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Real-world work environments require operators to perform multiple tasks with continual support from an automated system. Eye movement is often used as a surrogate measure of operator attention, yet conventional summary measures such as percent dwell time do not capture dynamic transitions of attention in complex visual workspace. This study analyzed eye movement data collected in a controlled a MATB-II task environment using gaze transition entropy analysis. In the study, human subjects performed a compensatory tracking task, a system monitoring task, and a communication task concurrently. The results indicate that both gaze transition entropy and stationary gaze entropy, measures of randomness in eye movements, decrease when the compensatory tracking task required more continuous monitoring. The findings imply that gaze transition entropy reflects attention allocation of operators performing dynamic operational tasks consistently., (© 2024. The Author(s).)

Purpose: The aim of this study was to investigate the utility of native T1 and T2 mapping in the bowel to evaluate disease activity in Crohn disease (CD) using endoscopy as the reference standard., Methods: This was a prospective study. Magnetic resonance imaging was performed by using a 1.5-T Philips scanner. We used a modified look-locker inversion recovery and a multiecho gradient-spin-echo sequences for single breath-hold native T1 and T2 maps, respectively, for the short-axis image of the intestine, and the measurement at the most severe site was compared with partial Simple Endoscopic Score for Crohn's Disease (pSES-CD, assessed by an expert endoscopist). A pSES-CD ≥ 4 indicated active disease. Statistical analyses were performed using the Student t test, Spearman correlation, and receiver operating characteristic curve analysis., Results: A total of 27 patients (mean age ± standard deviation, 37 ± 18 years; 20 men, 7 women) were included in this study. The native T1 value of active disease was significantly higher than that of inactive disease (1170.8 ± 100.5 milliseconds vs 924.5 ± 95.3 milliseconds; P = 0.018), but the T2 value was not significantly different between active and inactive disease (76.1 ± 7.8 milliseconds vs 69.3 ± 10.9 milliseconds; P = 0.424). A good correlation was found between native T1 value and pSES-CD (ρ = 0.71; P < 0.001) but not between T2 value and pSES-CD (ρ = 0.06; P = 0.790). The area under the receiver operating characteristic curve for differentiating the disease activity was 0.96 (95% confidence interval [CI]: 0.90-1.00) for T1 values and 0.68 (95% confidence interval: 0.41-0.96) for T2 values., Conclusions: Native T1 mapping could be potentially used as a noninvasive method to differentiate disease activity in patients with CD and may be superior to T2 mapping for this purpose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

