh, Bahie Mary; Santosham, Mathuram

    2014-01-01

    Aceh, Indonesia, was the hardest-hit area in the December 26, 2004 Indian Ocean earthquake and tsunami, with more than 500,000 people displaced, 120,000 people dead, and total damages and losses estimated at $4.5 billion. The relief effort following the tsunami was also immense, with billions of dollars of aid pledged to this province alone. Since then, there have been several natural disasters, including Typhoon Haiyan, which have caused great loss of life and displacement and for which these results are applicable. This study aimed to determine and assess utilization patterns of health services for children under the age of five with diarrhea, cough and difficulty breathing, fever, or skin disease and to identify determinants of formal and non-formal healthcare usage. A household survey of 1439 households was administered to caretakers of children aged 1-5 years. A sample of clusters within Banda Aceh and Aceh Besar were selected and those caretakers within the cluster who fit the inclusion criteria were interviewed. In the two weeks prior to the survey, 78.3% of respondents utilized formal health services as the first line of care for their child's illness episode. Factors significantly associated with decreased formal healthcare usage for the sick children were if the children were living in a displaced household, if the children's mother or father were not living, and if the children's caretaker was not the mother. Although utilization of formal health services for children was quite high after the tsunami, there were certain children who received significantly less care, including those who were displaced, those who were being cared for by someone other than their mother, and those for whom one or both parents had died. Among the recommendations are suggestions to target these children to ensure that they receive the health care they need.

  6. Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment.

    Directory of Open Access Journals (Sweden)

    Harry Campbell

    Full Text Available Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. Progress in improving the global coverage of antibiotic treatment is monitored through large household surveys such as the Demographic and Health Surveys (DHS and the Multiple Indicator Cluster Surveys (MICS, which estimate antibiotic treatment rates of pneumonia based on two-week recall of pneumonia by caregivers. However, these survey tools identify children with reported symptoms of pneumonia, and because the prevalence of pneumonia over a two-week period in community settings is low, the majority of these children do not have true pneumonia and so do not provide an accurate denominator of pneumonia cases for monitoring antibiotic treatment rates. In this review, we show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity. However, even at a test specificity of 95% (and a test sensitivity of 80%, the proportion of children with reported symptoms of pneumonia who truly have pneumonia is only 22% (the positive predictive value of the survey tool. Thus, although DHS and MICS survey data on rates of care seeking for children with reported symptoms of pneumonia and other childhood illnesses remain valid and important, DHS and MICS data are not able to give valid estimates of antibiotic treatment rates in children with pneumonia.

  7. The Development and Validation of an Auditory Perception Test in Spanish for Hispanic Children Receiving Reading Instruction in Spanish.

    Science.gov (United States)

    Morrison, James A.; Michael, William B.

    1982-01-01

    A Spanish auditory perception test, La Prueba de Analisis Auditivo, was developed and administered to 158 Spanish-speaking Latino children, kindergarten through grade 3. Psychometric data for the test are presented, including its relationship to SOBER, a criterion-referenced Spanish reading measure. (Author/BW)

  8. A Qualitative Exploration of Therapeutic Relationships from the Perspective of Six Children Receiving Speech-Language Therapy

    Science.gov (United States)

    Fourie, Robert; Crowley, Niamh; Oliviera, Ana

    2011-01-01

    Although some studies have explored the adult therapeutic relationship in speech-language pathology, few, if any, have examined it with regard to children. This study aimed to explore the therapeutic relationship in pediatric speech and language therapy, focusing on the child's experience. Accordingly, the study was qualitative and involved the…

  9. Increased Risk of Autism Development in Children Whose Mothers Experienced Birth Complications or Received Labor and Delivery Drugs

    Directory of Open Access Journals (Sweden)

    Melissa Smallwood

    2016-07-01

    Full Text Available Autism spectrum disorder (ASD is a perplexing and pervasive developmental disorder characterized by social difficulties, communicative deficits, and repetitive behavior. The increased rate of ASD diagnosis has raised questions concerning the genetic and environmental factors contributing to the development of this disorder; meanwhile, the cause of ASD remains unknown. This study surveyed mothers of ASD and non-ASD children to determine possible effects of labor and delivery (L&D drugs on the development of ASD. The survey was administered to mothers; however, the results were analyzed by child, as the study focused on the development of autism. Furthermore, an independent ASD dataset from the Southwest Autism Research and Resource Center was analyzed and compared. Indeed, L&D drugs are associated with ASD (p = .039. Moreover, the Southwest Autism Research and Resource Center dataset shows that the labor induction drug, Pitocin, is significantly associated with ASD (p = .004. We also observed a synergistic effect between administrations of L&D drugs and experiencing a birth complication, in which both obstetrics factors occurring together increased the likelihood of the fetus developing ASD later in life (p = .0003. The present study shows the possible effects of L&D drugs, such as Pitocin labor-inducing and analgesic drugs, on children and ASD.

  10. Comparison of long-term outcomes between children with aplastic anemia and refractory cytopenia of childhood who received immunosuppressive therapy with antithymocyte globulin and cyclosporine.

    Science.gov (United States)

    Hama, Asahito; Takahashi, Yoshiyuki; Muramatsu, Hideki; Ito, Masafumi; Narita, Atsushi; Kosaka, Yoshiyuki; Tsuchida, Masahiro; Kobayashi, Ryoji; Ito, Etsuro; Yabe, Hiromasa; Ohga, Shouichi; Ohara, Akira; Kojima, Seiji

    2015-11-01

    The 2008 World Health Organization classification proposed a new entity in childhood myelodysplastic syndrome, refractory cytopenia of childhood. However, it is unclear whether this morphological classification reflects clinical outcomes. We retrospectively reviewed bone marrow morphology in 186 children (median age 8 years; range 1-16 years) who were enrolled in the prospective study and received horse antithymocyte globulin and cyclosporine between July 1999 and November 2008. The median follow-up period was 87 months (range 1-146 months). Out of 186 patients, 62 (33%) were classified with aplastic anemia, 94 (49%) with refractory cytopenia of childhood, and 34 (18%) with refractory cytopenia with multilineage dysplasia. Aplastic anemia patients received granulocyte colony-stimulating factor more frequently and for longer durations than other patients (Paplastic anemia, 4 patients with refractory cytopenia of childhood, and 3 patients with refractory cytopenia with multilineage dysplasia. Although the cumulative incidence of total clonal evolution at ten years was not significantly different among the 3 groups, the cumulative incidence of monosomy 7 development was significantly higher in aplastic anemia than in the other groups (P=0.02). Multivariate analysis revealed that only granulocyte colony-stimulating factor administration duration of 40 days or more was a significant risk factor for monosomy 7 development (P=0.02). These findings suggest that even the introduction of a strict morphological distinction from hypoplastic myelodysplastic syndrome cannot eradicate clonal evolution in children with aplastic anemia.

  11. A trial of intermittent preventive treatment and home-based management of malaria in a rural area of The Gambia

    Directory of Open Access Journals (Sweden)

    Webb Emily L

    2011-01-01

    Full Text Available Abstract Background Individual malaria interventions provide only partial protection in most epidemiological situations. Thus, there is a need to investigate whether combining interventions provides added benefit in reducing mortality and morbidity from malaria. The potential benefits of combining IPT in children (IPTc with home management of malaria (HMM was investigated. Methods During the 2008 malaria transmission season, 1,277 children under five years of age resident in villages within the rural Farafenni demographic surveillance system (DSS in North Bank Region, The Gambia were randomized to receive monthly IPTc with a single dose of sulphadoxine/pyrimethamine (SP plus three doses of amodiaquine (AQ or SP and AQ placebos given by village health workers (VHWs on three occasions during the months of September, October and November, in a double-blind trial. Children in all study villages who developed an acute febrile illness suggestive of malaria were treated by VHWs who had been taught how to manage malaria with artemether-lumefantrine (Coartem™. The primary aims of the project were to determine whether IPTc added significant benefit to HMM and whether VHWs could effectively combine the delivery of both interventions. Results The incidence of clinical attacks of malaria was very low in both study groups. The incidence rate of malaria in children who received IPTc was 0.44 clinical attacks per 1,000 child months at risk while that for control children was 1.32 per 1,000 child months at risk, a protective efficacy of 66% (95% CI -23% to 96%; p = 0.35. The mean (standard deviation haemoglobin concentration at the end of the malaria transmission season was similar in the two treatment groups: 10.2 (1.6 g/dL in the IPTc group compared to 10.3 (1.5 g/dL in the placebo group. Coverage with IPTc was high, with 94% of children receiving all three treatments during the study period. Conclusion Due to the very low incidence of malaria, no firm

  12. Feasibility and acceptability of artemisinin-based combination therapy for the home management of malaria in four African sites

    Directory of Open Access Journals (Sweden)

    Munguti Kaendi

    2008-01-01

    Full Text Available Abstract Background The Home Management of Malaria (HMM strategy was developed using chloroquine, a now obsolete drug, which has been replaced by artemisinin-based combination therapy (ACT in health facility settings. Incorporation of ACT in HMM would greatly expand access to effective antimalarial therapy by the populations living in underserved areas in malaria endemic countries. The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated. Methods A multi-country study was performed in four district-size sites in Ghana (two sites, Nigeria and Uganda, with populations ranging between 38,000 and 60,000. Community medicine distributors (CMDs were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months, after exclusion of danger signs. A community mobilization campaign accompanied the programme. Artesunate-amodiaquine (AA was used in Ghana and artemether-lumefantrine (AL in Nigeria and Uganda. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance, caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs. Results Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites. Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks, of whom 1,289 (59% were reported to have received ACT from a CMD. Coverage varied from 52% in Nigeria to 75% in Ho District, Ghana. Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver. A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites (range 86–97%, average 90%. The proportion of children correctly treated in terms of dose and duration was also high (range 74–97%, average 85%. Overall, the proportion of febrile children who received prompt treatment and the

  13. Evaluation of the Electrically Evoked Action Potential Threshold Changes in Three Months after Receiving the Device in Children with Cochlear Implant

    Directory of Open Access Journals (Sweden)

    Alireza Pourjavid

    2009-12-01

    Full Text Available Background and Aim: In neural response telemetry (NRT, intracochlear electrodes stimulate the auditory nerve and record the neural responses. The electrical stimulation send to the auditory nerve by an electrode and the resulted response, called electrically evoked compound action potential (ECAP, is recorded by an adjacent electrode. The most important clinical applications of this test are evaluation and monitoring the intra and postoperative responses of auditory nerve and help to primary setting of speech processor. The aim of this study was evaluating of the potential's threshold changes in three monthes after receiving the devise in pediatric cochlear implant recipients.Materials and Methods: This longitudinal study evaluated the potential's threshold in four given electrodes in four sessions after receiving the device by approximately one months intervals in children implanted in Amir Alam and Hazrat-e-Rasoul hospitals in 2007, July to December.Results: ECAP mean threshold level of each electrode did not significantly change in differnent sessions, while there was significant difference between apical and basal electrodes’ responses in every session(p<0.001.Conclusion: The reliabiliy of the responses result in more certainty of clinician to fit the speech processor for a long time. Better responses in apical electrodes may lead to develope an effective coding strategy.

  14. Impact of combined intermittent preventive treatment of malaria and helminths on anaemia, sustained attention, and recall in Northern Ghanaian schoolchildren

    Directory of Open Access Journals (Sweden)

    Ernest Cudjoe Opoku

    2016-09-01

    Full Text Available Background: The benefits of integrated control of malaria, schistosomiasis, and soil-transmitted helminth infections have not been fully explored in Ghanaian schoolchildren. Objective: To assess the impact of co-administered artemether-lumefantrine plus albendazole, and artemether-lumefantrine plus albendazole plus praziquantel compared to albendazole plus praziquantel on anaemia, sustained attention, and recall in schoolchildren. Design: This three-arm, open-label intervention study was carried out in Ghana among class three schoolchildren. Artemether-lumefantrine and albendazole were co-administered to 131 schoolchildren in Study Arm 1; artemether-lumefantrine, albendazole, and praziquantel to 90 children in Study Arm 2 versus albendazole and praziquantel to 127 children in Control Arm 3. Medicines were administered to all children at least 30 min after a meal. A HemoCue® photometer was used to measure haemoglobin (Hb, while the code transmission test (CTT, adapted from the Test of Everyday Attention for Children (TEA-Ch, was used to measure sustained attention and recall before-and-after interventions in June 2011 and June 2012. Results: We observed significant malaria parasite prevalence reductions of 62.8 and 59.2% in Study Arm 1 from 24.2 to 9.0%, p0.05. Meanwhile, anaemia prevalence reduced significantly (p<0.01 in all three study arms after interventions by 38.4% (from 19.8 to 12.2%, 20.7% (from 26.6 to 21.1%, and 36.0% (from 28.3 to 18.1% in Study Arms 1, 2, and 3, respectively. Although the interventions had no significant effects on Hb levels, anaemia prevalence reduced insignificantly by 38.4 and 20.7% in Study Arms 1 and 2, respectively, compared to 36.0% in Control Arm 3. Among schoolchildren in Study Arms 1 and 2, mean CTT score improved significantly after interventions by 10.4% (from 3.18 to 3.55, p=0.01 and 20.5% (from 2.83 to 3.56, p=0.01 respectively, compared to 5.75% in Control Arm 3 (from 2.95 to 3.13, p=0.09. Likewise

  15. 人工耳蜗植入围手术期的心理护理探讨%Perioperative Psychological Nursing in Children Receiving Cochlear Implant

    Institute of Scientific and Technical Information of China (English)

    金伟; 宁丽丽; 刘燕京; 高小宁

    2013-01-01

    Objective To investigate the effect of perioperative psychological nursing in children receiving cochlear implant. Methods One hundred twenty seven parents of deaf children who were to receive cochlear implant completed a questionnaire for assessment of their psychological conditions and personality characteristics and for scoring anxiety levels. Games, health knowledge forum, group discussion and successful case presentation were administered as targeted nursing intervention to help the children and parents overcome negative psychological difficulties before, during and after the im⁃plant procedure. Results Anxiety was identified in 116 parents (91.3%), seemingly correlated to the level of their education and professions. The chochlear implant procedure was successful in all children in this study, with good results. All parents were willing to continue the speech and language rehabilitation in cooperation with medical stuff, with boosted confidence in acquisition of language ability both in the children and parents. Conclusion Systematic psychological nursing is not only an important factor for successful operation, but also an important measure to lessen the negative psychological influence on parents. It is also beneficial to postoperative speech and language rehabilitation.%  目的探讨心理护理在人工耳蜗植入患儿围手术期的作用.方法对127例患儿父母进行问卷调查,收集基本资料和对焦虑水平进行评分,分别采用导入式游戏、开展健康知识讲座、召开沟通座谈会、成功病例介绍等形式帮助患儿及父母在手术前、术中及术后各期存在负性心理时给予针对性心理护理干预.结果116名(91.3%)患儿父母存在焦虑,父母文化程度高及职业为干部者焦虑比例高.所有人工耳蜗植入患儿都能顺利地完成手术,术后效果好,同时患儿家长也都愿意积极的配合医护人员做好后期的言语康复训练,提高了患儿及家

  16. A non-inferiority, individually randomized trial of intermittent screening and treatment versus intermittent preventive treatment in the control of malaria in pregnancy

    DEFF Research Database (Denmark)

    Tagbor, Harry; Cairns, Matthew; Bojang, Kalifa;

    2015-01-01

    BACKGROUND: The efficacy of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine (IPTp-SP) in pregnancy is threatened in parts of Africa by the emergence and spread of resistance to SP. Intermittent screening with a rapid diagnostic test (RDT) and treatment of positive women......). Women in the IPTp-SP group received SP on two or three occasions whilst women in the ISTp group were screened two or three times with a RDT and treated if positive for malaria with artemether-lumefantrine (AL). ISTp-AL was non-inferior to IPTp-SP in preventing low birth weight (LBW), anemia...... with malaria parasitemia between routine antenatal clinics (310 vs 182 episodes, rate difference: 49.4 per 1,000 pregnancies [95% CI 30.5, 68.3], but the number of hospital admissions for malaria was similar in the two groups. CONCLUSIONS: Despite low levels of resistance to SP in the study areas, ISTp...

  17. Hypercholesterolemia is associated with the apolipoprotein C-III (APOC3 genotype in children receiving HAART: an eight-year retrospective study.

    Directory of Open Access Journals (Sweden)

    Carlos A Rocco

    Full Text Available Polymorphisms in apolipoprotein genes have shown to be predictors of plasma lipid levels in adult cohorts receiving highly active antiretroviral therapy (HAART. Our objective was to confirm the association between the APOC3 genotype and plasma lipid levels in an HIV-1-infected pediatric cohort exposed to HAART. A total of 130 HIV-1-infected children/adolescents that attended a reference center in Argentina were selected for an 8-year longitudinal study with retrospective data collection. Longitudinal measurements of plasma triglycerides, total cholesterol, HDL-C and LDL-C were analyzed under linear or generalized linear mixed models. The contribution of the APOC3 genotype at sites -482, -455 and 3238 to plasma lipid levels prediction was tested after adjusting for potential confounders. Four major APOC3 haplotypes were observed for sites -482/-455/3238, with estimated frequencies of 0.60 (C/T/C, 0.14 (T/C/C, 0.11 (C/C/C, and 0.11 (T/C/G. The APOC3 genotype showed a significant effect only for the prediction of total cholesterol levels (p<0.0001. However, the magnitude of the differences observed was dependent on the drug combination (p = 0.0007 and the drug exposure duration at the time of the plasma lipid measurement (p = 0.0002. A lower risk of hypercholesterolemia was predicted for double and triple heterozygous individuals, mainly at the first few months after the initiation of Ritonavir-boosted protease inhibitor-based regimens. We report for the first time a significant contribution of the genotype to total cholesterol levels in a pediatric cohort under HAART. The genetic determination of APOC3 might have an impact on a large portion of HIV-1-infected children at the time of choosing the treatment regimens or on the counter-measures against the adverse effects of drugs.

  18. Long-term anti-HBs antibody persistence and immune memory in children and adolescents who received routine childhood hepatitis B vaccination.

    Science.gov (United States)

    Behre, Ulrich; Bleckmann, Gerhard; Crasta, Priya Diana; Leyssen, Maarten; Messier, Marc; Jacquet, Jeanne-Marie; Hardt, Karin

    2012-06-01

    This paper presents data from two studies that evaluated 5-y and 10-y persistence of antibodies against hepatitis B (HBV) surface antigen (anti-HBs) and immune response to an HBV vaccine challenge in children and adolescents who had received three doses of a HBV vaccine in infancy as part of routine clinical practice [NCT00519649/NCT00984139]. Anti-HBs antibody concentrations ≥ 10 mIU/ml persisted in 83.3% (95% confidence interval [CI]: 78.5–87.5) and 78.3% (95% CI: 73.1–83.0) of subjects aged 7–8 y and 12–13 y, respectively 5–10 y after infant vaccination. One month postchallenge dose, 98.2% (95% CI: 95.9–99.4) and 93.7% (95% CI: 90.2–96.2) of subjects in the two age groups, respectively had anti-HBs antibody concentrations ≥ 100 mIU/ml. Overall, 99.6% (95% CI: 98–100) and 97.2% (95% CI: 94.5–98.8) of subjects aged 7–8 y and 12–13 y mounted an anamnestic response to the HBV challenge dose, which was well-tolerated. Healthy children aged 7–8 y and adolescents aged 12–13 y received three doses of a monovalent pediatric HBV vaccine (10 μg of HBsAg) before 18 mo of age. Serum samples collected before and one month post-HBV vaccine challenge dose were tested for anti-HBs antibody concentrations. Safety assessments were made for the HBV vaccine challenge dose. A three-dose childhood HBV immunization regimen induced persistence of antibodies against HBV infection for 10 y, up to adolescence. This vaccination regimen also conferred long-term immune memory against HBV as evidenced by the strong anamnestic response to the HBV vaccine challenge, despite waning anti-HBs antibody levels.

  19. Safety and efficacy of dihydroartemisinin-piperaquine in falciparum malaria: a prospective multi-centre individual patient data analysis.

    Directory of Open Access Journals (Sweden)

    Julien Zwang

    Full Text Available BACKGROUND: The fixed dose antimalarial combination of dihydroartemisinin-piperaquine (DP is a promising new artemisinin-based combination therapy (ACT. We present an individual patient data analysis of efficacy and tolerability in acute uncomplicated falciparum malaria, from seven published randomized clinical trials conducted in Africa and South East Asia using a predefined in-vivo protocol. Comparator drugs were mefloquine-artesunate (MAS3 in Thailand, Myanmar, Laos and Cambodia; artemether-lumefantrine in Uganda; and amodiaquine+sulfadoxine-pyrimethamine and artesunate+amodiaquine in Rwanda. METHODS AND FINDINGS: In total 3,547 patients were enrolled: 1,814 patients (32% children under five years received DP and 1,733 received a comparator antimalarial at 12 different sites and were followed for 28-63 days. There was no significant heterogeneity between trials. DP was well tolerated with 1.7% early vomiting. There were less adverse events with DP in children and adults compared to MAS3 except for diarrhea; ORs (95%CI 2.74 (2.13 to 3.51 and 3.11 (2.31 to 4.18, respectively. DP treatment resulted in a rapid clearance of fever and parasitaemia. The PCR genotype corrected efficacy at Day 28 of DP assessed by survival analysis was 98.7% (95%CI 97.6-99.8. DP was superior to the comparator drugs in protecting against both P.falciparum recurrence and recrudescence (P = 0.001, weighted by site. There was no difference between DP and MAS3 in treating P. vivax co-infections and in suppressing the first relapse (median interval to P. vivax recurrence: 6 weeks. Children under 5 y were at higher risk of recurrence for both infections. The proportion of patients developing gametocytaemia (P = 0.002, weighted by site and the subsequent gametocyte carriage rates were higher with DP (11/1000 person gametocyte week, PGW than MAS3 (6/1000 PGW, P = 0.001, weighted by site. CONCLUSIONS: DP proved a safe, well tolerated, and highly effective treatment of P

  20. Immune Activation and Viral Replication after Vaccination with an Influenza A H1N1 2009 Vaccine in HIV-Infected Children Receiving Antiretroviral Therapy

    Directory of Open Access Journals (Sweden)

    Nattawat Onlamoon

    2013-01-01

    Full Text Available Immunization with a pandemic influenza A H1N1 2009 was recommended for HIV-infected patients. However, there is limited information concerning the impact of immunization with this vaccine on immune activation and HIV viral replication. In this study, 45 HIV-infected children and adolescents receiving antiretroviral therapy were immunized with a 2-dose series of nonadjuvated monovalent influenza A H1N1 2009 vaccine upon enrollment and approximately 1 month later. Immunogenicity was determined by haemagglutination inhibition assay. The level of immune activation was determined by identification of CD38 and HLA-DR on CD8+ T cells. Patients were divided into 2 groups which include patients who had an undetectable HIV viral load (HIV detectable group and patients who show virological failure (HIV nondetectable group. The results showed seroconversion rate of 55.2% in HIV nondetectable group, whereas 31.3% was found in HIV detectable group. Both groups of patients showed no major increase in immune activation after immunization. Interestingly, a decrease in the frequency of CD8+ T cells that coexpressed CD38 and HLA-DR was observed after immunization in both groups of patients. We suggested that immunization with influenza A H1N1 2009 vaccine can induce immune response to the pandemic virus without major impact on HIV viral replication and immune activation.

  1. No evidence of chromosome damage in children and adolescents with differentiated thyroid carcinoma after receiving {sup 131}I radiometabolic therapy, as evaluated by micronucleus assay and microarray analysis

    Energy Technology Data Exchange (ETDEWEB)

    Federico, Giovanni; Fiore, Lisa; Massart, Francesco; Saggese, Giuseppe [Azienda Ospedaliero-Universitaria Pisana, Department of Pediatrics, Unit of Pediatric Endocrinology and Diabetes, Pisa (Italy); Boni, Giuseppe; Lazzeri, Patrizia; Mariani, Giuliano [Azienda Ospedaliero-Universitaria Pisana, Unit of Nuclear Medicine, Pisa (Italy); Fabiani, Barbara; Verola, Carmela; Scarpato, Roberto [University of Pisa, Department of Biology, Unit of Genetics, Mutagenesis and Environmental Epidemiology, Pisa (Italy); Traino, Claudio [Azienda Ospedaliero-Universitaria Pisana, Health Physics Service, Pisa (Italy)

    2008-11-15

    As {sup 131}I therapy, used to achieve ablation of thyroid gland remnant, can cause chromosome damage in cultured peripheral lymphocytes especially, we investigated whether administration of radioiodine may induce early genome damage in peripheral T lymphocytes of adolescents with differentiated thyroid carcinoma (DTC). We studied 11 patients, aged 14.8 {+-} 3.1 years, who assumed {sup 131}I (range: 1.11-4.44 GBq) to ablate thyroid remnant. A blood sample for micronucleus assay and for evaluating expression of some genes involved in the DNA repair or the apoptosis pathways was obtained from each patient 1 h before (T{sub 0}) and 24 (T{sub 1}) and 48 h (T{sub 2}) post-radioiodine administration. Compared to T{sub 0}, we did not find any difference in the number of micronucleated cells at both T{sub 1} and T{sub 2} in any subject. Nine out of 11 patients had altered expression levels in a majority of the DNA repair and apoptosis genes at T{sub 1}, which decreased at T{sub 2}. We demonstrated for the first time that peripheral cells of DTC children and adolescents who received {sup 131}I at a mean dosage of 3.50 {+-} 0.37 GBq did not show chromosome damage within 48 h from the end of radiometabolic therapy. This may be due to a prompt activation of the cell machinery that maintains the integrity of the genome to prevent harmful double-strand breaks from progressing to chromosome mutations, either by repairing the lesions or by eliminating the most seriously damaged cells via apoptosis. (orig.)

  2. Measles virus antibody responses in children randomly assigned to receive standard-titer edmonston-zagreb measles vaccine at 4.5 and 9 months of age, 9 months of age, or 9 and 18 months of age

    DEFF Research Database (Denmark)

    Martins, Cesario; Garly, May-Lill; Bale, Carlitos

    2014-01-01

    The World Health Organization recommends administration of measles vaccine (MV) at age 9 months in low-income countries. We tested the measles virus antibody response at 4.5, 9, 18, and 24 months of age for children randomly assigned to receive standard-titer Edmonston-Zagreb MV at 4.5 and 9 months...... levels at 24 months of age. In addition, the response at both 9 and 24 months of age was inversely correlated with the antibody level at receipt of the first dose of MV, and the second dose of MV, received at 9 months of age, provided a significant boost in antibody level to children who had low antibody...... levels. In the group of 318 children who received MV at 9 months of age, with or without a second dose at 18 months of age, 99% (314) had protective levels at 24 months of age. The geometric mean titer at 24 months of age was significantly lower in the group that received MV at 4.5 and 9 months of age...

  3. Randomized, multicentre assessment of the efficacy and safety of ASAQ – a fixed-dose artesunate-amodiaquine combination therapy in the treatment of uncomplicated Plasmodium falciparum malaria

    Directory of Open Access Journals (Sweden)

    Diallo Mouctar

    2009-06-01

    Full Text Available Abstract Background The use of artemisinin derivative-based combination therapy (ACT such as artesunate plus amodiaquine is currently recommended for the treatment of uncomplicated Plasmodium falciparum malaria. Fixed-dose combinations are more adapted to patients than regimens involving multiple tablets and improve treatment compliance. A fixed-dose combination of artesunate + amodiaquine (ASAQ was recently developed. To assess the efficacy and safety of this new combination and to define its optimum dosage regimen (once or twice daily in the treatment of uncomplicated P. falciparum malaria, a multicentre clinical study was conducted. Methods A multicentre, randomized, controlled, investigator-blinded, parallel-group study was conducted in five African centers in Cameroon, Madagascar, Mali and Senegal from March to December 2006. Efficacy and safety of ASAQ were assessed compared to those of artemether + lumefantrine (AL. The WHO protocol with a 28-day follow-up for assessing the drug therapeutic efficacy was used. Patients suffering from uncomplicated P. falciparum malaria were randomized to receive ASAQ orally once daily (ASAQ1, ASAQ twice daily (ASAQ2 or AL twice daily (AL for three days. The primary outcome was PCR-corrected parasitological cure rate and clinical response. Results Of 941 patients initially randomized and stratified into two age groups ( Conclusion The non-inferiority of ASAQ compared with AL was demonstrated. The fixed-dose combination artesunate + amodiaquine (ASAQ is safe and efficacious even in young children under 5 years of age. Whilst administration on a twice-a-day basis does not improve the efficacy of ASAQ significantly, a once-a-day intake of this new combination clearly appears as an effective and safe therapy in the treatment of uncomplicated P. falciparum malaria both in adults and children. Implications of such findings are of primary importance in terms of public health especially in African countries. As

  4. Efficacy of three artemisinin combination therapies for the treatmentof uncomplicated Plasmodium falciparum malaria in the Republic of Congo

    Directory of Open Access Journals (Sweden)

    Libama François

    2006-11-01

    Full Text Available Abstract Background Presented here are the results of a comparative trial on the efficacy of three artemisinin-based combinations conducted from May to October 2004, in Pool Province, Republic of Congo. Methods The main outcome was the proportion of cases of true treatment success at day 28. Recrudescences were distinguished from re-infections by PCR analysis. A total of 298 children of 6–59 months were randomized to receive either artesunate + SP (AS+SP, artesunate + amodiaquine (AS+AQ or artemether + lumefantrine (AL, of which 15 (5% were lost to follow-up. Results After 28 days, there were 21/85 (25% recurrent parasitaemias in the AS+SP group, 31/97 (32% in the AS+AQ group and 13/100 (13% in the AL group. The 28-day PCR-corrected cure rate was 90.1% [95% CI 80.7–95.9] for AS+SP, 98.5% [95% CI 92.0–100] for AS+AQ and 100% [95.8–100] for AL, thereby revealing a weaker response to AS+SP than to AL (p = 0.003 and to AS+AQ (p = 0.06. A potential bias was the fact that children treated with AL were slightly older and in better clinical condition, but logistic regression did not identify these as relevant factors. There was no significant difference between groups in fever and parasite clearance time, improvement of anaemia and gametocyte carriage at day 28. No serious adverse events were reported. Conclusion Considering the higher efficacy of AL as compared to AS+SP and the relatively high proportion of cases with re-infections in the AS+AQ group, we conclude that AL is clinically more effective than AS+SP and AS+AQ in this area of the Republic of Congo. Implementation of the recently chosen new national first-line AS+AQ should be monitored closely.

  5. Children who received PCV-10 vaccine from a two-dose vial without preservative are not more likely to develop injection site abscess compared with those who received pentavalent (DPT-HepB-Hib vaccine: a longitudinal multi-site study.

    Directory of Open Access Journals (Sweden)

    Yemane Berhane

    Full Text Available BACKGROUND: The single dose pneumonia ten-valent vaccine has been widely used and is highly efficacious against selected strains Streptococcus pneumonia. A two-dose vial without preservative is being introduced in developing countries to reduce the cost of the vaccine. In routine settings improper immunization practice could result in microbial contamination leading to adverse events following immunization. OBJECTIVE: To monitor adverse events following immunization recommended for routine administration during infancy by comparing the rate of injection-site abscess between children who received PCV-10 vaccine and children who received the Pentavalent (DPT-HepB-Hib vaccine. METHODS: A longitudinal population-based multi-site observational study was conducted between September 2011 and October 2012. The study was conducted in four existing Health and Demographic Surveillance sites run by public universities of Abraminch, Haramaya, Gondar and Mekelle. Adverse events following Immunization were monitored by trained data collectors. Children were identified at the time of vaccination and followed at home at 48 hour and 7 day following immunization. Incidence of abscess and relative risk with the corresponding 95% Confidence Intervals were calculated to examine the risk difference in the comparison groups. RESULTS: A total of 55, 268 PCV and 37, 480 Pentavalent (DPT-HepB-Hib vaccinations were observed. A total of 19 adverse events following immunization, 10 abscesses and 9 deaths, were observed during the one year study period. The risk of developing abscess was not statistically different between children who received PCV-10 vaccine and those received Pentavalent (RR = 2.7, 95% CI 0.576-12.770, and between children who received the first aliquot of PCV and those received the second aliquot of PCV (RR = 1.72, 95% CI 0.485-6.091. CONCLUSION: No significant increase in the risk of injection site abscess was observed between the injection sites of PCV

  6. Reduction of anti-malarial consumption after rapid diagnostic tests implementation in Dar es Salaam: a before-after and cluster randomized controlled study

    Directory of Open Access Journals (Sweden)

    Swai Ndeniria

    2011-04-01

    Full Text Available Abstract Background Presumptive treatment of all febrile patients with anti-malarials leads to massive over-treatment. The aim was to assess the effect of implementing malaria rapid diagnostic tests (mRDTs on prescription of anti-malarials in urban Tanzania. Methods The design was a prospective collection of routine statistics from ledger books and cross-sectional surveys before and after intervention in randomly selected health facilities (HF in Dar es Salaam, Tanzania. The participants were all clinicians and their patients in the above health facilities. The intervention consisted of training and introduction of mRDTs in all three hospitals and in six HF. Three HF without mRDTs were selected as matched controls. The use of routine mRDT and treatment upon result was advised for all patients complaining of fever, including children under five years of age. The main outcome measures were: (1 anti-malarial consumption recorded from routine statistics in ledger books of all HF before and after intervention; (2 anti-malarial prescription recorded during observed consultations in cross-sectional surveys conducted in all HF before and 18 months after mRDT implementation. Results Based on routine statistics, the amount of artemether-lumefantrine blisters used post-intervention was reduced by 68% (95%CI 57-80 in intervention and 32% (9-54 in control HF. For quinine vials, the reduction was 63% (54-72 in intervention and an increase of 2.49 times (1.62-3.35 in control HF. Before-and-after cross-sectional surveys showed a similar decrease from 75% to 20% in the proportion of patients receiving anti-malarial treatment (Risk ratio 0.23, 95%CI 0.20-0.26. The cluster randomized analysis showed a considerable difference of anti-malarial prescription between intervention HF (22% and control HF (60% (Risk ratio 0.30, 95%CI 0.14-0.70. Adherence to test result was excellent since only 7% of negative patients received an anti-malarial. However, antibiotic

  7. Erratum to "Progress and Outcomes for Children with Autism Receiving Parent-Managed Intensive Interventions" [Research in Developmental Disabilities 22 (2001) 425-447].

    Science.gov (United States)

    Bibby, Peter; Eikeseth, Svein; Martin, Neil T.; Mudford, Oliver C.; Reeves, David

    2002-01-01

    This corrected article on parent-managed interventions with children with autism reports on analysis of data on 66 children. Findings generally indicated that, after 31.6 months of intervention, IQ scores had not changed but adaptive behavior scores had increased significantly (n=21). However, overall interventions did not reproduce results from…

  8. Repeated treatment of recurrent uncomplicated Plasmodium falciparum malaria in Senegal with fixed-dose artesunate plus amodiaquine versus fixed-dose artemether plus lumefantrine: a randomized, open-label trial

    Directory of Open Access Journals (Sweden)

    Barry Aichatou

    2011-08-01

    Full Text Available Abstract Background The use of artemisinin-based combination therapy (ACT is currently recommended for treating uncomplicated malaria. The objective was to assess the efficacy and safety of repeated administrations of two fixed-dose presentations of ACT - artesunate plus amodiaquine (ASAQ and artemether-lumefantrine (AL - in subsequent episodes of Plasmodium falciparum malaria. Methods A randomized comparative study was conducted in a rural community of central Senegal from August 2007 to January 2009. Children and adults with uncomplicated P. falciparum malaria were randomized to receive open-label ASAQ once daily or AL twice daily for three days. Drug doses were given according to body weight. Treatments for first episodes were supervised. For subsequent episodes, only the first intake of study drug was supervised. ECGs and audiograms were performed in patients ≥12 years of age. Primary outcome was adequate clinical and parasitological response rate (ACPR after polymerase chain reaction (PCR correction on day 28 for the first episode. Results A total of 366 patients were enrolled in the two groups (ASAQ 184, AL 182 and followed up during two malaria transmission seasons. In the intent-to-treat population, PCR-corrected ACPRs at day 28 for the first episode were 98.4% and 96.2%, respectively, in the ASAQ and AL groups. For the per-protocol population (ASAQ 183, AL 182, PCR-corrected ACPRs at day 28 for the first episode were 98.9% and 96.7%, respectively. A 100% ACPR rate was obtained at day 28 in the 60 and four patients, respectively, who experienced second and third episodes. Treatment-related adverse events were reported in 11.7% of the patients, without significant differences between the two groups. A better improvement of haemoglobin at day 28 was noted in the ASAQ versus the AL group (12.2 versus 11.8 g/dL; p = 0.03. No sign of ototoxicity was demonstrated. A prolongation of the QTc interval was observed in both groups during

  9. Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme

    Directory of Open Access Journals (Sweden)

    Simiyu Chrispinus

    2011-10-01

    Full Text Available Abstract Background Poor access to prompt and effective treatment for malaria contributes to high mortality and severe morbidity. In Kenya, it is estimated that only 12% of children receive anti-malarials for their fever within 24 hours. The first point of care for many fevers is a local medicine retailer, such as a pharmacy or chemist. The role of the medicine retailer as an important distribution point for malaria medicines has been recognized and several different strategies have been used to improve the services that these retailers provide. Despite these efforts, many mothers still purchase ineffective drugs because they are less expensive than effective artemisinin combination therapy (ACT. One strategy that is being piloted in several countries is an international subsidy targeted at anti-malarials supplied through the retail sector. The goal of this strategy is to make ACT as affordable as ineffective alternatives. The programme, called the Affordable Medicines Facility - malaria was rolled out in Kenya in August 2010. Methods In December 2010, the affordability and accessibility of malaria medicines in a rural district in Kenya were evaluated using a complete census of all public and private facilities, chemists, pharmacists, and other malaria medicine retailers within the Webuye Demographic Surveillance Area. Availability, types, and prices of anti-malarials were assessed. There are 13 public or mission facilities and 97 medicine retailers (registered and unregistered. Results The average distance from a home to the nearest public health facility is 2 km, but the average distance to the nearest medicine retailer is half that. Quinine is the most frequently stocked anti-malarial (61% of retailers. More medicine retailers stocked sulphadoxine-pyramethamine (SP; 57% than ACT (44%. Eleven percent of retailers stocked AMFm subsidized artemether-lumefantrine (AL. No retailers had chloroquine in stock and only five were selling artemisinin

  10. My partner wants a child: A cross-sectional study of the determinants of the desire for children among mutually disclosed sero-discordant couples receiving care in Uganda

    Directory of Open Access Journals (Sweden)

    Mirembe Florence

    2010-05-01

    Full Text Available Abstract Background The percentages of couples in HIV sero-discordant relationships range from 5 to 31% in the various countries of Africa. Given the importance of procreation and the lack of assisted reproduction to avoid partner transmission, members of these couples are faced with a serious dilemma even after the challenge of disclosing their HIV status to their spouses. Identifying the determinants of the decision to have children among sero-discordant couples will help in setting reproductive intervention priorities in resource-poor countries. Methods We conducted a survey among 114 mutually disclosed sero-discordant couples (228 individuals receiving HIV care at four centres in Greater Kampala, between June and December 2007. The data we collected was classified according to whether the man or the woman was HIV-positive. We carried out multivariate logistic regression modelling to determine factors (age, gender, and the influences of relatives and of health workers, ART knowledge, and disclosure that are independently associated with a desire for children. Results The majority, 59%, of the participants, desired to have children. The belief that their partner wanted children was a major determinant of the desire to have children, irrespective of the HIV sero-status (adjusted odds ratio 24.0 (95% CI 9.15, 105.4. Among couples in which the woman was HIV-positive, young age and relatives' expectations for children were significantly associated with increased fertility desire, while among couples in which the man was positive; knowledge of ART effectiveness was associated with increased fertility desire. Availability of information on contraception was associated with decreased fertility desire. Conclusions The gender of the positive partner affects the factors associated with a desire for children. Interventions targeting sero-discordant couples should explore contraceptive choices, the cultural importance of children, and partner

  11. Perioperative respiratory adverse events in children with active upper respiratory tract infection who received general anesthesia through an orotracheal tube and inhalation agents

    OpenAIRE

    Kim, So Yeon; Kim, Jeong Min; Lee, Jae Hoon; Kang, Young Ran; Jeong, Seung Ho; Koo, Bon-Nyeo

    2013-01-01

    Background Active upper respiratory tract infection (URI), orotracheal intubation and use of inhalation anesthetics are known risk factors for perioperative respiratory adverse events (RAE). This study investigated the risk factors of perioperative RAE in children with these risk factors. Methods The records of 159 children who underwent general anesthesia with an orotracheal tube and inhalation were reviewed. These patients also had at least one of the following URI symptoms on the day of su...

