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Artemether-lumefantrine treatment of uncomplicated Plasmodium falciparum malaria: a systematic review and meta-analysis of day 7 lumefantrine concentrations and therapeutic response using individual patient data
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 concentration threshold needs to be defined better, particularly for important patient and parasite sub-populations.
Methods
The WorldWide Antimalarial Resistance Network (WWARN) conducted a large pooled analysis of individual pharmacokinetic-pharmacodynamic data from patients treated with artemether-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. Risk of bias in individual studies was evaluated based on study design, methodology and missing data.
Results
Of 31 studies identified through a systematic review, 26 studies were shared with WWARN and 21 studies with 2,787 patients were included. Recrudescence was associated with low day 7 lumefantrine concentrations (HR 1.59 (95 % CI 1.36 to 1.85) per halving of day 7 concentrations) and high baseline parasitemia (HR 1.87 (95 % CI 1.22 to 2.87) per 10-fold increase). Adjusted for mg/kg dose, day 7 concentrations were lowest in very young children (<3 years), among whom underweight-for-age children had 23 % (95 % CI −1 to 41 %) lower concentrations than adequately nourished children of the same age and 53 % (95 % CI 37 to 65 %) lower concentrations than adults. Day 7 lumefantrine concentrations were 44 % (95 % CI 38 to 49 %) lower following unsupervised treatment. The highest risk of recrudescence was observed in areas of emerging artemisinin resistance and very low transmission intensity. For all other populations studied, day 7 concentrations ≥200 ng/ml were associated with >98 % cure rates (if parasitemia <135,000/μL).
Conclusions
Current artemether-lumefantrine dosing recommendations achieve day 7 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 with emerging parasite resistance. In these groups, adherence and treatment response should be monitored closely. Higher, more frequent, or prolonged dosage regimens should now be evaluated in very young children, particularly if malnourished, and in patients with hyperparasitemia.
Journal Article
Can Economic Analysis Contribute to Disease Elimination and Eradication? A Systematic Review
by
Evans, David B.
,
Tediosi, Fabrizio
,
Sicuri, Elisa
in
Acquired immune deficiency syndrome
,
AIDS
,
Analysis
2015
Infectious diseases elimination and eradication have become important areas of focus for global health and countries. Due to the substantial up-front investments required to eliminate and eradicate, and the overall shortage of resources for health, economic analysis can inform decision making on whether elimination/eradication makes economic sense and on the costs and benefits of alternative strategies. In order to draw lessons for current and future initiatives, we review the economic literature that has addressed questions related to the elimination and eradication of infectious diseases focusing on: why, how and for whom?
A systematic review was performed by searching economic literature (cost-benefit, cost-effectiveness and economic impact analyses) on elimination/eradication of infectious diseases published from 1980 to 2013 from three large bibliographic databases: one general (SCOPUS), one bio-medical (MEDLINE/PUBMED) and one economic (IDEAS/REPEC).
A total of 690 non-duplicate papers were identified from which only 43 met the inclusion criteria. In addition, only one paper focusing on equity issues, the \"for whom?\" question, was found. The literature relating to \"why?\" is the largest, much of it focusing on how much it would cost. A more limited literature estimates the benefits in terms of impact on economic growth with mixed results. The question of how to eradicate or eliminate was informed by an economic literature highlighting that there will be opportunities for individuals and countries to free-ride and that forms of incentives and/or disincentives will be needed. This requires government involvement at country level and global coordination. While there is little doubt that eliminating infectious diseases will eventually improve equity, it will only happen if active steps to promote equity are followed on the path to elimination and eradication.
The largest part of the literature has focused on costs and economic benefits of elimination/eradication. To a lesser extent, challenges associated with achieving elimination/eradication and ensuring equity have also been explored. Although elimination and eradication are, for some diseases, good investments compared with control, countries' incentives to eliminate do not always align with the global good and the most efficient elimination strategies may not prioritize the poorest populations. For any infectious disease, policy-makers will need to consider realigning contrasting incentives between the individual countries and the global community and to assure that the process towards elimination/eradication considers equity.
Journal Article
Hispano-Americans in Europe: what do we know about their health status and determinants? A scoping review
by
Leyva-Moral, Juan M
,
Domingo, Andreu
,
Pool, Robert
in
Analysis
,
Attitude to Health - ethnology
,
Biostatistics
2015
Background
Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry.
Methods
We identified systematically papers that addressed the concepts “health” and “Hispano Americans” indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process.
Results
Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered “Hispano-Americans” as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed.
Conclusions
Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe.
Journal Article
Teaching Web search skills : techniques and strategies of top trainers
2006,2008
Here is a unique and practical reference for anyone who teaches Web searching. Greg Notess shares his own techniques and strategies along with expert tips and advice from a virtual \"who's who\" of Web search training: Joe Barker, Paul Barron, Phil Bradley, John Ferguson, Alice Fulbright, Ran Hock, Jeff Humphrey, Diane Kovacs, Gary Price, Danny Sullivan, Rita Vine, and Sheila Webber. Teaching Web Search Skills covers all these topics and more: (1) Understanding your audience; (2) Instructional session goals; (3) Online tutorials; (4) Web search terminology; (5) Organizing the training session; (6) Creating workshop Web pages; (7) Presentation tips, tricks, and shortcuts; and (8) Anecdotes, examples, and exercises. This comprehensive and readable guide presents a variety of approaches to instructional design and methodology, lists a range of essential training resources, and features dozens of helpful figures, search screens, worksheets, handouts, and sample training materials.