In visceral and mucocutaneous leishmaniasis, humoral immune response can reflect disease severity and parasite burden. Cutaneous leishmaniasis (CL) in Sri Lanka is caused by a usually visceralizing parasite, Leishmania donovani. We assessed the parasite burden (relative quantity-RQ) in 190 CL patients using quantitative real-time PCR (qPCR-with primers designed for this study) and smear microscopy, then correlated it with clinical parameters and IgG response. RQ of parasite DNA was determined with human-specific glyceraldehyde 3-phosphate dehydrogenase (GAPDH) as the internal control. The qPCR sensitivity was tested with serially diluted DNA from cultured L. donovani parasites. Smears were assigned a score based on number of parasites per high power field. Data from previous studies were used for comparison and correlation; nested Internal Transcribed Spacer 1 (ITS1) PCR as reference standard (RS) and IgG antibody titers to the Leishmania rKRp42 antigen as the immune response. The qPCR amplified and quantified 86.8% of the samples while demonstrating a fair and significant agreement with ITS1-PCR and microscopy. Parasite burden by qPCR and microscopy were highly correlated (r = 0.76; p = 0.01) but showed no correlation with the IgG response (r = 0.056; p = 0.48). Corresponding mean RQs of IgG titers grouped by percentiles, showed no significant difference (p = 0.93). Mean RQ was higher in early lesions (p = 0.04), decreased with lesion size (p = 0.12) and slightly higher among papules, nodules and wet ulcers (p = 0.72). Our study established qPCR's efficacy in quantifying parasite burden in Sri Lankan CL lesions but no significant correlation was observed between the parasite burden and host IgG response to the Leishmania rKRP42 antigen., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Unpredictable pedestrian and cyclist behavior associated with their appearance on the road in blind spots contributes to traffic near-misses or crashes. When experienced drivers are confronted with uncertainty, they take defensive measures called hazard-anticipatory driving, such as decreasing the vehicle velocity and/or increasing the lateral distance. Our research sought to understand the motivational determinants and perceptual processes that determine driver behavior in preparation for traffic conflicts with covert hazards. This study aimed to investigate the influence of driving experience on drivers' perceptions and behaviors to prepare for traffic conflicts. Two experiments were designed with 8 experienced and 13 inexperienced participants. In Experiment 1, participants were asked to provide their subjective impressions of task difficulty, feeling of risk, and statistical risk pertaining to assess their perceptions of the separation between task demand and capability after viewing animation clips of road scenes with blind intersections under different forced speeds. In Experiment 2, participants drove using a driving simulator in scenes with blind intersections, similar to those in Experiment 1. We sought to explore the motivational determinants of behavior regarding the relationship between subjective feelings and objective safety margins. The results showed that the driver's perception of task difficulty correlated with their driving speed, and inexperienced participants tended to underestimate task difficulty compared to experienced participants. The task difficulty and the feeling of risk were strongly correlated regardless of experience, and estimation of statistical risk differed depending on experience. The subjective task difficulty (and/or risk feeling) and objective safety margin were strongly correlated for experienced participants. Experienced participants who perceived a higher degree of difficulty in the forced-paced driving task tended to have greater safety margins in the self-paced driving task. These findings suggest that experienced participants with individually tolerable safety margins adjust their driving velocity and/or lateral distance in the control of task difficulty (and/or risk feeling) to prepare for traffic conflicts. Therefore, the underestimation of task difficulty should be considered when designing effective measures, such as driver assistance systems, to guide inexperienced drivers toward normative behaviors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Avoiding sexual-conflict-induced sexual coercion is crucial for females, especially in anurans, where the necessity of sexual coercion counterstrategies is increased because of their strong male-male competition and external fertilisation. In this study, we tested the hypothesis that the recently discovered female Pelophylax nigromaculatus calls prevent male courtship and prevented sexual coercion. By observing the reproductive behaviour of anurans, this study examined when females emitted calls and how males responded to them, while comparing the reproductive conditions of call-emitting and non-call-emitting females. The results of this study revealed that females without eggs which were assumed to finish spawning emitted calls in response to male approaches, and the males subsequently moved away from the females obediently. This suggests that female P. nigromaculatus calls work as a counterstrategy against male sexual coercion. This countermeasure communication was first identified in anurans, suggesting that they engage in more complex bidirectional vocal communication during the breeding season than previously assumed., Competing Interests: Declaration of Competing Interest We do not have any conflicts of interest to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Before Automated Driving Systems (ADS) with full driving automation (SAE Level 5) are placed into practical use, the issue of calibrating drivers' initial trust in Level 5 ADS to an appropriate degree to avoid inappropriate disuse or improper use should be resolved. This study aimed to identify the factors that affected drivers' initial trust in Level 5 ADS. We conducted two online surveys. Of these, one explored the effects of automobile brands and drivers' trust in automobile brands on drivers' initial trust in Level 5 ADS using a Structural Equation Model (SEM). The other identified drivers' cognitive structures regarding automobile brands using the Free Word Association Test (FWAT) and summarized the characteristics that resulted in higher initial trust among drivers in Level 5 ADS. The results showed that drivers' trust in automobile brands positively impacted their initial trust in Level 5 ADS, which showed invariance across gender and age. In addition, the degree of drivers' initial trust in Level 5 ADS was significantly different across different automobile brands. Furthermore, for automobile brands with higher trust in automobile brands and Level 5 ADS, drivers' cognitive structures were richer and varied, which included particular characteristics. These findings suggest the necessity of considering the influence of automobile brands on calibrating drivers' initial trust in driving automation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cui et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study analyzes the impact of cooperative human-machine interface designs on drivers' trust in and interaction with automated driving systems (ADSs) during lane changes on highways. While drivers' inappropriate trust in ADSs can affect their behavior toward the system, capability to detect inadequate system performance, and perception of surrounding traffic disturbances, their engagement in the automated process can improve their comprehension of the system and traffic conditions, which is necessary for the safe practice of automated driving. Forty drivers practiced conditional driving automation in a driving simulator and encountered traffic congestion on the main lane of a two-lane highway. Four ADS designs were proposed to bypass the congestion. ADS-1 detects the congestion and synchronizes the speed accordingly. ADS-2 requests the driver to resume manual control and overtake the congestion. ADS-3 requests the driver to push a button to let the system overtakes the congestion automatically. ADS-4 overtakes the congestion automatically after informing the driver, while the driver can cancel it by pushing a button within 6 s. In all these conditions, driver intervention was optional. Although the drivers preferred and trusted ADS-1 and ADS-2 more than ADS-3 and ADS-4, the results indicate significant improvements in the driving performance and system usage under ADS-3 and ADS-4. Driving with ADS-3 improved drivers' engagement and reduced the requirement for control transfer compared with other systems. However, the time headway between the subject and adjacent vehicles indicated that lane changes were more critical under ADS-3 and ADS-4 than ADS-1 and ADS-2. Such deficiency of alignment between driver perception and safe behaviors has implications for the design of future studies and systems that need to balance satisfaction and safety. These observations are likely to improve driver interaction with automated vehicles., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The recent surge in cutaneous leishmaniasis (CL) in Sri Lanka has rendered clinical diagnosis difficult; thus, laboratory confirmation is indispensable. A modified (two novel inner primers to detect CL caused by Leishmania donovani) nested Internal Transcribed Spacer-1 (ITS1) PCR-Restriction Fragment Length Polymorphism (RFLP) method was developed and tested. The sensitivity of the modified nested PCR was tested using serial dilutions (103 to 10−2) of the DNA extract of a cultured L. donovani DD8 strain. Patients (n = 194) from Southern Sri Lanka were examined clinically, microscopically (Slit Skin Smear-SSS) and using the modified nested PCR. The modified nested PCR detected 2.55 fg of parasite DNA compared to ITS1 PCR (25 fg) and detected more cases than SSS (94.3% vs. 77.3%; p < 0.01). The RFLP pattern was L. donovani in all cases. The modified nested PCR performed well in clinically doubtful lesions (95% by PCR vs. 60% by SSS; p < 0.01), ulcerated nodules (91% vs. 71.8%; p < 0.01) and plaques (100% vs. 66.7%; p < 0.01). SSS demonstrated sensitivity (80.9%), specificity (81.8%), PPV (98.7%) and NPV (20.5%) against modified PCR. Low parasite loads and atypical lesions can be diagnosed by the proposed method with higher accuracy.