  12. Breastfeeding and the anthropometric profile of children with sickle cell anemia receiving follow-up in a newborn screening reference service

    Directory of Open Access Journals (Sweden)

    Zeni Drubi Nogueira

    2015-06-01

    Full Text Available OBJECTIVE: To study the breastfeeding history (BF and the anthropometric status of children with Sickle Cell Disease (SCD. METHODS: A cross-sectional study of 357 children with SCD aged between 2 and 6 years, regularly followed at a Newborn Screening Reference Service (NSRS between November 2007 and January 2009. The outcome was anthropometric status and the exposures were: BF pattern, type of hemoglobinopathy and child's age and gender. RESULTS: The mean (SD age was 3.7 (1.1 years, 52.9% were boys and 53.5% had SCA (hemoglobin SS. The prevalence of exclusive breastfeeding (EBR up to six months of age was 31.5%, the median EBR times (p25-p75 was 90.0 (24.0-180.0 days and the median weaning ages (p25-p75 was 360.0 (90.0-720.0 days respectively. Normal W/H children experienced EBR for a mean duration almost four times longer than malnourished children (p=0.01, and were weaned later (p<0.05. Height deficit was found in 5.0% of children, while all the children with severe short stature had had SCA (hemoglobin SS and were older than 4 years of age. CONCLUSIONS: EBF time and weaning age were greater than that found in the literature, which is a possible effect of the multidisciplinary follow-up. Duration of EBF and later weaning were associated with improved anthropometric indicators.

  13. Bilingual Vocabulary Production in Young Children Receiving Maltese-Dominant Exposure: Individual Differences and the Influence of Demographic and Language Exposure Factors

    Science.gov (United States)

    Gatt, Daniela

    2017-01-01

    This study explored individual variability in the bilingual vocabularies of 65 Maltese children aged 23-27 months (N = 33) and 30-34 months (N = 32). Most of the participants' direct input consisted of Maltese sentences embedding English words. Bilingualism was present at the societal level. Word production was measured through parental report,…

  14. Oral manifestations of HIV infection in children and adults receiving highly active anti-retroviral therapy [HAART] in Dar es Salaam, Tanzania.

    NARCIS (Netherlands)

    Hamza, O.; Matee, M.I.N.; Simon, E.N.; Kikwilu, E.; Moshi, M.J.; Mugusi, F.; Mikx, F.H.M.; Verweij, P.E.; Ven, A.J.A.M. van der

    2006-01-01

    ABSTRACT: BACKGROUND: The aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+

  15. Immunogenicity and safety of monovalent RIVM meningococcal B OMP vesicle F91 vaccine administered to children that received hexavalent meningococcal B vaccine 2.5 years ago

    NARCIS (Netherlands)

    Lafeber AB; Limpt CJP van; Berbers GAM; Labadie J; Kleijn ED de; Groot R de; Rumke HC; Alphen AJW van; Sophia Kinderziekenhuis /; LVO

    2000-01-01

    This report describes the results with respect to immunogenicity as well as reactogenicity of a monovalent P1.7h,4 OMV vaccine (MonoMen) used as booster vaccination in children previously vaccinated with a hexavalent MenB vaccine. The participants in this study were immunised in 1995-1996 with hexav

  16. Short-term risk of disease progression in HIV-1-infected children receiving no antiretroviral therapy or zidovudine monotherapy : a meta-analysis

    NARCIS (Netherlands)

    Dunn, DT; Gibb, DM; Duong, T; Babiker, AG; Bulterys, M; Gabiano, C; Galli, L; Giaquinto, C; Harris, DR; Hughes, M; McKinney, R; Mofenson, L; Moye, J; Newell, ML; Pahwa, S; Palumbo, P; Rudin, C; Schluchter, M; Sharland, M; Shearer, W; Thompson, B; Tookey, P

    2003-01-01

    Background Data on the short-term risk of disease progression in HIV-1-infected children are needed to address the question of when to begin combination antiretroviral therapy. We estimated 12-month risks of progression to AIDS and death, by age and most recent measurement of CD4 T-cell percentage (

  17. Number and Controllability of Reinforcers as Predictors of Individual Outcome for Children with Autism Receiving Early and Intensive Behavioral Intervention: A Preliminary Study

    Science.gov (United States)

    Klintwall, Lars; Eikeseth, Svein

    2012-01-01

    Although Early and Intensive Behavioral Intervention (EIBI) is an effective treatment for many children with autism, there is a substantial individual difference in outcome. This study was designed to investigate whether treatment gains were associated with the number and type of stimuli that function as reinforcers for 21 preschool-aged children…

  18. A Comparison of the Cognitive Development of 3-6 Year-Old Children Who Receive Family-Supported Preschool Education, Institutional Education and No Education

    Science.gov (United States)

    Zembat, Rengin; Kuday, Fatma Servet

    2010-01-01

    This study aims to examine the effects of Family Supported Preschool Education programs on the development of preschool children. By measuring the effects of family-supported preschool education on cognitive development, this study helps support alternative methods of making preschool education more widespread. The study uses the experimental…

  19. Electronic warfare receivers and receiving systems

    CERN Document Server

    Poisel, Richard A

    2014-01-01

    Receivers systems are considered the core of electronic warfare (EW) intercept systems. Without them, the fundamental purpose of such systems is null and void. This book considers the major elements that make up receiver systems and the receivers that go in them.This resource provides system design engineers with techniques for design and development of EW receivers for modern modulations (spread spectrum) in addition to receivers for older, common modulation formats. Each major module in these receivers is considered in detail. Design information is included as well as performance tradeoffs o

  20. Validity of Measures Reflecting Visual Discrimination and Linguistic Constructs for a Sample of Second-Grade Hispanic Children Receiving Reading Instruction in Spanish.

    Science.gov (United States)

    Morrison, James A.; Michael, William B.

    1984-01-01

    The concurrent and discriminant validity of La Prueba de Analisis Auditivo, a Spanish auditory perception test, and the validity of the perceptual deficit hypothesis and of hypotheses derived from verbal processing theory were evaluated in a sample of 114 second-grade Hispanic pupils receiving reading instruction in Spanish. (Author/BW)

  1. Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapy

    Directory of Open Access Journals (Sweden)

    Bacha Tigist

    2012-08-01

    Full Text Available Abstract Background The emergence of resistance to first line antiretroviral therapy (ART regimen leads to the need for more expensive and less tolerable second line drugs. Hence, it is essential to identify and address factors associated with an increased probability of first line ART regimen failure. The objective of this article is to report on the predictors of first line ART regimen failure, the detection rate of ART regime failure, and the delay in switching to second line ART drugs. Methods A retrospective cohort study was conducted from 2005 to 2011. All HIV infected children under the age of 15 who took first line ART for at least six months at the four major hospitals of Addis Ababa, Ethiopia were included. Data were collected, entered and analyzed using Epi info/ENA version 3.5.1 and SPSS version 16. The Cox proportional-hazard model was used to assess the predictors of first line ART failure. Results Data of 1186 children were analyzed. Five hundred seventy seven (48.8% were males with a mean age of 6.22 (SD = 3.10 years. Of the 167(14.1% children who had treatment failure, 70 (5.9% had only clinical failure, 79 (6.7% had only immunologic failure, and 18 (1.5% had both clinical and immunologic failure. Patients who had height for age in the third percentile or less at initiation of ART were found to have higher probability of ART treatment failure [Adjusted Hazard Ratio (AHR, 3.25 95% CI, 1.00-10.58]. Patients who were less than three years old [AHR, 1.85 95% CI, 1.24-2.76], chronic diarrhea after initiation of antiretroviral treatment [AHR, 3.44 95% CI, 1.37-8.62], ART drug substitution [AHR, 1.70 95% CI, 1.05-2.73] and base line CD4 count below 50 cells/mm3 [AHR, 2.30 95% CI, 1.28-4.14] were also found to be at higher risk of treatment failure. Of all the 167 first line ART failure cases, only 24 (14.4% were switched to second line ART with a mean delay of 24 (SD = 11.67 months. The remaining 143 (85.6% cases were diagnosed

  2. Optimizing the interval between G-CSF therapy and F-18 FDG PET imaging in children and young adults receiving chemotherapy for sarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Trout, Andrew T.; Sharp, Susan E.; Gelfand, Michael J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Turpin, Brian K. [Cincinnati Children' s Hospital Medical Center, Cancer and Blood Diseases Institute, Division of Oncology, Cincinnati, OH (United States); Zhang, Bin [Cincinnati Children' s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH (United States)

    2015-07-15

    Granulocyte colony-stimulating factors (G-CSF) speed recovery from chemotherapy-induced myelosuppression but the marrow stimulation they cause can interfere with interpretation of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) exams. To assess the frequency of interfering G-CSF-induced bone marrow activity on FDG PET imaging in children and young adults with Ewing sarcoma and rhabdomyosarcoma and to define an interval between G-CSF administration and FDG PET imaging that limits marrow interference. Blinded, retrospective review of FDG PET exams performed in patients treated with long-acting G-CSF as part of their chemotherapeutic regimen. Exams were subjectively scored by two reviewers (R1 and R2) who assessed the level of marrow uptake of FDG and measured standardized uptake values in the marrow, liver, spleen and blood pool. FDG PET findings were correlated with time since G-CSF administration and with blood cell counts. Thirty-eight FDG PET exams performed in 17 patients were reviewed with 47.4% (18/38) of exams having marrow uptake of FDG sufficient to interfere with image interpretation. Primary predictors of marrow uptake of FDG were patient age (P = 0.0037) and time since G-CSF exposure (P = 0.0028 for subjective marrow uptake of FDG, P = 0.008 [R1] and P = 0.004 [R2] for measured maximum standardized uptake value (SUVmax)). The median interval between G-CSF administration and PET imaging in cases with marrow activity considered normal or not likely to interfere was 19.5 days (range: 7-55 days). In pediatric and young adult patients with Ewing sarcoma and rhabdomyosarcoma, an interval of 20 days between administration of the long-acting form of G-CSF and FDG PET imaging should limit interference by stimulated marrow. (orig.)

  3. 儿童髓母细胞瘤34例三维适形放射治疗的疗效分析%The follow-up of 34 children with medulloblastoma who received 3-dimensional conformal radiation therapy

    Institute of Scientific and Technical Information of China (English)

    Dongfeng He; Siheng Ha; Changsheng Wang

    2009-01-01

    Objective: In our investigation, we studied the patients with medulloblastoma who received 3-dimensional con- formal radiation therapy (3DCRT) and recorded their effects, side effects and failure reasons. Methods: From August 2001 to August 2007, 34 children with medulloblastoma were treated in our hospital. The age at diagnosis was 3-16 years old, and the mean age at diagnosis was 9.5 years old. Among all the patients, 16 cases were included in the high risk group and 18cases were included in the low risk group. All the patients were performed total resection or subtotal resection and no patientsreceived radiotherapy or chemotherapy before operation. All patients received 3DCRT within 3 weeks after resection. The dose of 30 Gy were given to the whole brain and whole spine, followed by 20-25 Gy boosted to the posterior brain fossa. The median fraction dose was 180 cGy. Every patient received the chemotherapy scheme of the Lomustine, Cisplatinum and Vincristine. Nobody received intrathecal chemotherapy. The tests of the complete blood count, blood biochemistry, hepatic and renal functions were required before every cycle of chemotherapy. Results: 5-year overall survival (OS) and 5-year disease free survival (DFS) were 71% and 62% respectively. The median follow-up time was 36.5 months. The 5-year OS of the high risk group was 71% compared to 62% of the low risk group. There were significant difference between the two groups (P = 0.01). There were 13 failure cases in all the patients. Of these 13 patients, 10 were dead and the other 3 were alive with tumor. The complete remission (CR) rate was 70.5% and the partial remission (PR) rate was 14%. Among the failure patients, there were 3 patients (8.8%) with the recurrences located in the brain of cribriform region. The 5-year OS of the patients with preoperative metastases was 12.5% (1/8), and which of the patients with residual tumor volume > 1.5 cm3 was 0% (0/5). Through the statistic analysis, it was found that both

  4. Musical therapy for children receiving venous transfusion in outpatient department%浅析音乐治疗在儿内科门诊静脉穿刺输液治疗患儿中的应用

    Institute of Scientific and Technical Information of China (English)

    段建华; 张婧雯; 张倩丽

    2013-01-01

    目的 通过分析患儿在北京新世纪儿童医院儿内科门诊静脉穿刺输液治疗时接受音乐治疗前后行为及言语紧张度数据,积累音乐治疗在儿科静脉穿刺输液治疗中的应用经验.方法 北京新世纪儿童医院门诊接受静脉穿刺输液治疗同时接受音乐治疗的患儿23名,采取行为评价量表和家长问卷评价患儿接受音乐治疗前后的行为和语言指标.结果 在儿内科门诊静脉穿刺输液治疗时接受音乐治疗可以使患儿语言恐惧表达率和紧张性肢体动作出现率降低,差异有统计学意义.结论 音乐治疗可以减轻静脉穿刺输液治疗对儿童的不良情绪刺激.%Objective To share the experience of musical therapy for children who receive venous transfusion in outpatient department. Methods Behavior scales and parents questionnaire were developed to obtain data before and after musical therapy for children receiving venous transfusion. Results Musical therapy could significantly reduce fearful language expression and tonic limb action. Conclusion Musical therapy was effective in reducing anxiety and distress.

  5. Application of virtual reality to children receiving removal of baby teeth%虚拟现实技术在儿童乳牙拔除术中的应用

    Institute of Scientific and Technical Information of China (English)

    熊晓菊; 毛靖

    2012-01-01

    Objective To explore the effect of virtual reality as a distraction method on pain relief during baby teeth removal. Methods Totally. 120 children aged 5 - 12 years old who needed to have their baby teeth removed were recruited and divided into an observation group of 60 and a control group of 60 according to their order of treatment. Children in the control group received conventional treatment, while those in the observation group were asked to wear visual-aiding device of virtual reality system during the process of teeth removal. Results The observation group perceived less severe pain during the process of teeth removal than the control group (P<0. 01). Conclusion The application of virtual reality as a distraction method can effectively relieve pain during the process of baby teeth removal for children. However, the game imbedded in the virtual reality system is claimed by some children to be too simple, which makes development of varied games in catering to children in different age groups a necessity.%目的 探索虚拟现实技术分散注意力疗法缓解儿童乳牙拔除术中疼痛的效果.方法 将120例5~12岁需拔除乳牙的患儿纳入试验,按就诊先后顺序分配到观察组和对照组各60例.对照组患儿接受常规方法拔牙,观察组患儿在常规拔牙的基础上于拔牙前5 min使用虚拟现实系统直至拔牙结束.结果 观察组患儿拔牙时疼痛程度显著低于对照组(P<0.01).结论 虚拟现实技术分散注意力疗法能有效缓解患儿乳牙拔除术中的疼痛,但游戏方法稍显简单,应针对不同年龄患儿研发适合的游戏.

  6. 我国流动人口子女平等受教育权的立法保障问题探讨%Discussion about Protection of Migrant Childrens' Equal Rights to Receive Education in Legislation

    Institute of Scientific and Technical Information of China (English)

    柯罗妮娜

    2015-01-01

    There are many inequalities in enrolment conditions, education fees and sharing public education resources when comparing migrant children with residential children at present, which infringe the former's equal rights to receive education. As a constitutional right, kinds of social problems will arise if it is unrealized. By analyzing this problem, the article suggests from the aspect of legislative protection that the legislature record migration freedom into constitution, reform the household registration system, and enact education law and statutes aiming at protecting migrant children.%当前流动人口子女与城镇常住人口子女相比,在入学条件、费用负担、公共教育资源享用等方面存在着诸多不平等现象,平等受教育权受到严重侵害。平等受教育权是我国宪法规定的一项基本权利,而基本权利得不到实现容易导致诸多社会问题的产生。在对此问题的现状进行分析与探讨后,从立法保障层面提出了在宪法中增加“迁徙自由权”、改革户籍制度、制定专门保护流动人口子女的教育法规等建议。

  7. 哮喘患儿吸入糖皮质激素治疗5年后过敏原变化观察%Allergen sensitization changes in asthmatic children receiving inhaled corticosteroid therapy for five years

    Institute of Scientific and Technical Information of China (English)

    汤正珍; 郑跃杰; 王和平; 宋萍; 刘晓莉; 刘萍; 白大明; 王莉

    2012-01-01

    目的 了解哮喘患儿吸入糖皮质激素(ICS)治疗5年后的过敏原变化情况.方法 对2003-2004年在深圳市儿童医院哮喘门诊登记且登记时均行皮肤点刺实验(SPT)并给予ICS治疗的133例哮喘患儿,进行现场回顾性调查.现场调查包括填写调查表和复查SPT.结果 133例哮喘患儿完成了5年前后的2次SPT检测,5年前121例(91%)SPT阳性,12例(9%)SPT阴性;5年后133例中119例 (89.5%)SPT检测阳性,14例(10.5%)SPT阴性,与5年前比较,差异无统计学意义(P>0.05).5年后吸入性过敏原和食物过敏原的阳性率均无明显变化,但蟑螂和树花粉明显增加(P>0.05),牛奶、鸡蛋明显减少(P>0.05).结论 哮喘患儿5年后过敏率变化不大,吸入性过敏有所增加,食物过敏有减少趋势.屋尘螨和粉尘螨仍然是主要过敏原.ICS治疗与否对过敏情况无明显影响.%Objective To assess the allergen -sensitization changes in asthmatic children receiving inhaled corticosteroid (ICS) therapy for 5 years. Methods . The retrospective study was carried out in 133 asthmatic children receiving treatment of ICS from 2003-2004 in Shenzhen Children' s Hospital. The patients were assessed by questionnaire and skin prick tests (SPT).Results Totally 133 patients finished the SPT before and after five years. The positive rate of SPT in 133 cases was 91% before five years,which was not significantly different(P > 0.05)from that of the patients (89.5%)af-ter five years . There was no significant increase in food and inhalant hypersensitivity (P > 0.05) ,but Cockroach and Tree-pollen increased obviously, and milk and eggs were reduced significantly.Conclusions Allergen sensitization changes in asthmatic children received inhaled corticosteroid therapy for five years are small.Inhalant allergens increase obviously, but the tendency of food hypersensitivity is reduced.Dermatophagoldes pteronyssinus and Dermatophagoides farina are still the main allergen.

  8. 授权式教育在行PICC化疗患儿家属健康教育中的应用%Application of empowerment education in health education of families of children receiving chemotherapy with percutaneously inserted central catheter

    Institute of Scientific and Technical Information of China (English)

    沈燕; 周玉峰; 王娟

    2014-01-01

    Objective To study the application effects of empowerment education in health education for families of children receiving chemotherapy with percutaneously inserted central catheter .Method Thirty five families of chil-dren diagnosed with malignancy and placed with percutaneously inserted central catheter (PICC) were enrolled in this study .Anxiety indexes of families of children before and after placed with PICC were assessed by Self-rating anxiety scale (SAS) established by Zung .Knowledge level of before and after PICC placement was evaluated by homemade health education evaluation .Result Compared with the parents of children before PICC treatment ,they known better of PICC after empowerment education (P< 0 .05) .Parents'anxiety was significantly reduced after PICC treatment ,There was significant differences between the two (P<0 .05) .Conclusion Empowerment education makes the families to participate in all aspects of health care ,changing their behavior and mental fitness and impro-ving their autonomy participation significantly .%目的:探讨授权式教育在行PICC化疗患儿家属健康教育中应用的效果。方法选取确诊为恶性肿瘤患儿行PICC置管的家属35例,分别在置管前和置管后采用Zung焦虑自评量表(SAS)测定家属焦虑指数,应用自制健康教育评价表观察比较置管前后家属对置管相关知识的掌握情况。结果置管后患儿家属对授权式教育获得的PICC知识掌握情况优于置管前(P<0.05),焦虑情绪明显减轻,与置管前相比差异有显著意义(P<0.05)。结论授权式教育让家庭参与健康照顾的各个方面,改变患儿家属行为方式和心理适应度,明显提升了患儿家属的自主性和参与性。

  9. Highly Sensitive Optical Receivers

    CERN Document Server

    Schneider, Kerstin

    2006-01-01

    Highly Sensitive Optical Receivers primarily treats the circuit design of optical receivers with external photodiodes. Continuous-mode and burst-mode receivers are compared. The monograph first summarizes the basics of III/V photodetectors, transistor and noise models, bit-error rate, sensitivity and analog circuit design, thus enabling readers to understand the circuits described in the main part of the book. In order to cover the topic comprehensively, detailed descriptions of receivers for optical data communication in general and, in particular, optical burst-mode receivers in deep-sub-µm CMOS are presented. Numerous detailed and elaborate illustrations facilitate better understanding.

  10. Development and linear growth in diabetic children who receiving insulin pigment%强化胰岛素治疗后1型糖尿病儿童生长发育情况调查

    Institute of Scientific and Technical Information of China (English)

    毛莉; 陆卫平; 季峰; 吕述军

    2011-01-01

    Objective:To ascertain if there is difference between the development and linear growth of children diagnosed with diabetes who have been receiving insulin pigment and unaffected children. Methods:Retrospective analysis of 57 children with diabetes who were diagnosed from the ages of 6 to 10 years old (26 boys and 31 girls),record their height and weight until they reached their 18th birthday. Results: At the onset of diabetes,diabetic children were slightly taller than unaffected children. When they reached their finial height,they were slightly shorter than unaffectd people,however,there was no significant difference between the two groups both in these two periods. The onset of puberty was delayed significantly both in boys and girls. The median age of onset of puberty was 12.62(95%CI 11.54~12.50) years in diabetic boys versus 10.55(10.27~10.79) years in general-population boys and 11.13 (95%CI 10.8~11.46) years versus 9.2 (9.06~9.32) years in girls,with the menarche of diabetic girls starting at 14.15 (13.64~14.65) years versus 12.27 (12.16~12.39) years. All the children with diabetes were thinner than the general-population children when they were diagnosed [male BMI:(14.45 ± 1.35) kg/m2 versus (16.08 ± 0.59) kg/m2,t = -0.63,P 0.05;female BMI (23.95 ± 2.37) kg/m2 versus(20.30 ± 0.00) kg/m2,t = 8.60,P < 0.05]. Conclusion:The development of patients with diabetes who have been receiving insulin pigment were still adversely affected but the finial height haven't been affected significantly. All the children, especially girls,became fatter when they reached their finial height.%目的:调查接受胰岛素治疗、血糖控制良好的1型糖尿病患儿的生长发育与一般人群是否存在差异。方法:选取自1993年1月~2003年1月于本院首次确诊的1型糖尿病患儿57例(男26例,女31例,起病年龄6~10岁)。记录并进行回顾分析其自起病至成年的身高、体重以及青春启动年龄和女性患儿

  11. Low complexity MIMO receivers

    CERN Document Server

    Bai, Lin; Yu, Quan

    2014-01-01

    Multiple-input multiple-output (MIMO) systems can increase the spectral efficiency in wireless communications. However, the interference becomes the major drawback that leads to high computational complexity at both transmitter and receiver. In particular, the complexity of MIMO receivers can be prohibitively high. As an efficient mathematical tool to devise low complexity approaches that mitigate the interference in MIMO systems, lattice reduction (LR) has been widely studied and employed over the last decade. The co-authors of this book are world's leading experts on MIMO receivers, and here they share the key findings of their research over years. They detail a range of key techniques for receiver design as multiple transmitted and received signals are available. The authors first introduce the principle of signal detection and the LR in mathematical aspects. They then move on to discuss the use of LR in low complexity MIMO receiver design with respect to different aspects, including uncoded MIMO detection...

  12. Delphi Accounts Receivable Module -

    Data.gov (United States)

    Department of Transportation — Delphi accounts receivable module contains the following data elements, but are not limited to customer information, cash receipts, line of accounting details, bill...

  13. Analysis on detection results of trace elements in 2 963 children receiving physical examination in Chengdu city%成都市2963例体检儿童微量元素检测结果分析

    Institute of Scientific and Technical Information of China (English)

    刘芳; 甘春玉; 李文胜; 沈川; 柳晓琴; 石华

    2013-01-01

    目的:了解成都地区0 ~14岁儿童体内微量元素的含量,分析其异常的原因,探讨干预措施及纠正方法.方法:原子吸收光谱法检测2 963例正常儿童全血微量元素(铜、锌、钙、镁、铁、铅、镉)含量,比较年龄、性别对微量元素异常的影响.结果:成都地区正常体检儿童血锌、钙、铁和铅的异常率相对较高,血铅有随年龄增加异常率增加的趋势,血铁及血钙5岁以下组与5岁以上组异常率比较差异有统计学意义(P<0.05),各微量元素测定结果无性别差异.结论:儿童微量元素含量与生理周期及喂养习惯有密切关系,婴儿期应注意补铁,幼儿期侧重补钙,良好的生活环境及个人卫生习惯可以预防铅中毒的发生.%Objective: To understand the contents of trace elements in 0 - 14 years old children in Chengdu city, analyze the causes of abnormal trace elements contents, and explore the interventional measures and correction methods.Methods: Atomic absorption spec-trometry was used to detect the contents of copper, zinc, calcium, magnesium, iron, lead, and cadmium in whole blood of 2 963 normal children, the effects of age and gender on abnormal trace elements.Results: The abnormal rates of blood zinc, calcium, iron, and lead in children receiving physical examination in Chengdu city were relatively high, the abnormal rate of blood lead showed an increasing trend with age, there were statistically significant differences in abnormal rates of blood iron and calcium between under 5 years old group and more than 5 years old group ( P < 0.05 ) , there was no gender difference in detection results of trace elements.Conclusion: The contents of trace elements in children are correlated with physiological cycle and feeding habits.Iron supplementation during infant period should be paid more attention, and calcium supplementation should be focused on during toddle period.Good living environment and personal health habits can

  14. Percepción y expectativas de cuidadoras de niños con gran discapacidad: Sobre la atención sanitaria recibida Perception and expectations of mothers with seriously disable children on received sanitary attention

    Directory of Open Access Journals (Sweden)

    María Isabel Cruz-Escobosa

    2006-11-01

    Full Text Available Objetivos: (1 Conocer la percepción que tienen las cuidadoras principales de niños con Gran Discapacidad respecto a la atención recibida dentro del Sistema Sanitario Público de Andalucía. (2 Identificar propuestas de mejora para la atención integral tanto de los niños, como de sus cuidadoras. Metodología: estudio cualitativo mediante Grupo Focal con madres/padres de niños y niñas diagnosticados de patologías crónicas que generan gran dependencia con edades comprendidas entre 4 y 12 años. Resultados: las repercusiones de la enfermedad de sus hijos en sus familias y en ellas supusieron un impacto total. Expresan una falta de apoyo familiar efectivo y de tiempo para su autocuidado. Perciben un trato y una atención mejorable por parte de algunos de los profesionales de Atención Especializada. En el Centro de Salud ven muy positivo el trato de los profesionales, la accesibilidad, las facilidades que encuentran ante cualquier problema que les surge y ahora el plan de atención a cuidadoras de grandes discapacitados. Conclusiones: es necesario tener en cuenta la visión de las madres en el tratamiento de la enfermedad de sus hijos. Asumirla por los profesionales como una información valiosa va a producir una mejora en la calidad prestada. Valoran que se les informe con claridad y no técnicamente. Cualquier intervención del sistema socio-sanitario debe abarcar al paciente, a la cuidadora y a la familia, aumentar las prestaciones ofrecidas, especialmente el tratamiento rehabilitador y facilitar recursos para minimizar la sobrecarga económica y emocional.Objectives: (1 To know the perception which they have the main nursemaids of children with seriously disabilities about the attention received within the Public System Sanitary of Andalusia, identifying strong and weak points. (2 To as much identify proposals of improvement for the integral attention of the children, as of its nursemaids. Methodology: qualitative study by means of Focal

  15. Study of the factors associated with dental caries in children who receive early dental care Estudo de fatores associados à cárie dental em crianças que recebem atendimento odontológico precoce

    Directory of Open Access Journals (Sweden)

    Fabian Calixto FRAIZ

    2001-09-01

    Full Text Available The present study investigated the factors associated with the development of dental caries in preschool children who receive regular dental care and follow-up. The research was carried out at the Baby Clinic, Londrina State University, and comprised two hundred preschool children, whose ages ranged from 24 to 48 months, as well as their mothers, who had already taken part in a dental program at the Baby Clinic during, at least, the previous twelve months. Regarding oral hygiene habits, there was no significant difference between the preschool children who presented with caries and those who did not present with caries. However, the presence of visible bacterial plaque on the upper incisors was strongly associated with the presence of dental caries. Other factors associated with the presence of caries were: period of formal education of the father or of both parents equal or inferior to 8 years, high sugar consumption and bottle-feeding during sleep. In the studied population, the dietary pattern is still the main cause of carious lesions. In addition, the presence of visible bacterial plaque on the labial surface of the upper incisors must be considered as an important clinical sign, often associated with inadequate patterns of diet and oral hygiene.Esta pesquisa estudou os fatores associados com o desenvolvimento de cárie dentária em pré-escolares que recebem acompanhamento e intervenção odontológica. O estudo abrangeu 200 crianças, de 24 a 48 meses de idade, que participavam do programa da Bebê-Clínica (Universidade Estadual de Londrina havia pelo menos 12 meses. A comparação entre as crianças com cárie e sem cárie não apresentou diferenças estatisticamente significantes com relação aos hábitos de higiene bucal. No entanto, a presença de placa visível nos incisivos superiores esteve fortemente associada com a presença de cárie dentária. Outros fatores relacionados à presença de cárie foram a educação formal

  16. Wideband CMOS receivers

    CERN Document Server

    Oliveira, Luis

    2015-01-01

    This book demonstrates how to design a wideband receiver operating in current mode, in which the noise and non-linearity are reduced, implemented in a low cost single chip, using standard CMOS technology.  The authors present a solution to remove the transimpedance amplifier (TIA) block and connect directly the mixer’s output to a passive second-order continuous-time Σ∆ analog to digital converter (ADC), which operates in current-mode. These techniques enable the reduction of area, power consumption, and cost in modern CMOS receivers.

  17. Maximizing antimalarial efficacy and the importance of dosing strategies.

    Science.gov (United States)

    Beeson, James G; Boeuf, Philippe; Fowkes, Freya J I

    2015-05-09

    Artemisinin-based combination therapies (ACTs) are the cornerstone for the treatment of malaria. However, confirmed resistance to artemisinins in South-East Asia, and reports of reduced efficacy of ACTs raise major concerns for malaria treatment and control. Without new drugs to replace artemisinins, it is essential to define dosing strategies that maximize therapeutic efficacy, limit the spread of resistance, and preserve the clinical value of ACTs. It is important to determine the extent to which reduced efficacy of ACTs reflects true resistance versus sub-optimal dosing, and quantify other factors that determine treatment failure. Pooled analyses of individual patient data from multiple clinical trials, by investigators in the Worldwide Antimalarial Resistance Network, have shown high overall efficacy for three widely used ACTs, artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine. Analyses also highlight that suboptimal dosing leads to increased risk of treatment failure, especially among children. In the most recent study, an analysis of clinical trials of artesunate-amodiaquine, widely used among children in Africa, revealed a superior efficacy for fixed-dose combination tablets compared to loose non-fixed dose combinations. This highlights the benefits of fixed-dose combinations as a practical strategy for ensuring optimal antimalarial dosing and maximizing efficacy. Please see related article: http://www.biomedcentral.com/1741-7015/13/66.

  18. Treatment Methods for Kidney Failure in Children

    Science.gov (United States)

    ... after the transplant before they get any additional vaccines. Children who take immunosuppressive medications should not receive vaccines ... Children with kidney failure should receive the standard vaccinations recommended for all children, as well as vaccinations to prevent influenza and ...

  19. Zero-power receiver

    Energy Technology Data Exchange (ETDEWEB)

    Brocato, Robert W.

    2016-10-04

    An unpowered signal receiver and a method for signal reception detects and responds to very weak signals using pyroelectric devices as impedance transformers and/or demodulators. In some embodiments, surface acoustic wave devices (SAW) are also used. Illustrative embodiments include satellite and long distance terrestrial communications applications.

  20. Subjective discomfort in children receiving 3 T MRI and experienced adults’ perspective on children’s tolerability of 7 T: a cross-sectional questionnaire survey

    OpenAIRE

    Chou, I-Jun; Tench, Christopher R.; Gowland, Penny; Jaspan, Tim; Dineen, Rob A; Evangelou, Nikos; Abdel-Fahim, Rasha; Whitehouse, William P; Constantinescu, Cris S

    2014-01-01

    Objectives To explore the possible discomfort perceived by children participating in 7 T MRI research, and the age range in which children are most likely to tolerate it well. Design A cross-sectional survey using age-appropriate questionnaires containing six measures of subjective discomfort (general discomfort, dizziness, noisiness, claustrophobia and feeling of cold or warm). Setting For children, 3 T clinical scanner in a tertiary referral teaching hospital; for adults, 3 and 7 T scanner ...

  1. Incidencia de bacteriemia asociada a catéter en niños hospitalizados que reciben nutrición parenteral Blood-stream catheter related infection in inpatient children receiving parenteral nutrition

    Directory of Open Access Journals (Sweden)

    E. Vaquero Sosa

    2011-02-01

    Full Text Available Las infecciones relacionadas con el catéter son la complicación más grave en los pacientes portadores de un catéter venoso central. Se considera que la nutrición parenteral (NP constituye un factor de riesgo de desarrollar una infección relacionada con el catéter (IRCat. Material y métodos: para conocer la tasa de infección y poder establecer estrategias de prevención de la infección nosocomial, se revisaron todas las historias de los 120 pacientes que recibieron NP a lo largo de 2008. Todas las historias de los pacientes con un episodio fiebre y hemocultivo positivo fueron consideradas. La tasa de infección se definió como número de episodios por cada 1000 días de NP. Resultados: Se obtuvieron 48 hemocultivos positivos. La tasa global de bacteriemia asociada a catéter fue de 37,8/1000 días de NP. La incidencia fue significativamente mayor en lactantes menores de 2 años de edad. Los gérmenes que se encontraron con mayor frecuencia fueron Estafilococo coagulasa negativo (56,8%, seguidos de bacilos Gram (20,8%, Staph aureus (12,5% y los hongos (12,5%. No encontramos diferencias en la tasa de infección cuando ajustamos por la enfermedad de base o la duración de la NP. Conclusiones: La tasa de infección en niños con NP en el hospital es considerablemente elevada. La NP parece constituir un factor de riesgo de desarrollar IRCat. Es necesario establecer políticas adecuadas y continuadas para conseguir disminuir la tasa de infección nosocomial.Blood-stream catheter related infection is the most severe complication in patients carrying a central venous catheter. Parenteral nutrition (PN use seems to be a risk factor for developing a catheter-related infection (CRI. Material & methods: In order to know the incidence of CRI in children to further implement policies to reduce nosocomial infection, we review all charts of children (1 month to 17 years who received parenteral nutrition while in hospital. All episodes of fever

  2. Artemisinin-based combinations versus amodiaquine plus sulphadoxine-pyrimethamine for the treatment of uncomplicated malaria in Faladje, Mali

    Directory of Open Access Journals (Sweden)

    Traore Boubacar

    2009-01-01

    Full Text Available Abstract Background Because of the emergence of chloroquine resistance in Mali, artemether-lumefantrine (AL or artesunate-amodiaquine (AS+AQ are recommended as first-line therapy for uncomplicated malaria, but have not been available in Mali until recently because of high costs. Methods From July 2005 to January 2006, a randomized open-label trial of three oral antimalarial combinations, namely AS+AQ, artesunate plus sulphadoxine-pyrimethamine (AS+SP, and amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP, was conducted in Faladje, Mali. Parasite genotyping by polymerase chain reaction (PCR was used to distinguish new from recrudescent Plasmodium falciparum infections. Results 397 children 6 to 59 months of age with uncomplicated Plasmodium falciparum malaria were enrolled, and followed for 28 days to assess treatment efficacy. Baseline characteristics were similar in all three treatment groups. The uncorrected rates of adequate clinical and parasitologic response (ACPR were 55.7%, 90.8%, and 97.7% in AS+AQ, AS+SP, and AQ+SP respectively (p Conclusion The combination of AQ+SP provides a potentially low cost alternative for treatment of uncomplicated P. falciparum infection in Mali and appears to have the added value of longer protective effect against new infection.

  3. Declining responsiveness of Plasmodium falciparum infections to artemisinin-based combination treatments on the Kenyan coast.

    Directory of Open Access Journals (Sweden)

    Steffen Borrmann

    Full Text Available BACKGROUND: The emergence of artemisinin-resistant P. falciparum malaria in South-East Asia highlights the need for continued global surveillance of the efficacy of artemisinin-based combination therapies. METHODS: On the Kenyan coast we studied the treatment responses in 474 children 6-59 months old with uncomplicated P. falciparum malaria in a randomized controlled trial of dihydroartemisinin-piperaquine vs. artemether-lumefantrine from 2005 to 2008. (ISRCTN88705995. RESULTS: The proportion of patients with residual parasitemia on day 1 rose from 55% in 2005-2006 to 87% in 2007-2008 (odds ratio, 5.4, 95%CI, 2.7-11.1; P37.5°C, 2.8, 1.9-4.1; P<0.001. Neither in vitro sensitivity of parasites to DHA nor levels of antibodies against parasite extract accounted for parasite clearance rates or changes thereof. CONCLUSIONS: The significant, albeit small, decline through time of parasitological response rates to treatment with ACTs may be due to the emergence of parasites with reduced drug sensitivity, to the coincident reduction in population-level clinical immunity, or both. Maintaining the efficacy of artemisinin-based therapy in Africa would benefit from a better understanding of the mechanisms underlying reduced parasite clearance rates. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN88705995.

  4. A non-inferiority, individually randomized trial of intermittent screening and treatment versus intermittent preventive treatment in the control of malaria in pregnancy

    DEFF Research Database (Denmark)

    Tagbor, Harry; Cairns, Matthew; Bojang, Kalifa;

    2015-01-01

    BACKGROUND: The efficacy of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine (IPTp-SP) in pregnancy is threatened in parts of Africa by the emergence and spread of resistance to SP. Intermittent screening with a rapid diagnostic test (RDT) and treatment of positive women......). Women in the IPTp-SP group received SP on two or three occasions whilst women in the ISTp group were screened two or three times with a RDT and treated if positive for malaria with artemether-lumefantrine (AL). ISTp-AL was non-inferior to IPTp-SP in preventing low birth weight (LBW), anemia......-AL performed as well as IPTp-SP. In the absence of an effective alternative medication to SP for IPTp, ISTp-AL is a potential alternative to IPTp in areas where SP resistance is high. It may also have a role in areas where malaria transmission is low and for the prevention of malaria in HIV positive women...