The Quintessential Searcher: The Wit & Wisdom of Barbara Quint
2001
This book presents selected writings by Barbara Quint (BQ) on online searching. The selections are organized into the following chapters: (1) \"The Art of Searching,\" including finding out what the patron wants, preparing for the search, knowing when the search is done, search styles, rules of online searching, cost issues, Quint's Laws, and medical searching; (2) \"On Librarians,\" including what a librarian is, why people become librarians, librarians' salaries, lack of respect for the profession, professional ethics, why techies are no substitute for librarians when you want information, why searchers must educate database vendors, Quint's rules for negotiating with vendors, threats to the future of librarians, time to set new proprieties, and the future of libraries; (3) \"The Internet\"; (4) \"Database Vendors,\" including bad database design, bad customer relations, listening trousers, bad marketing, and advice to vendors; (5) \"Scholarly Publishing,\" including copyright and fair use, and user-hostile publishers; (6) \"Random Musings,\" including censorship, democracy and citizens, danger to the information infrastructure, editing, trade publications, technology, Y2K, taking risks, truth, management, learning and memory, improving with age, books, movies, and California; (7) \"Words To Live by\"; (8) \"BQ on BQ,\" including the early days, the love-hate relationship with computers, personal foibles, professional accomplishments, and philosophy of life. An interview with Quint and comments by her fans are also included. (Contains an index.) (MES)
Multitarget multiprotocol client application for search and retrieval of bibliographic records
by
Boberi Krsti ev, Danijela
,
Surla, Dušan
,
Zari, Miroslav
in
Application
,
Archives & records
,
Attributes
2012
Purpose - The aim of the research is modelling and implementation of a client application that enables parallel search and retrieval of bibliographic records from multiple servers. The client application supports simultaneous communication over Z39.50 and SRW SRU protocols. The application design is flexible and later addition of other communication protocols for search retrieval is envisioned and supported.Design methodology approach - Object-oriented approach has been used for modelling and implementation of client application. CASE tool, Sybase PowerDesigner, supporting Unified Modelling Language (UML 2.0), was used for modelling. Java programming language and Eclipse environment were used for implementation.Findings - The result of the research is a client application that enables parallel search and retrieval of multiple Z39.50 and SRW SRU servers. Additionally, the application supports conversion from type-1 query language, defined by Z39.50 standard, to CQL query language required for search retrieval from SRW SRU servers. The application was verified by performing parallel search and retrieval from several publicly accessible Z39.50 and SRW SRU servers.Research limitations implications - The application supports only the use of bib-1 attribute set for type-1 queries created according to Z39.50 standard. Hence, only such queries can be converted to CQL notation. The use of other attribute sets is not supported.Practical implications - The client application is integrated into the BISIS software system, version 4. This enables the cataloguing of bibliographic records retrieved over Z39.50 and SRW SRU protocol.Originality value - The contribution of this work is in client application architecture that enables parallel communication with multiple servers, which can use different communication protocols, Z39.50 or SRW SRU. Search retrieval from servers using some other protocol is also supported. This can be achieved by adding new classes that implement protocol specification, and classes for query transformation into notation required by that new protocol, if required.
Journal Article
Designing effective library tutorials : a guide for accommodating multiple learning styles
by
Mestre, Lori
in
Cognitive learning
,
Effect of technological innovations on
,
Information literacy
2012
Learning styles are highly relevant for students in the online environment.Designing Effective Library Tutorials provides examples of, and steps for, how to create tutorials that match learning styles, based on usability studies of students from various cultural groups and styles of learning.
Information retrieval
by
Ridley, D. D
in
Database management
,
Information retrieval
,
Information storage and retrieval systems
2009
SciFinder® is rapidly becoming a preferred means to access scientific information in industry and universities worldwide. It accesses databases which span the chemical, engineering, life, medical, and physical sciences, including five Chemical Abstract Service databases and the National Library of Medicine bibliographic database Medline®. No other single information access tool has such breadth of coverage for scientific journal and patent documents. Information Retrieval: SciFinder®, 2nd Edition is an essential guide explaining how to get the best out of SciFinder. It discusses the 50+ options in SciFinder® including topic, bibliographic, and chemical substance explore options, and post-processing options Analyze, Refine, and Categorize. The book: Summarises the databases and explains how to take advantage of the unique search and analysis options Explains selected algorithms behind the operation of SciFinder® and why it helps to understand them Discusses why it is important, and how to apply scientific method to information retrieval Describes how to search for chemical structures and chemical reactions This second edition of Information Retrieval: SciFinder® has been fully revised and updated to incorporate the latest functionality and content of SciFinder®. Written by a scientist for scientists, this book will increase your research creativity and productivity and is an essential resource for anyone needing scientific information in academia or industry.