Purpose: To compare image quality and the detectability of gallstones in patients with T 1 hyperintense bile between single breath-hold three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) with gradient and spin-echo (GRASE) and with compressed sensing (CS)., Methods: We retrospectively evaluated patients who underwent MRCP using GRASE and CS and had hyperintense bile on T 1 -weighted fat-suppressed images. The relative duct-to-periductal contrast ratios (RCs) of each bile duct segment were calculated. Pancreaticobiliary duct visibility, motion artifacts, background suppression, and overall image quality were scored on a 5-point scale. The Wilcoxon signed-rank test was used to analyze differences in qualitative and quantitative results. Diagnostic performance in detecting common bile duct (CBD) and gallbladder stones was assessed using receiver operating characteristic (ROC) curves., Results: In total, 96 patients were included in the study. RCs of all bile duct segments in GRASE MRCP were significantly lower than those in CS MRCP (p < 0.001). All biliary duct visibility and overall image quality had significantly higher scores in GRASE MRCP than in CS MRCP (p < 0.001-0.003). Area under ROC curves of GRASE MRCP and CS MRCP were 1.00 and 0.88 for CBD stone (p = 0.14) and 0.93 and 0.82 for gallbladder stone (p = 0.08), respectively., Conclusions: GRASE MRCP provides better image quality than CS MRCP in patients with hyperintense bile on T 1 -weighted images. The detectability of biliary stones was also higher in GRASE MRCP than in CS MRCP, although not significantly., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Using the equations which describe the oxide thickness as a function of the oxidation time and temperature in the thermal oxidation of Si, various experimental results on the oxidation and corrosion of metals and alloys available in the literature are analyzed. By the analyses, it is found that the weight loss of copper by atmospheric corrosion and the weight gains of austenitic stainless steel and Ni-Cr alloy by high temperature oxidation follow a time-dependent power law in which both diffusion and reaction are involved. It is also found that the pitting corrosion of aluminum alloys by the immersion with seawater and the high-temperature oxidation of Al(431) follow a time-dependent power law of a reaction-limited kind. In addition, an estimation is given of the activation energy for the pitting corrosion of mild steel by the immersion with seawater., (© 2022. The Author(s).)