  5. Digital Receiver Phase Meter

    Science.gov (United States)

    Marcin, Martin; Abramovici, Alexander

    2008-01-01

    The software of a commercially available digital radio receiver has been modified to make the receiver function as a two-channel low-noise phase meter. This phase meter is a prototype in the continuing development of a phase meter for a system in which radiofrequency (RF) signals in the two channels would be outputs of a spaceborne heterodyne laser interferometer for detecting gravitational waves. The frequencies of the signals could include a common Doppler-shift component of as much as 15 MHz. The phase meter is required to measure the relative phases of the signals in the two channels at a sampling rate of 10 Hz at a root power spectral density digital receiver. The input RF signal is first fed to the input terminal of an analog-to-digital converter (ADC). To prevent aliasing errors in the ADC, the sampling rate must be at least twice the input signal frequency. The sampling rate of the ADC is governed by a sampling clock, which also drives a digital local oscillator (DLO), which is a direct digital frequency synthesizer. The DLO produces samples of sine and cosine signals at a programmed tuning frequency. The sine and cosine samples are mixed with (that is, multiplied by) the samples from the ADC, then low-pass filtered to obtain in-phase (I) and quadrature (Q) signal components. A digital signal processor (DSP) computes the ratio between the Q and I components, computes the phase of the RF signal (relative to that of the DLO signal) as the arctangent of this ratio, and then averages successive such phase values over a time interval specified by the user.

  6. Pressure difference receiving ears

    DEFF Research Database (Denmark)

    Michelsen, Axel; Larsen, Ole Næsbye

    2007-01-01

    of such pressure difference receiving ears have been hampered by lack of suitable experimental methods. In this review, we review the methods for collecting reliable data on the binaural directional cues at the eardrums, on how the eardrum vibrations depend on the direction of sound incidence, and on how sound...... waves behave in the air spaces leading to the interior surfaces of eardrums. A linear mathematical model with well-defined inputs is used for exploring how the directionality varies with the binaural directional cues and the amplitude and phase gain of the sound pathway to the inner surface...

  7. Analysis of physiological indexes of 128 healthy children receiving cardiopulmonary exercise testing%健康儿童128例心肺运动试验生理指标分析

    Institute of Scientific and Technical Information of China (English)

    相婷; 杨巧芝

    2015-01-01

    评价运动能力的有价值指标之一.%Objective To study the physiological indexes of children receiving cardiopulmonary exercise testing (CPET) in order to provide some data for establishing the normal CPET reference value in Chinese children.Methods One hundred and twenty-eight healthy children underwent the CPET with the standard scheme.All children were divided into 3 groups according to ages:3-6 years old, >6-10 years old and > 10-14 years old.The physiological indexes of CPET were collected, including maximal oxygen uptake (VO2max/kg) , oxygen uptake at anaerobic threshold (VO2/kg@AT), maximal tolerance power (Pmax), maximal heart rate (HRmax), peak respiratory minute volume to CO2 (peak VE/VCO2), slope of respiratory minute volume to CO2 (VE/VCO2 slope), maximal tidal volume (VTmax) and the maximal minute ventilation (VEmax).The range in normal values for physiological CPET variables was recorded.Results The VO2max/kg was (31.71 ± 7.31) mL/(min · kg), (31.05 ± 5.96) mL/(min · kg), and (34.10 ±8.72) mL/(min · kg) in the 3-6 years old group, >6-10 years old group and > 10-14 years old group of boys.The VO2/kg@AT was (28.32 ± 10.20) mL/ (min · kg), (23.13 ± 9.56) mL/(min · kg), and (22.18 ± 7.72) mL/(min · kg)in the 3-6 years old group, >6-10 years old group and > 10-14 years old group of boys.The VO2 max/kg was (29.27 ± 4.19) mL/(min · kg), (30.67 ± 5.59) mL/ (min · kg) (29.18 ± 6.56) mL/ (min · kg) in the 3-6 years old group, > 6-10 years old group and > 10-14 years old group of girls.The VO2@AT was (26.64 ±9.49) mL/(min · kg) ,(20.53 ±7.66) mL/(min · kg) ,(17.83 ±6.49) mL/(min · kg)in the 3-6 years old group, >6-10 years old group and > 10-14 years old group of girls.VO2max/kg and VO2/kg@AT did not change with age,there was no gender difference in VO2max/kg(P >0.05).VO2/kg@AT of boys was higher than girls in the 3-6 years old group(t =2.351 ,P =0.023).The Pmax,VEmax and VTmax increased with the growth of age

  8. GNSS Software Receiver for UAVs

    DEFF Research Database (Denmark)

    Olesen, Daniel Madelung; Jakobsen, Jakob; von Benzon, Hans-Henrik

    2016-01-01

    This paper describes the current activities of GPS/GNSS Software receiver development at DTU Space. GNSS Software receivers have received a great deal of attention in the last two decades and numerous implementations have already been presented. DTU Space has just recently started development of ...... of our own GNSS software-receiver targeted for mini UAV applications, and we will in in this paper present our current progress and briefly discuss the benefits of Software Receivers in relation to our research interests....

  9. CERN apprentice receives award

    CERN Multimedia

    2008-01-01

    Another CERN apprentice has received an award for the quality of his work. Stéphane Küng (centre), at the UIG ceremony last November, presided over by Geneva State Councillor Pierre-François Unger, Head of the Department of Economics and Health. Electronics technician Stéphane Küng was honoured in November by the Social Foundation of the Union Industrielle Genevoise (UIG) as one of Geneva’s eight best apprentices in the field of mechatronics. The 20-year-old Genevan obtained his Federal apprentice’s certificate (Certificat fédéral de capacité - CFC) in June 2007, achieving excellent marks in his written tests at the Centre d’Enseignement Professionnel Technique et Artisanal (CEPTA). Like more than 200 youngsters before him, Stéphane Küng spent part of his four-year sandwich course working at CERN, where he followed many practical training courses and gained valuable hands-on experience in various technical groups and labs. "It’ always very gr...

  10. Five-year surveillance of molecular markers of Plasmodium falciparum antimalarial drug resistance in Korogwe District, Tanzania: accumulation of the 581G mutation in the em>P. falciparum dihydropteroate synthase gene

    DEFF Research Database (Denmark)

    Alifrangis, Michael; Lusingu, John P; Mmbando, Bruno;

    2009-01-01

    In January 2007, Tanzania replaced sulfadoxine-pyrimethamine (SP) with artemether-lumefantrine for treatment of uncomplicated malaria. This study examined the impact of widespread SP use on molecular markers of Plasmodium falciparum drug resistance in blood samples from persons living in two vill...

  11. Measurement of lumefantrine and its metabolite in plasma by high performance liquid chromatography with ultraviolet detection

    DEFF Research Database (Denmark)

    Khalil, Insaf F; Abildrup, Ulla; Alifrangis, Lene H

    2011-01-01

    Artemether-lumefantrine (ARM-LUM) has in recent years become the first-line treatment for uncomplicated malaria in many Sub-Saharan African countries. Vigorous monitoring of the therapeutic efficacy of this treatment is needed. This requires high-quality studies following standard protocols...

  12. Monitoring the efficacy of antimalarial medicines in India via sentinel sites: Outcomes and risk factors for treatment failure

    Directory of Open Access Journals (Sweden)

    Neelima Mishra

    2016-01-01

    Interpretation & conclusion: Till 2012, India′s national antimalarial drug resistance monitoring system proved highly efficacious and safe towards first-line antimalarials used in the country, except in Northeastern region where a decline in efficacy of AS+SP has been observed. This led to change in first-line treatment for P. falciparum to artemether-lumefantrine in Northeastern region.

  13. Malaria in HIV-Infected Children Receiving HIV Protease-Inhibitor- Compared with Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy, IMPAACT P1068s, Substudy to P1060

    Science.gov (United States)

    Hobbs, Charlotte V.; Gabriel, Erin E.; Kamthunzi, Portia; Tegha, Gerald; Tauzie, Jean; Petzold, Elizabeth; Barlow-Mosha, Linda; Chi, Benjamin H.; Li, Yonghua; Ilmet, Tiina; Kirmse, Brian; Neal, Jillian; Parikh, Sunil; Deygoo, Nagamah; Jean Philippe, Patrick; Mofenson, Lynne; Prescott, William; Chen, Jingyang; Musoke, Philippa; Palumbo, Paul; Duffy, Patrick E.; Borkowsky, William

    2016-01-01

    Background HIV and malaria geographically overlap. HIV protease inhibitors kill malaria parasites in vitro and in vivo, but further evaluation in clinical studies is needed. Methods Thirty-one children from Malawi aged 4–62 months were followed every 3 months and at intercurrent illness visits for ≤47 months (September 2009-December 2011). We compared malaria parasite carriage by blood smear microscopy (BS) and confirmed clinical malaria incidence (CCM, or positive BS with malaria symptoms) in children initiated on HIV antiretroviral therapy (ART) with zidovudine, lamivudine, and either nevirapine (NVP), a non-nucleoside reverse transcriptase inhibitor, or lopinavir-ritonavir (LPV-rtv), a protease inhibitor. Results We found an association between increased time to recurrent positive BS, but not CCM, when anti-malarial treatment and LPV-rtv based ART were used concurrently and when accounting for a LPV-rtv and antimalarial treatment interaction (adjusted HR 0.39; 95% CI (0.17,0.89); p = 0.03). Conclusions LPV-rtv in combination with malaria treatment was associated with lower risk of recurrent positive BS, but not CCM, in HIV-infected children. Larger, randomized studies are needed to confirm these findings which may permit ART optimization for malaria-endemic settings. Trial Registration ClinicalTrials.gov NCT00719602 PMID:27936233

  14. Evaluation of risk for graft-versus-host disease in children who receive less than the full doses of mini-dose methotrexate for graft-versus-host disease prophylaxis in allogeneic hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Sook Kyung Yum

    2013-11-01

    Full Text Available Purpose: The use of cyclosporine and mini-dose methotrexate (MTX is a common strategy for graftversus- host disease (GVHD prophylaxis in allogeneic transplants. We investigated whether patients who receive fewer than the planned MTX doses are at increased risk for GVHD. Methods: The study cohort included 103 patients who received allogeneic transplants at the Department of Pediatrics of The Catholic University of Korea College of Medicine, from January 2010 to December 2011. MTX was administered on days 1, 3, 6, and 11 after transplant at a dose of 5 mg/ m2 each. Within the cohort, 76 patients (74% received all 4 doses of MTX [MTX(4 group], while 27 patients (26% received 0&#8211;3 doses [MTX(0–3 group]. Results: Although there was no difference in neutrophil engraftment between the 2 groups, platelet engraftment was significantly faster in the MTX(4 group (median, 15 days, compared to the MTX(0&#8211; 3 group (median, 25 days; P =0.034. The incidence of grades II&#8211;IV acute GVHD was not different between the MTX(4 and MTX(0&#8211;3 groups (P =0.417. In the multivariate study, human leukocyte antigen mismatch was the most significant factor causing grades II&#8211;IV acute GVHD (P =0.002, followed by female donor to male recipient transplant (P =0.034. No difference was found between the MTX(4 and MTX (0&#8211;3 groups regarding grades III&#8211;IV acute GVHD, chronic GVHD, and disease-free survival. Conclusion: Our results indicate that deviations from the full dose schedule of MTX for GVHD prophylaxis do not lead to increased incidence of either acute or chronic GVHD.

  15. 126例漏斗胸患儿胸腔镜辅助行Nuss手术的术后护理%Postoperative care of 126 children with pectus excavatum receiving Nuss procedure with thoracoscope

    Institute of Scientific and Technical Information of China (English)

    诸纪华; 李忠丽; 朱红梅

    2012-01-01

    This paper introduces the nursing care of 126 children with pectus excavatum after Nuss procedure with thoracoscope. The key points in nursing were intensive observation of illness condition,early detection and treatment of postoperative complications such as pneumothorax and pleura] effusion,postoperative pain management,respiratory care,instruction on rehabilitation training and discharge education. All the children underwent Nuss procedure successfully without severe postoperative complications. Three cases underwent secondary Nuss procedure and the other patients recovered well within the six months to two years of follow-up period.%报告了126例漏斗胸患儿在胸腔镜辅助下行Nuss手术的术后护理.护理重点包括:严密观察病情,及早发现和处理气胸、胸腔积液等并发症,做好疼痛管理、呼吸道护理,正确指导患儿进行康复训练,并做好出院宣教,以防支架移位.本组均顺利完成手术,无严重并发症发生.随访6个月至2年,除3例行二次Nuss术外,其余漏斗胸畸形矫治满意.

  16. Treating Children Fairly.

    Science.gov (United States)

    Wolfe, Barbara L.

    1991-01-01

    Examines whether children are receiving less than their share of public resources, considering (1) how the economic situations of children and the elderly have changed; (2) effects of insufficient resources and causes of disparities in treatment of young people; and (3) proposals for increasing society's investment in children. (SLD)

  17. Stability of heterodyne terahertz receivers

    NARCIS (Netherlands)

    Kooi, J.W.; Baselmans, J.J.A.; Baryshev, A.; Schieder, R.; Hajenius, M.; Gao, J.R.; Klapwijk, T.M.; Voronov, B.; Gol'tsman, G.

    2006-01-01

    In this paper we discuss the stability of heterodyne terahertz receivers based on small volume NbN phonon cooled hot electron bolometers (HEBs). The stability of these receivers can be broken down in two parts: the intrinsic stability of the HEB mixer and the stability of the local oscillator (LO) s

  18. Noise Stability of SIS Receivers

    Science.gov (United States)

    Kooi, J. W.; Chattopadhyay, G.; Thielman, M.; Phillips, T. G.; Schieder, R.

    2000-05-01

    There is a strong interest in the submillimeter astronomy community to increase the IF bandwidth of SIS receivers in order to better facilitate broad spectral linewidth and continuum observations of extragalactic sources. However, with an increase in receiver IF bandwidth there is a decrease in the mixer stability. This in turn effects the integration efficiency and quality of the measurement. In order to better understand the noise mechanisms responsible for reducing the receiver stability, we employed a technique first described by D.W. Allan and later elaborated upon by Schieder et al. In this paper we address a variety of factors that degrade the noise stability of SIS receivers. The goal of this exercise is to make recommendations aimed at maximizing SIS receiver stability.

  19. Clinical Factors Associated with Long-Term Complete Remission versus Poor Response to Chemotherapy in HIV-Infected Children and Adolescents with Kaposi Sarcoma Receiving Bleomycin and Vincristine: A Retrospective Observational Study.

    Science.gov (United States)

    El-Mallawany, Nader Kim; Kamiyango, William; Slone, Jeremy S; Villiera, Jimmy; Kovarik, Carrie L; Cox, Carrie M; Dittmer, Dirk P; Ahmed, Saeed; Schutze, Gordon E; Scheurer, Michael E; Kazembe, Peter N; Mehta, Parth S

    2016-01-01

    Kaposi sarcoma (KS) is the most common HIV-associated malignancy in children and adolescents in Africa. Pediatric KS is distinct from adult disease. We evaluated the clinical characteristics associated with long-term outcomes. We performed a retrospective observational analysis of 70 HIV-infected children and adolescents with KS less than 18 years of age diagnosed between 8/2010 and 6/2013 in Lilongwe, Malawi. Local first-line treatment included bleomycin and vincristine plus nevirapine-based highly active anti-retroviral therapy (HAART). Median age was 8.6 years (range 1.7-17.9); there were 35 females (50%). Most common sites of presentation were: lymph node (74%), skin (59%), subcutaneous nodules (33%), oral (27%), woody edema (24%), and visceral (16%). Eighteen (26%) presented with lymphadenopathy only. Severe CD4 suppression occurred in 28%. At time of KS diagnosis, 49% were already on HAART. Overall, 28% presented with a platelet count < 100 x 109/L and 37% with hemoglobin < 8 g/dL. The 2-year event-free (EFS) and overall survival (OS) were 46% and 58% respectively (median follow-up 29 months, range 15-50). Multivariable analysis of risk of death and failure to achieve EFS demonstrated that visceral disease (odds ratios [OR] 19.08 and 11.61, 95% CI 2.22-163.90 and 1.60-83.95 respectively) and presenting with more than 20 skin/oral lesions (OR 9.57 and 22.90, 95% CI 1.01-90.99 and 1.00-524.13 respectively) were independent risk factors for both. Woody edema was associated with failure to achieve EFS (OR 7.80, 95% CI 1.84-33.08) but not death. Univariable analysis revealed that lymph node involvement was favorable for EFS (OR 0.28, 95% CI 0.08-0.99), while T1 TIS staging criteria, presence of cytopenias, and severe immune suppression were not associated with increased mortality. Long-term complete remission is achievable in pediatric KS, however outcomes vary according to clinical presentation. Based on clinical heterogeneity, treatment according to risk

  20. 急性淋巴细胞白血病患儿化疗期间的疲乏状况及相关因素的研究%Study of fatigue and related factors among children with acute lymphoblastic leukemia receiving chemotherapy in hospital

    Institute of Scientific and Technical Information of China (English)

    卜秀青; 尤黎明; 刘可; 叶启蒙

    2015-01-01

    Objective To describe fatigue among children with acute lymphoblastic leukemia (ALL)receiving chemotherapy in hospital and explore its related factors.Methods A total of 100 hospitalized children with ALL receiving chemotherapy and their main caregivers were surveyed on demographic information,treatment data,Wong-Baker facial scale and the PedsQLTMMFS Multidimensional Fatigue Scale.Results The incidence of fatigue was 99% (99/100).The total score of fatigue scale was (56.71±17.32) on average.Multiple linear regression modeling showed that the factors related with fatigue included the time of dexamethasone use,childen's sleep quality,hemoglobin content,pain score,the time for the present chemotherapy,age and main caregivers' self-rating health status (P< 0.05 or 0.01).Conclusions Fatigue is serious among children with ALL receiving chemotherapy and is related with demographic factors,diseases,treatment condition and health status of the caregivers.%目的 调查急性淋巴细胞白血病(acute lyrnphoblastic leakemia,ALL)患儿化疗期间的疲乏状况并探讨其影响因素.方法 采用便利抽样法选取1 10例住院化疗的ALL患儿及其照顾者,进行问卷调查,内容包括患儿和照顾者一般资料、治疗资料、Wong-Baker面部表情量表和PedsQLTMMFS儿童多维疲乏量表.结果 ALL患儿化疗期间的疲乏发生率为99%(99/100),疲乏量表总分为(56.71±17.32)分,进入患儿疲乏总分及各疲乏维度得分回归方程的因素包括服用激素的天数、睡眠质量、血红蛋白含量、疼痛评分、本次化疗的天数、年龄及主要照顾者的健康自评等(P< 0.01或P<0.05).结论 ALL患儿化疗期间疲乏发生率高,且较为严重.患儿的疲乏程度与其社会人口学因素、疾病、治疗因素及照顾者的健康状况相关.

  1. Endocarditis - children

    Science.gov (United States)

    Valve infection - children; Staphylococcus aureus - endocarditis - children; Enterococcus - endocarditis- children; Streptococcus viridians - endocarditis - children; Candida - endocarditis - children; Bacterial endocarditis - children; Infective ...

  2. HIGH-EFFICIENCY INFRARED RECEIVER

    Directory of Open Access Journals (Sweden)

    A. K. Esman

    2016-01-01

    Full Text Available Recent research and development show promising use of high-performance solid-state receivers of the electromagnetic radiation. These receivers are based on the low-barrier Schottky diodes. The approach to the design of the receivers on the basis of delta-doped low-barrier Schottky diodes with beam leads without bias is especially actively developing because for uncooled receivers of the microwave radiation these diodes have virtually no competition. The purpose of this work is to improve the main parameters and characteristics that determine the practical relevance of the receivers of mid-infrared electromagnetic radiation at the operating room temperature by modifying the electrodes configuration of the diode and optimizing the distance between them. Proposed original design solution of the integrated receiver of mid-infrared radiation on the basis of the low-barrier Schottky diodes with beam leads allows to effectively adjust its main parameters and characteristics. Simulation of the electromagnetic characteristics of the proposed receiver by using the software package HFSS with the basic algorithm of a finite element method which implemented to calculate the behavior of electromagnetic fields on an arbitrary geometry with a predetermined material properties have shown that when the inner parts of the electrodes of the low-barrier Schottky diode is performed in the concentric elliptical convex-concave shape, it can be reduce the reflection losses to -57.75 dB and the standing wave ratio to 1.003 while increasing the directivity up to 23 at a wavelength of 6.09 μm. At this time, the rounded radii of the inner parts of the anode and cathode electrodes are equal 212 nm and 318 nm respectively and the gap setting between them is 106 nm. These parameters will improve the efficiency of the developed infrared optical-promising and electronic equipment for various purposes intended for work in the mid-infrared wavelength range. 

  3. Receiver-exciter controller design

    Science.gov (United States)

    Jansma, P. A.

    1982-01-01

    A description of the general design of both the block 3 and block 4 receiver-exciter controllers for the Deep Space Network (DSN) Mark IV-A System is presented along with the design approach. The controllers are designed to enable the receiver-exciter subsystem (RCV) to be configured, calibrated, initialized and operated from a central location via high level instructions. The RECs are designed to be operated under the control of the DMC subsystem. The instructions are in the form of standard subsystem blocks (SSBs) received via the local area network (LAN). The centralized control provided by RECs and other DSCC controllers in Mark IV-A is intended to reduce DSN operations costs from the Mark III era.

  4. UWB communication receiver feedback loop

    Science.gov (United States)

    Spiridon, Alex; Benzel, Dave; Dowla, Farid U.; Nekoogar, Faranak; Rosenbury, Erwin T.

    2007-12-04

    A novel technique and structure that maximizes the extraction of information from reference pulses for UWB-TR receivers is introduced. The scheme efficiently processes an incoming signal to suppress different types of UWB as well as non-UWB interference prior to signal detection. Such a method and system adds a feedback loop mechanism to enhance the signal-to-noise ratio of reference pulses in a conventional TR receiver. Moreover, sampling the second order statistical function such as, for example, the autocorrelation function (ACF) of the received signal and matching it to the ACF samples of the original pulses for each transmitted bit provides a more robust UWB communications method and system in the presence of channel distortions.

  5. Erythemal ultraviolet solar radiation doses received by young skiers.

    Science.gov (United States)

    Serrano, María-Antonia; Cañada, Javier; Moreno, Juan Carlos

    2013-11-01

    Children are a special group since epidemiological evidence indicates that excessive exposure to sunlight at an early age increases the risk of skin cancer in later life. The purpose of this study is to quantify children's UV exposure when skiing, using dosimeters (VioSpor) placed on the shoulders of 10 participants. The children received a median daily Standard Erythema Dose of 2.1 within a range of 4.9-0.71, this being approximately 35% of the calculated 24 h ambient UV radiation on the horizontal plane. According to the results obtained, young skiers are exposed to UV radiation that can potentially cause skin damage and erythema and increase the risk of skin cancer in the course of a lifetime. These findings emphasise the need for adequate protective measures against solar radiation when skiing. The results also suggest that sun-protection campaigns should be undertaken aimed at children engaged in outdoor sports, including winter activities.

  6. A pilot randomised trial of induced blood-stage Plasmodium falciparum infections in healthy volunteers for testing efficacy of new antimalarial drugs.

    Directory of Open Access Journals (Sweden)

    James S McCarthy

    Full Text Available BACKGROUND: Critical to the development of new drugs for treatment of malaria is the capacity to safely evaluate their activity in human subjects. The approach that has been most commonly used is testing in subjects with natural malaria infection, a methodology that may expose symptomatic subjects to the risk of ineffective treatment. Here we describe the development and pilot testing of a system to undertake experimental infection using blood stage Plasmodium falciparum parasites (BSP. The objectives of the study were to assess the feasibility and safety of induced BSP infection as a method for assessment of efficacy of new drug candidates for the treatment of P. falciparum infection. METHODS AND FINDINGS: A prospective, unblinded, Phase IIa trial was undertaken in 19 healthy, malaria-naïve, male adult volunteers who were infected with BSP and followed with careful clinical and laboratory observation, including a sensitive, quantitative malaria PCR assay. Volunteers were randomly allocated to treatment with either of two licensed antimalarial drug combinations, artemether-lumefantrine (A/L or atovaquone-proguanil (A/P. In the first cohort (n = 6 where volunteers received ∼360 BSP, none reached the target parasitemia of 1,000 before the day designated for antimalarial treatment (day 6. In the second and third cohorts, 13 volunteers received 1,800 BSP, with all reaching the target parasitemia before receiving treatment (A/L, n = 6; A/P, n = 7 The study demonstrated safety in the 19 volunteers tested, and a significant difference in the clearance kinetics of parasitemia between the drugs in the 13 evaluable subjects, with mean parasite reduction ratios of 759 for A/L and 17 for A/P (95% CI 120-4786 and 7-40 respectively; p<0.01. CONCLUSIONS: This system offers a flexible and safe approach to testing the in vivo activity of novel antimalarials. TRIAL REGISTRATION: ClinicalTrials.gov NCT01055002.

  7. LU Peizhang receives Golay Award

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ Prof. LU Peizhang, an analytical chemist with the CAS Dalian Institute of Chemical Physics, received the prestigious Golay Award at the 30th International Symposium on Capillary Chromatography opened on 5 June in Dalian, a port city in northeast China's Liaoning Province.

  8. RFID receiver apparatus and method

    Science.gov (United States)

    Scott, Jeffrey Wayne

    2006-12-26

    An RFID backscatter interrogator for transmitting data to an RFID tag, generating a carrier for the tag, and receiving data from the tag modulated onto the carrier, the interrogator including a single grounded-coplanar wave-guide circuit board and at least one surface mount integrated circuit supported by the circuit board.

  9. Absorption Efficiency of Receiving Antennas

    DEFF Research Database (Denmark)

    Andersen, Jørgen Bach; Frandsen, Aksel

    2005-01-01

    A receiving antenna with a matched load will always scatter some power. This paper sets an upper and a lower bound on the absorption efficiency (absorbed power over sum of absorbed and scattered powers), which lies between 0 and 100% depending on the directivities of the antenna and scatter...

  10. Different methodological approaches to the assessment of in vivo efficacy of three artemisinin-based combination antimalarial treatments for the treatment of uncomplicated falciparum malaria in African children

    Directory of Open Access Journals (Sweden)

    Zongo Issaka

    2008-08-01

    Full Text Available Abstract Background Use of different methods for assessing the efficacy of artemisinin-based combination antimalarial treatments (ACTs will result in different estimates being reported, with implications for changes in treatment policy. Methods Data from different in vivo studies of ACT treatment of uncomplicated falciparum malaria were combined in a single database. Efficacy at day 28 corrected by PCR genotyping was estimated using four methods. In the first two methods, failure rates were calculated as proportions with either (1a reinfections excluded from the analysis (standard WHO per-protocol analysis or (1b reinfections considered as treatment successes. In the second two methods, failure rates were estimated using the Kaplan-Meier product limit formula using either (2a WHO (2001 definitions of failure, or (2b failure defined using parasitological criteria only. Results Data analysed represented 2926 patients from 17 studies in nine African countries. Three ACTs were studied: artesunate-amodiaquine (AS+AQ, N = 1702, artesunate-sulphadoxine-pyrimethamine (AS+SP, N = 706 and artemether-lumefantrine (AL, N = 518. Using method (1a, the day 28 failure rates ranged from 0% to 39.3% for AS+AQ treatment, from 1.0% to 33.3% for AS+SP treatment and from 0% to 3.3% for AL treatment. The median [range] difference in point estimates between method 1a (reference and the others were: (i method 1b = 1.3% [0 to24.8], (ii method 2a = 1.1% [0 to21.5], and (iii method 2b = 0% [-38 to19.3]. The standard per-protocol method (1a tended to overestimate the risk of failure when compared to alternative methods using the same endpoint definitions (methods 1b and 2a. It either overestimated or underestimated the risk when endpoints based on parasitological rather than clinical criteria were applied. The standard method was also associated with a 34% reduction in the number of patients evaluated compared to the number of patients enrolled. Only 2% of the sample size

  11. Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon

    Directory of Open Access Journals (Sweden)

    Thalabard Jean-Christophe

    2010-02-01

    Full Text Available Abstract Background The use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT, is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant Plasmodium falciparum. Its use is strongly recommended in most sub-Saharan African countries, namely Cameroon, where resistance to chloroquine is widespread and antifolate resistance is emerging. Methods Studies were conducted in Cameroonian children with acute uncomplicated P. falciparum malaria according to the standard World Health Organization protocol at four sentinel sites between 2003 and 2007. A total of 1,401 children were enrolled, of whom 1,337 were assigned to randomized studies and 64 were included in a single non-randomized study. The proportions of adequate clinical and parasitological response (PCR-uncorrected on day 14 and PCR-corrected on day 28 were the primary endpoints to evaluate treatment efficacy on day 14 and day 28. The relative effectiveness of drug combinations was compared by a multi-treatment Bayesian random-effect meta-analysis. Findings The results based on the meta-analysis suggested that artesunate-amodiaquine (AS-AQ is as effective as other drugs (artesunate-sulphadoxine-pyrimethamine [AS-SP], artesunate-chlorproguanil-dapsone [AS-CD], artesunate-mefloquine [AS-MQ], dihydroartemisinin-piperaquine [DH-PP], artemether-lumefantrine [AM-LM], amodiaquine, and amodiaquine-sulphadoxine-pyrimethamine [AQ-SP]. AM-LM appeared to be the most effective with no treatment failure due to recrudescence, closely followed by DH-PP. Conclusion Although AM-LM requires six doses, rather than three doses for other artemisinin-based combinations, it has potential advantages over other forms of ACT. Further studies are needed to evaluate the clinical efficacy and tolerance of these combinations in different epidemiological context.

  12. Scintillation-Hardened GPS Receiver

    Science.gov (United States)

    Stephens, Donald R.

    2015-01-01

    CommLargo, Inc., has developed a scintillation-hardened Global Positioning System (GPS) receiver that improves reliability for low-orbit missions and complies with NASA's Space Telecommunications Radio System (STRS) architecture standards. A software-defined radio (SDR) implementation allows a single hardware element to function as either a conventional radio or as a GPS receiver, providing backup and redundancy for platforms such as the International Space Station (ISS) and high-value remote sensing platforms. The innovation's flexible SDR implementation reduces cost, weight, and power requirements. Scintillation hardening improves mission reliability and variability. In Phase I, CommLargo refactored an open-source GPS software package with Kalman filter-based tracking loops to improve performance during scintillation and also demonstrated improved navigation during a geomagnetic storm. In Phase II, the company generated a new field-programmable gate array (FPGA)-based GPS waveform to demonstrate on NASA's Space Communication and Navigation (SCaN) test bed.

  13. Comparação entre os questionários IT-MAIS e MUSS com vídeo-gravação para avaliação de crianças candidatas ao implante coclear Comparison between the IT-MAIS and MUSS questionnaires with video-recording for evaluation of children who may receive a cochlear implantation

    Directory of Open Access Journals (Sweden)

    Elaine Soares Monteiro Pinto

    2008-02-01

    Full Text Available Existe uma grande dificuldade para determinar precocemente crianças que se beneficiariam ou não com o implante coclear, até porque devido à pouca idade são muito sutis as respostas apresentadas. OBJETIVO: Comparar os resultados obtidos através da vídeo-gravação de situações de interação de crianças candidatas ao implante coclear com os resultados obtidos através de protocolos de avaliação. MÉTODO: Fizeram parte da amostra 7 crianças com idade média de 39,7 meses, portadores de perda auditiva neurossensorial profunda. Foram aplicados os questionários IT-MAIS e MUSS aos pais e os resultados foram comparados com a observação da vídeo-gravação destas crianças. RESULTADOS: Foi possível observar que os dados são compatíveis no que se refere às etapas auditivas. No entanto, no que se refere ao questionário MUSS, os dados obtidos na observação lúdica são bastante diferentes. O questionário leva em consideração apenas a uso da linguagem oral e, portanto, a maioria das crianças apresentou um escore muito baixo. CONCLUSÃO: A observação lúdica permitiu traçar um perfil mais amplo do comportamento lingüístico e de aspectos relativos à linguagem apresentando diferenças do questionário.There is a great difficulty in determining earlier on which children would benefit or not from cochlear implants, especially because of their young age, the responses they give are very subtle. AIM: To compare results obtained through video-recording of the interactions of children who may receive a cochlear implant with the results obtained through evaluation protocols. METHOD: Seven children, with an average age of 39.7 months, with profound hearing loss were selected for the study. IT-MAIS and MUSS questionnaires were given to their parents/guardians of these children and the results were compared with the observation of the video-recordings. RESULTS: It was possible to observe that the data is compatible with the auditory

  14. Desempenho de pais de crianças em dieta de exclusão do leite de vaca na identificação de alimentos industrializados com e sem leite vaca The performance of parents of children receiving cow's milk free diets at indentification of commercial food products with and without cows's milk

    Directory of Open Access Journals (Sweden)

    Thabata Koester Weber

    2007-10-01

    of children on exclusion diets (4.0 was greater than for the control group (3.0; p = 0.005. Reading at least one label was associated with a greater chance of correctly identifying more than five of the 10 products (odds ratio = 8.0. CONCLUSIONS: Despite having received guidance, the parents of children on exclusion diets were not fully prepared to manage these diets, indicating a need for improvements to the instruction provided when indicating exclusion diets.

  15. Diversity of MMSE MIMO Receivers

    CERN Document Server

    Mehana, Ahmed Hesham

    2011-01-01

    In most MIMO systems, the family of waterfall error curves, calculated at different spectral efficiencies, are asymptotically parallel at high SNR. In other words, most MIMO systems exhibit a single diversity value for all {\\em fixed} rates. The MIMO MMSE receiver does not follow this pattern and exhibits a varying diversity in its family of error curves. This effect cannot be captured by DMT analysis, due to the fact that all fixed rates correspond to the same multiplexing gain, thus they cannot be differentiated within DMT analysis. This work analyzes this interesting behavior of the MMSE MIMO receiver and produces the MMSE MIMO diversity at each rate. The diversity of the quasi-static flat-fading MIMO channel consisting of any arbitrary number of transmit and receive antennas is fully characterized, showing that full spatial diversity is possible for all antenna configurations if and only if the rate is within a certain bound which is a function of the number of antennas. For other rate brackets, the avail...

  16. Morphine sulphation in children.

    OpenAIRE

    Choonara, I.; Ekbom, Y; Lindström, B; Rane, A.

    1990-01-01

    The metabolism of morphine was studied in nine children and seven preterm neonates receiving a continuous infusion of morphine. All the neonates and three children had detectable concentrations of morphine-3-sulphate (M3S) in urine. None of the neonates or the children had detectable concentrations of morphine-6-sulphate (M6S) in urine. None of the children had detectable concentrations of M3S in plasma. The M3S/morphine ratios were significantly higher in neonates than children (P less than ...

  17. Curvas ROC para identificação de pontos de corte do peso ao nascer na predição do excesso de peso em escolares mexicanos Receiver operating characteristic (ROC curves to identify birth weight cutoffs to predict overweight in Mexican school children

    Directory of Open Access Journals (Sweden)

    Suzana A. de Moraes

    2009-02-01

    Full Text Available OBJETIVO: Identificar pontos de corte do peso ao nascer na predição do excesso de peso em crianças e adolescentes mexicanos em idade escolar da cidade de Chilpancingo, México, em 2004. MÉTODOS: Seiscentos e sessenta e dois escolares de ambos os sexos, entre 5 e 13 anos, foram selecionados por amostragem probabilística, com partilha proporcional ao tamanho. Medidas do peso ao nascer foram extraídas das carteiras de vacinação. Para a classificação do estado nutricional, utilizaram-se pontos de corte do índice de massa corporal (IMC segundo idade e sexo. Equações de predição foram construídas utilizando-se modelos de regressão linear. Áreas sob as curvas ROC (receiver operating characteristic foram calculadas e curvas ROC de dois gráficos (TG-ROC foram construídas, respectivamente, para detecção da acurácia global e identificação de pontos de corte do peso ao nascer, correspondentes à intersecção das curvas de sensibilidade e especificidade. RESULTADOS: Entre as crianças, a prevalência de excesso de peso foi maior no sexo feminino (46% que no masculino (38,5%; entre adolescentes, as respectivas prevalências foram de 43,5 e 38,9%. O IMC médio e os decis de peso ao nascer apresentaram relação linear. As áreas sob as curvas ROC apresentaram valores > 78% em cada estrato, detectando-se diferença, em relação ao sexo, no grupo de adolescentes. As curvas TG-ROC apresentaram pontos de corte do peso ao nascer mais elevados nos meninos que nas meninas, e as intersecções das curvas de sensibilidade e especificidade foram > 0,70. CONCLUSÕES: Os resultados do estudo indicaram que pontos de corte do peso ao nascer podem ser utilizados como marcadores de excesso de peso, na infância e adolescência, constituindo-se em estratégia para o rastreamento de grupos de risco.OBJECTIVE: To identify birth weight cutoffs to predict overweight in school children and adolescents from Chilpancingo, Mexico, in 2004. METHODS: Six

  18. The majority of sick children receive paracetamol during the winter

    DEFF Research Database (Denmark)

    Ertmann, R.; Møller, J.J.; Waldorff, F.B.

    2012-01-01

    Even though fever is a common symptom in childhood, it often worries parents and they may try to reduce discomfort by giving the child paracetamol, which is currently the most commonly sold over-the-counter medicine. The objective of this study was to investigate parent-administered paracetamol...

  19. Chip Advancer For GPS Receiver

    Science.gov (United States)

    Meehan, Thomas K.; Srinivasan, Jeffrey M.; Thomas, J. Brooks

    1989-01-01

    Instrument errors made negligible. For each integration interval, both delay and rate of change of delay initialized to small fraction of chip - for example, to order of 10 to the negative 7th power - thereby making feedback control and extraction of delay highly accurate and flexible. With appropriate selection of sampling rate relative to chip rate, commensurability errors reduced to extremely small levels. In Global Positioning System (GPS) receiver, pseudorandom code sequence generated by simple digital logic incorporating effects of time, delay, and rate of change of delay. Flexibility in starting time and sum interval very useful in aligning correlation interval with beginnings and endings of data bits.

  20. Broadband direct RF digitization receivers

    CERN Document Server

    Jamin, Olivier

    2014-01-01

    This book discusses the trade-offs involved in designing direct RF digitization receivers for the radio frequency and digital signal processing domains.  A system-level framework is developed, quantifying the relevant impairments of the signal processing chain, through a comprehensive system-level analysis.  Special focus is given to noise analysis (thermal noise, quantization noise, saturation noise, signal-dependent noise), broadband non-linear distortion analysis, including the impact of the sampling strategy (low-pass, band-pass), analysis of time-interleaved ADC channel mismatches, sampling clock purity and digital channel selection. The system-level framework described is applied to the design of a cable multi-channel RF direct digitization receiver. An optimum RF signal conditioning, and some algorithms (automatic gain control loop, RF front-end amplitude equalization control loop) are used to relax the requirements of a 2.7GHz 11-bit ADC. A two-chip implementation is presented, using BiCMOS and 65nm...

  1. Adherence and uptake of artemisinin-based combination treatments for uncomplicated malaria: a qualitative study in northern Ghana.

    Directory of Open Access Journals (Sweden)

    Samuel Chatio

    Full Text Available Based on the recommendations of the World Health Organization in 2004, Ghana changed her antimalarial drug policy from mono-therapy to Artemisinin-based Combination Therapy (ACTs. The country is currently using three first line drugs artesunate-amodiaquine, artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated malaria. Despite this policy, little or no qualitative studies have been conducted to establish the factors influencing adherence to the new treatment for malaria. This study explored factors influencing adherence to the use of ACTs in northern Ghana.This was a qualitative study comprising forty (40 in-depth interviews with patients with malaria who visited selected public and private health facilities and received ACTs. Systematic sampling technique was used to select participants who were given ACTs for the interviews. Nvivo 9 software was used to code the data into themes for further analysis.The study revealed very important differences in knowledge about ACTs. As expected, the less or illiterates could not mention the type of ACT they would prefer to use for treating their malaria. The educated ones had a good knowledge on ACTs and preferred artemether-lumefantrinee in treating their malaria. The reason was that the drug was good and it had minimal or no side effects. Individual attitudes toward the use of medications and the side effects associated with the use of these ACTs were found to be the main factors affecting adherence to the use of ACTs. Perceived cure of illness after the initial dose greatly affected adherence. Other factors such as forgetfulness and lack of information also influenced patient adherence to ACTs use.Individual knowledge, attitudes and behaviors greatly influence patients' adherence to ACTs use. Since ACTs take a number of days to complete, continuous education by health professionals could improve on adherence to ACTs use by patients with malaria.

  2. Efficacy and tolerability of a new formulation of artesunate-mefloquine for the treatment of uncomplicated malaria in adult in Senegal: open randomized trial

    Directory of Open Access Journals (Sweden)

    CK Tine Roger

    2012-12-01

    Full Text Available Abstract Background Prompt treatment of malaria attacks with arteminisin-based combination therapy (ACT is an essential tool for malaria control. A new co-blister tablet of artesunate-mefloquine (AM with 25 mg/kg mefloquine has been developed for the management of uncomplicated malaria attacks. This non-inferiority randomized trial, was conducted to evaluate the efficacy and safety of the new formulation of AM in comparison to artemether-lumefantrine (AL for the treatment of acute uncomplicated Plasmodium falciparum malaria in adults in Senegal. Methods The study was carried out from September to December 2010 in two health centres in Senegal. The study end points included (i PCR corrected adequate clinical and parasitological response (ACPR at day 28, (ii ACPR at days 42 and 63, (iii parasites and fever clearance time, (iv incidence of adverse events and patients biological profile at day 7 using the WHO 2003 protocol for anti-malarial drug evaluation. Results Overall, 310 patients were randomized to receive either AM (n = 157 or AL (n = 153. PCR corrected ACPR at day 28 was at 95.5% in the AM arm while that in the AL arm was at 96.7% (p = 0.83. Therapeutic efficacy was at 98.5% in the AM arm versus 98.2% in the AL group at day 42 (p = 1. At day 63, ACPR in the AM and AL arms was at 98.2% and 97.7%, respectively (p = 0.32. The two treatments were well tolerated with similar biological profile at day 7. However, dizziness was more frequent in the AM arm. Conclusion Artesunate-mefloquine (25 mg/Kg mefloquine is efficacious and well-tolerated for the treatment of uncomplicated P. falciparum malaria in adult patients.

  3. As informações recebidas pelos pais durante a hospitalização do filho Las informaciones recibidas por los padres durante la internación del niño Information received by parents during children's hospitalization

    Directory of Open Access Journals (Sweden)

    Ana Llonch Sabatés

    2005-12-01

    la atención al hijo hospitalizado. Los padres solicitan de las enfermeras informaciones sobre el tiempo de hospitalización, evolución de la enfermedad, medicación y tratamiento de su hijo.This study aimed to find out how parents perceive the information they received from nurses during the hospital stay of their children and identify what information nurses indicate they supply to the parents. We carried out a descriptive-exploratory study with a quantitative approach at the pediatric internment units of a teaching hospital in the city of São Paulo, interviewing 50 parents whose children were hospitalized and 12 nurses working at these units. The results showed that parents were not completely satisfied with the information received from the nurses during the children's stay in hospital. The nurses mainly provided information to the parents about rules and routines, rights and obligations, reasons for procedures and parents' participation in care for the child. Parents asked the nurses information about the duration of their child`s hospitalization, progression of the disease, medication and treatment.

  4. CERN physicist receives Einstein Medal

    CERN Multimedia

    2006-01-01

    On 29 June the CERN theorist Gabriele Veneziano was awarded the prestigious Albert Einstein Medal for significant contributions to the understanding of string theory. This award is given by the Albert Einstein Society in Bern to individuals whose scientific contributions relate to the work of Einstein. Former recipients include exceptional physicists such as Murray Gell-Mann last year, but also Stephen Hawking and Victor Weisskopf. Gabriele Veneziano, a member of the integrated CERN Theory Team since 1977, led the Theory Division from 1994 to 1997 and has already received many prestigious prizes for his outstanding work, including the Enrico Fermi Prize (see CERN Courier, November 2005), the Dannie Heineman Prize for mathematical physics of the American Physical Society in 2004 (see Bulletin No. 47/2003), and the I. Ya. Pomeranchuk Prize of the Institute of Theoretical and Experimental Physics (Moscow) in 1999.

  5. Providing nursing care in a children's hospice.

    Science.gov (United States)

    Day, Alison

    Children who are admitted to hospices need specialist treatment that enables them to enjoy their childhood as much as possible while they receive the care they require. Their parents also have particular needs. During Children's Hospice Week, which started on September 21, the Association of Children's Hospices aims to raise awareness of the work done by children's hospices and the services they provide.

  6. The Mechanism of Company Accounts Receivable Management

    Directory of Open Access Journals (Sweden)

    Halyna Yamnenko

    2017-02-01

    Full Text Available The relevance of the accounts receivable management is caused by its ability to influence on the filling of the company working capital. Therefore it is necessary to create a specific mechanism for management of accounts receivable in the company. The article analyses the components of the mechanism and the influence of factors that significantly affect the operation. The result of the functioning of the accounts receivable management is to receive funds and to minimize accounts receivable.

  7. Determinants of receiving the pandemic (H1N1 2009 vaccine and intention to receive the seasonal influenza vaccine in Taiwan.

    Directory of Open Access Journals (Sweden)

    Ta-Chien Chan

    Full Text Available The paper examines the factors associated with both receiving pandemic (H1N1 2009 vaccines and individuals' intentions to get the next seasonal influenza vaccine in Taiwan.We conducted a representative nationwide survey with in-person household interviews during April-July 2010. Multivariate logistic regression incorporated socio-demographic background, household characteristics, health status, behaviors, and perceptions of influenza and vaccination.We completed interviews with 1,954 respondents. Among those, 548 (28.0% received the pandemic (H1N1 2009 vaccination, and 469 (24.0% intended to get the next seasonal influenza vaccine. Receipt of the H1N1 vaccine was more prevalent among schoolchildren, the elderly, those who had contact with more people in their daily lives, and those who had received influenza vaccinations in previous years. In comparison, the intention to receive the next seasonal influenza vaccine tended to be stronger among children, the elderly, and those who reported less healthy status or lived with children, who received a seasonal influenza vaccination before, and who worried more about a possible new pandemic.Children, the elderly, and those who had gotten seasonal flu shots before in Taiwan were more likely to both receive a pandemic H1N1 vaccination and intend to receive a seasonal influenza vaccine.

  8. Vertebrate pressure-gradient receivers.

    Science.gov (United States)

    Christensen-Dalsgaard, Jakob

    2011-03-01

    The eardrums of all terrestrial vertebrates (tetrapods) are connected through Eustachian tubes or interaural canals. In some of the animals, these connections create pressure-gradient directionality, an enhanced directionality by interaction of sound arriving at both sides of the eardrum and strongly dependent on interaural transmission attenuation. Even though the tympanic middle ear has originated independently in the major tetrapod groups, in each group the ancestral condition probably was that the two middle ears were exposed in the mouth cavity with relatively high interaural transmission. Recent vertebrates form a continuum from perfect interaural transmission (0 dB in a certain frequency band) and pronounced eardrum directionality (30-40 dB) in the lizards, over somewhat attenuated transmission and limited directionality in birds and frogs, to the strongly attenuated interaural transmission and functionally isolated pressure receiver ears in the mammals. Since some of the binaural interaction already takes place at the eardrum in animals with strongly coupled ears, producing enhanced interaural time and level differences, the subsequent neural processing may be simpler. In robotic simulations of lizards, simple binaural subtraction (EI cells, found in brainstem nuclei of both frogs and lizards) produces strongly lateralized responses that are sufficient for steering the animal robustly to sound sources.

  9. Recent developments in superconducting receivers

    Science.gov (United States)

    Richards, Paul L.

    1990-09-01

    A description is given of recent work at Berkeley on superconducting mixers and detectors for infrared and millimeter wavelengths. The first report is a review article which summarizes the status of development of superconducting components for infrared and millimeter wave receivers. The next report describes accurate measurements and also theoretical modeling of an SIS quasiparticle waveguide mixer for W-band which uses very high quality Ta junctions. The best mixer noise is only 1.3 times the quantum limit. Both the mixer gain and the noise are in quantitative agreement with the quantum theory. Next, a report is given on measurements and theoretical modeling of the absorptivity (surface resistance) of high quality epitaxial films of the high Tc superconductor YBCO from 750 GHz to 21 THz. Finally, there are reports on the design and experimental performance of two different types of high Tc bolometric detectors. One is a conventional bolometer with a gold-black absorber. The other is an antenna coupled microbolometer.

  10. Thermal resistance model for CSP central receivers

    Science.gov (United States)

    de Meyer, O. A. J.; Dinter, F.; Govender, S.

    2016-05-01

    The receiver design and heliostat field aiming strategy play a vital role in the heat transfer efficiency of the receiver. In molten salt external receivers, the common operating temperature of the heat transfer fluid or molten salt ranges between 285°C to 565°C. The optimum output temperature of 565°C is achieved by adjusting the mass flow rate of the molten salt through the receiver. The reflected solar radiation onto the receiver contributes to the temperature rise in the molten salt by means of heat transfer. By investigating published work on molten salt external receiver operating temperatures, corresponding receiver tube surface temperatures and heat losses, a model has been developed to obtain a detailed thermographic representation of the receiver. The steady state model uses a receiver flux map as input to determine: i) heat transfer fluid mass flow rate through the receiver to obtain the desired molten salt output temperature of 565°C, ii) receiver surface temperatures iii) receiver tube temperatures iv) receiver efficiency v) pressure drop across the receiver and vi) corresponding tube strain per panel.

  11. Síndrome da lipodistrofia e fatores de risco cardiovasculares em crianças e adolescentes infectados pelo HIV/AIDS em uso de terapia antirretroviral de alta potência Lipodystrophy syndrome and cardiovascular risk factors in children and adolescents infected with HIV/AIDS receiving highly active antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Maria L. F. Werner

    2010-02-01

    Full Text Available OBJETIVO: Descrever o perfil lipídico, alterações da conformação corporal e fatores de risco cardiovasculares em crianças e adolescentes infectados pelo HIV/AIDS, tratados com terapia antirretroviral de alta potência. MÉTODOS: Foram estudadas 43 crianças e adolescentes em uso dessa terapia atendidas no ambulatório de doenças infecciosas em Pediatria do Instituto Fernandes Figueira/Fundação Oswaldo Cruz, Rio de Janeiro (RJ. Foram realizadas dosagens de colesterol total, lipoproteína de alta densidade, lipoproteína de baixa densidade, triglicerídeos, teste de tolerância à glicose e avaliada a distribuição de gordura corporal, estado nutricional, ingestão dietética e história familiar de risco cardiovascular. As análises estatísticas foram realizadas com o teste t de Student. O nível de significância estatístico do p foi menor que 0,05. RESULTADOS: Observou-se alteração lipídica em 88,3% e de conformação corporal em 13,9% dos casos. O estado nutricional foi adequado na maioria (81,3% da população do estudo. A ingestão de colesterol em crianças com mais de 9 anos foi acima do recomendado. CONCLUSÃO: A prevalência de dislipidemia e, consequentemente, o risco para doenças cardiovasculares foram altos durante o uso de terapia antirretroviral de alta potência.OBJECTIVE: To describe lipid profile, body shape changes, and cardiovascular risk factors in children and adolescents infected with HIV/AIDS receiving highly active antiretroviral therapy. METHODS: We investigated 43 children and adolescents being treated with this therapy at the outpatient clinic of pediatric infectious diseases of Instituto Fernandes Figueira/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. Values of total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides were determined. We also performed glucose tolerance test and analyzed body fat distribution, nutritional status, dietary intake, and family history of

  12. Microwave receivers with electronic warfare applications

    CERN Document Server

    Tsui, James

    2005-01-01

    This book by the author of Digital Techniques for Wideband Receivers willbe like no other one on your book shelf as the definitive word on electronicwarfare (EW) receiver design and performance. Whether you are an EWscientist involved in the test and evaluation of EW receivers or a designerof RWR's and other EW-related receivers, Microwave Receivers withElectronic Warfare Applications is a handy reference through which you canperfect your technical art. Lucidly written, this book is a treatise on EWreceivers that is relevant to you if you are just looking for a top-levelinsight into EW receive

  13. Influencing factors of life qualities of children and adolescents with congenital heart disease received cardiac catheter interventional treatment%儿童和青少年先天性心脏病患者介入治疗后生存质量的影响因素研究

    Institute of Scientific and Technical Information of China (English)

    林平; 李玲; 高学琴

    2012-01-01

    Objective To explore the ifluencing factors of life qualities of children and adolescents with congenital heart disease received cardiac catheter interventional treatment and to provide theoretical guidance for formulating targeted nursing strategies,so as to improve their quality of life.Methods Totals of 96children and adolescences who underwent cardiac catheter interventional treatment were recruited from a hospital' s department of cardiology in Harbin city,Heilongjiang province.Pediatric quality of life inventory Generic Core Scales Version 4.0 and self-designed questionnaire including demographic data and possible influencing factors were used to investigated,respectively in 24 hours pre - treatment,1 month and 6 months post - treatment.Results The total score of PedsQLTM4.0 was ( 67.38 ± 15.31 ) before treatment,and (76.55 ±11.37 ),(80.47 ± 9.69 )after received treatment one months and six months later,respectively.The statistical data showed that patients' age,state of the household economy,social assistance influenced with total score of life quality (t =-3.26,2.58,2.73,2.54,2.37,respectively,P < 0.05 ) and state of the household economy,family relationship,parenting style were influenced factors for physiology function of patients ( t =2.92,3.40,-1.51,-2.86,-3.66,respectively; P<0.05 ).Patients age,self-care ability,parents cognition had effect on psychosocial functioning of quality of life for children and adolescences with congenital heart disease ( t =- 2.31,1.80,-1.40,2.64,respectively; P<0.05 ).Conclusions Patients' age,self-care ability,state of the household economy,parenting style,family relationship,parents' cognitive and social assistance have effect on quality of life of children and adolescences with congenital heart disease.So we should pay attention to conduct targeted nursing interventions for both patients and their families to improve their quality of life.%目的 探讨儿童和青少年先天性心脏病患者介入治疗后

  14. Drug procurement, the Global Fund and misguided competition policies

    Directory of Open Access Journals (Sweden)

    Hess Kimberly

    2009-12-01

    Full Text Available Abstract In an effort to increase competition and decrease price, the Global Fund to Fight AIDS, Tuberculosis and Malaria recently began asking some grant recipients to use international competitive bidding processes for certain drug purchases. Unfortunately, for countries like Kenya, this request has caused more harm than good. After awarding the tender for its annual supply of the anti-malarial artemether-lumefantrine to the lowest bidder, Ajanta Pharma, Kenya experienced wide stock-outs in part due to the company's inability to supply the order in full and on time. Similar problems could arise in Uganda. Despite Kenya's experience, Uganda has awarded its next tender for artemether-lumefantrine to Ajanta Pharma. Uganda is already facing wide stock-outs and risks exacerbating an already dire situation the longer it takes to fulfil the procurement contract. A tender process based primarily on price cannot account for a company's ability to consistently supply sufficient product in time.

  15. Trough Receiver Heat Loss Testing (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Lewandowski, A.; Feik, C.; Hansen, R.; Phillips, S.; Bingham, C.; Netter, J.; Forristal, R.; Burkholder, F.; Meglan, B.; Wolfrum, E.

    2006-02-01

    This presentation describes the design, fabrication, and qualification of an experimental capability for thermal loss testing of full-size trough receiver elements; and the testing on a variety of receivers.

  16. The First Six ALMA Band 10 Receivers

    Science.gov (United States)

    Fujii, Y.; Gonzalez, A.; Kroug, M.; Kaneko, K.; Miyachi, A.; Yokoshima, T.; Kuroiwa, K.; Ogawa, H.; Makise, K.; Wang, Z.; Uzawa, Y.

    2013-01-01

    The first six Atacama Large Millimeter/submillimeter Array (ALMA) Band 10 (787-950 GHz) receivers have been developed and characterized during the receiver preproduction phase. State-of-the-art measurement systems at THz frequencies have been implemented and successfully used to measure the performance of the first six receivers. Extensive tests ranging from receiver sensitivity and stability to optical aperture efficiency on the secondary antenna have been performed. Performance of all six receivers is well within the stringent ALMA requirements. Moreover, our extensive tests have shown that there are no big performance differences between receivers. These results indicate that the ALMA Band 10 receiver is ready for the production phase, during which an additional 67 receivers will be produced and characterized.

  17. Social Information Processing in Elementary-School Aged Children with ADHD: Medication Effects and Comparisons with Typical Children

    Science.gov (United States)

    King, Sara; Waschbusch, Daniel A.; Pelham, William E., Jr.; Frankland, Bradley W.; Andrade, Brendan F.; Jacques, Sophie; Corkum, Penny V.

    2009-01-01

    Examined social information processing (SIP) in medicated and unmedicated children with ADHD and in controls. Participants were 75 children (56 boys, 19 girls) aged 6-12 years, including 41 children with ADHD and 34 controls. Children were randomized into medication conditions such that 20 children with ADHD participated after receiving placebo…

  18. 49 CFR 393.88 - Television receivers.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Television receivers. 393.88 Section 393.88... NECESSARY FOR SAFE OPERATION Miscellaneous Parts and Accessories § 393.88 Television receivers. Any motor vehicle equipped with a television viewer, screen or other means of visually receiving a...

  19. 49 CFR 236.730 - Coil, receiver.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Coil, receiver. 236.730 Section 236.730 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Coil, receiver. Concentric layers of insulated wire wound around the core of a receiver of an...

  20. Measuring Patient Adherence to Malaria Treatment: A Comparison of Results from Self-Report and a Customised Electronic Monitoring Device

    OpenAIRE

    Bruxvoort, K; Festo, C; Cairns, M.; Kalolella, A; Mayaya, F; Kachur, SP; Schellenberg, D; Goodman, C

    2015-01-01

    Background Self-report is the most common and feasible method for assessing patient adherence to medication, but can be prone to recall bias and social desirability bias. Most studies assessing adherence to artemisinin-based combination therapies (ACTs) have relied on self-report. In this study, we use a novel customised electronic monitoring device—termed smart blister packs—to examine the validity of self-reported adherence to artemether-lumefantrine (AL) in southern Tanzania. Methods Smart...

  1. Prevalence of Single Nucleotide Polymorphisms in the Plasmodium falciparum Multidrug Resistance Gene (Pfmdr-1) in Korogwe District in Tanzania Before and After Introduction of Artemisinin-Based Combination Therapy

    DEFF Research Database (Denmark)

    Thomsen, Thomas T; Ishengoma, Deus S; Mmbando, Bruno P;

    2011-01-01

    Abstract. Tanzania implemented artemether-lumefantrine (AL) as the first-line treatment for uncomplicated malaria in November of 2006 because of resistance to sulfadoxine-pyrimethamine. AL remains highly efficacious, but widespread use may soon facilitate emergence of artemisinin tolerance/resist.......9). The observed changes may be because of introduction of AL, and if so, this finding gives cause for concern and argues for continued surveillance of these molecular markers....

  2. A zero-power radio receiver.

    Energy Technology Data Exchange (ETDEWEB)

    Brocato, Robert Wesley

    2004-09-01

    This report describes both a general methodology and some specific examples of passive radio receivers. A passive radio receiver uses no direct electrical power but makes sole use of the power available in the radio spectrum. These radio receivers are suitable as low data-rate receivers or passive alerting devices for standard, high power radio receivers. Some zero-power radio architectures exhibit significant improvements in range with the addition of very low power amplifiers or signal processing electronics. These ultra-low power radios are also discussed and compared to the purely zero-power approaches.

  3. Astronomical Receiver Modelling Using Scattering Matrices

    CERN Document Server

    King, O G; Copley, C; Davis, R J; Leahy, J P; Leech, J; Muchovej, S J C; Pearson, T J; Taylor, Angela C

    2014-01-01

    Proper modelling of astronomical receivers is vital: it describes the systematic errors in the raw data, guides the receiver design process, and assists data calibration. In this paper we describe a method of analytically modelling the full signal and noise behaviour of arbitrarily complex radio receivers. We use electrical scattering matrices to describe the signal behaviour of individual components in the receiver, and noise correlation matrices to describe their noise behaviour. These are combined to produce the full receiver model. We apply this approach to a specified receiver architecture: a hybrid of a continous comparison radiometer and correlation polarimeter designed for the C-Band All-Sky Survey. We produce analytic descriptions of the receiver Mueller matrix and noise temperature, and discuss how imperfections in crucial components affect the raw data. Many of the conclusions drawn are generally applicable to correlation polarimeters and continuous comparison radiometers.

  4. Children's (Pediatric) CT (Computed Tomography)

    Medline Plus

    Full Text Available ... radiation children may receive from a CT scan. One of the best ways of limiting radiation exposure ... or pediatrician and the radiologist will decide which type of examination is best for your child. top ...

  5. Práticas alimentares e estado nutricional de crianças no segundo semestre de vida atendidas na rede pública de saúde Feeding practices and nutritional status of children in the second semester of life who receive care in public health facilities

    Directory of Open Access Journals (Sweden)

    Simone Paula Modesto

    2007-08-01

    Full Text Available OBJETIVO: Avaliar o estado nutricional e as práticas alimentares de crianças no segundo semestre de vida atendidas na rede pública de saúde do município de Taboão da Serra, SP. MÉTODOS: Estudo de corte transversal conduzido em Unidades Básicas de Saúde, classificadas em dois agrupamentos (região central e região periférica. A amostra foi constituída por 180 crianças, sendo 90 de cada agrupamento. O consumo alimentar foi registrado pelo método recordatório de 24 horas. Foram tomadas medidas de peso e dosagem de hemoglobina por punção capilar. RESULTADOS: A prevalência de anemia encontrada foi de 30,5% sem diferença entre os grupos. Os valores das medianas do escore-Z (peso/idade foram: 0,02 e 0,03, para os agrupamentos central e periférico, respectivamente. A utilização de suplemento de ferro apresentou diferença entre os grupos (p=0,001, sendo mais presente no agrupamento periférico, enquanto que para a vitamina A, a suplementação foi significantemente maior no agrupamento central (p=0,044. Verificou-se introdução precoce de alimentos distintos do leite materno na dieta infantil e diferença significante entre os grupos na idade de introdução de chá, suco de fruta, sopa e sopa com carne no esquema alimentar. Em relação à ingestão de nutrientes verificou-se consumo adequado de energia e proteínas, mas quanto aos micronutrientes estudados, há grande probabilidade de inadequação do consumo de ferro e vitamina C. CONCLUSÃO: A prevalência de anemia é relativamente reduzida, comparada com os dados obtidos em outros locais, e o esquema de introdução de alimentos complementares é inadequado, frente às recomendações atuais. A utilização de suplementos de nutrientes deve ser revista.OBJECTIVE: To assess the nutritional status and feeding practices of children in the second semester of life who receive care in public health facilities of the city of Taboão da Serra, SP. METHODS: This is a cross

  6. High stable remote photoelectric receiver for interferometry

    Science.gov (United States)

    Yang, Hongxing; Zhu, Pengfei; Tan, Jiubin; Hu, Pengcheng; Fan, Zhigang

    2017-03-01

    A high sensitive and high stable remote photoelectric receiver has been developed to reduce noise and phase delay drift caused by thermal pollution and environmental interference. The phase delay drift model is analyzed and built based on a traditional photoelectric receiver. According to the model, a new mechanical isolation structure and a temperature control system are designed to keep the photoelectric receiver in a low constant temperature. Comparison experiments with traditional bias voltage compensation method and temperature control method are carried out between photoelectric receivers. The results verify that the output voltage fluctuation of photoelectric receiver used is reduced by 65% while the phase drift between measurement and reference photoelectric receivers decreases from 1.05° to 0.02°.

  7. Analysis of the omnium-g receiver

    Energy Technology Data Exchange (ETDEWEB)

    Bohn, M.

    1980-03-01

    A thermal analysis of the Omnium-G receiver is presented and the technique is shown to be generally applicable to solar thermal receivers utilizing a directly heated thermal mass. The thermal loss coefficient, including reradiation losses, is calculated and shown to agree quite well with the experimentally measured thermal loss coefficient. The rate of heat transfer to the working fluid is also analyzed and the analysis is used to show that the Omnium-G receiver is well matched to the water/steam working fluid because the steam outlet temperature is almost the same as the receiver temperature. A general procedure for calculating receiver performance is presented. With this procedure, the energy delivery to any working fluid, the delivered temperature of the working fluid, and the pressure drop through the receiver can be determined. An example of the calculation is also presented.

  8. Nursing process approach improves receivables management.

    Science.gov (United States)

    Dias, K; Stockamp, D

    1992-09-01

    The "nursing process" is a systematic decision-making approach to problem solving based on open-system theory. This theory assumes that there is an on-going interchange between all system components. Components cannot be viewed in isolation, because decisions regarding one component will affect other components. Receivables management is similar to the nursing process, in that it involves constant diagnosis, assessment, and intervention in the work in process during all phases of the receivables cycle. In experiments that applied the nursing process concept to the management of accounts receivable in several hospitals, gross days in accounts receivable were reduced and cash flow was increased.

  9. Shipping/Receiving and Quality Control

    Data.gov (United States)

    Federal Laboratory Consortium — Shipping receiving, quality control, large and precise inspection and CMM machines. Coordinate Measuring Machines, including "scanning" probes, optical comparators,...

  10. Special design topics in digital wideband receivers

    CERN Document Server

    Tsui, James B Y

    2009-01-01

    Offering engineers a thorough examination of special, more advanced aspects of digital wideband receiver design, this practical book builds on fundamental resources on the topic, helping you gain a more comprehensive understanding of the subject. This in-depth volume presents a detailed look at a complete receiver design, including the encoder. Moreover, it discusses the detection of exotic signals and provides authoritative guidance on designing receivers used in electronic warfare. From frequency modulation and biphase shifting keys, to parameter encoders in electronic warfare receivers and

  11. Efficient structures for wideband digital receiver

    Institute of Scientific and Technical Information of China (English)

    Wang Hong; Lu Youxin; Wang Xuegang; Wan Yonglun

    2006-01-01

    Digital receivers have become more and more popular in radar, communication, and electric warfare for the advantages compared with their analog counterparts. But conventional digital receivers have been generally considered impractical for bandwidth greater than several hundreds MHz. To extend receiver bandwidth, decrease data rate and save hardware resources, three novel structures are proposed. They decimate the data stream prior to mixing and filtering, then process the multiple decimated streams in parallel at a lower rate. Consequently it is feasible to realize wideband receivers on the current ASIC devices. A design example and corresponding simulation results are demonstrated to evaluate the proposed structures.

  12. Receiver function estimated by maximum entropy deconvolution

    Institute of Scientific and Technical Information of China (English)

    吴庆举; 田小波; 张乃铃; 李卫平; 曾融生

    2003-01-01

    Maximum entropy deconvolution is presented to estimate receiver function, with the maximum entropy as the rule to determine auto-correlation and cross-correlation functions. The Toeplitz equation and Levinson algorithm are used to calculate the iterative formula of error-predicting filter, and receiver function is then estimated. During extrapolation, reflective coefficient is always less than 1, which keeps maximum entropy deconvolution stable. The maximum entropy of the data outside window increases the resolution of receiver function. Both synthetic and real seismograms show that maximum entropy deconvolution is an effective method to measure receiver function in time-domain.

  13. Design and implementation of the CAPS receiver

    Science.gov (United States)

    Hu, Yonghui; Hua, Yu; Hou, Lei; Wei, Jingfa; Wu, Jianfeng

    2009-03-01

    In this paper, based on analyses of the Chinese Area Positioning System (CAPS) satellite (GEO satellite) resources and signal properties, the signal power at the port of the receiver antenna is estimated, and the implementation projects are presented for a switching band C to band L CAPS C/A code receiver integrated with GPS receiver suite and for a CAPS dual frequency P code receiver. A microstrip receiving antenna is designed with high sensitivity and wide beam orientation, the RF front end of the C/A code and P code receivers, and a processor is designed for the navigation baseband. A single frequency CAPS C/A code receiver and a CAPS dual frequency P code receiver are built at the same time. A software process flow is provided, and research on relatively key techniques is also conducted, such as signal searching, code loop and carrier loop algorithms, a height assistant algorithm, a dual frequency difference speed measurement technique, a speed measurement technique using a single frequency source with frequency assistance, and a CAPS time correcting algorithm, according to the design frame of the receiver hardware. Research results show that the static plane positioning accuracy of the CAPS C/A code receiver is 20.5-24.6 m, height accuracy is 1.2-12.8 m, speed measurement accuracy is 0.13-0.3 m/s, dynamic plane positioning accuracy is 24.4 m, height accuracy is 3.0 m, and speed measurement accuracy is 0.24 m/s. In the case of C/A code, the timing accuracy is 200 ns, and it is also shown that the positioning accuracy of the CAPS precise code receiver (1 σ) is 5 m from south to north, and 0.8 m from east to west. Finally, research on positioning accuracy is also conducted.

  14. Design and implementation of the CAPS receiver

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    In this paper, based on analyses of the Chinese Area Positioning System (CAPS) satellite (GEO satellite) resources and signal properties, the signal power at the port of the receiver antenna is estimated, and the implementation projects are presented for a switching band C to band L CAPS C/A code receiver integrated with GPS receiver suite and for a CAPS dual frequency P code receiver. A microstrip receiving antenna is designed with high sensitivity and wide beam orientation, the RF front end of the C/A code and P code receivers, and a processor is designed for the navigation baseband. A single frequency CAPS C/A code receiver and a CAPS dual frequency P code receiver are built at the same time. A software process flow is provided, and research on relatively key techniques is also conducted, such as signal searching, code loop and carrier loop algorithms, a height assistant algorithm, a dual frequency difference speed measurement technique, a speed measurement technique using a single frequency source with frequency assistance, and a CAPS time correcting algorithm, according to the design frame of the receiver hardware. Research results show that the static plane positioning accuracy of the CAPS C/A code receiver is 20.5-24.6 m, height accuracy is 1.2-12.8 m, speed measurement accuracy is 0.13-0.3 m/s, dynamic plane positioning accuracy is 24.4 m, height accuracy is 3.0 m, and speed measurement accuracy is 0.24 m/s. In the case of C/A code, the timing accuracy is 200 ns, and it is also shown that the positioning accuracy of the CAPS precise code receiver (1σ ) is 5 m from south to north, and 0.8 m from east to west. Finally, research on positioning accuracy is also conducted.

  15. Superconducting integrated submillimeter receiver for TELIS

    NARCIS (Netherlands)

    Koshelets, Valery P.; Ermakov, Andrey B.; Filippenko, Lyudmila V.; Khudchenko, Andrey V.; Kiselev, Oleg S.; Sobolev, Alexander S.; Torgashin, Mikhail Yu.; Yagoubov, Pavel A.; Hoogeveen, Ruud W. M.; Wild, Wolfgang

    2007-01-01

    In this report an overview of the results on the development of a single-chip superconducting integrated receiver for the Terahertz Limb Sounder (TELIS) balloon project intended to measure a variety of stratosphere trace gases is presented. The Superconducting Integrated Receiver (SIR) comprises in

  16. Social networks and receiving informal care.

    NARCIS (Netherlands)

    Boer, A. de; Klerk, M. de; Cardol, M.; Westert, G.

    2006-01-01

    In 2001, roughly half a million people (4% of the Dutch population) received informal care from family members living outside their home, and a quarter of a million (2% of the Dutch population) received this care from acquaintances, such as friend, neighbours and work colleagues. The potential suppl

  17. Superconducting chip receivers for imaging application

    NARCIS (Netherlands)

    Shitov, SV; Koshelets, VP; Ermakov, AB; Filippenko, LV; Baryshev, AM; Luinge, W; Gao, [No Value

    1999-01-01

    Experimental details of a unique superconducting imaging array receiver are discussed. Each pixel contains an internally pumped receiver chip mounted on the back of the elliptical microwave lens. Each chip comprises a quasi-optical SIS mixer integrated with a superconducting flux-flow oscillator (FF

  18. 21 CFR 1020.10 - Television receivers.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Television receivers. 1020.10 Section 1020.10 Food...) RADIOLOGICAL HEALTH PERFORMANCE STANDARDS FOR IONIZING RADIATION EMITTING PRODUCTS § 1020.10 Television receivers. (a) Applicability. The provisions of this section are applicable to television...

  19. 47 CFR 32.1170 - Receivables.

    Science.gov (United States)

    2010-10-01

    ... FOR TELECOMMUNICATIONS COMPANIES Instructions for Balance Sheet Accounts § 32.1170 Receivables. (a... enable the company to make the following analysis: (1) Amounts due from customers who are receiving... process of collection. (b) Collections in excess of amounts charged to this account may be credited to...

  20. RF performance of T-DAB receivers

    NARCIS (Netherlands)

    Schiphorst, R.; Potman, J.; Hofstra, K.L.; Cronie, H.S.; Slump, C.H.

    2008-01-01

    In every wireless system, the weakest link determines the performance of the network. In this paper the Radio Frequency (RF) performance of both band III and L-band Terrestrial Digital Audio Broadcasting (T-DAB) consumer receivers are discussed. The receivers have been tested based on the EN 50248 s

  1. Compressive Sensing for Spread Spectrum Receivers

    DEFF Research Database (Denmark)

    Fyhn, Karsten; Jensen, Tobias Lindstrøm; Larsen, Torben

    2013-01-01

    With the advent of ubiquitous computing there are two design parameters of wireless communication devices that become very important: power efficiency and production cost. Compressive sensing enables the receiver in such devices to sample below the Shannon-Nyquist sampling rate, which may lead...... to a decrease in the two design parameters. This paper investigates the use of Compressive Sensing (CS) in a general Code Division Multiple Access (CDMA) receiver. We show that when using spread spectrum codes in the signal domain, the CS measurement matrix may be simplified. This measurement scheme, named...... Compressive Spread Spectrum (CSS), allows for a simple, effective receiver design. Furthermore, we numerically evaluate the proposed receiver in terms of bit error rate under different signal to noise ratio conditions and compare it with other receiver structures. These numerical experiments show that though...

  2. An SDR based AIS receiver for satellites

    DEFF Research Database (Denmark)

    Larsen, Jesper Abildgaard; Mortensen, Hans Peter; Nielsen, Jens Frederik Dalsgaard

    2011-01-01

    For a few years now, there has been a high interest in monitoring the global ship traffic from space. A few satellite, capable of listening for ship borne AIS transponders have already been launched, and soon the AAUSAT3, carrying two different types of AIS receivers will also be launched. One...... of the AIS receivers onboard AAUSAT3 is an SDR based AIS receiver. This paper serves to describe the background of the AIS system, and how the SDR based receiver has been integrated into the AAUSAT3 satellite. Amongst some of the benefits of using an SDR based receiver is, that due to its versatility, new...... detection algorithms are easily deployed, and it is easily adapted the new proposed AIS transmission channels....

  3. Social exclusion of children

    NARCIS (Netherlands)

    Annette Roest; Anne Marike Lokhorst; Cok Vrooman

    2010-01-01

    Original title: Sociale uitsluiting bij kinderen. Combating social exclusion of children is a subject that has received growing attention in Dutch government policy in recent years. To date, however, no analysis has been performed to ascertain the extent and origins of this phenomenon. This report

  4. Terahertz Array Receivers with Integrated Antennas

    Science.gov (United States)

    Chattopadhyay, Goutam; Llombart, Nuria; Lee, Choonsup; Jung, Cecile; Lin, Robert; Cooper, Ken B.; Reck, Theodore; Siles, Jose; Schlecht, Erich; Peralta, Alessandro; Thomas, Bertrand; Mehdi, Imran

    2011-01-01

    Highly sensitive terahertz heterodyne receivers have been mostly single-pixel. However, now there is a real need of multi-pixel array receivers at these frequencies driven by the science and instrument requirements. In this paper we explore various receiver font-end and antenna architectures for use in multi-pixel integrated arrays at terahertz frequencies. Development of wafer-level integrated terahertz receiver front-end by using advanced semiconductor fabrication technologies has progressed very well over the past few years. Novel stacking of micro-machined silicon wafers which allows for the 3-dimensional integration of various terahertz receiver components in extremely small packages has made it possible to design multi-pixel heterodyne arrays. One of the critical technologies to achieve fully integrated system is the antenna arrays compatible with the receiver array architecture. In this paper we explore different receiver and antenna architectures for multi-pixel heterodyne and direct detector arrays for various applications such as multi-pixel high resolution spectrometer and imaging radar at terahertz frequencies.

  5. Fundamentals of GPS Receivers A Hardware Approach

    CERN Document Server

    Doberstein, Dan

    2012-01-01

    While much of the current literature on GPS receivers is aimed at those intimately familiar with their workings, this volume summarizes the basic principles using as little mathematics as possible, and details the necessary specifications and circuits for constructing a GPS receiver that is accurate to within 300 meters. Dedicated sections deal with the features of the GPS signal and its data stream, the details of the receiver (using a hybrid design as exemplar), and more advanced receivers and topics including time and frequency measurements. Later segments discuss the Zarlink GPS receiver chip set, as well as providing a thorough examination of the TurboRogue receiver, one of the most accurate yet made. Guiding the reader through the concepts and circuitry, from the antenna to the solution of user position, the book’s deployment of a hybrid receiver as a basis for discussion allows for extrapolation of the core ideas to more complex, and more accurate designs. Digital methods are used, but any analogue c...

  6. Enhanced AIS receiver design for satellite reception

    Science.gov (United States)

    Clazzer, Federico; Lázaro, Francisco; Plass, Simon

    2016-12-01

    The possibility to detect Automatic Identification System (AIS) messages from low earth orbit (LEO) satellites paves the road for a plurality of new and unexplored services. Besides worldwide tracking of vessels, maritime traffic monitoring, analysis of vessel routes employing big data, and oceans monitoring are just few of the fields, where satellite-aided AIS is beneficial. Designed for ship-to-ship communication and collision avoidance, AIS satellite reception performs poorly in regions with a high density of vessels. This calls for the development of advanced satellite AIS receivers able to improve the decoding capabilities. In this context, our contribution focuses on the introduction of a new enhanced AIS receiver design and its performance evaluation. The enhanced receiver makes use of a coherent receiver for the low signal-to-noise ratio (SNR) region, while for medium to high SNRs, a differential Viterbi receiver is used. Additional novelty of our work is in the exploitation of previously decoded packets from one vessel that is still under the LEO reception range, to improve the vessel detection probability. The assessment of the performance against a common receiver is done making the use of a simple and tight model of the medium access (MAC) layer and the multi-packet reception (MPR) matrix for physical layer (PHY) representation. Performance results show the benefits of such enhanced receiver, especially when it is bundled with successive interference cancellation (SIC).