Clinical diagnosis has become a challenge amidst a surge of cutaneous leishmaniasis in Southern Sri Lanka. The routine diagnostic method, slit-skin smear (SSS), has variable sensitivity, leading to undiagnosed cases. Improved diagnostics are urgently needed. We assessed a new in-house ELISA method for its diagnostic capabilities against ITS-1 nested PCR (gold standard—Gs). A cohort of 190 clinical CL cases was examined by SSS microscopy, anti-rKRP42 IgG ELISA (serum- and urine-based), and rK39-Immunochromatographic strip test. Validation was done using non-endemic sera, and cutoffs were developed using the receiver operating curve. The sensitivity of SSS for case detection was 77.9% (authors) and 76.3% (technicians). ELISA vs. Gs demonstrated sensitivity (Sn) = 94.4%; specificity (Sp) = 50.0%; positive predictive value (PPV) = 97.1%; negative predictive value (NPV) = 33.3%; Kappa agreement (Kp) = 0.39/p < 0.01. Comparison of the combination method (SSS by technicians and ELISA) vs. Gs showed: Sn = 98.9%; Sp = 30.0; PPV = 96.2; NPV 60.0%; Kp = 0.378/p < 0.01. All methods performed better compared to SSS (29.4%) where the clinical diagnosis was doubtful (PCR = 94.15%; serum ELISA = 88.2%; combination = 94.1%; p < 0.01 for all). High serum anti-rKRP42 titers were seen in those with multiple lesions. Anti-rKRP42 urine ELISA was suboptimal as a diagnostic test. A 9% rate of positivity was seen for rk39-ICT, and positives recorded high anti-rKRP42 titers. The diagnostic accuracy can be increased above the level of the Gs by combining SSS and ELISA. Advanced studies are required to understand the association between rk39-ICT positivity and high anti-rKRP42 titers.

Trust is a critical factor that drives successful human-automation interaction in a myriad of modern professional environments. One seminal work on human-automation trust is Muir and Moray (1996) showing that human-machine trust evolves from faith, then dependability, and finally predictability in a simulated supervisory control task. However, our recent work failed to replicate the finding of the original study, calling for further replication efforts. Experiment 1 aimed to fully replicate Muir and Moray (1996) where participants performed a simulated pasteurizer task. Experiment 2 attempted to replicate Experiment 1 using participants who major in Engineering as used in the original study. Both experiments showed that dependability was the best initial predictor of trust, building later to predictability and faith. Two experiments consistently failed to support both the hypothesis proposed by Muir and Moray (1996), that trust develops from predictability to dependability to faith, and their original findings that trust develops initially from faith. The results of the current experiments challenge this widely cited view of how human-machine trust develops. Modern automation designers should be aware that dependability might control initial trust development for general users and incorporate dependability information into their designs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Taking human factors approach in which the human is involved as a part of the system design and evaluation process, this paper aims to improve driving performance and safety impact of driver support systems in the long view of human-automation interaction., Background: Adaptive automation in which the system implements the level of automation based on the situation, user capacity, and risk has proven effective in dynamic environments with wide variations of human workload over time. However, research has indicated that drivers may not efficiently deal with dynamically changing system configurations. Little effort has been made to support drivers' understanding of and behavioral adaptation to adaptive automation., Method: Using a within-subjects design, 42 participants completed a four-stage driving simulation experiment during which they had to gradually interact with an adaptive collision avoidance system while exposed to hazardous lane-change scenarios over 1 month., Results: Compared to unsupported driving (stage i), although collisions have been significantly reduced when first experienced driving with the system (stage ii), improvements in drivers' trust in and understanding of the system and driving behavior have been achieved with more driver-system interaction and driver training during stages iii and iv., Conclusion: While designing systems that take into account human skills and abilities can go some way to improving their effectiveness, this alone is not sufficient. To maximize safety and system usability, it is also essential to ensure appropriate users' understanding and acceptance of the system., Application: These findings have important implications for the development of active safety systems and automated driving.

This study conducted a driving simulation experiment to compare four automated driving systems (ADS) designs during lane change demanding traffic situations on highways while accounting for the drivers' gender, age, experience, and practice. A lane-change maneuver was required when the automated vehicle approaches traffic congestion on the left-hand lane. ADS-1 can only reduce the speed to synchronize with the congestion. ADS-2 reduces the speed and issues an optional request to intervene, advising the driver to change lanes manually. ADS-3 offers to overtake the congestion autonomously if the driver approves it. ADS-4 overtakes the congestion autonomously without the driver's approval. Results of drivers' reaction, acceptance, and trust indicated that differences between ADS designs increase when considering the combined effect of drivers' demographic factors more than the individual effect of each factor. However, the more ADS seems to have driver-like capacities, the more impact of demographic factors is expected. While preliminary, these findings may help us understand how ADS users' behavior can differ based on the interaction between human demographic factors and system design., (© 2021. The Author(s).)