  7. Temperature influences in receiver clock modelling

    Science.gov (United States)

    Wang, Kan; Meindl, Michael; Rothacher, Markus; Schoenemann, Erik; Enderle, Werner

    2016-04-01

    In Precise Point Positioning (PPP), hardware delays at the receiver site (receiver, cables, antenna, …) are always difficult to be separated from the estimated receiver clock parameters. As a result, they are partially or fully contained in the estimated "apparent" clocks and will influence the deterministic and stochastic modelling of the receiver clock behaviour. In this contribution, using three years of data, the receiver clock corrections of a set of high-precision Hydrogen Masers (H-Masers) connected to stations of the ESA/ESOC network and the International GNSS Service (IGS) are firstly characterized concerning clock offsets, drifts, modified Allan deviations and stochastic parameters. In a second step, the apparent behaviour of the clocks is modelled with the help of a low-order polynomial and a known temperature coefficient (Weinbach, 2013). The correlations between the temperature and the hardware delays generated by different types of antennae are then analysed looking at daily, 3-day and weekly time intervals. The outcome of these analyses is crucial, if we intend to model the receiver clocks in the ground station network to improve the estimation of station-related parameters like coordinates, troposphere zenith delays and ambiguities. References: Weinbach, U. (2013) Feasibility and impact of receiver clock modeling in precise GPS data analysis. Dissertation, Leibniz Universität Hannover, Germany.

  8. Vivencias psicosociales reveladas por niños que reciben tratamiento con quimioterapia por cáncer Psychosocial experiences of children receiving chemotherapy for cancer Vivências psicossociais de crianças com tratamento de quimioterapia por câncer

    Directory of Open Access Journals (Sweden)

    RIVERA ZABALA JOHANNA MARCELA

    2009-12-01

    Full Text Available Se realizó un estudio cualitativo con el propósito de descubrir las vivencias psicosociales de niños y niñas de 9 a 12 años que recibían tratamiento con quimioterapia por cáncer. La recolección de la información se hizo mediante encuentros lúdicos con el apoyo de algunas preguntas básicas que facilitaron las revelaciones narrativas. Tres aspectos se destacan en los hallazgos del estudio: vivencias desfavorables, vivencias relacionadas con la autoestima y vivencias favorables; las dos primeras, de diversa manera, afectan en estos niños su vida personal, familiar, escolar y, en general, todo su entorno. Es de resaltar que, como consecuencia de la caída del cabello, con frecuencia han sido objeto de burla y de rechazo por sus compañeros de estudio, lo que produce el más notorio efecto sobre su autoimagen; por otra parte, el ausentismo escolar conlleva dificultades académicas y sentimientos de tristeza en estos niños, situación que empeora cuando, por motivos de tratamiento, su lugar de residencia está alejado de la ciudad, viéndose sometidos a largos periodos de separación, no solo de su familia sino de sus pares. Se concluye que la mayor parte de las revelaciones son impactantes por su gran contenido de sufrimiento y dolor para estos niños, lo que demuestra la urgencia de retomar los hallazgos del estudio para orientar el cuidado de enfermería de manera más integral y apoyar para que se haga lo propio en el hogar y en las instituciones educativas.A qualitative study was carried out in order to discover psychosocial experiences of boys and girls receiving chemotherapy treatment for cancer. Information was collected through ludic encounters with the support of some basic questions to facilitate narrative disclosures. Three aspects stand out among findings in the study: unfavorable experiences, experiences related to self esteem and favorable experiences; the first two, in different ways, affect boys and girls’ personal

  9. Vivencias psicosociales reveladas por niños que reciben tratamiento con quimioterapia por cáncer Vivências psicossociais de crianças com tratamento de quimioterapia por câncer Psychosocial experiences of children receiving chemotherapy for cancer

    Directory of Open Access Journals (Sweden)

    BLANCA CECILIA VANEGAS DE AHOGADO

    áveis; as duas primeiras afetam de forma diferente na vida pessoal, familiar, escolar e geral das crianças. é importante salientar que normalmente a queda de cabelo nas crianças provoca deboche e repulsão por parte de seus companheiros, o que produz o efeito mais notório sobre a imagem própria; por outro lado, o absentismo escolar traz dificuldades acadêmicas e sentimentos de tristeza nessas crianças, situação que se agrava quando, por causa do tratamento, elas devem viajar longe de seu domicilio e ficar afastados da sua família e seus amigos por muito tempo. Conclui-se que a maior parte das revelações são chocantes devido a o alto conteúdo de sofrimento e dor para essas crianças, o que demonstra a urgência de retomar os achados do estudo para orientar o cuidado de enfermagem para uma forma mais integral e fazer tudo que for preciso para fazer o mesmo no lar e nas instituições educativas.A qualitative study was carried out in order to discover psychosocial experiences of boys and girls receiving chemotherapy treatment for cancer. Information was collected through ludic encounters with the support of some basic questions to facilitate narrative disclosures. Three aspects stand out among findings in the study: unfavorable experiences, experiences related to self esteem and favorable experiences; the first two, in different ways, affect boys and girls' personal, family and school life, and in general, all of their environment. It is worth highlighting that, as a consequence of hair loss, they are frequently the object of mockery and rejection by school mates, which produces the most notorious effect over their self image; on the other hand, school absenteeism causes academic difficulties and feelings of sadness in these children, situations get worse when, due to treatment, they have to live far away from the city, being subject to long periods of separation, not only from their families, but also from their peers. It is concluded that most disclosures are

  10. Travelers' Health: Vaccine Recommendations for Infants and Children

    Science.gov (United States)

    ... at age 6 weeks. Routine Infant and Childhood Vaccinations Children should receive routine vaccination for hepatitis A virus; ... recommendations about seasonal influenza vaccination. MMR or MMRV vaccine: Children traveling abroad may need to be vaccinated at ...

  11. 49 CFR 236.788 - Receiver.

    Science.gov (United States)

    2010-10-01

    ... OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Definitions § 236.788 Receiver. A device on a locomotive, so placed that it is in position to be influenced inductively or actuated by...

  12. Metal Mesh Filters for Terahertz Receivers Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The technical objective of this SBIR program is to develop and demonstrate metal mesh filters for use in NASA's low noise receivers for terahertz astronomy and...

  13. List of Nuclear Materials Licensing Actions Received

    Data.gov (United States)

    Nuclear Regulatory Commission — A catalog of all Materials Licensing Actions received for review. The catalog lists the name of the entity submitting the license application, their city and state,...

  14. Metal Mesh Filters for Terahertz Receivers Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The best low-noise receiver solutions for frequencies above about 800 GHz rely on either a low-noise bolometric direct detector or a hot electron bolometric mixer....

  15. High-Rate Receiver Design Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We propose an initial architectural and preliminary hardware design study for a high-rate receiver capable of decoding modulation suites specified by CCSDS...

  16. Collector/Receiver Characterization (Fact Sheet)

    Energy Technology Data Exchange (ETDEWEB)

    2010-08-01

    Fact sheet describing NREL CSP Program capabilities for collector/receiver characterization: determining optical efficiency, measuring heat loss, developing and testing concentrators, concentrating the sun's power, and optically characterizing CSP plants.

  17. Digital Receiver for Laser Imaging Radar

    Institute of Scientific and Technical Information of China (English)

    WANG Wei Ran; SUN Bing

    2004-01-01

    With the extension of the application domains for laser imaging radar,it is necessary to find a new technical way to obtain high technical performance and adaptive ability.In this paper,A new concept of digital receiver of laser imaging radar system is presented.This digital receiver is defined as a time varying parameter receiver which possesses large dynamics region and time domain filter.The receiver's mode,component structure as well as every function of its processing are described.The results and laboratorial data show the feasibility of digital reception.Also,it can exploit the inherent nature of laser imaging radar to obtain high probability of detection.

  18. Design and implementation of the CAPS receiver

    Institute of Scientific and Technical Information of China (English)

    HU YongHui; HUA Yu; HOU Lei; WEI JingFa; WU JianFeng

    2009-01-01

    In this paper,baaed on analyses of the Chinese Area Positioning System (CAPS) satellite (GEO satellite) resources and signal properties,the signal power at the port of the receiver antenna is estimated,and the implementation projects are presented for a switching band C to band L CAPS C/A code receiver integrated with GPS receiver suite and for a CAPS dual frequency P code receiver.A microstrip receiving antenna is designed with high sensitivity and wide beam orientation,the RF front end of the C/A code and P code receivers,and a processor is designed for the navigation baseband.A single frequency CAPS C/A code receiver and a CAPS dual frequency P code receiver are built at the same time.A software process flow is provided,and research on relatively key techniques is also conducted,such as signal searching,code loop and carrier loop algorithms,a height assistant algorithm,a dual frequency difference speed measurement technique,a speed measurement technique using a single frequency source with frequency assistance,and a CAPS time correcting algorithm,according to the design frame of the receiver hardware.Research results show that the static plane positioning accuracy of the CAPS C/A code receiver is 20.5-24.6 m,height accuracy is 1.2-12.8 m,speed measurement accuracy is 0.13-0.3 m/s,dynamic plane positioning accuracy is 24.4 m,height accuracy is 3.0 m,and speed measurement accuracy is 0.24 m/s.In the case of C/A code,the timing accuracy is 200 ha,and it is also shown that the positioning accuracy of the CAPS precise code receiver (1σ) is 5 m from south to north,and 0.8 m from east to west.Finally,research on positioning accuracy is also conducted.

  19. A handbook for solar central receiver design

    Energy Technology Data Exchange (ETDEWEB)

    Falcone, P.K.

    1986-12-01

    This Handbook describes central receiver technology for solar thermal power plants. It contains a description and assessment of the major components in a central receiver system configured for utility scale production of electricity using Rankine-cycle steam turbines. It also describes procedures to size and optimize a plant and discussed examples from recent system analyses. Information concerning site selection criteria, cost estimation, construction, and operation and maintenance is also included, which should enable readers to perform design analyses for specific applications.

  20. Flexible receiver adapter formal design review

    Energy Technology Data Exchange (ETDEWEB)

    Krieg, S.A.

    1995-06-13

    This memo summarizes the results of the Formal (90%) Design Review process and meetings held to evaluate the design of the Flexible Receiver Adapters, support platforms, and associated equipment. The equipment is part of the Flexible Receiver System used to remove, transport, and store long length contaminated equipment and components from both the double and single-shell underground storage tanks at the 200 area tank farms.

  1. 47 CFR 15.121 - Scanning receivers and frequency converters used with scanning receivers.

    Science.gov (United States)

    2010-10-01

    ... receivers and frequency converters designed or marketed for use with scanning receivers, shall: (1) Be...; replacing a plug-in semiconductor chip; or programming a semiconductor chip using special access codes or an external device, such as a personal computer. Scanning receivers, and frequency converters designed for...

  2. Comparing Drug Use between Welfare-Receiving Arrestees and Non-Welfare-Receiving Arrestees.

    Science.gov (United States)

    Yacoubian, George S., Jr.; Peters, Ronald J., Jr.; Urbach, Blake J.; Johnson, Regina J.

    2002-01-01

    Compares drug-positive rates between welfare-receiving arrestees, non-welfare receiving arrestees living below the poverty level, and non-welfare arrestees living above the poverty level. Welfare-receiving arrestees were more likely to be female, older, less educated, and to test positive for opiates and benzodiazepines than the other subgroups.…

  3. Visual Status of Children with Down Syndrome

    OpenAIRE

    Robert H. Duckman, OD, MA

    2014-01-01

    Background: Children with Down syndrome (DS) are known to have a high prevalence of visual anomalies including strabismus, high refractive errors, Brushfield spots, nystagmus, keratoconus, and external pathologies such as blepharitis and conjunctivitis. These anomalies can impair children with DS from maximum functional capabilities. Methods: This study looks at 42 children from Stepping Stone Day School between the ages of 2.33 years and 5.17 years. All 42 children received a co...

  4. Efficient receiver tuning using differential evolution strategies

    Science.gov (United States)

    Wheeler, Caleb H.; Toland, Trevor G.

    2016-08-01

    Differential evolution (DE) is a powerful and computationally inexpensive optimization strategy that can be used to search an entire parameter space or to converge quickly on a solution. The Kilopixel Array Pathfinder Project (KAPPa) is a heterodyne receiver system delivering 5 GHz of instantaneous bandwidth in the tuning range of 645-695 GHz. The fully automated KAPPa receiver test system finds optimal receiver tuning using performance feedback and DE. We present an adaptation of DE for use in rapid receiver characterization. The KAPPa DE algorithm is written in Python 2.7 and is fully integrated with the KAPPa instrument control, data processing, and visualization code. KAPPa develops the technologies needed to realize heterodyne focal plane arrays containing 1000 pixels. Finding optimal receiver tuning by investigating large parameter spaces is one of many challenges facing the characterization phase of KAPPa. This is a difficult task via by-hand techniques. Characterizing or tuning in an automated fashion without need for human intervention is desirable for future large scale arrays. While many optimization strategies exist, DE is ideal for time and performance constraints because it can be set to converge to a solution rapidly with minimal computational overhead. We discuss how DE is utilized in the KAPPa system and discuss its performance and look toward the future of 1000 pixel array receivers and consider how the KAPPa DE system might be applied.

  5. GPS Receiver Performance Inspection by Wavelet Transform

    Institute of Scientific and Technical Information of China (English)

    Xia Lin-yuan; Liu Jing-nan; Lu Liang-xi

    2003-01-01

    As a powerful analysis tool and the result of contemporary mathematics development, wavelet transform has shown its promising application potentials through the research in the paper. Three aspects regarding GPS receiver performance is tackled: cycle slip detection, receiver noise analysis and receiver channel bias inspection. Wavelet decomposition for double differential observation has demonstrated that this multi-level transform can reveal cycle slips as small as 0.5 cycles without any pre-adjustment processes or satellite orbit information, it can therefore be regarded as a 'geometry free' method. Based on property assumption of receiver noise, signal of noise serial is obtained at the high frequency scale in wavelet decomposition layers. This kind of noise influence on GPSb aseline result can be effectively eliminated by reconstruction process during wavelet reconstruction. Through observed data analysis, the transform has detected a kind of receiver channel bias that has not been completely removed by processing unit of GPS receiver during clock offset resetting operation. Thus the wavelet approach can be employed as a kind of system diagnosis in a generalized point of view.

  6. Inversion of receiver function by wavelet transformation

    Institute of Scientific and Technical Information of China (English)

    吴庆举; 田小波; 张乃铃; 李桂银; 曾融生

    2003-01-01

    A new method for receiver function inversion by wavelet transformation is presented in this paper. Receiver func-tion is expanded to different scales with different resolution by wavelet transformation. After an initial model be-ing taken, a generalized least-squares inversion procedure is gradually carried out for receiver function from low tohigh scale, with the inversion result for low order receiver function as the initial model for high order. Aneighborhood containing the global minimum is firstly searched from low scale receiver function, and will gradu-ally focus at the global minimum by introducing high scale information of receiver function. With the gradual ad-dition of high wave-number to smooth background velocity structure, wavelet transformation can keep the inver-sion result converge to the global minimum, reduce to certain extent the dependence of inversion result on theinitial model, overcome the nonuniqueness of generalized least-squares inversion, and obtain reliable crustal andupper mantle velocity with high resolution.

  7. Community response to artemisinin-based combination therapy for childhood malaria: a case study from Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Nyato Daniel J

    2010-02-01

    Full Text Available Abstract Background New malaria treatment guidelines in Tanzania have led to the large-scale deployment of artemether-lumefantrine (Coartem®, popularly known as ALu or dawa mseto. Very little is known about how people in malaria endemic areas interpret policy makers' decision to replace existing anti-malarials, such as sulphadoxine-pyrimethamine (SP with "new" treatment regimens, such as ALu or other formulations of ACT. This study was conducted to examine community level understandings and interpretations of ALu's efficacy and side-effects. The paper specifically examines the perceived efficacy of ALu as articulated by the mothers of young children diagnosed with malaria and prescribed ALu. Methods Participant observation, six focus group discussions in two large villages, followed by interviews with a random sample of 110 mothers of children less than five years of age, who were diagnosed with malaria and prescribed ALu. Additionally, observations were conducted in two village dispensaries involving interactions between mothers/caretakers and health care providers. Results While more than two-thirds of the mothers had an overall negative disposition toward SP, 97.5% of them spoke favourably about ALu, emphasizing it's ability to help their children to rapidly recover from malaria, without undesirable side-effects. 62.5% of the mothers reported that they were spending less money dealing with malaria than previously when their child was treated with SP. 88% of the mothers had waited for 48 hours or more after the onset of fever before taking their child to the dispensary. Mothers' knowledge and reporting of ALu's dosage was, in many cases, inconsistent with the recommended dosage schedule for children. Conclusion Deployment of ALu has significantly changed community level perceptions of anti-malarial treatment. However, mothers continue to delay seeking care before accessing ALu, limiting the impact of highly subsidized rollout of the drug

  8. The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME)

    Science.gov (United States)

    Chandler, Clare I. R.; Webb, Emily L.; Maiteki-Sebuguzi, Catherine; Nayiga, Susan; Nabirye, Christine; DiLiberto, Deborah D.; Ssemmondo, Emmanuel; Dorsey, Grant; Kamya, Moses R.; Staedke, Sarah G.

    2017-01-01

    Background Rapid diagnostic tests for malaria (mRDTs) have been scaled-up widely across Africa. The PRIME study evaluated an intervention aiming to improve fever case management using mRDTs at public health centers in Uganda. Methods A cluster-randomized trial was conducted from 2010–13 in Tororo, a high malaria transmission setting. Twenty public health centers were randomized in a 1:1 ratio to intervention or control. The intervention included training in health center management, fever case management with mRDTs, and patient-centered services; plus provision of mRDTs and artemether-lumefantrine (AL) when stocks ran low. Three rounds of Interviews were conducted with caregivers of children under five years of age as they exited health centers (N = 1400); reference mRDTs were done in children with fever (N = 1336). Health worker perspectives on mRDTs were elicited through semi-structured questionnaires (N = 49) and in-depth interviews (N = 10). The primary outcome was inappropriate treatment of malaria, defined as the proportion of febrile children who were not treated according to guidelines based on the reference mRDT. Findings There was no difference in inappropriate treatment of malaria between the intervention and control arms (24.0% versus 29.7%, adjusted risk ratio 0.81 [95% CI: 0.56, 1.17] p = 0.24). Most children (76.0%) tested positive by reference mRDT, but many were not prescribed AL (22.5% intervention versus 25.9% control, p = 0.53). Inappropriate treatment of children testing negative by reference mRDT with AL was also common (31.3% invention vs 42.4% control, p = 0.29). Health workers appreciated mRDTs but felt that integrating testing into practice was challenging given constraints on time and infrastructure. Conclusions The PRIME intervention did not have the desired impact on inappropriate treatment of malaria for children under five. In this high transmission setting, use of mRDTs did not lead to the reductions in antimalarial prescribing

  9. Millimeter-wave receivers for wireless communications

    Science.gov (United States)

    Overmiller, Brock Morgan

    The modern communications environment is becoming an increasingly crowded place, resulting in rapidly increasing demands on current technology. Military and civilian operations require the ability to locate and decode all communication signals in the environment. However, developments in RADAR (RAdio Detection And Ranging) and communications technology are making it harder to effectively identify and maintain bandwidth usage for everyone. Millimeter waves--waves measured between one millimeter to one centimeter in wavelength--have only recently been explored as a new technology to replace the augment receiver architectures. These small wavelengths introduce many engineering challenges, such as: large atmospheric losses, poor sensitivity, and expensive electronic equipment. With growing developments in Microwave Photonics, low-noise RF amplifiers and high-speed modulators have demonstrated the ability to design RF communication links in the millimeter wave regime to counter such problems. However, despite these developments, toward a cost-effective, spatial division multiplexing (SDM) receiver concept has not proved capable of being implemented as part of the next generation 5G wireless network infrastructure. To this end, we present a novel receiver architecture utilizing an optically addressed phased-array millimeter wave receiver based on optical-upconversion and signal recovery. This receiver is capable of geolocation and spatial multiplexing of multiple Tunable Optically Paired Source (TOPS) communication signals in its scene. Operating at 35 GHz, the receiver up-converts the received RF onto an optical sideband, which, to our advantage, contains all of the frequency, amplitude, and phase information of the received signals. Subsequent optical processing allows routing of the sideband to a free space detector port. Photomixing a coherent optical local oscillator (LO) with the optical sideband performs heterodyne down-conversion to an Intermediate Frequency (IF

  10. Performance outlook of the SCRAP receiver

    Science.gov (United States)

    Lubkoll, Matti; von Backström, Theodor W.; Harms, Thomas M.

    2016-05-01

    A combined cycle (CC) concentrating solar power (CSP) plant provides significant potential to achieve an efficiency increase and an electricity cost reduction compared to current single-cycle plants. A CC CSP system requires a receiver technology capable of effectively transferring heat from concentrated solar irradiation to a pressurized air stream of a gas turbine. The small number of pressurized air receivers demonstrated to date have practical limitations, when operating at high temperatures and pressures. As yet, a robust, scalable and efficient system has to be developed and commercialized. A novel receiver system, the Spiky Central Receiver Air Pre-heater (SCRAP) concept has been proposed to comply with these requirements. The SCRAP system is conceived as a solution for an efficient and robust pressurized air receiver that could be implemented in CC CSP concepts or standalone solar Brayton cycles without a bottoming Rankine cycle. The presented work expands on previous publications on the thermal modeling of the receiver system. Based on the analysis of a single heat transfer element (spike), predictions for its thermal performance can be made. To this end the existing thermal model was improved by heat transfer characteristics for the jet impingement region of the spike tip as well as heat transfer models simulating the interaction with ambient. While the jet impingement cooling effect was simulated employing a commercial CFD code, the ambient heat transfer model was based on simplifying assumptions in order to employ empirical and analytical equations. The thermal efficiency of a spike under design conditions (flux 1.0 MW/m2, air outlet temperature just below 800 °C) was calculated at approximately 80 %, where convective heat losses account for 16.2 % of the absorbed radiation and radiative heat losses for a lower 2.9 %. This effect is due to peak surface temperatures occurring at the root of the spikes. It can thus be concluded that the geometric

  11. Direct broadcast satellite-radio, receiver development

    Science.gov (United States)

    Vaisnys, A.; Bell, D.; Gevargiz, J.; Golshan, Nasser

    1993-01-01

    The status of the ongoing Direct Broadcast Satellite-Radio (DBS-R) Receiver Development Task being performed at the Jet Propulsion Laboratory, California Institute of Technology (JPL) is reported. This work is sponsored by the Voice of America/U.S. Information Agency through an agreement with NASA. The objective of this task is to develop, build, test, and demonstrate a prototype receiver that is compatible with reception of digital audio programs broadcast via satellites. The receiver is being designed to operate under a range of reception conditions, including fixed, portable, and mobile, as well as over a sufficiently wide range of bit rates to accommodate broadcasting systems with different cost/audio quality objectives. While the requirements on the receiver are complex, the eventual goal of the design effort is to make the design compatible with low cost production as a consumer product. One solution may be a basic low cost core design suitable for a majority of reception conditions, with optional enhancements for reception in especially difficult environments. Some of the receiver design parameters were established through analysis, laboratory tests, and a prototype satellite experiment accomplished in late 1991. Many of the necessary design trades will be made during the current simulation effort, while a few of the key design options will be incorporated into the prototype for evaluation during the planned satellite field trials.

  12. Sexual function in women receiving maintenance dialysis.

    Science.gov (United States)

    Seethala, Srikanth; Hess, Rachel; Bossola, Maurizio; Unruh, Mark L; Weisbord, Steven D

    2010-01-01

    While substantial attention has been paid to the issue of sexual dysfunction in men on chronic dialysis, less is known about this problem in women with end-stage renal disease. We sought to assess sexual dysfunction in women on chronic dialysis and determine whether patients discuss this problem with their providers and receive treatment. We prospectively enrolled women receiving chronic hemodialysis or peritoneal dialysis in Pittsburgh, PA. We asked patients to complete the 19-item Female Sexual Function Index (FSFI) to assess sexual function and a 5-item survey that assessed whether patients had discussed sexual dysfunction with their providers and/or received treatment for this problem in the past. We enrolled 66 patients; 59 (89%) on hemodialysis and 7 (11%) on peritoneal dialysis. All patients completed the FSFI, of whom 53 (80%) had FSFI scores <26.55, consistent with the presence of sexual dysfunction. Of 37 patients who were married or residing with a significant other, 27 (73%) had sexual dysfunction. Among 24 participants who reported having been sexually active over the previous 4 weeks, 11 (46%) had sexual dysfunction. Only 21% of patients with sexual dysfunction had discussed this problem with their gynecologist, renal or primary provider, and 3 (6%) reported having received treatment. Sexual dysfunction is common in women on dialysis, even among patients who are married or residing with a significant other and those who are sexually active. However, few women discuss this issue with their providers or receive treatment.

  13. Dish/stirling hybrid-receiver

    Science.gov (United States)

    Mehos, Mark S.; Anselmo, Kenneth M.; Moreno, James B.; Andraka, Charles E.; Rawlinson, K. Scott; Corey, John; Bohn, Mark S.

    2002-01-01

    A hybrid high-temperature solar receiver is provided which comprises a solar heat-pipe-receiver including a front dome having a solar absorber surface for receiving concentrated solar energy, a heat pipe wick, a rear dome, a sidewall joining the front and the rear dome, and a vapor and a return liquid tube connecting to an engine, and a fossil fuel fired combustion system in radial integration with the sidewall for simultaneous operation with the solar heat pipe receiver, the combustion system comprising an air and fuel pre-mixer, an outer cooling jacket for tangentially introducing and cooling the mixture, a recuperator for preheating the mixture, a burner plenum having an inner and an outer wall, a porous cylindrical metal matrix burner firing radially inward facing a sodium vapor sink, the mixture ignited downstream of the matrix forming combustion products, an exhaust plenum, a fossil-fuel heat-input surface having an outer surface covered with a pin-fin array, the combustion products flowing through the array to give up additional heat to the receiver, and an inner surface covered with an extension of the heat-pipe wick, a pin-fin shroud sealed to the burner and exhaust plenums, an end seal, a flue-gas diversion tube and a flue-gas valve for use at off-design conditions to limit the temperature of the pre-heated air and fuel mixture, preventing pre-ignition.

  14. Receiver-Controlled Multi-Node Cooperation

    Institute of Scientific and Technical Information of China (English)

    Liang Ye; Yue Li; XueJun Sha; Esko Alasaarela

    2014-01-01

    Since wireless links in Ad hoc networks are more fragile than those in traditional wireless networks due to route flapping, multi-node cooperation plays an important role in ensuring the quality of service ( QoS) . Based on the authors’ previous work, this paper proposes a receiver-controlled multi-node cooperation routing protocol, known as AODV-RCC. In this protocol, nodes form a cooperation group based on signal power. In a cooperation group, signal power between a partner and a transmitter, as well as signal power between the partner and the receiver, must be larger than the signal power between the transmitter and the receiver. Otherwise, the transmission will not benefit from cooperation. To avoid collision or congestion, each cooperation group only contains one partner. This partner offers both data and ACK cooperative retransmission. Its retransmission time should be shorter than the internal retry time of the transmitter’ s MAC layer, because it is better for the partner to retransmit firstly, as it offers a more reliable cooperative link. In AODV-RCC, it is the receiver that chooses the partner, because the link between the partner and the receiver is the most important. According to our simulation results, AODV-RCC shortens the end-to-end delay and increases the packet delivery ratio.

  15. Schottky Heterodyne Receivers With Full Waveguide Bandwidth

    Science.gov (United States)

    Hesler, Jeffrey; Crowe, Thomas

    2011-01-01

    Compact THz receivers with broad bandwidth and low noise have been developed for the frequency range from 100 GHz to 1 THz. These receivers meet the requirements for high-resolution spectroscopic studies of planetary atmospheres (including the Earth s) from spacecraft, as well as airborne and balloon platforms. The ongoing research is significant not only for the development of Schottky mixers, but also for the creation of a receiver system, including the LO chain. The new receivers meet the goals of high sensitivity, compact size, low total power requirement, and operation across complete waveguide bands. The exceptional performance makes these receivers ideal for the broader range of scientific and commercial applications. These include the extension of sophisticated test and measurement equipment to 1 THz and the development of low-cost imaging systems for security applications and industrial process monitoring. As a particular example, a WR-1.9SHM (400-600 GHz) has been developed (see Figure 1), with state-of-the-art noise temperature ranging from 1,000-1,800 K (DSB) over the full waveguide band. Also, a Vector Network Analyzer extender has been developed (see Figure 2) for the WR1.5 waveguide band (500 750 GHz) with 100-dB dynamic range.

  16. Direct broadcast satellite-radio, receiver development

    Science.gov (United States)

    Vaisnys, A.; Bell, D.; Gevargiz, J.; Golshan, Nasser

    The status of the ongoing Direct Broadcast Satellite-Radio (DBS-R) Receiver Development Task being performed at the Jet Propulsion Laboratory, California Institute of Technology (JPL) is reported. This work is sponsored by the Voice of America/U.S. Information Agency through an agreement with NASA. The objective of this task is to develop, build, test, and demonstrate a prototype receiver that is compatible with reception of digital audio programs broadcast via satellites. The receiver is being designed to operate under a range of reception conditions, including fixed, portable, and mobile, as well as over a sufficiently wide range of bit rates to accommodate broadcasting systems with different cost/audio quality objectives. While the requirements on the receiver are complex, the eventual goal of the design effort is to make the design compatible with low cost production as a consumer product. One solution may be a basic low cost core design suitable for a majority of reception conditions, with optional enhancements for reception in especially difficult environments. Some of the receiver design parameters were established through analysis, laboratory tests, and a prototype satellite experiment accomplished in late 1991. Many of the necessary design trades will be made during the current simulation effort, while a few of the key design options will be incorporated into the prototype for evaluation during the planned satellite field trials.

  17. The Communication Between Designer and Design Receiver

    DEFF Research Database (Denmark)

    Dai, Zheng; Dai, Yan

    2009-01-01

    When people think about a product,the first impression always mainly influences the result.Product is the medium of communication between designer and designer receiver.Because both of them have varied different experience and background,the information would be biased during the transferring...... process.The common symbols which can be recognized by both of designer and receiver are the key tools for communication.In some case,the same symbol in one product would be leads to different receiver impression.Generally,impression includes 3 aspects:aesthetics,function, and emotion.Designer needs...... to create an attractive and accurate impression in product from these 3 aspects.For facing the dilemma of communication,some experimental approaches can help designer deal with unique and diversity situations.Solving the detail problem in each step could keep the original meaning of designer....

  18. Implementation of Universal Asynchronous Receiver and Transmitter

    Directory of Open Access Journals (Sweden)

    Payata Srikanth Yadav

    2015-03-01

    Full Text Available Universal Asynchronous Receiver Transmitter (UART is the serial communication protocol that is used for data exchange between computer & peripherals. UART is a low velocity, short-distance, low-cost protocol. UART includes three modules which are received, the baud rate generator and transmitter. The UART design with Very High Description Language can be integrated into the Field Programmable Gate Array to achieve stable data transmission and to make system reliable and compact. In the result and simulation part, this project will focus on check the receive data with error free & baud rate generation at different frequencies. Before synthesizing of UART a baud rate generator is incorporated into the system. We use the frequency divider which sets itself to required frequency for the functionality at lower frequency. All modules are designed using VERILOG and implemented on Xilinx Suite development board.

  19. Precision Continuum Receivers for Astrophysical Applications

    Science.gov (United States)

    Wollack, Edward J.

    2011-01-01

    Cryogenically cooled HEMT (High Electron Mobility Transistor) amplifiers find widespread use in radioastronomy receivers. In recent years, these devices have also been commonly employed in broadband receivers for precision measurements of the Cosmic Microwave Background (CMB) radiation. In this setting, the combination of ultra-low-noise and low-spectral-resolution observations reinforce the importance achieving suitable control over the device environment to achieve fundamentally limited receiver performance. The influence of the intrinsic amplifier stability at low frequencies on data quality (e.g., achievable noise and residual temporal correlations), observational and calibration strategies, as well as architectural mitigation approaches in this setting will be discussed. The implications of device level 1/f fluctuations reported in the literature on system performance will be reviewed.

  20. Randomized transmit and receive ultrasound tomography

    CERN Document Server

    Clement, Gregory T

    2015-01-01

    A tomographic method is considered that forms images from sets of spatially randomized source signals and receiver sensitivities. The method is designed to allow image reconstruction for an extended number of transmitters and receivers in the presence noise and without plane wave approximation or otherwise approximation on the size or regularity of source and receiver functions. An overdetermined set of functions are formed from the Hadamard product between a Gaussian function and a uniformly distributed random number set. It is shown that this particular type of randomization tends to produce well-conditioned matrices whose pseudoinverses may be determined without implementing relaxation methods. When the inverted sets are applied to simulated first-order scattering from a Shepp-Logan phantom, successful image reconstructions are achieved for signal-to-noise ratios (SNR) as low as 1. Evaluation of the randomization approach is conducted by comparing condition numbers with other forms of signal randomization....

  1. Olympus receiver evaluation and phase noise measurements

    Science.gov (United States)

    Campbell, Richard L.; Wang, Huailiang; Sweeney, Dennis

    1990-01-01

    A set of measurements performed by the Michigan Tech Sensing and Signal Processing Group on the analog receiver built by the Virginia Polytechnic Institute (VPI) and the Jet Propulsion Laboratory (JPL) for propagation measurements using the Olympus Satellite is described. Measurements of local oscillator (LO) phase noise were performed for all of the LOs supplied by JPL. In order to obtain the most useful set of measurements, LO phase noise measurements were made using the complete VPI receiver front end. This set of measurements demonstrates the performance of the receiver from the Radio Frequency (RF) input through the high Intermediate Frequency (IF) output. Three different measurements were made: LO phase noise with DC on the voltage controlled crystal oscillator (VCXO) port; LO phase noise with the 11.381 GHz LO locked to the reference signal generator; and a reference measurement with the JPL LOs out of the system.

  2. Antennas and Receivers in Radio Interferometry

    CERN Document Server

    Hunter, Todd R

    2016-01-01

    The primary antenna elements and receivers are two of the most important components in a synthesis telescope. Together they are responsible for locking onto an astronomical source in both direction and frequency, capturing its radiation, and converting it into signals suitable for digitization and correlation. The properties and performance of antennas and receivers can affect the quality of the synthesized images in a number of fundamental ways. In this lecture, their most relevant design and performance parameters are reviewed, with emphasis on the current ALMA and VLA systems. We discuss in detail the shape of the primary beam and the components of aperture efficiency, and we present the basics of holography, pointing, and servo control. On receivers, we outline the use of amplifiers and mixers both in the cryogenic front-end and in the room temperature back-end signal path. The essential properties of precision local oscillators (LOs), phase lock loops (PLLs), and LO modulation techniques are also describ...

  3. Carnitine ester excretion in pediatric patients receiving parenteral nutrition.

    Science.gov (United States)

    Schmidt-Sommerfeld, E; Penn, D; Bieber, L L; Kerner, J; Rossi, T M; Lebenthal, E

    1990-08-01

    Carnitine plasma concentrations and the excretion of carnitine and individual carnitine esters were determined in 25 children and adolescents with gastrointestinal diseases receiving carnitine-free parenteral nutrition for at least 1 mo using radiochemical and radioisotopic exchange HPLC methods. Children less than 12-y-old usually had carnitine plasma concentrations less than -2 SD from the normal mean for age, whereas patients greater than 12-y-old had carnitine plasma concentrations within the normal range. Age was the only variable to correlate significantly with plasma carnitine concentrations during parenteral nutrition. Free carnitine (FC) excretion was closely correlated with plasma FC concentrations and minimal at values less than 25 mumols/L. The excretion of FC and short-chain acylcarnitines was reduced by an order of magnitude in younger compared with older patients and controls, but the excretion of "other" acylcarnitines was less affected. Some of the latter were tentatively identified using gas-liquid chromatographic and mass spectroscopic techniques as unsaturated and/or branched medium-chain carnitine esters with a carbon chain of C8-C10. The results suggest that FC and short-chain acylcarnitine are conserved by the kidney in nutritional carnitine deficiency but that there may be an obligatory renal excretion of other carnitine esters that contributes to the development of hypocarnitinemia in the younger age group.

  4. Avalanche Photodiode Arrays for Optical Communications Receivers

    Science.gov (United States)

    Srinivasan, M.; Vilnrotter, V.

    2001-01-01

    An avalanche photodiode (APD) array for ground-based optical communications receivers is investigated for the reception of optical signals through the turbulent atmosphere. Kolmogorov phase screen simulations are used to generate realistic spatial distributions of the received optical field. It is shown that use of an APD array for pulse-position modulation detection can improve performance by up to 4 dB over single APD detection in the presence of turbulence, but that photon-counting detector arrays yield even greater gains.

  5. The new indicators of accounts receivable excellence.

    Science.gov (United States)

    Lampi, G L

    1996-01-01

    Calculation of AR days will continue to be a valuable internal measurement tool of accounts receivable excellence. As healthcare organizations move toward managed care through a mix of reimbursement systems--many with conflicting incentives--the director of patient accounting must approach each system separately and ensure that the hospital receives all of the reimbursement to which it is entitled. The director of patient accounting must understand the industry and recognize that healthcare reimbursement will almost certainly continue to become more complex rather than simpler. Creativity will be a necessity, and good luck will be an advantage.

  6. On Satellite Multicast to Heterogeneous Receivers

    Science.gov (United States)

    2001-01-01

    combined into one bulk file. Let the multicast source use Reed-Solomon erasure ( RSE ) coding (e.g. [Mac97]) and let the bulk file be encoded into W ≥ 1... RSE -based FEC blocks. Each FEC block consists of h data packets and c parity packets – all of the same length. We assume a multicast tree that has a... RSE -based FEC block, a receiver must receive at least h distinct packets, either data or parity, from the same FEC block. To allow a systematic way

  7. Financing with Receivables: Factoring, Securitization and Collateral

    Directory of Open Access Journals (Sweden)

    Ioana Benea

    2013-11-01

    Full Text Available Short term financing is vital for the financial survival of any company, because very often they are facing deficits of cash during their activity. Therefore a company has to identify the optimal solutions in order to cover those (temporary deficits. A good solution to this problem is the financing with receivables using factoring, securitization and collateral. In this paper we try to analyze how this types of financing works and which are their advantages and costs. Also, we developed a reasoning pattern in order to evaluate the best receivables financing alternative for the Romanian companies.

  8. Social Status and Self-Esteem: Children with ADHD and Their Peers.

    Science.gov (United States)

    Stewart, Jennifer; Buggey, Tom

    This study compared the social status and self-esteem of 8 third grade children with attention deficit hyperactivity disorder, 2 children with attention deficit disorder (ADD) alone, and 26 children without the disorders, in light of hypothesized effects of perceived negative feedback received by these children from peers. The children nominated…

  9. Going to School with Madame Curie and Mr. Einstein: Gender Roles in Children's Science Biographies

    Science.gov (United States)

    Owens, Trevor

    2009-01-01

    One of the first places children encounter science and scientists is children's literature. Children's books about science and scientists have, however, received limited scholarly attention. By exploring the history of children's biographies of Marie Curie and Albert Einstein, the two most written about scientist in children's literature, this…

  10. 不同输液方式对小儿亲属肾移植术中供受者生命体征的影响%The influence of different ways to signs of life of donors and recipients in children receiving consanguineous kidney transplantation

    Institute of Scientific and Technical Information of China (English)

    戴旻晖; 陆璨

    2011-01-01

    目的 对10对小儿亲属肾移植供受者术中输液干预后进行回顾总结,了解供受者输液的最佳效果.方法 10对小儿亲属肾移植供者在肾循环阻断前采用快速输液提高基础血压10% ~ 15%,受者肾循环开放前补液全部采用胶体和血液,速度以维持受者术中的血压平稳.结果 对供受者的术中输液进行干预后,受者开放肾循环后血压平稳及肾脏泌尿快.结论 小儿亲属肾移植供肾循环阻断前快速输液方式提高血压,受者术中补液全部采用胶体和血液,有利于受者开放循环后血压平稳及泌尿,可降低受者围手术期的不良反应,减少并发症发生.%Objective To know the best results of the infusion on the donors and recipients,by reviewing and summarizing the intra-operative infusion intervention on 10 pairs of children consanguineous living donors and recipients on the kidney transplantation operation.Methods Increase 10% - 15% of the basis blood pressure of children consanguineous living donors by using rapid infusion on the 10 donors for kidney transplantation before the renal circulation is blocked; use blood and colloid as fluid infusion of children consanguineous living recipients for kidney transplantation before opening up the renal circulation,to maintain the recipients' blood pressure in the intra-operation.Results After the intra-operative infusion intervention on children consanguineous living donors and recipients,the recipients' blood pressure are stable and the kidney urinates were fast.Conclusions It could maintain stable blood pressure and smooth the urinary status of the children and reduce adverse events of recipients and complications by increasing the speed of infusion before blocking the renal circulation and using blood and colloid as fiuid for the children consanguineous living recipients.

  11. Carnitine deficiency in premature infants receiving total parenteral nutrition.

    Science.gov (United States)

    Penn, D; Schmidt-Sommerfeld, E; Wolf, H

    1980-03-01

    Carnitine plays a significant role in fatty acid utilization and ketone body production. Its availability is especially important during the immediate postnatal period. To determine whether low birth weight infants who cannot be orally fed are at risk of developing carnitine deficiency, we compared the carnitine blood levels and urinary excretion of 12 premature infants (Group A) receiving total parenteral nutrition (TPN) with those of 8 infants of similar gestational age and birth weight (Group B) who received carnitine-containing milk formulas. In Group A, serum levels of total and free carnitine fell after 5 days of carnitine-deficient parenteral nutrition, and urinary excretion was significantly reduced. Serum levels and urinary excretion increased after the onset of oral feedings. The control Group B exhibited no significant changes in carnitine blood levels between the first and fifth days of life, but did show a later increase. Children in Group A had lower carnitine blood levels compared to those in Group B on the fifth day of life. These findings suggest that premature infants are not able to synthesize enough carnitine to maintain blood levels, and that carnitine deficiency can occur following TPN. Further investigation of metabolic consequences secondary to deficient carnitine intake in premature infants is necessary before carnitine supplementation should be considered.

  12. Colonização nasofaríngea pelo Streptococcus pneumoniae em crianças com doença falciforme usando penicilina profilática Nasopharyngeal colonization by Streptococcus pneumoniae in children with sickle cell disease receiving prophylactic penicillin

    Directory of Open Access Journals (Sweden)

    Patricia B. Blum Fonseca

    2005-04-01

    Full Text Available OBJETIVOS: Determinar a prevalência de colonização nasofaríngea pelo pneumococo em crianças com doença falciforme, em uso de profilaxia com penicilina; identificar fatores de risco para colonização; sorotipar as cepas isoladas e avaliar a resistência antimicrobiana. METODOLOGIA: Foram colhidos 188 suabes de nasofaringe de 98 crianças com doença falciforme em acompanhamento no Hospital São Paulo, da Universidade Federal de São Paulo, no período de 09 de abril de 2002 a 28 de fevereiro de 2003. O isolamento e a identificação dos pneumococos seguiram procedimentos padronizados. A concentração inibitória mínima para penicilina foi determinada pelo método do E-test. A sorotipagem foi realizada pela reação de Neufeld-Quellung com anti-soros para 46 sorotipos. RESULTADOS: A idade variou de 4 meses a 17 anos (média e desvio padrão de 6,8±4,7 anos. Das 98 crianças do estudo, 13 apresentaram colonização pelo pneumococo (prevalência de 13,3%. O maior risco de colonização ocorreu em menores de 2 anos de idade (p = 0,02. A prevalência de cepas com resistência intermediária à penicilina foi de 21,4%, não sendo evidenciada resistência plena. Também não houve cepas resistentes à eritromicina, ceftriaxona e vancomicina. Os sorotipos isolados mais freqüentes foram o 18C e o 23F. CONCLUSÕES: O uso profilático de penicilina diminuiu a colonização nasofaríngea pelo pneumococo e não determinou aumento da resistência a esse antimicrobiano nas crianças com doença falciforme. A penicilina ainda pode ser usada na profilaxia e no tratamento dos episódios febris dessas crianças.OBJECTIVES: To determine the prevalence of nasopharyngeal pneumococcus colonization in children with sickle cell disease undergoing penicillin prophylaxis, to identify risk factors for colonization and to serotype and determine antibiotic resistance in pneumococci obtained from those children. METHODS: Between April 9, 2002 and February 28, 2003

  13. A 24GHz Radar Receiver in CMOS

    NARCIS (Netherlands)

    Kwok, K.C.

    2015-01-01

    This thesis investigates the system design and circuit implementation of a 24GHz-band short-range radar receiver in CMOS technology. The propagation and penetration properties of EM wave offer the possibility of non-contact based remote sensing and through-the-wall imaging of distance stationary or

  14. Superconducting Submm Integrated Receiver for TELIS

    NARCIS (Netherlands)

    Koshelets, V. P.; Ermakov, A. B.; Filippenko, L. V.; Koryukin, O. V.; Khudchenko, A. V.; Sobolev, A. S.; Torgashin, M. Yu; Yagoubov, P. A.; Hoogeveen, R. W. M.; Vreeling, W. J.; Wild, W.; Pylypenko, O. M.

    2006-01-01

    In this report we present design and first experimental results for development of the submm superconducting integrated receiver spectrometer for Terahertz Limb Sounder (TELIS). TELIS is a collaborative European project to build up a three-channel heterodyne balloon-based spectrometer for measuring

  15. 7 CFR 29.42 - Receiving station.

    Science.gov (United States)

    2010-01-01

    ... Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... INSPECTION Regulations Definitions § 29.42 Receiving station. Points at which producer tobacco is offered for marketing (other than sale at auction on a designated market), including tobacco auction warehouses,...

  16. Why Receiving Feedback Collides with Self Determination

    Science.gov (United States)

    ten Cate, Olle Th. J.

    2013-01-01

    Providing feedback to trainees in clinical settings is considered important for development and acquisition of skill. Despite recommendations how to provide feedback that have appeared in the literature, research shows that its effectiveness is often disappointing. To understand why receiving feedback is more difficult than it appears, this paper…

  17. Richard W. Ziolkowski Receives Honorary Doctorate

    DEFF Research Database (Denmark)

    Breinbjerg, Olav

    2012-01-01

    At the annual Commemoration of the Technical University of Denmark (DTU) on April 27, 2012, Prof. Richard W. Ziolkowski, University of Arizona (UoA), received DTU's highest academic degree, the Honorary Doctor degree: Doctor Technices Honoris Causa (Figure 1). Prof. Ziolkowski has been a close...

  18. Compressed Sensing-Based Direct Conversion Receiver

    DEFF Research Database (Denmark)

    Pierzchlewski, Jacek; Arildsen, Thomas; Larsen, Torben

    2012-01-01

    Due to the continuously increasing computational power of modern data receivers it is possible to move more and more processing from the analog to the digital domain. This paper presents a compressed sensing approach to relaxing the analog filtering requirements prior to the ADCs in a direct...

  19. Receiving Assistance and Local Food System Participation

    Directory of Open Access Journals (Sweden)

    Rebecca L. Som Castellano

    2017-02-01

    Full Text Available A body of literature has noted that local food systems (LFSs may not involve active participation by individuals with lower incomes. This is, in part, a function of racial and class hegemony, as well as physical and financial accessibility of LFSs. LFS institutions, such as farmers’ markets, have been working to facilitate receipt of food assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP. Charitable assistance programs, such as food banks, have also been actively working to engage in LFSs, for example, by making local foods available. However, little research has explored the role that receiving public or charitable assistance can play in influencing LFS participation. In this article, I utilize quantitative and qualitative data collected from across the state of Ohio to examine the relationship between receiving assistance and LFS participation for women, who remain predominately responsible for food provisioning in the U.S., including among those who participate in LFSs. Quantitative results suggest that receiving assistance can increase participation in LFSs. Qualitative data provides more nuanced information about the importance of food assistance for women who want to participate in LFSs, and suggest that it is essential that food cooperatives and farmers’ markets are equipped to receive food assistance programs, such as SNAP, in order for women with lower incomes to participate in LFSs.

  20. CAS expert receives Tribology Gold Medal

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Prof. XUE Qunji, a senior expert in tribology from the CAS Lanzhou Institute of Chemical Physics (L1CP) and member of the Chinese Academy of Engineering, received the Tribology Gold Medalfor 2011 on February 27, 2012 in Beijing. As one of the world's most outstanding and influential tribologists in the last forty years, Prof.

  1. Anatomy of a digital coherent receiver

    DEFF Research Database (Denmark)

    Borkowski, Robert; Zibar, Darko; Tafur Monroy, Idelfonso

    2014-01-01

    Digital coherent receivers have gained significant attention in the last decade. The reason for this is that coherent detection, along with digital signal processing (DSP) allows for substantial increase of the channel capacity by employing advanced detection techniques. In this paper, we first r...

  2. Howard Feiertag receives hospitality industry award

    OpenAIRE

    Ho, Sookhan

    2004-01-01

    Howard Feiertag, of Blacksburg, an instructor in hospitality and tourism management at Virginia Tech's Pamplin College of Business, received the inaugural Excellence in Sales and Marketing Strategy Award at the Hospitality Sales and Marketing Association/New York University Strategy Conference in New York recently.

  3. Social effects of migration in receiving countries.

    Science.gov (United States)

    Ohndorf, W

    1989-06-01

    This paper examines the impact of post-1945 migration into Western, Middle, and Northern Europe from Southern Europe, Turkey, and Northern Africa, and migration to the traditional immigration countries by Asian and Latin American immigrants, on the social structures of receiving countries. Between 1955 and 1974, 1) traditional migration to the US and Australia became less important for European countries while traditional receiving countries accepted many immigrants from developing countries; and 2) rapid economic revival in Western and Northern Europe caused a considerable labor shortage which was filled by migrant workers especially from Southern Europe, Turkey, and Northern Africa, who stayed only until they reached their economic goals. Since 1974, job vacancies have declined and unemployment has soared. This employment crisis caused some migrants 1) to return to their countries of origin, 2) to bring the rest of their families to the receiving country, or 3) to lengthen their stay considerably. The number of refugees has also significantly increased since the mid-970s, as has the number of illegal migrants. After the mid-1970s, Europe began to experience integration problems. The different aspects of the impact of migration on social structures include 1) improvement of the housing situation for foreigners, 2) teaching migrants the language of the receiving country, 3) solving the unemployment problem of unskilled migrants, 4) improvement of educational and vocational qualifications of 2nd generation migrants, 5) development of programs to help unemployed wives of migrants to learn the language and meet indigenous women, 6) encouraging migrants to maintain their cultural identity and assisting them with reintegration if they return to their original country, 7) coping with the problems of refugees, and 8) solving the problems of illegal migration. Almost all receiving countries now severely restrict further immigration. [Those policies should result in

  4. A GPS Receiver for Lunar Missions

    Science.gov (United States)

    Bamford, William A.; Heckler, Gregory W.; Holt, Greg N.; Moreau, Michael C.

    2008-01-01

    Beginning with the launch of the Lunar Reconnaissance Orbiter (LRO) in October of 2008, NASA will once again begin its quest to land humans on the Moon. This effort will require the development of new spacecraft which will safely transport people from the Earth to the Moon and back again, as well as robotic probes tagged with science, re-supply, and communication duties. In addition to the next-generation spacecraft currently under construction, including the Orion capsule, NASA is also investigating and developing cutting edge navigation sensors which will allow for autonomous state estimation in low Earth orbit (LEO) and cislunar space. Such instruments could provide an extra layer of redundancy in avionics systems and reduce the reliance on support and on the Deep Space Network (DSN). One such sensor is the weak-signal Global Positioning System (GPS) receiver "Navigator" being developed at NASA's Goddard Space Flight Center (GSFC). At the heart of the Navigator is a Field Programmable Gate Array (FPGA) based acquisition engine. This engine allows for the rapid acquisition/reacquisition of strong GPS signals, enabling the receiver to quickly recover from outages due to blocked satellites or atmospheric entry. Additionally, the acquisition algorithm provides significantly lower sensitivities than a conventional space-based GPS receiver, permitting it to acquire satellites well above the GPS constellation. This paper assesses the performance of the Navigator receiver based upon three of the major flight regimes of a manned lunar mission: Earth ascent, cislunar navigation, and entry. Representative trajectories for each of these segments were provided by NASA. The Navigator receiver was connected to a Spirent GPS signal generator, to allow for the collection of real-time, hardware-in-the-loop results for each phase of the flight. For each of the flight segments, the Navigator was tested on its ability to acquire and track GPS satellites under the dynamical

  5. Vulcan: A deep-towed CSEM receiver

    Science.gov (United States)

    Constable, Steven; Kannberg, Peter K.; Weitemeyer, Karen

    2016-03-01

    We have developed a three-axis electric field receiver designed to be towed behind a marine electromagnetic transmitter for the purpose of mapping the electrical resistivity in the upper 1000 m of seafloor geology. By careful adjustment of buoyancy and the use of real-time monitoring of depth and altitude, we are able to deep-tow multiple receivers on arrays up to 1200 m long within 50 m of the seafloor, thereby obtaining good coupling to geology. The rigid body of the receiver is designed to reduce noise associated with lateral motion of flexible antennas during towing, and allows the measurement of the vertical electric field component, which modeling shows to be particularly sensitive to near-seafloor resistivity variations. The positions and orientations of the receivers are continuously measured, and realistic estimates of positioning errors can be used to build an error model for the data. During a test in the San Diego Trough, offshore California, inversions of the data were able to fit amplitude and phase of horizontal electric fields at three frequencies on three receivers to about 1% in amplitude and 1° in phase and vertical fields to about 5% in amplitude and 5° in phase. The geological target of the tests was a known cold seep and methane vent in 1000 m water depth, which inversions show to be associated with a 1 km wide resistor at a depth between 50 and 150 m below seafloor. Given the high resistivity (30 Ωm) and position within the gas hydrate stability field, we interpret this to be massive methane hydrate.

  6. North Dakota geology school receives major gift

    Science.gov (United States)

    Showstack, Randy

    2012-10-01

    Petroleum geology and related areas of study at the University of North Dakota (UND) received a huge financial boost with the announcement on 24 September of $14 million in private and public partnership funding. The university announced the naming of the Harold Hamm School of Geology and Geological Engineering, formerly a department within the College of Engineering and Mines, in recognition of $10 million provided as a gift by oilman Harold Hamm and Continental Resources, Inc. Hamm is the chair and chief executive officer of Continental, the largest leaseholder in the Bakken Play oil formation in North Dakota and Montana, and he is also an energy policy advisor to Republican presidential candidate Mitt Romney. UND also received $4 million from the Oil and Gas Research Program of the North Dakota Industrial Commission to support geology and geological engineering education and research.

  7. Fused silica windows for solar receiver applications

    Science.gov (United States)

    Hertel, Johannes; Uhlig, Ralf; Söhn, Matthias; Schenk, Christian; Helsch, Gundula; Bornhöft, Hansjörg

    2016-05-01

    A comprehensive study of optical and mechanical properties of quartz glass (fused silica) with regard to application in high temperature solar receivers is presented. The dependence of rupture strength on different surface conditions as well as high temperature is analyzed, focussing particularly on damage by devitrification and sandblasting. The influence of typical types of contamination in combination with thermal cycling on the optical properties of fused silica is determined. Cleaning methods are compared regarding effectiveness on contamination-induced degradation for samples with and without antireflective coating. The FEM-aided design of different types of receiver windows and their support structure is presented. A large-scale production process has been developed for producing fused silica dome shaped windows (pressurized window) up to a diameter of 816 mm. Prototypes were successfully pressure-tested in a test bench and certified according to the European Pressure Vessel Directive.

  8. Perception of older adults receiving palliative care

    Directory of Open Access Journals (Sweden)

    Fernanda Laporti Seredynskyj

    2014-06-01

    Full Text Available The present study aimed at understanding the perception of older adults who are receiving palliative oncological care on self care in relation to different stages of the disease and how such perception affected their lives. This is a qualitative study using oral history conducted with 15 older adults receiving palliative chemotherapy treatment in a health institution. The following categories emerged: social network, perspectives for confronting life, changes and spirituality. It is necessary for nursing staff to understand this process so that the measures implemented take into account all of the implications of the disease and aim at improving quality of life.   doi: 10.5216/ree.v16i2.22795.

  9. Screen-printed flexible MRI receive coils.

    Science.gov (United States)

    Corea, Joseph R; Flynn, Anita M; Lechêne, Balthazar; Scott, Greig; Reed, Galen D; Shin, Peter J; Lustig, Michael; Arias, Ana C

    2016-03-10

    Magnetic resonance imaging is an inherently signal-to-noise-starved technique that limits the spatial resolution, diagnostic image quality and results in typically long acquisition times that are prone to motion artefacts. This limitation is exacerbated when receive coils have poor fit due to lack of flexibility or need for padding for patient comfort. Here, we report a new approach that uses printing for fabricating receive coils. Our approach enables highly flexible, extremely lightweight conforming devices. We show that these devices exhibit similar to higher signal-to-noise ratio than conventional ones, in clinical scenarios when coils could be displaced more than 18 mm away from the body. In addition, we provide detailed material properties and components performance analysis. Prototype arrays are incorporated within infant blankets for in vivo studies. This work presents the first fully functional, printed coils for 1.5- and 3-T clinical scanners.

  10. Grooms receives 2011 Donald L. Turcotte Award

    Science.gov (United States)

    2012-02-01

    Ian Grooms has been awarded the AGU Donald L. Turcotte Award, given annually to recent Ph.D. recipients for outstanding dissertation research that contributes directly to the field of nonlinear geophysics. Grooms's thesis is entitled “Asymptotic and numerical methods for rapidly rotating buoyant flow.” He presented an invited talk and was formally presented with the award at the 2011 AGU Fall Meeting, held 5-9 December in San Francisco, Calif. Grooms received his B.S. in mathematics from the College of William and Mary, Williamsburg, Va., in 2005. He received a Ph.D. in applied mathematics in 2011 under the supervision of Keith Julien at the University of Colorado at Boulder. His research interests include asymptotic and numerical methods for multiscale problems in geophysical fluid dynamics.

  11. CERN Press Office receives award from Euroscience

    CERN Multimedia

    2009-01-01

    The CERN Communication group has received an award for its efforts in communicating the LHC first beam to the media and the public. James Gillies, head of the Communication group was presented the AlphaGalileo Research Public Relations Award on Wednesday, 14 October during the Euroscience Media Award Ceremony in Hannover. "It’s great to receive this recognition," said Gillies. "Of course, we had great material to work with: the LHC is a fantastic story and one that is going to get even better. Angels, Demons and black holes also had their roles to play, but behind the media interest there’s been a lot of hard work by my team. This is for them." The CERN Communication group also works with communication professionals in all the CERN Member States and major physics labs around the world through the European Particle Physics Communication Network, and the InterAction collaboration. "Without them," says Gillies, &am...

  12. Next Generation Radio Astronomy Receiver Systems

    CERN Document Server

    Morgan, Matthew A

    2009-01-01

    Radio astronomy observations in the coming decade will require new levels of sensitivity while mapping large regions of space with much greater efficiency than is achieved with current telescopes. This requires new instrumentation with the greatest achievable sensitivity, dynamic range, and field of view. Receiver noise is quickly approaching fundamental limits at most radio wavelengths, so significant gains in sensitivity can only be made by increasing collecting area. Jointly, these requirements suggest using large arrays of smaller antennas, or many moderate-size antennas equipped with multi-beam arrays. The challenge is to develop receivers and wide bandwidth data transport systems which are lower cost, more compact, more reliable, lower weight, and more reproducible than the best current systems, with no compromise to performance. This can be achieved with a greater degree of component integration, extensive use of digital signal processing and transport, and replacement of functions currently performed ...

  13. Reducing the convective losses of cavity receivers

    Science.gov (United States)

    Flesch, Robert; Grobbel, Johannes; Stadler, Hannes; Uhlig, Ralf; Hoffschmidt, Bernhard

    2016-05-01

    Convective losses reduce the efficiency of cavity receivers used in solar power towers especially under windy conditions. Therefore, measures should be taken to reduce these losses. In this paper two different measures are analyzed: an air curtain and a partial window which covers one third of the aperture opening. The cavity without modifications and the usage of a partial window were analyzed in a cryogenic wind tunnel at -173°C. The cryogenic environment allows transforming the results from the small model cavity to a large scale receiver with Gr≈3.9.1010. The cavity with the two modifications in the wind tunnel environment was analyzed with a CFD model as well. By comparing the numerical and experimental results the model was validated. Both modifications are capable of reducing the convection losses. In the best case a reduction of about 50 % was achieved.

  14. Graphene radio frequency receiver integrated circuit.

    Science.gov (United States)

    Han, Shu-Jen; Garcia, Alberto Valdes; Oida, Satoshi; Jenkins, Keith A; Haensch, Wilfried

    2014-01-01

    Graphene has attracted much interest as a future channel material in radio frequency electronics because of its superior electrical properties. Fabrication of a graphene integrated circuit without significantly degrading transistor performance has proven to be challenging, posing one of the major bottlenecks to compete with existing technologies. Here we present a fabrication method fully preserving graphene transistor quality, demonstrated with the implementation of a high-performance three-stage graphene integrated circuit. The circuit operates as a radio frequency receiver performing signal amplification, filtering and downconversion mixing. All circuit components are integrated into 0.6 mm(2) area and fabricated on 200 mm silicon wafers, showing the unprecedented graphene circuit complexity and silicon complementary metal-oxide-semiconductor process compatibility. The demonstrated circuit performance allow us to use graphene integrated circuit to perform practical wireless communication functions, receiving and restoring digital text transmitted on a 4.3-GHz carrier signal.

  15. TRA - Transmit Receive Array (project plan)

    OpenAIRE

    Zabel, F; Martins, C.; Jesus, S.M.; Silva, A

    2006-01-01

    SiPLAB Report 05/06, FCT, University of Algarve,2006. This report describes a project plan for the development of a Transmit Receive Array (TRA). This system is under development for the Underwater Acoustic Barriers (UAB) project which aims at studying, developing and testing in the field the concept of building an underwater acoustic barrier for detecting intruders in a given area. FCT

  16. Counterrotator And Correlator For GPS Receivers

    Science.gov (United States)

    Thomas, J. Brooks; Srinivasan, Jeffrey M.; Meehan, Thomas K.

    1989-01-01

    Accurate, all-digital, high-speed processor comprising correlator and down-converter developed for receivers in Global Positioning System (GPS). Processor reduces roundoff and commensurability errors to extremely small values. Use of digital chip and phase advancers provides outstanding control and accuracy in phase and feedback. Great flexibility imparted by provision for arbitrary starting time and integration length. Minimum-bit design requires minimum number of logical elements, thereby reducing size, power, and cost.

  17. Armstrong Receives Space Medal of Honor

    Science.gov (United States)

    1978-01-01

    Astronaut Neil A. Armstrong receives the first Congressional Space Medal of Honor from President Jimmy Carter, assisted by Captain Robert Peterson. Armstrong, one of six astronauts to be presented the medal during ceremonies held in the Vehicle Assembly Building (VAB), was awarded for his performance during the Gemini 8 mission and the Apollo 11 mission when he became the first human to set foot upon the Moon.

  18. Optical antenna gain. II - Receiving antennas

    Science.gov (United States)

    Degnan, J. J.; Klein, B. J.

    1974-01-01

    Expressions are developed for the gain of a centrally obscured, circular optical antenna used as the collecting and focusing optics in a laser receiver, involving losses due to (1) incoming light blockage by central obscuration, (2) energy spillover at the detector, and (3) the effect of local oscillator distribution in the case of heterodyne or homodyne detection. Numerical results are presented for direct detection and for three types of local oscillator distribution (uniform, Gaussian, and matched).

  19. Digital Signal Processor For GPS Receivers

    Science.gov (United States)

    Thomas, J. B.; Meehan, T. K.; Srinivasan, J. M.

    1989-01-01

    Three innovative components combined to produce all-digital signal processor with superior characteristics: outstanding accuracy, high-dynamics tracking, versatile integration times, lower loss-of-lock signal strengths, and infrequent cycle slips. Three components are digital chip advancer, digital carrier downconverter and code correlator, and digital tracking processor. All-digital signal processor intended for use in receivers of Global Positioning System (GPS) for geodesy, geodynamics, high-dynamics tracking, and ionospheric calibration.

  20. Development of Receiver Stimulator for Auditory Prosthesis

    Directory of Open Access Journals (Sweden)

    K. Raja Kumar

    2010-05-01

    Full Text Available The Auditory Prosthesis (AP is an electronic device that can provide hearing sensations to people who are profoundly deaf by stimulating the auditory nerve via an array of electrodes with an electric current allowing them to understand the speech. The AP system consists of two hardware functional units such as Body Worn Speech Processor (BWSP and Receiver Stimulator. The prototype model of Receiver Stimulator for Auditory Prosthesis (RSAP consists of Speech Data Decoder, DAC, ADC, constant current generator, electrode selection logic, switch matrix and simulated electrode resistance array. The laboratory model of speech processor is designed to implement the Continuous Interleaved Sampling (CIS speech processing algorithm which generates the information required for electrode stimulation based on the speech / audio data. Speech Data Decoder receives the encoded speech data via an inductive RF transcutaneous link from speech processor. Twelve channels of auditory Prosthesis with selectable eight electrodes for stimulation of simulated electrode resistance array are used for testing. The RSAP is validated by using the test data generated by the laboratory prototype of speech processor. The experimental results are obtained from specific speech/sound tests using a high-speed data acquisition system and found satisfactory.

  1. Transient simulation of molten salt central receiver

    Science.gov (United States)

    Doupis, Dimitri; Wang, Chuan; Carcorze-Soto, Jorge; Chen, Yen-Ming; Maggi, Andrea; Losito, Matteo; Clark, Michael

    2016-05-01

    Alstom is developing concentrated solar power (CSP) utilizing 60/40wt% NaNO3-KNO3 molten salt as the working fluid in a tower receiver for the global renewable energy market. In the CSP power generation cycle, receivers undergo a daily cyclic operation due to the transient nature of solar energy. Development of robust and efficient start-up and shut-down procedures is critical to avoiding component failures due to mechanical fatigue resulting from thermal transients, thus maintaining the performance and availability of the CSP plant. The Molten Salt Central Receiver (MSCR) is subject to thermal transients during normal daily operation, a cycle that includes warmup, filling, operation, draining, and shutdown. This paper describes a study to leverage dynamic simulation and finite element analysis (FEA) in development of start-up, shutdown, and transient operation concepts for the MSCR. The results of the FEA also verify the robustness of the MSCR design to the thermal transients anticipated during the operation of the plant.

  2. Optical antenna gain. 2: receiving antennas.

    Science.gov (United States)

    Degnan, J J; Klein, B J

    1974-10-01

    Expressions are derived for the gain of a centrally obscured, circular optical antenna when used as the collecting and focusing optics in a laser receiver which include losses due to (1) blockage of the incoming light by the central obscuration, (2) the spillover of energy at the detector, and (3) the effect of local oscillator distribution in the case of heterodyne or homodyne detection. Numerical results are presented for direct detection and for three types of local oscillator distributions (uniform, Gaussian, and matched) in the case of heterodyne or homodyne detection. The results are presented in several graphs that allow the rapid evaluation of receiver gain for an arbitrary set of telescope and detector parameters. It is found that, for uniform illumination by the LO, the optimum SNR is obtained when the detector radius is approximately 0.74 times the Airy disk radius. The use of an optimized Gaussian (spot size = 0.46 times the Airy disk radius) improves the receiver gain by less than 1 dB. Theuse results are insensitive to the size of the central obscuration.

  3. Russian institute receives CMS Gold Award

    CERN Multimedia

    Patrice Loïez

    2003-01-01

    The Snezhinsk All-Russian Institute of Scientific Research for Technical Physics (VNIITF) of the Russian Federal Nuclear Centre (RFNC) is one of twelve CMS suppliers to receive awards for outstanding performance this year. The CMS Collaboration took the opportunity of the visit to CERN of the Director of VNIITF and his deputy to present the CMS Gold Award, which the institute has received for its exceptional performance in the assembly of steel plates for the CMS forward hadronic calorimeter. This calorimeter consists of two sets of 18 wedge-shaped modules arranged concentrically around the beam-pipe at each end of the CMS detector. Each module consists of steel absorber plates with quartz fibres inserted into them. The institute developed a special welding technique to assemble the absorber plates, enabling a high-quality detector to be produced at relatively low cost.RFNC-VNIITF Director Professor Georgy Rykovanov (right), is seen here receiving the Gold Award from Felicitas Pauss, Vice-Chairman of the CMS ...

  4. Solar receiver performance of point focusing collector system

    Science.gov (United States)

    Wu, Y. C.; Wen, L. C.

    1978-01-01

    The solar receiver performance of cavity receivers and external receivers used in dispersed solar power systems was evaluated for the temperature range 300-1300 C. Several parameters of receiver and concentrator are examined. It was found that cavity receivers are generally more efficient than external receivers, especially at high temperatures which require a large heat transfer area. The effects of variation in the ratio of receiver area to aperture area are considered.

  5. Dividing Attention Lowers Children's but Increases Adults' False Memories

    Science.gov (United States)

    Otgaar, Henry; Peters, Maarten; Howe, Mark L.

    2012-01-01

    The present study examined the impact of divided attention on children's and adults' neutral and negative true and false memories in a standard Deese/Roediger-McDermott paradigm. Children (7- and 11-year-olds; n = 126) and adults (n = 52) received 5 neutral and 5 negative Deese/Roediger-McDermott word lists; half of each group also received a…

  6. Cerebral Palsy Symptoms in Children Decreased Following Massage Therapy

    Science.gov (United States)

    Hernandez-Reif, Maria; Field, Tiffany; Largie, Shay; Diego, Miguel; Manigat, Natasha; Seoanes, Jacqueline; Bornstein, Joan

    2005-01-01

    Twenty young children (mean age = 32 months) with cerebral palsy (CP) recruited from early intervention programs received 30 minutes of massage or reading twice weekly for 12 weeks. The children receiving massage therapy showed fewer physical symptoms including reduced spasticity, less rigid muscle tone overall and in the arms, and improved fine…

  7. UK malaria treatment guidelines 2016.

    Science.gov (United States)

    Lalloo, David G; Shingadia, Delane; Bell, David J; Beeching, Nicholas J; Whitty, Christopher J M; Chiodini, Peter L

    2016-06-01

    . Most patients treated for P. falciparum malaria should be admitted to hospital for at least 24 h as patients can deteriorate suddenly, especially early in the course of treatment. In specialised units seeing large numbers of patients, outpatient treatment may be considered if specific protocols for patient selection and follow up are in place. 10. Uncomplicated P. falciparum malaria should be treated with an artemisinin combination therapy (Grade 1A). Artemether-lumefantrine (Riamet(®)) is the drug of choice (Grade 2C) and dihydroartemisinin-piperaquine (Eurartesim(®)) is an alternative. Quinine or atovaquone-proguanil (Malarone(®)) can be used if an ACT is not available. Quinine is highly effective but poorly-tolerated in prolonged treatment and should be used in combination with an additional drug, usually oral doxycycline. 11. Severe falciparum malaria, or infections complicated by a relatively high parasite count (more than 2% of red blood cells parasitized) should be treated with intravenous therapy until the patient is well enough to continue with oral treatment. Severe malaria is a rare complication of P. vivax or P. knowlesi infection and also requires parenteral therapy. 12. The treatment of choice for severe or complicated malaria in adults and children is intravenous artesunate (Grade 1A). Intravenous artesunate is unlicensed in the EU but is available in many centres. The alternative is intravenous quinine, which should be started immediately if artesunate is not available (Grade 1A). Patients treated with intravenous quinine require careful monitoring for hypoglycemia. 13. Patients with severe or complicated malaria should be managed in a high-dependency or intensive care environment. They may require haemodynamic support and management of: acute respiratory distress syndrome, disseminated intravascular coagulation, acute kidney injury, seizures, and severe intercurrent infections including Gram-negative bacteraemia/septicaemia. 14. Children with

  8. Sustained attention in intellectually gifted children assessed using a continuous performance test.

    Directory of Open Access Journals (Sweden)

    Jiannong Shi

    Full Text Available This study aimed to investigate two aspects of sustained attention in intellectually gifted children: first, the differences to intellectually average children; second, the differences between receiving standard education and enrichment education. Study 1 compared sustained attention between 24 intellectually gifted and 26 intellectually average children. The results showed that intellectually gifted children had better performance than their average peers, not only for the whole task but also on all indices. Study 2 compared sustained attention between 24 intellectually gifted children who received standard education and 24 intellectually gifted children who received enrichment education. The results showed that intellectually gifted children who received enrichment education performed better than those who received standard education. These findings are consistent with previous work and provide support for the implementation of enrichment education for intellectually gifted children.

  9. How Important Is Teaching Phonemic Awareness to Children Learning to Read in Spanish?

    Science.gov (United States)

    Goldenberg, Claude; Tolar, Tammy D.; Reese, Leslie; Francis, David J.; Bazán, Antonio Ray; Mejía-Arauz, Rebeca

    2014-01-01

    This comparative study examines relationships between phonemic awareness and Spanish reading skill acquisition among three groups of Spanish-speaking first and second graders: children in Mexico receiving reading instruction in Spanish and children in the United States receiving reading instruction in either Spanish or English. Children were…

  10. The Influence of Juggling on Mental Rotation Performance in Children with Spina Bifida

    Science.gov (United States)

    Lehmann, Jennifer; Jansen, Petra

    2012-01-01

    This study examined the influence of juggling training on mental rotation ability in children with spina bifida. Children between the ages of 8 and 12 solved a chronometric mental rotation test. Half of the children received juggling training (EG) over an 8 week time period; the other half did not receive training (CG). Afterwards, all…

  11. Multiple treatment comparisons in a series of anti-malarial trials with an ordinal primary outcome and repeated treatment evaluations

    Directory of Open Access Journals (Sweden)

    Youdom Solange

    2012-05-01

    -sulphadoxine-pyrimethamine (ASSP, artemether-lumefantrine (AMLM and DHPP, the difference with the latter being significant. No difference in efficacy was found between ASAQ and AMLM. Conclusions Bayesian mixed treatment comparisons of a network of connected randomized trials with repeated measurements of the primary categorical outcome allowed to take into account both the individual- and between- studies sources of heterogeneity. The results of the present study complete the previous quantitative review based on a binary outcome at a fixed time point, suggesting that DHPP represents an alternative for the treatment of uncomplicated P. falciparum malaria in Cameroonian children.

  12. Does anti-malarial drug knowledge predict anti-malarial dispensing practice in drug outlets? A survey of medicine retailers in western Kenya

    Directory of Open Access Journals (Sweden)

    Rusk Andria

    2012-08-01

    Full Text Available Abstract Background Malaria is a major cause of morbidity and mortality in Kenya, where it is the fifth leading cause of death in both children and adults. Effectively managing malaria is dependent upon appropriate treatment. In Kenya, between 17 to 83 percent of febrile individuals first seek treatment for febrile illness over the counter from medicine retailers. Understanding medicine retailer knowledge and behaviour in treating suspected malaria and dispensing anti-malarials is crucial. Methods To investigate medicine retailer knowledge about anti-malarials and their dispensing practices, a survey was conducted of all retail drug outlets that sell anti-malarial medications and serve residents of the Webuye Health and Demographic Surveillance Site in the Bungoma East District of western Kenya. Results Most of the medicine retailers surveyed (65% were able to identify artemether-lumefantrine (AL as the Kenyan Ministry of Health recommended first-line anti-malarial therapy for uncomplicated malaria. Retailers who correctly identified this treatment were also more likely to recommend AL to adult and paediatric customers. However, the proportion of medicine retailers who recommend the correct treatment is disappointingly low. Only 48% would recommend AL to adults, and 37% would recommend it to children. It was discovered that customer demand has an influence on retailer behaviour. Retailer training and education were found to be correlated with anti-malarial drug knowledge, which in turn is correlated with dispensing practices. Medicine retailer behaviour, including patient referral practice and dispensing practices, are also correlated with knowledge of the first-line anti-malarial medication. The Kenya Ministry of Health guidelines were found to influence retailer drug stocking and dispensing behaviours. Conclusion Most medicine retailers could identify the recommended first-line treatment for uncomplicated malaria, but the percentage that could

  13. Paediatric pharmacovigilance: use of pharmacovigilance data mining algorithms for signal detection in a safety dataset of a paediatric clinical study conducted in seven African countries.

    Directory of Open Access Journals (Sweden)

    Dan K Kajungu

    Full Text Available BACKGROUND: Pharmacovigilance programmes monitor and help ensuring the safe use of medicines which is critical to the success of public health programmes. The commonest method used for discovering previously unknown safety risks is spontaneous notifications. In this study we examine the use of data mining algorithms to identify signals from adverse events reported in a phase IIIb/IV clinical trial evaluating the efficacy and safety of several Artemisinin-based combination therapies (ACTs for treatment of uncomplicated malaria in African children. METHODS: We used paediatric safety data from a multi-site, multi-country clinical study conducted in seven African countries (Burkina Faso, Gabon, Nigeria, Rwanda, Uganda, Zambia, and Mozambique. Each site compared three out of four ACTs, namely amodiaquine-artesunate (ASAQ, dihydroartemisinin-piperaquine (DHAPQ, artemether-lumefantrine (AL or chlorproguanil/dapsone and artesunate (CD+A. We examine two pharmacovigilance signal detection methods, namely proportional reporting ratio and Bayesian Confidence Propagation Neural Network on the clinical safety dataset. RESULTS: Among the 4,116 children (6-59 months old enrolled and followed up for 28 days post treatment, a total of 6,238 adverse events were reported resulting into 346 drug-event combinations. Nine signals were generated both by proportional reporting ratio and Bayesian Confidence Propagation Neural Network. A review of the manufacturer package leaflets, an online Multi-Drug Symptom/Interaction Checker (DoubleCheckMD and further by therapeutic area experts reduced the number of signals to five. The ranking of some drug-adverse reaction pairs on the basis of their signal index differed between the two methods. CONCLUSIONS: Our two data mining methods were equally able to generate suspected signals using the pooled safety data from a phase IIIb/IV clinical trial. This analysis demonstrated the possibility of utilising clinical studies safety data

  14. Children Adrift: Educating China's Millions of Migrants.

    Science.gov (United States)

    Cao, Haili

    1999-01-01

    The population of migrants moving within China's borders has reached some 80 million, including 2-3 million school-aged children. As migrant workers flock to cities, their children strain urban school systems or receive no education. But independent schools for migrants are illegal and substandard. In some rural provinces, vocational training may…

  15. School-Based Counseling of Abused Children

    Science.gov (United States)

    Brassard, Marla R.; Rivelis, Erin; Diaz, Vielka

    2009-01-01

    Abused children experience high rates of behavior, emotional, and learning problems but infrequently receive treatment. Most services provided to abused children and their families are not based on any clear evidence that they work. A number of evidence-based treatments (EBTs), demonstrated to be safe and effective in treating a range of…

  16. Spatial Training Improves Children's Mathematics Ability

    Science.gov (United States)

    Cheng, Yi-Ling; Mix, Kelly S.

    2014-01-01

    We tested whether mental rotation training improved math performance in 6- to 8-year-olds. Children were pretested on a range of number and math skills. Then one group received a single session of mental rotation training using an object completion task that had previously improved spatial ability in children this age (Ehrlich, Levine, &…

  17. A Non-Inferiority, Individually Randomized Trial of Intermittent Screening and Treatment versus Intermittent Preventive Treatment in the Control of Malaria in Pregnancy.