This study aimed to replicate Muir and Moray that demonstrated operators' trust in automated machines developing from faith, then dependability, and lastly predictability. Following the procedure of Muir and Moray, we asked undergraduate participants to complete a training program in a simulated pasteuriser plant and an experimental program including various errors in the pasteuriser. Results showed that the best predictor of overall trust was not faith but dependability, and that dependability consistently governed trust throughout the interaction with the pasteuriser. Thus, the obtained data patterns were inconsistent with those reported in Muir and Moray. We observed that operators in the current study used automatic control more frequently than manual control to successfully produce performance scores contrary to the operators in Muir and Moray. The results imply that dependability is a critical predictor of human-machine trust, which automation designer may focus on. More extensive future research using more modern automated technologies is necessary for understanding what factors control human-autonomy trust in modern ages. Practitioner Summary: The results suggest that dependability is a key factor that shapes human-machine trust across the time course of the trust development. This replication study suggests a new perspective for designing effective human-machine systems for untrained users who do not go through extensive training programs on automated systems.

For epidemiological studies of infectious diseases, pathogen-specific antibody levels in an area give us essential and appropriate information. The antibodies against pathogens are usually detected in blood, the drawing of which inconveniences people. Collection of blood increases the risk of accidental infections through blood, and it is difficult to obtain the participation of the target populations, especially the younger generation. On the other hand, urine samples, which contain a high enough level of antibodies for ELISA, can be harmlessly and easily collected and therefore have been used for epidemiological studies for diseases. The antibody examination of urine has been used for the epidemiology of parasitic diseases with a high sensitivity and specificity of serum samples. In this paper, we reviewed antibody assays with urine for seven parasitic diseases that urine diagnostic methods have reported in the past, and these are important infections included in NTDs, caused, for example, by Leishmania donovani , Wuchereria bancrofti , Schistosoma japonicum , Paragonimus westermani , Echinococcus granulosus , Echinococcus multilocularis , Strongyloides stercoralis , and Opisthorchis viverrini . The easy and safe urine surveillance system might be an admirable tool for future epidemiological studies for infectious diseases.

Objective and Background: Trust is a critical factor that influences the success or failure of human-automation interaction in a variety of professional domains such as transportation, military, and healthcare. The unprecedented COVID-19 crisis will likely accelerate the implementation of automation and create unique problems involving human-automation trust for naïve users of automated technologies in the future., Method: We briefly review factors that can influence the development of human-automation trust amidst and following the COVID-19 pandemic. We focus on two theories on human-automation trust and how naïve users develop and maintain their trust in unfamiliar technologies., Results: The current review identifies user workload and perceived risk as critical factors that will impact human-automation trust during the COVID-19 pandemic. Both theories predict that it is important for naïve users to accumulate and analyze behavioral evidence of automated technologies to maintain appropriate trust levels as the pandemic progresses., Conclusion and Application: Theories of human-automation trust inform trajectories of trust development toward unfamiliar technologies for naïve users. In application, manufacturers and distributers should focus on communicating system information effectively to retain users who may be "forced" to use unfamiliar technologies during the COVID-19 pandemic.

Purpose: To examine whether MRCP using a combination of compressed sensing and sensitivity encoding with navigator-triggered and breath-hold techniques (NT C-SENSE and BH C-SENSE, respectively) have comparable image quality to that of navigator-triggered MRCP using only sensitivity encoding (NT SENSE) at 1.5-T., Methods: Fifty-one participants were enrolled in this prospective study between July and October 2018 and underwent the three 3D MRCP sequences each. The acquisition time and relative duct-to-periductal contrast ratios (RC values) of each bile duct segment were obtained. Visualization of the bile and main pancreatic ducts, background suppression, artifacts, and overall image quality were scored on 5-point scales. Mean and median differences in RC values and qualitative scores of NT C-SENSE and BH C-SENSE relative to NT SENSE were calculated with 95% confidence intervals (CIs)., Results: Acquisition time of NT SENSE, NT C-SENSE, and BH C-SENSE were 348, 143 (mean for both), and 18 s (for all participants), respectively. The RC value of each bile duct segment was inferior, but the lower limits of the 95% CIs of the mean differences were ≥ - 0.10, for both NT C-SENSE and BH C-SENSE. The visualization score of the intrahepatic duct in BH C-SENSE was inferior to that in NT SENSE (lower 95% CI limit, - 1.5). In both NT C-SENSE and BH C-SENSE, the 95% CIs of the median differences in the other qualitative scores were from - 1.0 to 0.0., Conclusion: NT C-SENSE and BH C-SENSE have comparable image quality to NT SENSE at 1.5-T.