    Directory of Open Access Journals (Sweden)

    Harry Tagbor

    Full Text Available The efficacy of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine (IPTp-SP in pregnancy is threatened in parts of Africa by the emergence and spread of resistance to SP. Intermittent screening with a rapid diagnostic test (RDT and treatment of positive women (ISTp is an alternative approach.An open, individually randomized, non-inferiority trial of IPTp-SP versus ISTp was conducted in 5,354 primi- or secundigravidae in four West African countries with a low prevalence of resistance to SP (The Gambia, Mali, Burkina Faso and Ghana. Women in the IPTp-SP group received SP on two or three occasions whilst women in the ISTp group were screened two or three times with a RDT and treated if positive for malaria with artemether-lumefantrine (AL. ISTp-AL was non-inferior to IPTp-SP in preventing low birth weight (LBW, anemia and placental malaria, the primary trial endpoints. The prevalence of LBW was 15.1% and 15.6% in the IPTp-SP and ISTp-AL groups respectively (OR = 1.03 [95% CI: 0.88, 1.22]. The mean hemoglobin concentration at the last clinic attendance before delivery was 10.97g/dL and 10.94g/dL in the IPTp-SP and ISTp-AL groups respectively (mean difference: -0.03 g/dL [95% CI: -0.13, +0.06]. Active malaria infection of the placenta was found in 24.5% and in 24.2% of women in the IPTp-SP and ISTp-AL groups respectively (OR = 0.95 [95% CI 0.81, 1.12]. More women in the ISTp-AL than in the IPTp-SP group presented with malaria parasitemia between routine antenatal clinics (310 vs 182 episodes, rate difference: 49.4 per 1,000 pregnancies [95% CI 30.5, 68.3], but the number of hospital admissions for malaria was similar in the two groups.Despite low levels of resistance to SP in the study areas, ISTp-AL performed as well as IPTp-SP. In the absence of an effective alternative medication to SP for IPTp, ISTp-AL is a potential alternative to IPTp in areas where SP resistance is high. It may also have a role in areas where malaria

  18. Thatcher Receives 2004 Charles A. Whitten Medal

    Science.gov (United States)

    Stein, Ross

    2005-02-01

    Wayne Thatcher received the Whitten Medal at the 2004 Fall Meeting Honors Ceremony on 15 December, in San Francisco, California. The medal is given for outstanding achievement in research on the form and dynamics of the Earth and planets. Citation. Armed with geodesy, Wayne Thatcher has probed the behavior of great earthquakes, concentrating on the two sites where large events are frequent and the geodetic record is lush: the western United States and Japan. From this, he has garnered deep insights into the earthquake cycle-the pattern of strain accumulation and release of which an earthquake is only the most visible part.

  19. Perspectives from older adults receiving cancer treatment about the cancer-related information they receive

    OpenAIRE

    2015-01-01

    Objective: Cancer patients have reported that information plays a significant role in their capacity to cope with cancer and manage the consequences of treatment. This study was undertaken to identify the importance older adults receiving cancer treatment assign to selected types of cancer-related information, their satisfaction with the cancer-related information they received, and the barriers to effective information provision for this age group. Methods: This study was conducted in two ph...

  20. Children Teaching Children

    Science.gov (United States)

    Williams, Pia

    2007-01-01

    This study describes children's awareness of what it means to teach a game to a peer where the act of teaching becomes expression of the child's possible awareness. Awareness is defined as the attention to different aspects of the teaching process shown by the teaching child, sometimes through their own verbal reflection. This implies an…

  1. Woese on the received view of evolution.

    Science.gov (United States)

    Sarkar, Sahotra

    2014-01-01

    As part of his attempt to reconstruct the earliest phase of the evolution of life on Earth, Woese produced a compelling critique of the received view of evolution from the 20th century. This paper explicitly articulates two related features of that critique that are fundamental but the first of which has not been sufficiently clearly recognized in the context of evolutionary theorizing: (1) according to Woese's scenario of communal evolution during life's earliest phase (roughly, the first billion years of life on Earth), well-defined biological individuals (and, thus, individual lineages) did not exist; and (2) during that phase, evolutionary change took place through ubiquitous horizontal gene transfer (HGT) rather than through vertical transmission of features (including genes) and the combinatorics of HGT was the dominant mechanism of evolutionary change. Both factors present serious challenges to the received view of evolution and that framework would have to be radically altered to incorporate these factors. The extent to which this will be necessary will depend on whether Woese's scenario of collective early evolution is correct.

  2. Solar central receiver heliostat reflector assembly

    Science.gov (United States)

    Horton, Richard H.; Zdeb, John J.

    1980-01-01

    A heliostat reflector assembly for a solar central receiver system comprises a light-weight, readily assemblable frame which supports a sheet of stretchable reflective material and includes mechanism for selectively applying tension to and positioning the sheet to stretch it to optical flatness. The frame is mounted on and supported by a pipe pedestal assembly that, in turn, is installed in the ground. The frame is controllably driven in a predetermined way by a light-weight drive system so as to be angularly adjustable in both elevation and azimuth to track the sun and efficiently continuously reflect the sun's rays to a focal zone, i.e. central receiver, which forms part of a solar energy utilization system, such as a solar energy fueled electrical power generation system. The frame may include a built-in system for testing for optical flatness of the reflector. The preferable geometric configuration of the reflector is octagonal; however, it may be other shapes, such as hexagonal, pentagonal or square. Several different embodiments of means for tensioning and positioning the reflector to achieve optical flatness are disclosed. The reflector assembly is based on the stretch frame concept which provides an extremely light-weight, simple, low-cost reflector assembly that may be driven for positioning and tracking by a light-weight, inexpensive drive system.

  3. Omnidirectional free-space optical receiver architecture

    Science.gov (United States)

    Murshid, Syed H.; Lovell, Gregory L.; Finch, Michael F.

    2013-05-01

    Free Space Optical (FSO) communication is the fusion of wireless technology and optical fiber communications systems. It has the potential of providing fiber optic data rates without the physical restraints of optical fiber cables. This endeavor presents a novel receiver structure with potential for omnidirectional free space optical communications. Interesting approaches for accomplishing omnidirectional free space lasercomm such as direct detection and solar blind non-line of sight UV scattering have been reported over the last few years. However, these technologies have resulted in limited distances of the order of 10 to 100 meters and data rates often limited to less than 1 Mb/s. This endeavor reports the architecture of an omnidirectional receiver setup by integrating an off the shelf detector and a fiber bundle, where the fiber bundle couples omnidirectional photons within its field of view and delivers these photons to the detector. The coupling of light from all directions into a detector is regulated by the cone of the acceptance angle of the fiber. Multiple fibers with overlapping acceptance angles provide the necessary coverage that may be needed to extract the optical signal from the free space optical channel. Simulated results showing the normalized power pattern of the system is presented to demonstrate omnidirectional potential of the structure. Theoretical power level versus distance plot for an FSO System employing On-O Keying (OOK) is also presented.

  4. Parabolic Trough Receiver Heat Loss Testing (Poster)

    Energy Technology Data Exchange (ETDEWEB)

    Price, H.; Netter, J.; Bingham, C.; Kutscher, C.; Burkholder, F.; Brandemuehl, M.

    2007-03-01

    Parabolic trough receivers, or heat collection elements (HCEs), absorb sunlight focused by the mirrors and transfer that thermal energy to a fluid flowing within them. Thje absorbing tube of these receivers typically operates around 400 C (752 F). HCE manufacturers prevent thermal loss from the absorbing tube to the environment by using sputtered selective Cermet coatings on the absorber and by surrounding the absorber with a glass-enclosed evacuated annulus. This work quantifies the heat loss of the Solel UVAC2 and Schott PTR70 HCEs. At 400 C, the HCEs perform similarly, losing about 400 W/m of HCE length. To put this in perspective, the incident beam radiation on a 5 m mirror aperture is about 4500 W/m, with about 75% of that energy ({approx} 3400 W/m) reaching the absorber surface. Of the 3400 W/m on the absorber, about 3000 W/m is absorbed into the working fluid while 400 W/m is lost to the environment.

  5. Transactions Security Tools in Account Receivables Management

    Directory of Open Access Journals (Sweden)

    Anna Wodyńska

    2008-03-01

    Full Text Available Large competition among goods and services suppliers caused that granting clients deferred term of payment became a standard, so in other word granting clients commercial credit is a standard. Companies try to limit credit risk by securing their trade transactions in accordance with their credit policy that determines in some way the choice of trade transaction security tools.This article presents a full range of trade transaction security tools according to the general division into personal and property securities. The author pays attention to the fact that while conducting a proper credit policy in relation to clients, a company has chances to monitor efficiently the receivables and insist on their payment as well as use, as needed, the earlier prepared trade transaction security tools.The author convinces that regardless of the choice of trade transaction security tools, or reasons leading the receivables managing person, the basic criterion of security evaluation shall be its real, checked and verified value. The pledge on an object that does not exist is not worth much. The same applies to security granted by an insolvent person.

  6. The Submillimeter Array Antennas and Receivers

    CERN Document Server

    Blundell, R

    2005-01-01

    The Submillimeter Array (SMA) was conceived at the Smithsonian Astrophysical Observatory in 1984 as a six element interferometer to operate in the major atmospheric windows from about 200 to 900 GHz. In 1996, the Academica Sinica Institute of Astronomy and Astrophysics of Taiwan joined the project and agreed to provide additional hardware to expand the interferometer to eight elements. All eight antennas are now operating at the observatory site on Mauna Kea, and astronomical observations have been made in the 230, 345, and 650 GHz bands. The SMA antennas have a diameter of 6 m, a surface accuracy of better than 25 micron rms, and can be reconfigured to provide spatial resolutions down to about 0.5" at 200 GHz and, eventually, 0.1" at 850 GHz. Coupling to the receiver package within each antenna is achieved via a beam waveguide, in a bent Nasmyth configuration, comprised of a flat tertiary mirror and two ellipsoidal mirrors that form a secondary pupil used for receiver calibration. An additional fixed mirror ...

  7. Multidrug-Resistant Pathogens in Hospitalized Syrian Children

    Science.gov (United States)

    Kassem, Diana Faour; Hoffmann, Yoav; Shahar, Naama; Ocampo, Smadar; Salomon, Liora; Zonis, Zeev

    2017-01-01

    Since 2013, wounded and ill children from Syria have received treatment in Israel. Screening cultures indicated that multidrug-resistant (MDR) pathogens colonized 89 (83%) of 107 children. For 58% of MDR infections, the pathogen was similar to that identified during screening. MDR screening of these children is valuable for purposes of isolation and treatment. PMID:27618479

  8. Impaired glucose absorption in children with severe malnutrition

    NARCIS (Netherlands)

    Bandsma, Robert H. J.; Spoelstra, Martijn N.; Mari, Andrea; Mendel, Marijke; van Rheenen, Patrick F.; Senga, Edward; van Dijk, Theo; Heikens, Geert Tom

    2011-01-01

    Objective To quantify intestinal glucose absorption in children with two types of severe malnutrition, kwashiorkor and marasmus, compared with healthy children. Study design Children with kwashiorkor (n = 6) and marasmus (n = 9) and control subjects (n = 3) received a primed (13 mg/kg), constant inf

  9. Filtering the Internet: The Children's Internet Protection Act. Legal Update

    Science.gov (United States)

    McCarthy, Martha M.

    2004-01-01

    Accompanying the explosive growth of the Internet have been concerns about protecting children from viewing pornographic and other harmful images through cyberspace. In the past few years, Congress has passed several acts to censor Internet sites available to children, but only the Children's Internet Protection Act (CIPA) has received Supreme…

  10. Preschool Children's Sleep and Wake Behavior: Effects of Massage Therapy.

    Science.gov (United States)

    Field, Tiffany; And Others

    1996-01-01

    Preschool children received twice-weekly massages for five weeks. Compared to control children, the massaged children had better behavior ratings on mood state, vocalization, activity, and cooperation following massage on day one and throughout the study. Teachers rated their behavior more optimally, and their parents rated them as having less…

  11. Phase Noise Tolerant QPSK Receiver Using Phase Sensitive Wavelength Conversion

    DEFF Research Database (Denmark)

    Da Ros, Francesco; Xu, Jing; Lei, Lei

    2013-01-01

    A novel QPSK receiver based on a phase noise reduction pre-stage exploiting PSA in a HNLF and balanced detection is presented. Receiver sensitivity improvement over a conventional balanced receiver is demonstrated.......A novel QPSK receiver based on a phase noise reduction pre-stage exploiting PSA in a HNLF and balanced detection is presented. Receiver sensitivity improvement over a conventional balanced receiver is demonstrated....

  12. The Life Circumstances and Development of Children in Welfare Families: A Profile Based on National Survey Data.

    Science.gov (United States)

    Zill, Nicholas; And Others

    The study described in this paper used data from two national samples of families with children to describe the home environments in which welfare children are being raised and to identify the children's health, learning, and behavior problems. The study compared children whose families had received Aid to Families with Dependent Children (AFDC)…

  13. How children change their minds: strategy change can be gradual or abrupt.

    Science.gov (United States)

    Alibali, M W

    1999-01-01

    This study investigated patterns of change in children's strategies for solving mathematical equivalence problems. The strategies children expressed in speech and in gesture were assessed both before and after an instructional intervention. In the intervention, children received either no input, accuracy feedback, or feedback plus instruction about a principle, an analogy, or a procedure. From pretest to posttest, many children changed both the variability of their strategy use and the content of their strategy repertoires. Patterns of change depended on type of instruction and on children's initial level of variability. Children who received instruction were especially likely to generate new strategies, and children with high variability were especially likely to abandon prior strategies. Gradual change was most common; however, many children modified their repertoires abruptly. Abrupt strategy change was especially prevalent among children who received procedure-based instruction and among children with low initial variability.

  14. Three Specialized Innovations for FAST Wideband Receiver

    Science.gov (United States)

    Zhang, Xia; Yu, Xinying; Duan, Ran; Hao, Jie; Li, Di

    2015-08-01

    The National Astronomical Observatories of the Chinese Academy of Sciences (NAOC) will soon finish the largest antenna in the world. Known as FAST, the Five-hundred-meter Aperture Spherical Radio Telescope will be the most sensitive single-dish radio telescope in the low frequency radio bands between 70 MHz and 3 GHz.To take advantage of its giant aperture, all relevant cutting-edge technology should be applied to FAST to ensure that it achieves the best possible overall performance. The wideband receiver that is currently under development can not only be directly applied to FAST, but also used for other Chinese radio telescopes, such as the Shanghai 65-meter telescope and the Xinjiang 110-meter telescope, to ensure that these telescopes are among the best in the world. Recently, rapid development related to this wideband receiver has been underway. In this paper, we will introduce three key aspects of the FAST wideband receiver project. First is the use of a high-performance analog-to-digital converter (ADC). With the cooperation of Hao Jie’s team from the Institute of Automation of the Chinese Academy of Sciences(CASIA), we have developed 3-Gsps,12-bit ADCs, which have not been used previously in astronomy, and we expect to realize the 3-GHz bandwidth in a single step by covering the entire bandwidth via interleaving or a complex fast Fourier transform (FFT).Second is the front-end analog signal integrated circuit board. We wish to achieve a series of amplification, attenuation, and mixing filtering operations on a single small board, thereby achieving digital control of the bandpass behavior both flexibly and highly-efficiently. This design will not only greatly reduce the required cost and power but will also make the best use of the digital-system’s flexibility. Third is optimization of the FFT: the existing FFT is not very efficient; therefore, we will optimize the FFT for large-scale operation. For this purpose, we intend to cascade two FFTs. Another

  15. Eosinophils increase in animals that received biotherapic

    Directory of Open Access Journals (Sweden)

    Pedro Gilberto Silva Morais

    2012-12-01

    Full Text Available Dairy industry is an important Brazilian economic activity participating of income generation. European breeds cattle aren’t adapted to parasites found in the tropics, like the Rhipicephalus microplus tick. Parasites can acquire resistance to allopathic products, but not to homeopathic products. We evaluate the efficacy of an antiparasiticide biotherapic against the R. microplus tick. The biotherapic was prepared according to the homeopathic pharmacopoeia recommendations from vegetable (Abrotanum and animal products (Rhipicephalus microplus, Amblyomma cajenennense, Haematobia irritans, Musca domestica, Dermatobia hominis, all diluted and vigorous shaken (dynamized in water or alcohol at a ratio of 1:99, in the 12th Centesimal Hahnemann (CH12, with limestone as the carrier. This homeophatic product found in veterinary pharmacies of Ituiutaba’s region, Minas Gerais State, is registered at Ministério da Agricultura, Pecuária e Abastecimento (MAPA. Natural tick infestation was accessed in thirty Girolando (Gir x Holstein cows with 7 to 13 year-old, by monthly counting of tick female bigger than 6 mm, from October/2009 to July/2011. Cows were divided in three groups of 10 similar animals. The treated group (T1 received roughage, concentrate and biotherapic. The placebo group (T2 received roughage, concentrate and limestone and the control group (T3 received only roughage and concentrate. T1 and T2 groups were managed together and remained in the same paddock. T3 group was separed from T1 and T2 by a wire fence. From October 2009 to September 2010 blood cell counts and serum biochemical tests were performed monthly only in T1 and T2, but visual clinical observations were made in all animals. Any group was treated with acaricide when the count’s average reached 50 or more ticks. It was necessary 7 baths with acaricide in T1 and T2, while in T3 group (control group it was necessary 19 acaricide baths to control the cattle tick. We verified

  16. A perspectiva dos pais sobre a obtenção do diagnóstico de leucemia linfóide aguda em crianças e adolescentes: uma experiência no Brasil The parents' perspective on receiving a diagnosis of acute lymphoid leukemia in children and adolescents: a Brazilian experiment

    Directory of Open Access Journals (Sweden)

    Rosa Maria Quadros Nehmy

    2011-09-01

    Full Text Available OBJETIVOS: conhecer a percepção dos pais para o diagnóstico de leucemia em seus filhos. MÉTODOS: pesquisa qualitativa tendo como referencial a teoria das representações sociais ancorada na tradição da sociologia compreensiva. Utilizou-se entrevista semi estruturada para a coleta de dados. Foram entrevistados 20 pais de crianças e adolescentes com diagnóstico de leucemia linfóide aguda (LLA. Para análise dos dados empregou-se a técnica de "análise do conteúdo". As diretrizes de humanização da assistência e princípios bioéticos foram os eixos norteadores da análise dos dados. RESULTADOS: os pais recordaram-se claramente da progressão dos sintomas da doença até o diagnóstico. A palavra leucemia foi associada ao câncer e à morte. Dificuldades relacionadas à escuta dos sintomas, a particularidades clínicas da leucemia e ao encaminhamento no sistema de saúde foram os principais motivos para a demora do diagnóstico definitivo. Destacam-se as peregrinações por diferentes locais, perda da resolubilidade, gastos desnecessários, desgaste emocional e atraso nas ações de saúde. CONCLUSÕES: o câncer envolve valores culturais sobre a morte, cuja carga simbólica é maior no caso da criança. A busca do diagnóstico da leucemia pelos pais é exemplo emblemático do tortuoso caminho percorrido quando o mal que acomete a criança não se enquadra no rótulo das doenças "comuns".OBJECTIVES: to investigate how parents perceive a diagnosis of lymphoid leukemia in their children. METHODS: qualitative research based on the sociological theory of social representations was used. Data was gathered by way of semi-structured interviews. Twenty parents of children diagnosed as having acute lymphoid leukemia (ALL. The content analysis technique was used to analyze data. Data analysis was guided by the principles of bioethics and humane care. RESULTS: the parents clearly recalled the progression of symptoms up to diagnosis. The word

  17. Okul Öncesi Eğitimi Almış Çocukların Akran İlişkileri Değişkenlerinin 5 Ve 6 Yaşta İncelenmesi: İki Yıllık Boylamsal Çalışma Investigation Of Variables Of Peer Relationships Of Children Receiving Preschool Education In Ages 5 And 6: A Two-Year Longitudinal Study

    Directory of Open Access Journals (Sweden)

    Hatice ERTEN SARIKAYA

    2013-09-01

    Full Text Available The purpose of this study is to examine whether variables of peerrelationships of children who attend preschool education significantlychange in ages 5 and 6 or not. The sample group of the study consistedof 78 children aged 5 and 6, who attended a private kindergarten in thecity center of Denizli and 2 independent kindergartens in Tavas andSerinhisar districts in the school year of 2010-2011, as well as 7preschool teachers. Ladd and Profilet Child Behavior Scale and PeerVictimization Scale were used in the study. The data collection processwas performed by applying the scales on the same sample group once in2011 and once in 2012. Preschool teachers filled out the “ChildBehavior Scale and Peer Victimization Scale” once for each child duringeach application period. While the first data of the study were collectedin May of 2011, one year later the second data were collected in May of2012. One way analysis of variance (ANOVA was used for the correlatedsamples in the data analysis in order to examine whether variables ofpeer relationships of children attending preschool educationsignificantly change in ages 5 and 6 or not.According to the general results of the study; while aggressionlevels, asocial behavior levels, anxious-fearful levels, exclusion levelsand peer victimization levels of preschool children decrease at the age of6, their prosocial behavior levels increase at the age of 6. Variables ofpeer relationships of children who received preschool education vary inages 5 and 6. Aggression levels, prosocial behavior levels, asocialbehavior levels, anxious-fearful levels, exclusion levels and peervictimization levels, which were among peer relationship variables ofchildren who received preschool education, did not remain stable inages 5 and 6 and showed decreases and increases. Araştırmanın amacı, okul öncesi eğitime devam eden çocuklarının akran ilişkileri değişkenlerinin 5 ve 6 yaşta anlamlı düzeyde değişiklik gösterip g

  18. Jiang Zemin Receives New ACWF Leadership

    Institute of Scientific and Technical Information of China (English)

    1998-01-01

    FOUR days after the adjournment of the 8th Chinese Women’s National Congress, President Jiang Zemin received all the newly-elected members of the executive committee and several deputies at Zhongnanhai. Gu Xiulian, Vice President and the First Member of the Secretariat of the All-China Women’s Federation (ACWF), briefed Jiang on the congress. She said deputies had reached consensus on certain issues: that women should capitalize on their abilities in the overall social participation; that the uplifting of women’s quality should be seen as a long-term strategy; and that women’s development requires a supportive social environment. Jiang Zemin listened attentively to the speeches delivered by seven deputies. Jiang Daguo, president of Hubei Provincial Women’s Federation, from one of the

  19. Teleseismic receiver functions imaging of Siberia

    DEFF Research Database (Denmark)

    Soliman, Mohammad Youssof Ahmad; Thybo, Hans; Artemieva, Irina

    2014-01-01

    be used for determining Moho depth, and are excellent for detecting relatively broad vertical gradients in velocity, such as expected for a thermally controlled LAB. The combination of both types of RFs allows for independent discontinuity models of the same area in different frequency bands using......We map the lithosphere in Siberia by using the available broadband seismic data for calculation of Ps- and Sp-wave receiver functions (RF). RFs show converted waves from discontinuities in the vicinity of the seismic stations. The main objective is to image the Moho and upper mantle discontinuities......, including the lithosphere-asthenosphere boundary (LAB) beneath the study area. We construct the RF using the LQT method (Vinnik, 1977; Kind et al. 1995) in the version by Yuan et al. (1997). Rotation of ray coordinates uses the incidence angles predicted by the AK135 velocity model. This decomposes the wave...

  20. The BINP receives its Golden Hadron award

    CERN Multimedia

    2002-01-01

    On Thursday, 14 September, the LHC Project Leader, Lyn Evans, handed over a Golden Hadron award to Alexander Skrinsky of Russia's Budker Institute of Nuclear Physics (BINP). The prize is awarded in recognition of exceptional performances by suppliers and this year prizes were awarded to two firms, Cockerill-Sambre (Belgium) and Wah-Chang (United States), and to the Budker Institute, which was unable to receive the award at the same time as the two other recipients (see Bulletin No 34/2002, of 19 August 2002). The Russian institute has been rewarded for the particularly high-quality production of 360 dipole magnets and 185 quadrupole magnets for the LHC proton beam transfer lines.

  1. Receiver based PAPR reduction in OFDMA

    KAUST Repository

    Ali, Anum Z.

    2014-05-01

    High peak-to-average power ratio is one of the major drawbacks of orthogonal frequency division multiplexing (OFDM). Clipping is the simplest peak reduction scheme, however, it requires clipping mitigation at the receiver. Recently compressed sensing has been used for clipping mitigation (by exploiting the sparse nature of clipping signal). However, clipping estimation in multi-user scenario (i.e., OFDMA) is not straightforward as clipping distortions overlap in frequency domain and one cannot distinguish between distortions from different users. In this work, a collaborative clipping removal strategy is proposed based on joint estimation of the clipping distortions from all users. Further, an effective data aided channel estimation strategy for clipped OFDM is also outlined. Simulation results are presented to justify the effectiveness of the proposed schemes. © 2014 IEEE.

  2. Humboldt SK pilot biodigester receives funding

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2005-09-30

    The Canada-Saskatchewan Western Economic Partnership Agreement (WEPA) will provide funding for Canada's first pilot-scale biodigester to be built in Humboldt, Saskatchewan. The $208,138 pilot facility will use household garbage as well as agricultural waste such as manure and livestock operations, abattoirs and food processing to create heat or power and fertilizer. Support for this bio-energy facility, which could also reduce greenhouse gases, will come from the Prairie Agricultural Machinery Institute which has received $186,138 from Canada and Saskatchewan in the form of cost-shared federal-provincial funding. The pilot plant will test different combinations of waste material feedstocks and the characteristics of the resulting gas end products. The pilot facility will also provide design information for full-scale biodigester manufacturers in Canada. It is expected that 25 full-scale biodigesters will be constructed in Canada in the near future.

  3. Cost-effectiveness study of three antimalarial drug combinations in Tanzania.

    Directory of Open Access Journals (Sweden)

    Virginia Wiseman

    2006-10-01

    Full Text Available BACKGROUND: As a result of rising levels of drug resistance to conventional monotherapy, the World Health Organization (WHO and other international organisations have recommended that malaria endemic countries move to combination therapy, ideally with artemisinin-based combinations (ACTs. Cost is a major barrier to deployment. There is little evidence from field trials on the cost-effectiveness of these new combinations. METHODS AND FINDINGS: An economic evaluation of drug combinations was designed around a randomised effectiveness trial of combinations recommended by the WHO, used to treat Tanzanian children with non-severe slide-proven malaria. Drug combinations were: amodiaquine (AQ, AQ with sulfadoxine-pyrimethamine (AQ+SP, AQ with artesunate (AQ+AS, and artemether-lumefantrine (AL in a six-dose regimen. Effectiveness was measured in terms of resource savings and cases of malaria averted (based on parasitological failure rates at days 14 and 28. All costs to providers and to patients and their families were estimated and uncertain variables were subjected to univariate sensitivity analysis. Incremental analysis comparing each combination to monotherapy (AQ revealed that from a societal perspective AL was most cost-effective at day 14. At day 28 the difference between AL and AQ+AS was negligible; both resulted in a gross savings of approximately US1.70 dollars or a net saving of US22.40 dollars per case averted. Varying the accuracy of diagnosis and the subsistence wage rate used to value unpaid work had a significant effect on the number of cases averted and on programme costs, respectively, but this did not change the finding that AL and AQ+AS dominate monotherapy. CONCLUSIONS: In an area of high drug resistance, there is evidence that AL and AQ+AS are the most cost-effective drugs despite being the most expensive, because they are significantly more effective than other options and therefore reduce the need for further treatment. This is

  4. Assessment of the molecular marker of Plasmodium falciparum chloroquine resistance (Pfcrt) in Senegal after several years of chloroquine withdrawal.

    Science.gov (United States)

    Ndiaye, Magatte; Faye, Babacar; Tine, Roger; Ndiaye, Jean Louis; Lo, Aminata; Abiola, Annie; Dieng, Yemou; Ndiaye, Daouda; Hallett, Rachel; Alifrangis, Michael; Gaye, Oumar

    2012-10-01

    As a result of widespread antimalarial drug resistance, all African countries with endemic malaria have, in recent years, changed their malaria treatment policy. In Senegal, the health authorities changed from chloroquine (CQ) to a combination of sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ) in 2003. Since 2006, the artemisinin combination therapies (ACTs) artemether-lumefantrine (AL) and artesunate plus amodiaquine (AS/AQ) were adopted for uncomplicated malaria treatment. After several years of CQ withdrawal, the current study wished to determine the level of CQ resistance at the molecular level in selected sites in Senegal, because the scientific community is interested in using CQ again. Finger prick blood samples were collected from Plasmodium falciparum-positive children below the age of 10 years (N = 474) during cross-sectional surveys conducted in two study sites in Senegal with different malaria transmission levels. One site is in central Senegal, and the other site is in the southern part of the country. All samples were analyzed for single nucleotide polymorphisms (SNPs) in the P. falciparum CQ resistance transporter gene (Pfcrt; codons 72-76) using polymerase chain reaction (PCR) sequence-specific oligonucleotide probe (SSOP) enzyme-linked immunosorbent assay (ELISA) and real-time PCR methods. In total, the 72- to 76-codon region of Pfcrt was amplified in 449 blood samples (94.7%; 285 and 164 samples from the central and southern sites of Senegal, respectively). In both study areas, the prevalence of the Pfcrt wild-type single CVMNK haplotype was very high; in central Senegal, the prevalence was 70.5% in 2009 and 74.8% in 2010, and in southern Senegal, the prevalence was 65.4% in 2010 and 71.0% in 2011. Comparing data with older studies in Senegal, a sharp decline in the mutant type Pfcrt prevalence is evident: from 65%, 64%, and 59.5% in samples collected from various sites in 2000, 2001, and 2004 to approximately 30% in our study. A similar

  5. Management of imported malaria in Europe

    Directory of Open Access Journals (Sweden)

    Askling Helena H

    2012-09-01

    Full Text Available Abstract In this position paper, the European Society for Clinical Microbiology and Infectious Diseases, Study Group on Clinical Parasitology, summarizes main issues regarding the management of imported malaria cases. Malaria is a rare diagnosis in Europe, but it is a medical emergency. A travel history is the key to suspecting malaria and is mandatory in patients with fever. There are no specific clinical signs or symptoms of malaria although fever is seen in almost all non-immune patients. Migrants from malaria endemic areas may have few symptoms. Malaria diagnostics should be performed immediately on suspicion of malaria and the gold- standard is microscopy of Giemsa-stained thick and thin blood films. A Rapid Diagnostic Test (RDT may be used as an initial screening tool, but does not replace urgent microscopy which should be done in parallel. Delays in microscopy, however, should not lead to delayed initiation of appropriate treatment. Patients diagnosed with malaria should usually be hospitalized. If outpatient management is preferred, as is the practice in some European centres, patients must usually be followed closely (at least daily until clinical and parasitological cure. Treatment of uncomplicated Plasmodium falciparum malaria is either with oral artemisinin combination therapy (ACT or with the combination atovaquone/proguanil. Two forms of ACT are available in Europe: artemether/lumefantrine and dihydroartemisinin/piperaquine. ACT is also effective against Plasmodium vivax, Plasmodium ovale, Plasmodium malariae and Plasmodium knowlesi, but these species can be treated with chloroquine. Treatment of persistent liver forms in P. vivax and P. ovale with primaquine is indicated after excluding glucose 6 phosphate dehydrogenase deficiency. There are modified schedules and drug options for the treatment of malaria in special patient groups, such as children and pregnant women. The potential for drug interactions and the role of food in the

  6. I Can Do Maths: Changing Children's Mathematics Percentile Ranking.

    Science.gov (United States)

    Le Grice, Bonny; Mabin, Tony; Graham, Sue

    Three groups of children aged 8-10 who scored below the 22nd percentile on the PATests were taught basic math skills for 16 hours. One group received individual instruction using Precision Teaching and Direct Instruction, the second group received group instruction using Precision Teaching and Direct Instruction, and the third group received group…

  7. An open randomized controlled trial to compare the efficacy of two fixed dose combinations of artemesinin based combinations for uncomplicated falciparum malaria in Bangladesh.

    Science.gov (United States)

    Samad, R; Rahman, M R; Yunus, E B; Hussain, M A; Arif, S M; Islam, M N; Hafiz, S A M M A; Hossain, M M; Faiz, M A

    2013-12-01

    National Malaria Control Program (NMCP) of Bangladesh has introduced Artemisinin Based Combination (ACT), Coartem(R) (Artemether-Lumefantrine (AL), fixed dose combination, in the confirmed cases of uncomplicated P. falciparum malaria since 2004. Despite the reduction of mortality due to malaria, the development and spread of anti-malarial drug resistance wordwide posing a threat to the health services and will make it difficult to control malaria in Bangladesh in future. We need to have an alternative to Coartem which could be Artesunate-amodiaquine (AA) in a fixed dose combination (FDC), a cheaper altenative not yet evidenced to be effective and safe to our population. In this study we compared the efficacy and safety of Artemether + Lumefantrene (FDC, Coartem) with Artesunate +Amodiaquine tablets (100/270 mg FDC) for the treatment of uncomplicated P. falciparum malaria in three high risk multi-drug resistant malaria prevalent areas of Bangladesh. It was an open label randomized controlled trial conducted between December 2008 and November 2009 in 4 upazillas in patients over the age 12 to 60 years diagnosed as a case of uncomplicated P. falciparum malaria. The outcome of the cases were measured as clinical response, parasitological response, defervescence time and parasite clearance time. Drug safety was assessed by comparing the adverse events. A total of 252 cases were randomized to receive Artesunate + Amodiaquine (AA group, 147 cases) and Artemether + Lumefantrene (AL group, 106 cases), one lost to follow up at day 28 in AA group. The distribution of the cases was comparable by age, sex and study sites. Treatment success' response was observed 100% in the AL group and AA group had 99%, two failures with AA were late treatment failures and the difference was not statistically significant (p > .1). The parasitological sensitive (S) response was observed in 97% of cases in AL group and 95% in the AA group, and was not a statistically significant difference

  8. Efficacy of artesunate-amodiaquine for treating uncomplicated falciparum malaria in sub-Saharan Africa: a multi-centre analysis

    Directory of Open Access Journals (Sweden)

    Same-Ekobo Albert

    2009-08-01

    Full Text Available Abstract Background Artesunate and amodiaquine (AS&AQ is at present the world's second most widely used artemisinin-based combination therapy (ACT. It was necessary to evaluate the efficacy of ACT, recently adopted by the World Health Organization (WHO and deployed over 80 countries, in order to make an evidence-based drug policy. Methods An individual patient data (IPD analysis was conducted on efficacy outcomes in 26 clinical studies in sub-Saharan Africa using the WHO protocol with similar primary and secondary endpoints. Results A total of 11,700 patients (75% under 5 years old, from 33 different sites in 16 countries were followed for 28 days. Loss to follow-up was 4.9% (575/11,700. AS&AQ was given to 5,897 patients. Of these, 82% (4,826/5,897 were included in randomized comparative trials with polymerase chain reaction (PCR genotyping results and compared to 5,413 patients (half receiving an ACT. AS&AQ and other ACT comparators resulted in rapid clearance of fever and parasitaemia, superior to non-ACT. Using survival analysis on a modified intent-to-treat population, the Day 28 PCR-adjusted efficacy of AS&AQ was greater than 90% (the WHO cut-off in 11/16 countries. In randomized comparative trials (n = 22, the crude efficacy of AS&AQ was 75.9% (95% CI 74.6–77.1 and the PCR-adjusted efficacy was 93.9% (95% CI 93.2–94.5. The risk (weighted by site of failure PCR-adjusted of AS&AQ was significantly inferior to non-ACT, superior to dihydroartemisinin-piperaquine (DP, in one Ugandan site, and not different from AS+SP or AL (artemether-lumefantrine. The risk of gametocyte appearance and the carriage rate of AS&AQ was only greater in one Ugandan site compared to AL and DP, and lower compared to non-ACT (p = 0.001, for all comparisons. Anaemia recovery was not different than comparator groups, except in one site in Rwanda where the patients in the DP group had a slower recovery. Conclusion AS&AQ compares well to other treatments and meets the

  9. Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective

    Directory of Open Access Journals (Sweden)

    Obrist Brigit

    2010-06-01

    Full Text Available Abstract Background The ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP to artemether-lumefantrine (ALu in 2007 and subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment. Methods Three treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days. Results Treatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%; an increase in health facility attendance as first treatment option for patients older than five years (27% to 52%; higher treatment coverage with anti-malarials (86% to 96% and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs. Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%. The availability of outlets (health facilities or drug shops is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent. Conclusions An

  10. A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia

    Institute of Scientific and Technical Information of China (English)

    Pascalina Chanda-Kapata; Emmanuel Chanda; Freddie Masaninga; Annette Habluetzel; Felix Masiye; Ibrahima Soce Fall

    2014-01-01

    Objective: To establish the appropriateness of malaria case management at health facility level in four districts in Zambia. Methods: This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage. The review period was from January to December 2008. The sample included twelve lower level health facilities from four districts. The Pearson Chi-square test was used to identify characteristics which affected the quality of case management.Results:Out of 4891 suspected malaria cases recorded at the 12 health facilities, more than 80% of the patients had a temperature taken to establish their fever status. About 67% (CI95 66.1-68.7) were tested for parasitemia by either rapid diagnostic test or microscopy, whereas the remaining 22.5% (CI95 21.3.1-23.7) were not subjected to any malaria test. Of the 2247 malaria cases reported (complicated and uncomplicated), 71% were parasitologically confirmed while 29% were clinically diagnosed (unconfirmed). About 56% (CI95 53.9-58.1) of the malaria cases reported were treated with artemether-lumefantrine (AL), 35% (CI95 33.1-37.0) with sulphadoxine-pyrimethamine, 8% (CI95 6.9-9.2) with quinine and 1% did not receive any anti-malarial. Approximately 30% of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial, contrary to the guidelines. There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used, and in the choice of anti-malarials for the treatment of malaria confirmed cases. Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not. Gender, in service training on malaria

  11. Wednesday's Children.

    Science.gov (United States)

    Paterson, Katherine

    1986-01-01

    The author of "Jacob Have I Loved" and "Come Sing, Jimmy Jo" describes the characters in books she has written who are like "Wednesday's children"--full of woe. Discusses dealing with tragedy in children's books. (EL)

  12. Children's Health

    Science.gov (United States)

    Your child's health includes physical, mental and social well-being. Most parents know the basics of keeping children healthy, like offering ... for children to get regular checkups with their health care provider. These visits are a chance to ...

  13. 30 CFR 57.13011 - Air receiver tanks.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Air receiver tanks. 57.13011 Section 57.13011... Boilers § 57.13011 Air receiver tanks. Air receiver tanks shall be equipped with one or more automatic... exceeding the maximum allowable working pressure in a receiver tank by not more than 10 percent....

  14. 30 CFR 56.13011 - Air receiver tanks.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Air receiver tanks. 56.13011 Section 56.13011... § 56.13011 Air receiver tanks. Air receiver tanks shall be equipped with one or more automatic pressure... the maximum allowable working pressure in a receiver tank by not more than 10 percent. Air...

  15. Flu: A Guide for Parents of Children or Adolescents with Chronic Health Conditions

    Science.gov (United States)

    ... they get a flu shot. What types of vaccine should my child receive and how many doses? Children with or ... years old may need 2 doses of the vaccine. Children 9 years of age and older need only ...