Compensatory behaviour is regarded as a helpful strategy to mediate drivers' deteriorated hazard perception ability due to visual field defects. However, helpfulness of compensatory behaviour for drivers with advanced visual field defects has largely unexplored. This study aims to clarify the effectiveness and limitation of compensatory head movements in critical situations where included pedestrians stepping off a sidewalk under the simulation of advanced visual defects. 18 healthy-sighted drivers participated the data collection that was conducted in a driving simulator under three driving conditions: (1) without visual impairment, (2) with visual impairment and not performing active compensation, and (3) with visual impairment but performing active compensation. The result showed that active compensation led quick accelerator and brake response times, reducing the risk and number of pedestrian collisions. The active compensation led a decrease in the number of non-responses to hazardous pedestrians compared to while driving not performing compensation. However, the compensation could not reduce the number of pedestrian collisions to those of healthy-sighted drivers. Compensatory viewing behaviour contributed to improved driving performance as well as has limits to lead driving performance like healthy-sighted drivers. Developing driver assistance systems and practical compensatory strategies concerning the degrees of impairment and traffic conditions may provide opportunities to improve driving safety deteriorated hazard perception for visually impaired drivers., Competing Interests: The authors have declared that no competing interests exist.

Background: Surveillance of hidden foci or resurgence of the bancroftian filariasis has high priority to maintain the elimination status in Sri Lanka. For the surveillance, two methods were applied in Matotagama, Matara, Sri Lanka; (i) molecular xenomonitoring (MX) by PCR to detect parasite DNA in the vector, Culex ( Cx ) quinquefasciatus and (ii) survey of anti-filarial IgG4 in urine samples from schoolchildren., Results: Mosquitoes were collected monthly from index houses for 17 months (2013 to 2014) to confirm the existence of bancroftian parasite. Index houses in Matotagama had recorded microfilaria-positive cases in the recent past. Five schools were selected considering Matotagama as the catchment area and all students who presented on the day were tested for urine anti-filarial IgG4 in 2015. Wuchereria bancrofti DNA in Cx . quinquefasciatus pools were found in 14 of 17 months studied and ranged between 0 and 1.4%. The MX rate was greatly increased at least two times in the year following the driest months (March, August). A total of 735 schoolchildren were tested for urine anti-filarial IgG4. Three schools located closer to the MX area had higher positive rates, 3.4%, 3.6%, and 6.6%. Both highest positive rates of MX and urine were located in a nearer vicinity., Conclusion: Monthly collections to study lymphatic filariasis (LF) transmission by MX was conducted for the first time in Sri Lanka. We observed that the filarial DNA-positive rate had an association with seasonal cycle of precipitation. More than 1% filarial DNA and > 5% anti-filarial antibody rates confirmed ongoing transmission in Matotagama. The combination of two non-invasive surveys, the urine anti-filarial IgG4 levels of schoolchildren and MX of vector mosquitoes, would be a convenient package to monitor the ongoing transmission (hotspots) of LF in the surveillance., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

IgE plays a key role in allergies by binding to allergens and then sensitizing mast cells through the Fc receptor, resulting in the secretion of proinflammatory mediators. Therefore, IgE is a major target for managing allergies. Previous studies have reported that oligomannose on IgE can be a potential target to inhibit allergic responses. However, enzymes that can modulate IgE activity are not yet known. Here, we found that the commercial receptor-destroying enzyme (RDE) (II) from Vibrio cholerae culture fluid specifically modulates IgE, but not IgG, and prevents the initiation of anaphylaxis. RDE (II)-treated IgE cannot access its binding site on bone marrow-derived mast cells, resulting in reduced release of histamine and cytokines. We also noted that RDE (II)-treated IgE could not induce passive cutaneous anaphylaxis in mouse ears. Taken together, we concluded that RDE (II) modulates the IgE structure and renders it unable to mediate allergic responses. To reveal the mechanism by which RDE (II) interferes with IgE activity, we performed lectin microarray analysis to unravel the relationship between IgE modulation and glycosylation. We observed that RDE (II) treatment significantly reduced the binding of IgE to Lycopersicon esculentum lectin, which recognizes poly- N -acetylglucosamine and poly- N -acetyllactosamine. These results suggest that RDE (II) specifically modulates branched glycans on IgE, thereby interfering with its ability to induce allergic responses. Our findings may provide a basis for the development of drugs to inhibit IgE activity in allergies., (© 2019 Yamazaki et al.)

Lymphatic filariasis (LF) has been declared eliminated in Sri Lanka in September 2016. To maintain elimination status, a surveillance system to detect hidden endemic foci or LF resurgence is of highest priority. In this paper, we have reported an investigation of LF transmission in Trincomalee district where a surveillance program was not carried out due to 30 years of civil unrest. Proposed surveillance system included, measurement of anti-filarial IgG4 in urine of schoolchildren in areas where LF transmission could exist and assessment of circulating filarial antigen (CFA) and microfilaria (mf) in all urine antibody positive schoolchildren, their family members and 10-15 neighbours of each urine antibody positive household. Spatial distribution of the anti-filarial antibody titers in urine in a high antibody suspected area was analyzed using GPS logger data. Among 2301 school children from 11 schools studied, 41 (1.8%) urine antibody positives were found. The antibody positive rates of the schools ranged between 0 and 4.0%. Nine of the 630 (1.4%) examined became positive for CFA but were negative for mf. Although there were no mf positives, positive CFA and antibody results indicated the existence of Wuchereria bancrofti in Trincomalee. Highest antibody titres in an area correlated with the prevalences of urine antibodies and CFA. Spatial analysis showed LF transmission foci. Therefore, a combination of the non-invasive methods, urine ELISA and GPS mapping, will be a new effective surveillance system to identify hidden LF transmission foci., (Copyright © 2018. Published by Elsevier B.V.)

To evaluate the accuracy and reliability of urine assay for the diagnosis of strongyloidiasis, three different immunoassays were used to assess the diagnostic accuracy of anti- Strongyloides immunoglobulin G (IgG) in urine and compared with those in serum samples. Analyses by InBios enzyme-linked immunosorbent assay (ELISA) kit (recombinant NIE antigen), SciMedx ELISA kit ( Strongyloides stercoralis antigen), and our in-house ELISA ( Strongyloides ratti antigen) yielded comparable diagnostic performances between urine and serum assays. Levels of Strongyloides -specific IgG in urine significantly correlated with those in serum. Tests for diagnostic agreement between urine and serum IgG assays showed substantial to fair agreement (κ = 0.207-0.615). The observed quantitative and qualitative concordance between urine and serum assays in strongyloidiasis suggests that urine has similar diagnostic value to that for serum. Because of the ease and noninvasiveness of clinical sample collection, urine assay has a high potential for the initial diagnosis and mass screening of strongyloidiasis.

The diagnosis of strongyloidiasis by coprological methods has a low sensitivity, underestimating the prevalence of Strongyloides stercoralis in endemic areas. Serodiagnostic tests for strongyloidiasis have shown robust diagnostic properties. However, these methods require a blood draw, an invasive and labor-intensive sample collection method, especially in the resource-limited settings where S. stercoralis is endemic. Our study examines a urine-based assay for strongyloidiasis and compares its diagnostic accuracy with coprological and serological methods. Receiver operating characteristic (ROC) curve analyses determined the diagnostic sensitivity (D-Sn) and specificity (D-Sp) of the urine ELISA, as well as estimates its positive predictive value and diagnostic risk. The likelihood ratios of obtaining a positive test result (LR+) or a negative test result (LR-) were calculated for each diagnostic positivity threshold. The urine ELISA assay correlated significantly with the serological ELISA assay for strongyloidiasis, with a D-Sn of 92.7% and a D-Sp of 40.7%, when compared to coprological methods. Moreover, the urine ELISA IgG test had a detection rate of 69%, which far exceeds the coprological method (28%). The likelihood of a positive diagnosis of strongyloidiasis by the urine ELISA IgG test increased significantly with increasing units of IgG detected in urine. The urine ELISA IgG assay for strongyloidiasis assay has a diagnostic accuracy comparable to serological assay, both of which are more sensitive than coprological methods. Since the collection of urine is easy and non-invasive, the urine ELISA IgG assay for strongyloidiasis could be used to screen populations at risk for strongyloidiasis in S. stercoralis endemic areas., Competing Interests: The authors have declared that no competing interests exist.