  16. Credits and Exemptions for Children. Tax Facts from the Tax Policy Center. Tax Notes[R

    Science.gov (United States)

    Maag, Elaine

    2009-01-01

    The Earned Income Tax Credit, Child Tax Credit (CTC), Additional Child Tax Credit (ACTC), and the dependent exemption all provide benefits to families with children. In 2009, a single mom (or dad) with two children can receive benefits ranging from $0 to about $7,500--depending on her income, age of the children, and where the children live. While…

  17. Acute hepatitis C in patients receiving hemodialysis.

    Science.gov (United States)

    Griveas, I; Germanidis, G; Visvardis, G; Morice, Y; Perelson, A S; Pawlotsky, J M; Papadopoulou, D

    2007-01-01

    Hepatitis C virus (HCV) infection is frequent in patients with end-stage renal disease treated by chronic dialysis, with a prevalence varying from 10-65% according to the geographical data. The prevalence is significantly associated with the duration of dialysis and the number of transfused blood products[1,2] and has dramatically declined with efficient blood screening.[3] We studied patients with acute HCV infection in a dialysis unit. The diagnosis was based on both anti-HCV detection and HCV-RNA detection. Other virological tools including HCV genotype determination was also used to tailor treatment to the individual patient and determine its efficacy for a one-year follow-up period. Seventeen patients (7 male and 10 female, mean age: 63.7 +/- 11.6 SD) with acute hepatitis C were enrolled to our study. All of them were followed up for a period of one year after the diagnosis was established. Phylogenetic analysis distinguished two separate HCV subtypes 1b, which were both responsible for this acute infection (see Figure 1). These types did not differ in their behavior on the clinical situation of our patients, as confirmed by the fact that in both groups of patients, there was only one patient who presented with acute illness. Six patients of our study group, three months after the acute infection, received pegylated interferon (Peg-IFNa2a) 135 mug for a six-month period. Four of them responded very well to therapy and at the first determination HCV RNA was below the cutoff point. One of our patients with very high HCV levels (HCV RNA > 50,000,000 IU/mL), despite receiving the same therapy, did not respond well and developed cirrhosis. In conclusion, it is clear from our experience that better information is needed about the current incidence, prevalence, and risk factors for HCV infection in dialysis patients. Algorithms for the diagnosis and management of hepatitis C should be developed by academic societies. Routine screening for hepatitis C also would allow

  18. Congenitally Deafblind Children and Cochlear Implants

    DEFF Research Database (Denmark)

    Dammeyer, Jesper Herup

    2008-01-01

    There has been much research conducted demonstrating the positive benefits of cochlear implantation (CI) in children who are deaf. Research on cochlear implantation in children who are both deaf and blind, however, is lacking. The purpose of this article is to present a study of 5 congenitally...... deafblind children who received cochlear implants between 2.2 and 4.2 years of age.  Ratings of video observations were used to measure the children's early communication development with and without the use of their cochlear implants. In addition, parental interviews were used to assess the benefits...... parents perceived regarding their children's cochlear implants. Two examples are included in this article to illustrate the parents' perspectives about cochlear implantation in their deafblind children. Benefits of cochlear implantation in this cohort of children included improved attention and emotional...

  19. Arm Swing during Walking at Different Speeds in Children with Cerebral Palsy and Typically Developing Children

    Science.gov (United States)

    Meyns, Pieter; Van Gestel, Leen; Massaad, Firas; Desloovere, Kaat; Molenaers, Guy; Duysens, Jacques

    2011-01-01

    Children with Cerebral Palsy (CP) have difficulties walking at a normal or high speed. It is known that arm movements play an important role to achieve higher walking speeds in healthy subjects. However, the role played by arm movements while walking at different speeds has received no attention in children with CP. Therefore we investigated the…

  20. Does Facial Expressivity Count? How Typically Developing Children Respond Initially to Children with Autism

    Science.gov (United States)

    Stagg, Steven D.; Slavny, Rachel; Hand, Charlotte; Cardoso, Alice; Smith, Pamela

    2014-01-01

    Research investigating expressivity in children with autism spectrum disorder has reported flat affect or bizarre facial expressivity within this population; however, the impact expressivity may have on first impression formation has received little research input. We examined how videos of children with autism spectrum disorder were rated for…

  1. 3-Receiver Broadcast Channels with Common and Confidential Messages

    CERN Document Server

    Chia, Yeow-Khiang

    2009-01-01

    Achievable secrecy rate regions for the general 3-receiver broadcast channel with one common and one confidential message sets are established. We consider two setups: (i) when the confidential message is to be sent to two of the receivers and the third receiver is an eavesdropper; and (ii) when the confidential message is to be sent to one of the receivers and the other two receivers are eavesdroppers. We show that our secrecy rate regions are optimum for some special cases.

  2. Dish stirling solar receiver combustor test program

    Science.gov (United States)

    Bankston, C. P.; Back, L. H.

    1981-01-01

    The operational and energy transfer characteristics of the Dish Stirling Solar Receiver (DSSR) combustor/heat exchanger system was evaluated. The DSSR is designed to operate with fossil fuel augmentation utilizing a swirl combustor and cross flow heat exchanger consisting of a single row of 4 closely spaced tubes that are curved into a conical shape. The performance of the combustor/heat exchanger system without a Stirling engine was studied over a range of operating conditions and output levels using water as the working fluid. Results show that the combustor may be started under cold conditions, controlled safety, and operated at a constant air/fuel ratio (10 percent excess air) over the required range of firing rates. Furthermore, nondimensional heat transfer coefficients based on total heat transfer are plotted versus Reynolds number and compared with literature data taken for single rows of closely spaced tubes perpendicular to cross flow. The data show enhanced heat transfer for the present geometry and test conditions. Analysis of the results shows that the present system meets specified thermal requirements, thus verifying the feasibility of the DSSR combustor design for final prototype fabrication.

  3. Patrick Janot receives the CNRS silver medal

    CERN Multimedia

    2005-01-01

    Patrick Janot during the award ceremony. (Photo Schwemling, Paris) On 25 November, Patrick Janot of the CERN Physics Department received the CNRS silver medal for IN2P3 (Institut national de physique nucléaire et de physique des particules). This prize, one of the most prestigious awarded by the French research centre, is given to scientists for the 'originality, quality and importance of their work, as recognised both nationally and internationally'. Patrick Janot joined the ALEPH collaboration, one of the four experiments at LEP, then under construction, in 1987. First a CERN Fellow, he went on to work for the CNRS at LAL in 1989. Together with his team, he developed innovative algorithms for the reconstruction of events. This work and others earned him the bronze CNRS medal in 1993, which is awarded to scientists for their first achievements. In 1997, he became a permanent physicist at CERN, where he continued to work for ALEPH. He was appointed LEP scientific co-ordinator for the last two years of the ac...

  4. CERN Web Pages Receive a Makeover

    CERN Multimedia

    2001-01-01

    Asudden allergic reaction to the colour turquoise? Never fear, from Monday 2 April you'll be able to click in the pink box at the top of the CERN users' welcome page to go to the all-new welcome page, which is simpler and better organized. CERN's new-look intranet is the first step in a complete Web-makeover being applied by the Web Public Education (WPE) group of ETT Division. The transition will be progressive, to allow users to familiarize themselves with the new pages. Until 17 April, CERN users will still get the familiar turquoise welcome page by default, with the new pages operating in parallel. From then on, the default will switch to the new pages, with the old ones being finally switched off on 25 May. Some 400 pages have received the makeover treatment. For more information about the changes to your Web, take a look at: http://www.cern.ch/CERN/NewUserPages/ Happy surfing!

  5. Neufeld Receives 2009 Donald L. Turcotte Award

    Science.gov (United States)

    2010-03-01

    Jerome Neufeld has been awarded the Donald L. Turcotte Award, given annually to recent Ph.D. recipients for outstanding dissertation research that contributes directly to the field of nonlinear geophysics. Neufeld's thesis is entitled “Solidification in the fast lane: Flow-induced morphological instability in geological systems.” He was formally presented with the award at the Nonlinear Geophysics Focus Group reception during the 2009 AGU Fall Meeting, held 14-18 December in San Francisco, Calif. Jerome received his B.A.S. in engineering science from the University of Toronto in 2001, and a Ph.D. in geophysics from Yale University in 2008, under the supervision of J. S. Wettlaufer, on the impact of oceanic currents on the formation of sea ice. He is currently a fellow at the Institute of Theoretical Geophysics, University of Cambridge, working on the fluid dynamics of geophysical systems including carbon dioxide sequestration, the influence of flow on the crystal structure of mushy layers, and the evolution of icicles.

  6. Animal choruses emerge from receiver psychology

    Science.gov (United States)

    Greenfield, Michael D.; Esquer-Garrigos, Yareli; Streiff, Réjane; Party, Virginie

    2016-01-01

    Synchrony and alternation in large animal choruses are often viewed as adaptations by which cooperating males increase their attractiveness to females or evade predators. Alternatively, these seemingly composed productions may simply emerge by default from the receiver psychology of mate choice. This second, emergent property hypothesis has been inferred from findings that females in various acoustic species ignore male calls that follow a neighbor’s by a brief interval, that males often adjust the timing of their call rhythm and reduce the incidence of ineffective, following calls, and from simulations modeling the collective outcome of male adjustments. However, the purported connection between male song timing and female preference has never been tested experimentally, and the emergent property hypothesis has remained speculative. Studying a distinctive katydid species genetically structured as isolated populations, we conducted a comparative phylogenetic analysis of the correlation between male call timing and female preference. We report that across 17 sampled populations male adjustments match the interval over which females prefer leading calls; moreover, this correlation holds after correction for phylogenetic signal. Our study is the first demonstration that male adjustments coevolved with female preferences and thereby confirms the critical link in the emergent property model of chorus evolution. PMID:27670673

  7. CERN safety expert receives international award

    CERN Multimedia

    2005-01-01

    On 18 December 2004, the President of the Swiss Electro-technical Committee, Martin Reichle (left), presented the award to Helmut Schönbacher. Helmut Schönbacher, of the Safety Commission at CERN, has received, the "1906 Award" of the International Electrotechnical Commission (IEC) for his standardisation work on the influence of ionizing radiation on insulating materials. From 1986 until 2004, Schönbacher was leader of a working group on radiation composed of internationally recognised experts. It edited standards of the IEC 60544 series on the determination of the effects of ionizing radiation on electrical insulating materials. The working group also edited three IEC Technical Reports on the determination of long-term radiation ageing in polymers. This standardisation work and long-term experience from CERN on the radiation ageing of materials also contributed to research coordination programmes of the International Atomic Energy Agency (IAEA). From 1968 until 1988, Schönbacher was a member of the Rad...

  8. Children’s spontaneous emotional expressions while receiving (unwanted prizes in the presence of peers

    Directory of Open Access Journals (Sweden)

    Mandy eVisser

    2015-09-01

    Full Text Available Although current emotion theories emphasize the importance of contextual factors for emotional expressive behavior, developmental studies that examine such factors are currently thin on the ground. In this research, we studied the course of emotional expressions of 8- and 11-year-old children after winning a (large first prize or a (substantially smaller consolation prize, while playing a game competing against the computer or a physically co-present peer. We analyzed their emotional reactions by conducting two perception tests in which participants rated children’s level of happiness. Results showed that co-presence positively affected children’s happiness only when receiving the first prize. Moreover, for children who were in the presence of a peer, we found that eye contact affected children’s expressions of happiness, but that the effect was different for different age groups: 8-year-old children were negatively affected, and 11-year-old children positively. Overall, we can conclude that as children grow older and their social awareness increases, the presence of a peer affects their nonverbal expressions, regardless of their appreciation of their prize.

  9. Endowments at Birth and Parents’ Investments in Children*

    OpenAIRE

    Adhvaryu, Achyuta; Nyshadham, Anant

    2014-01-01

    Do parents invest more in higher quality children, or do they compensate for lower quality by giving more to children with lower endowments? We answer this question in the context of a large-scale iodine supplementation programme in Tanzania. We find that children with higher programme exposure were more likely to receive necessary vaccines and were breastfed for longer. Siblings of treated children were also more likely to be immunised. Fertility behavior and investments at the time of birth...

  10. Likeable children, uneasy children

    DEFF Research Database (Denmark)

    Anderson, Sally Dean

    2014-01-01

    Drawing on fieldwork in small-town schools with children of Muslim background whose families came to Denmark as United Nation refugees, the chapter explores how pedagogical ideologies of school-based peer sociability inflect children’s experiences of ‘being Muslim.’ Danish provincial schools......, with their permanent classes, emphasis on class-based sociability, and particular understandings of what constitutes religion, represent a particular context for children’s school experiences. An analysis of two contrasting cases reveals that participation in peer sociability in and beyond school tends to erase...

  11. Hypocupremia in patients receiving total parenteral nutrition.

    Science.gov (United States)

    Bozzetti, F; Inglese, M G; Terno, G; Pupa, A; Sequeira, C; Migliavacca, S

    1983-01-01

    Although hypocupremia is a well-known consequence of long-term total parenteral nutrition (TPN), its incidence as well as the duration of TPN necessary to induce it are still unsettled. The purpose of this study is to review the changes in serum copper level in 25 patients receiving TPN for a period longer than 2 wk (mean duration 6 wk) at the Istituto Nazionale Tumori of Milan and to evaluate the possible relationship of cupremia with the basic disease. Main indications for TPN included enterocutaneous fistulas (11 patients), cancer cachexia (10 patients), radiation enteropathy (two patients), and severe postoperative stricture following esophagogastric resection (two patients). Mean value of serum copper at the beginning of the study was 143 micrograms/100 ml (normal value 65-165 micrograms/100 ml), and the regression analysis showed a mean fall of 5.64 micrograms/100 ml/wk. Hypocupremia occurred in four patients (three with intestinal fistulas and one with radiation obstructive enteritis) at 5th, 6th, 9th, and 6th wk of TPN, respectively. No patient with cancer cachexia developed hypocupremia. No patient with hypocupremia had clinical evidence of a copper deficiency syndrome. We conclude that 1) hypocupremia does not occur within the first month of TPN; 2) its incidence is about 16% in patients intravenously fed for period longer than 2 wk; 3) it is more frequent in patients with enterocutaneous fistulas, whereas it never occurs in patients with cancer cachexia, and 4) it is not necessarily associated to a clinicometabolic syndrome of copper deficiency. Finally, the "nutritional" meaning of serum copper should be questioned in cancer patients since it could represent a "tumor marker."

  12. Turcotte Receives 2003 William Bowie Medal

    Science.gov (United States)

    Cathles, Lawrence M.; Turcotte, Donald L.

    2004-01-01

    ``Few have contributed more to fundamental geophysics, or been better at encouraging others to contribute, than Donald L. Turcotte. Don trained as an engineer, receiving a Ph.D. in Aeronautics and Physics from the California Institute of Technology in 1958. After a year at the Naval Postgraduate School in Monterey, he joined the Cornell Graduate School of Aeronautical Engineering, rising to full professor. He established expertise on seeded combustion, magnetohydrodynamic and electrical phenomena in turbulent boundary layers, and shock waves and authored a book, Space Propulsion, and co-authored a textbook, Statistical Thermodynamics. ``In 1965 he went on sabbatical to Oxford and returned an Earth scientist. The catalyst was Ron Oxburgh. Plate tectonics was just on the horizon, and Don joined his quantitative abilities and physical intuition with Ron's skills and knowledge of geology to produce over the next decade a remarkable series of 24 papers that explored topics such as the many implications of the Earth's thermal boundary layer, ridge melting, subduction zone volcanism, and intraplate tectonics and magmatism, and established the physical bases for many of the processes operating on our planet. Shifting to the Cornell Department of Geological Sciences in 1973, Don explored virtually every aspect of physical Earth geology and became an expert on planetary remote sensing and geophysical interpretation. He published over 150 papers on thermal subsidence in sedimentary basins, two-phase hydrothermal porous media convection, lithosphere flexure, cyclic sedimentation, and stick-slip earthquakes and the lithospheres and mantles of the other planets. He worked and published with outstanding students and colleagues including Ken Torrance, Gerald Schubert, David Spence, Marc Parmentier, Bill Haxby, John Ockendon, Kevin Burke, Jud Ahern, Steve Emerman, and Charlie Angevine. In 1982 he published Geodynamics with Jerry Schubert, a book that became the primary reference in

  13. Salivary oxytocin concentrations in seven boys with autism spectrum disorder received massage from their mothers: a pilot study

    Directory of Open Access Journals (Sweden)

    Shuji eTsuji

    2015-04-01

    Full Text Available Seven male children with autism spectrum disorder (ASD, aged 8 – 12 years, attending special education classrooms for ASD and disabled children, were assigned to receive touch therapy. Their mothers were instructed to provide gentle touch in the massage style of the International Liddle Kidz Association. The mothers gave massages to their child for 20 minutes every day over a period of 3 months followed by no massage for 4 months. To assess the biological effects of such touch therapy, saliva was collected before and 20 minutes after a single session of massage for 20 minutes from the children and mothers every 3 weeks during the massage period and every 4 weeks during the non-massage period, when they visited a community meeting room. Salivary oxytocin levels were measured using an enzyme immunoassay kit. During the period of massage therapy, the children and mothers exhibited higher oxytocin concentrations compared those during the non-massage period. The changes in oxytocin levels before and after a single massage session were not significantly changed in children and mothers. The results suggested that the ASD children (massage receivers and their mothers (massage givers show touch therapy-dependent changes in salivary oxytocin concentrations.

  14. Salivary oxytocin concentrations in seven boys with autism spectrum disorder received massage from their mothers: a pilot study.

    Science.gov (United States)

    Tsuji, Shuji; Yuhi, Teruko; Furuhara, Kazumi; Ohta, Shogo; Shimizu, Yuto; Higashida, Haruhiro

    2015-01-01

    Seven male children with autism spectrum disorder (ASD), aged 8-12 years, attending special education classrooms for ASD and disabled children, were assigned to receive touch therapy. Their mothers were instructed to provide gentle touch in the massage style of the International Liddle Kidz Association. The mothers gave massages to their child for 20 min every day over a period of 3 months, followed by no massage for 4 months. To assess the biological effects of such touch therapy, saliva was collected before and 20 min after a single session of massage for 20 min from the children and mothers every 3 weeks during the massage period and every 4 weeks during the non-massage period, when they visited a community meeting room. Salivary oxytocin levels were measured using an enzyme immunoassay kit. During the period of massage therapy, the children and mothers exhibited higher oxytocin concentrations compared to those during the non-massage period. The changes in oxytocin levels before and after a single massage session were not significantly changed in children and mothers. The results suggested that the ASD children (massage receivers) and their mothers (massage givers) show touch therapy-dependent changes in salivary oxytocin concentrations.

  15. Superior Coherent Receivers for AF Relaying with Distributed Alamouti Code

    KAUST Repository

    Khan, Fahd Ahmed

    2012-01-01

    Coherent receivers are derived for a pilot-symbol aided distributed Alamouti-coded system with imperfect channel state information. The derived coherent receivers do not perform channel estimation but rather use the received pilot signals for decoding. The derived receiver metrics use the statistics of the channel to give improved performance. The performance is further improved by using the decision history. Simulation results show that a performance gain of up to 1.8 dB can be achieved for the new receivers with decision history as compared with the conventional mismatched coherent receiver. © 2011 IEEE.

  16. Perspectives from older adults receiving cancer treatment about the cancer-related information they receive

    Directory of Open Access Journals (Sweden)

    Margaret I Fitch

    2015-01-01

    Full Text Available Objective: Cancer patients have reported that information plays a significant role in their capacity to cope with cancer and manage the consequences of treatment. This study was undertaken to identify the importance older adults receiving cancer treatment assign to selected types of cancer-related information, their satisfaction with the cancer-related information they received, and the barriers to effective information provision for this age group. Methods: This study was conducted in two phases with separate samples. Six hundred and eighty-four older cancer patients receiving treatment completed a standardized survey and 39 completed a semi-structured interview to gather perspectives about cancer-related information. Data were analyzed for 65-79 years and 80+ year groups. Results: Information topics about their medical condition, treatment options, and side effects of treatment were rated as most important by the older cancer patients. Women assigned a higher importance ratings than men to information overall (t = 4.8, P < 0.01. Although participants were generally satisfied with the information, they received many described challenges they experienced in communicating with health care professionals because of the medical language and fast pace of speaking used by the professionals. Conclusions: The older cancer patients in this study endorsed the same topics of cancer-related information as most important as has been reported in studies for other age groups. However, this older group recommended that, during their interactions with older individuals, health care professionals use fewer medical words, speak at a slower pace, and provide written information in addition to the actual conversation.

  17. English Education of Children

    Institute of Scientific and Technical Information of China (English)

    盛雨潇

    2014-01-01

    With the further development of China's reform and opening up, our communication with the world more and more frequently, more and more closely. As the primary tool of international communication, English is particularly important. Now, to strengthen foreign language teaching, especially to learn foreign languages at children, has become a global trend. In China, many schools and teachers for many years to carry out a useful attempt of children's English teaching, and accumulated a lot of successful experience, of course, there are many difficulties and setbacks, and even failure. How to exclude the difficulty and the setback, avoid failure? I combined with my own teaching practice, discusses and studies for many years, has received the good ef-fect.

  18. Hydrocephalus in children.

    Science.gov (United States)

    Kahle, Kristopher T; Kulkarni, Abhaya V; Limbrick, David D; Warf, Benjamin C

    2016-02-20

    Hydrocephalus is a common disorder of cerebral spinal fluid (CSF) physiology resulting in abnormal expansion of the cerebral ventricles. Infants commonly present with progressive macrocephaly whereas children older than 2 years generally present with signs and symptoms of intracranial hypertension. The classic understanding of hydrocephalus as the result of obstruction to bulk flow of CSF is evolving to models that incorporate dysfunctional cerebral pulsations, brain compliance, and newly characterised water-transport mechanisms. Hydrocephalus has many causes. Congenital hydrocephalus, most commonly involving aqueduct stenosis, has been linked to genes that regulate brain growth and development. Hydrocephalus can also be acquired, mostly from pathological processes that affect ventricular outflow, subarachnoid space function, or cerebral venous compliance. Treatment options include shunt and endoscopic approaches, which should be individualised to the child. The long-term outcome for children that have received treatment for hydrocephalus varies. Advances in brain imaging, technology, and understanding of the pathophysiology should ultimately lead to improved treatment of the disorder.

  19. [Traveling with small children].

    Science.gov (United States)

    Olivier, C

    1997-01-01

    Traveling with children especially in the tropics requires special planning. Contraindications are rare but care providers should obtain information about medical and transfusional facilities at the destination. Children should receive all vaccinations required for international travel and for specific countries, taking into account age, location, duration of stay, and purpose of trip. A first aid kit should be packed containing a thermometer, bandages, antiseptic agents, a total sunscreen preparation, a mosquito net, sterile compresses, tablets for water disinfection, and indispensable medications (antimalarial agents, antipyretics, oral rehydration solutions, antiemetics, and eye wash). The main indication for chemoprophylaxis is malaria. Chloroquine is recommended for most locations but proguanil may be necessary in areas of resistance. Special attention must be paid to skin care in infants: maintaining cleanliness, avoiding cuts insofar as possible, and treating any wounds. Clothing must be carefully laundered and adequate to prevent overexposure to sunlight and insect bites. Insect bites must also be prevented by applying repellents, using mosquito nets, and wearing insecticide-treated garments. Handwashing by people who prepare meals and by the children before eating is important to prevent food poisoning. Breast feeding is advisable for infants. Thorough cooking of meats, rinsing of fresh produce, drinking of bottled beverages, and sterilization of water are also important food safety measures. These precautions are usually adequate to allow safe travel with children.

  20. Social anxiety in children

    Directory of Open Access Journals (Sweden)

    Avakyan, Tamara V.

    2014-03-01

    Full Text Available Results of research on social anxiety in orphaned children are presented in this article. The goal of this study was to identify the relationship between depressive states, anxiety states, characteristics of the situation at school, and fear of social evaluation in orphaned children. The differences in these parameters between orphaned children and children living with their families were also studied. The sample consisted of 123 teenagers. The main group comprised 57 orphans from an orphanage near the Moscow region, aged 10 to 16 years old. The control group comprised 66 students from a general school, aged 10 to 15 years old, and all living with their families. Differences were found in the parameters studied. The orphans were characterized by higher levels of social and general anxiety. On the one hand, they strove for the attention and approval of adults, but, on the other hand, they were more worried than their peers who lived with their families about the impression they made on others. They were afraid of receiving a negative evaluation.

  1. Lawnmower injuries in children.

    LENUS (Irish Health Repository)

    Nugent, Nora

    2012-02-03

    OBJECTIVE: Power lawnmowers can pose significant danger of injury to both the operator and the bystander, from direct contact with the rotary blades or missile injury. Our objective was to review our experience with paediatric lawnmower-associated trauma, and the safety recommendations available to operators of power lawnmowers. METHODS: The patient cohort comprised paediatric (<16 years of age) patients treated for lawnmower-associated trauma, by the plastic surgery service, between 1996 and 2003. These patients were identified retrospectively. Age at the time of injury, location and extent of bony and soft tissue injuries sustained, treatment instituted and clinical outcome were recorded. Brochures and instruction manuals of six lawnmower manufacturers were reviewed, and safety recommendations noted. RESULTS: Fifteen patients were identified. The majority of injuries occurred from direct contact with the rotary blades (93%); the remaining child sustained a burn injury. Fourteen children (93%) required operative intervention. Seven patients (46%) sustained injuries resulting in amputation, two of whom had major limb amputations. All children, except the burns patient, underwent wound debridement and received antibiotic therapy. Reconstructive methods ranged from primary closure to free tissue transfer. Many patients required multiple procedures. In all instruction manuals, instructions to keep children and pets indoors or out of the yard when mowing were found. CONCLUSIONS: Lawnmower injuries can be devastating, particularly in children. Many victims have lasting deformities as a result of their injuries. Awareness of and stringent adherence to safety precautions during use of power lawnmowers can prevent many of these accidents.

  2. Medulloblastoma in children: Birmingham experience

    Directory of Open Access Journals (Sweden)

    Anil Sivasankaran

    2006-01-01

    Full Text Available A retrospective review of 41 children diagnosed with medulloblastoma in Birmingham (United Kingdom between 1992-2002 presented. The age of the patients ranged from 2 weeks to 14.1 years (mean 5.89 years and the mean follow-up was 3.8 years. Children less than 3 years of age fared worse than those over 3 years. The 5-year survival with total and subtotal tumor excision was 61.3 and 40% respectively. Those children who received radiotherapy following surgery had an improved survival of 68% at 5 years as compared to 18% in those who did not receive irradiation. With regards to chemotherapy, the 5-year survival rates were 57% in those who received it and 52% in those who did not. The overall survival was 62% at 5 years for those patients who had postoperative combined radiotherapy and chemotherapy and only 48% for the rest, who received no adjuvant therapy. Age of the patient has a definite influence on overall survival. We found significant statistical difference in survival between patients with total tumor resection and those with subtotal resection. The 5-year survival rate was not directly affected by tumor location, hydrocephalus or ventriculo-peritoneal shunting. Postoperative irradiation and chemotherapy are clearly associated with improved survival.

  3. Active Versus Passive: Receiver Model Transforms for Diffusive Molecular Communication

    CERN Document Server

    Noel, Adam; Makrakis, Dimitrios; Hafid, Abdelhakim

    2016-01-01

    This paper presents an analytical comparison of the active and passive receiver models in diffusive molecular communication. In the active model, molecules are absorbed when they collide with the receiver surface. In the passive model, the receiver is a virtual boundary that does not affect molecule behavior. Two approaches are presented to derive transforms between the active and passive receiver signals. As an example, we unify the two models for an unbounded diffusion-only molecular communication system with a spherical receiver. As time increases in the three-dimensional system, the transform functions have constant scaling factors, such that the receiver models are effectively equivalent. Methods are presented to enable the transformation of stochastic simulations, which are used to verify the transforms and demonstrate that transforming the simulation of a passive receiver can be more efficient and more accurate than the direct simulation of an absorbing receiver.

  4. Plasmodium falciparum Polymorphisms associated with ex vivo drug susceptibility and clinical effectiveness of artemisinin-based combination therapies in Benin.

    Science.gov (United States)

    Dahlström, Sabina; Aubouy, Agnès; Maïga-Ascofaré, Oumou; Faucher, Jean-François; Wakpo, Abel; Ezinmègnon, Sèm; Massougbodji, Achille; Houzé, Pascal; Kendjo, Eric; Deloron, Philippe; Le Bras, Jacques; Houzé, Sandrine

    2014-01-01

    Artemisinin-based combination therapies (ACTs) are the main option to treat malaria, and their efficacy and susceptibility must be closely monitored to avoid resistance. We assessed the association of Plasmodium falciparum polymorphisms and ex vivo drug susceptibility with clinical effectiveness. Patients enrolled in an effectiveness trial comparing artemether-lumefantrine (n = 96), fixed-dose artesunate-amodiaquine (n = 96), and sulfadoxine-pyrimethamine (n = 48) for the treatment of uncomplicated malaria 2007 in Benin were assessed. pfcrt, pfmdr1, pfmrp1, pfdhfr, and pfdhps polymorphisms were analyzed pretreatment and in recurrent infections. Drug susceptibility was determined in fresh baseline isolates by Plasmodium lactate dehydrogenase enzyme-linked immunosorbent assay (ELISA). A majority had 50% inhibitory concentration (IC50) estimates (the concentration required for 50% growth inhibition) lower than those of the 3D7 reference clone for desethylamodiaquine, lumefantrine, mefloquine, and quinine and was considered to be susceptible, while dihydroartemisinin and pyrimethamine IC50s were higher. No association was found between susceptibility to the ACT compounds and treatment outcome. Selection was observed for the pfmdr1 N86 allele in artemether-lumefantrine recrudescences (recurring infections) (4/7 [57.1%] versus 36/195 [18.5%]), and of the opposite allele, 86Y, in artesunate-amodiaquine reinfections (new infections) (20/22 [90.9%] versus 137/195 [70.3%]) compared to baseline infections. The importance of pfmdr1 N86 in lumefantrine tolerance was emphasized by its association with elevated lumefantrine IC50s. Genetic linkage between N86 and Y184 was observed, which together with the low frequency of 1246Y may explain regional differences in selection of pfmdr1 loci. Selection of opposite alleles in artemether-lumefantrine and artesunate-amodiaquine recurrent infections supports the strategy of multiple first-line treatment. Surveillance based on clinical, ex

  5. Ingestion of cigarettes and cigarette butts by children--Rhode Island, January 1994-July 1996 .

    Science.gov (United States)

    1997-02-14

    During 1995, the American Association of Poison Control Centers (AAPCC) received 7917 reports of potentially toxic exposures to tobacco products among children aged cigars. Acute nicotine poisoning is characterized by rapid onset of symptoms that may be severe when large amounts have been ingested. During January 1994-July 1996, the Rhode Island Poison Control Center (RIPCC) received 146 reports of ingestion of products containing nicotine by children aged cigarette butts among children aged cigarette butts by children aged < or = 6 years resulted in minor toxic effects and occurred more frequently in households where smoking was permitted in the presence of children and where cigarettes and cigarette wastes were accessible to children.

  6. Noise and intercept point calculation for modern radio receiver planning

    DEFF Research Database (Denmark)

    Iversen, Christian Rye; Kolding, T. E.

    2001-01-01

    The paper presents analytical expressions for determining noise and intercept points for cascaded radio receiver stages. The theory allows for active receiver stages with frequency selectivity and flexible impedance levels. This makes the method highly usable for planning of modem receivers where...

  7. Sideband ratio in double sideband receivers with a Michelson interferometer

    NARCIS (Netherlands)

    Romanini, M.; Baryshev, A. M.; Hesper, R.; Mena, F. P.; Wild, W.

    2007-01-01

    Terahertz heterodyne receivers typically use double sideband (DSB) mixers. The precise knowledge of the receiver sideband ratio (SBR) is a fundamental requirement for the calibration of the data taken with this type of receivers. At the moment the spectroscopic techniques developed for submillimeter

  8. 5 CFR 551.425 - Time spent receiving medical attention.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Time spent receiving medical attention... Relation to Other Activities § 551.425 Time spent receiving medical attention. (a) Time spent waiting for and receiving medical attention for illness or injury shall be considered hours of work if: (1)...

  9. Processing In A GPS Receiver To Reduce Multipath Errors

    Science.gov (United States)

    Meehan, Thomas K.

    1994-01-01

    Four techniques of ancillary real-time digital processing of signals in Global Positioning System, GPS, receiver introduced reducing effects of multipath propagation of signals on position estimates produced by receiver. Multipath range errors halved. Applied in addition to other signal-processing techniques and to other techniques designing as receiving antenna to make it insensitive to reflections of GPS signals from nearby objects.

  10. A Novel Multi-Receiver Signcryption Scheme with Complete Anonymity.

    Science.gov (United States)

    Pang, Liaojun; Yan, Xuxia; Zhao, Huiyang; Hu, Yufei; Li, Huixian

    2016-01-01

    Anonymity, which is more and more important to multi-receiver schemes, has been taken into consideration by many researchers recently. To protect the receiver anonymity, in 2010, the first multi-receiver scheme based on the Lagrange interpolating polynomial was proposed. To ensure the sender's anonymity, the concept of the ring signature was proposed in 2005, but afterwards, this scheme was proven to has some weakness and at the same time, a completely anonymous multi-receiver signcryption scheme is proposed. In this completely anonymous scheme, the sender anonymity is achieved by improving the ring signature, and the receiver anonymity is achieved by also using the Lagrange interpolating polynomial. Unfortunately, the Lagrange interpolation method was proven a failure to protect the anonymity of receivers, because each authorized receiver could judge whether anyone else is authorized or not. Therefore, the completely anonymous multi-receiver signcryption mentioned above can only protect the sender anonymity. In this paper, we propose a new completely anonymous multi-receiver signcryption scheme with a new polynomial technology used to replace the Lagrange interpolating polynomial, which can mix the identity information of receivers to save it as a ciphertext element and prevent the authorized receivers from verifying others. With the receiver anonymity, the proposed scheme also owns the anonymity of the sender at the same time. Meanwhile, the decryption fairness and public verification are also provided.

  11. 49 CFR 236.555 - Repaired or rewound receiver coil.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Repaired or rewound receiver coil. 236.555 Section 236.555 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD... or rewound receiver coil. Receiver coil which has been repaired or rewound shall have the...

  12. 47 CFR 80.290 - Auxiliary receiving antenna.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Auxiliary receiving antenna. 80.290 Section 80... antenna. An auxiliary receiving antenna must be provided when necessary to avoid unauthorized interruption or reduced efficiency of the required watch because the normal receiving antenna is not...

  13. A Bluetooth-enabled HiperLan/2 Receiver

    NARCIS (Netherlands)

    Schiphorst, R.; Hoeksema, F.W.; Slump, C.H.

    2003-01-01

    In our SDR project we aim to combine a GFSK receiver (Bluetooth) with an OFDM receiver (HiperLAN/2). Other WLAN standards use the same frequency bands and modulation techniques. So our Bluetooth-enabled HiperLAN/2 receiver can easily be adapted to other WLAN standards. This paper focuses on the inte

  14. A Bluetooth-enabled HiperLAN/2 receiver

    NARCIS (Netherlands)

    Schiphorst, R.; Hoeksema, F.W.; Slump, C.H.

    2003-01-01

    n our SDR project we aim to combine a GFSK receiver (Bluetooth) with an OFDM receiver (HiperLAN/2). Other WLAN standards use the same frequency bands and modulation techniques. So our Bluetooth-enabled HiperLAN/2 receiver can easily be adapted to other WLAN standards. This paper focuses on the integ

  15. Treatment of membranous nephropathy in children.

    Science.gov (United States)

    Makker, Sudesh P

    2003-07-01

    Membranous nephropathy (MN) is not a common pediatric glomerular disease and not a common cause of idiopathic nephrotic syndrome (NS) in children. Because of the rarity of the disease, there is only a limited amount of uncontrolled data and no controlled data available in children regarding the treatment of MN. Older uncontrolled data indicate that nearly a quarter of children with NS, whether untreated or treated with various immunosuppressive agents, develop chronic renal failure. Current recommendations for treatment both for children presenting with or without NS therefore are based on controlled data obtained in adults with MN. All children should receive angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Children with NS may be treated initially with corticosteroids. If a satisfactory response is not obtained with corticosteroids, then treatment with cyclosporine or chlorambucil can be tried. The protocols of treatment with these drugs are described in this article.

  16. Moments Of Microdiversity EGC Receivers And Macrodiversity SC Receiver Output Signal Over Gamma Shadowed Nakagami-m Multipath Fading Channel

    Science.gov (United States)

    Djordjević, Nebojša; Jaksić, Branimir S.; Matović, Ana; Matović, Marija; Smilić, Marko

    2015-11-01

    A system with macrodiversity selection combining (SC) receiver and for microdiversity equal gain combining (EGC) receivers is considered. Received signal is subjected, simultaneously to multipath fading and shadowing, resulting in signal envelope and signal power variation. Closed form expressions for moments of macrodiversity SC receiver output signal envelope are calculated. Numerical expressions are plotted to present the influences of Gamma shadowing severity and Nakagami-m severity on moments of proposed system output signal.

  17. Hybrid lidar radar receiver for underwater imaging applications

    Science.gov (United States)

    Seetamraju, Madhavi; Gurjar, Rajan; Squillante, Michael; Derderian, Jeffrey P.

    2009-05-01

    In this work, we present research performed to improve the receiver characteristics for underwater imaging applications using the hybrid lidar-radar detection technique. We report the development of the next-generation coherent heterodyne receiver using modulation of the optical receiver's amplifier gain. Significant advantages in the receiver specifications are achieved using a large-area, high gain, low-noise silicon avalanche photodiode (APD) as the photodetector cum frequency mixer-demodulator. We demonstrate that heterodyne detection by gain modulation of APD can be used to increase the signal-to-noise ratio, detection sensitivity and bandwidth for the hybrid receiver system.

  18. Cost-effectiveness of malaria microscopy and rapid diagnostic tests versus presumptive diagnosis

    DEFF Research Database (Denmark)

    Batwala, Vincent; Magnussen, Pascal; Hansen, Kristian S.;

    2011-01-01

    ABSTRACT: BACKGROUND: Current Uganda National Malaria treatment guidelines recommend parasitological confirmation either by microscopy or rapid diagnostic test (RDT) before treatment with artemether-lumefantrine (AL). However, the cost-effectiveness of these strategies has not been assessed...... at rural operational primary care centres. METHODS: Three health centres (HCs) were randomized to three diagnostic arms (microscopy, RDT and presumptive diagnosis) in a district of low and another of high malaria transmission intensities in Uganda. Some 22,052 patients presenting with fever at outpatients...

  19. Solar Central Receiver Hybrid Power Systems sodium-cooled receiver concept. Final report. Volume III. Appendices

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-01-01

    The overall, long term objective of the Solar Central Receiver Hybrid Power System is to identify, characterize, and ultimately demonstrate the viability and cost effectiveness of solar/fossil, steam Rankine cycle, hybrid power systems that: (1) consist of a combined solar central receiver energy source and a nonsolar energy source at a single, common site, (2) may operate in the base, intermediate, and peaking capacity modes, (3) produce the rated output independent of variations in solar insolation, (4) provide a significant savings (50% or more) in fuel consumpton, and (5) produce power at the minimum possible cost in mills/kWh. It is essential that these hybrid concepts be technically feasible and economically competitive with other systems in the near to mid-term time period (1985-1990) on a commercial scale. The program objective for Phase I is to identify and conceptually characterize solar/fossil steam Rankine cycle, commercial-scale, power plant systems that are economically viable and technically feasible. This volume contains appendices to the conceptual design and systems analysis studies gien in Volume II, Books 1 and 2. (WHK)

  20. Brain tumor - children

    Science.gov (United States)

    ... children; Neuroglioma - children; Oligodendroglioma - children; Meningioma - children; Cancer - brain tumor (children) ... The cause of primary brain tumors is unknown. Primary brain tumors may ... (spread to nearby areas) Cancerous (malignant) Brain tumors ...