Alleviating morbidity due to lymphatic filariasis (LF)-especially in elderly patients who are rather ignorant-is presently the biggest challenge for the national filariasis campaign. We introduced two follow-up schemes and compared each other to address three key programmatic issues (1) locating patients, (2) educating patients, family members on practice of lymphoedema self-care (3) well sustained daily self-care. Hundred and seven lymphoedema patients were introduced to the new Community Home Based Care (CHBC) programme as a part of MMDP programme at their homes. Twenty seven of 107 patients were selected by purposive sampling and followed-up under two schemes, 14 in Daily follow-up (DFU) scheme and 13 in Monthly follow-up (MFU) scheme. Impact was assessed using a KAP score, number of entry lesions (EL) and number of ADL episodes, limb volume, its appearance, changes in the quality of life and gained benefits. Visiting patients in their homes to introduce lymphoedema care programme was a success. KAP scores of the more important activities on lymphoedema care were significantly higher in DFU scheme. Number of patients (51.9%; 14/27) who had EL/s at baseline reduced significantly to 18.5% (5/27) at one year follow-up. The mean numbers of ADL episodes/year reduced significantly in both schemes. Six photographs of 27 showed obvious improvement in lymphoedema and its grade. Mean volume of lymphoedema reduced significantly in both schemes at one year no significant difference between schemes. Benefit score at one year revealed that the patients in DFU scheme received significantly higher amount of benefits compared to MFU scheme. In conclusion daily instruction has significantly motivated the patient and his/her family bringing a new hope., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The effect of glycyrrhizin on the replication of human parainfluenza virus type 2 (hPIV-2) was examined. Cell fusion induced by hPIV-2 was inhibited by glycyrrhizin, and glycyrrhizin reduced the number of viruses released from the cells. Glycyrrhizin did not change cell morphology at 1 day of culture, but caused some damage at 4 days, as determined by the effect on actin microfilaments. However, it affected the cell viability at 1 day: about 20% of the cells were not alive by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay at 1 day of culture. Real-time polymerase chain reaction (PCR) and PCR showed that virus genome synthesis was largely inhibited. mRNA synthesis was also inhibited by glycyrrhizin. Viral protein synthesis was largely inhibited as observed by an indirect immunofluorescence study. Multinucleated giant cell formation was studied using a recombinant green fluorescence protein (GFP)-expressing hPIV-2 without matrix protein (rhPIV-2ΔMGFP). A few single cells with fluorescence were observed, but the formation of giant cells was completely blocked. Taken together, it was shown that viral genome, mRNA and protein syntheses, including F and HN proteins, were inhibited by glycyrrhizin, and consequently multinucleated giant cell formation was not observed and the infectious virus was not detected in the culture medium.

Objective: To analyze the clinical outcome of concurrent chemoradiotherapy in superficial esophageal cancer patients., Methods: We retrospectively analyzed data for 123 patients with superficial esophageal cancer who received external beam radiotherapy without intracavitary brachytherapy plus systemic chemotherapy during 1998-2015. Elective nodal irradiation was not performed. The dosage to planning treatment volume was 60 Gy in 30 fractions. The main outcome measure was overall survival., Results: Patient characteristics were as follows: median age, 66 (41-83) years; male/female ratio, 106/17; squamous cell carcinoma/other, 122/1; cT1a/cT1b, 27/96; cervical esophagus/upper thoracic esophagus/middle thoracic esophagus/lower thoracic esophagus, 7/9/66/41 and concurrent chemoradiotherapy/radiotherapy alone, 100/23. Cisplatin and 5-fluorouracil were the most commonly used agents (85%). At the last follow-up (median 60.5 months), 91 (74%) patients were alive. Complete response was achieved in 116 (94.4%) patients. The 5-year overall survival, progression-free survival and local control rates were 77.0, 46.9 and 62.7%, respectively, similar to that in the elderly patients (P = 0.878, 0.754 and 0.648, respectively). There were 55 failures: 42 local, 10 regional and 3 distant failures. Nine local and seven regional failures developed out-of-field. Thirty-eight local failures (90%) were successfully salvaged, of which 30 (71%) were salvaged via endoscopic removal; only 2 regional failures (20%) were salvaged. Fifteen G3 acute toxicities occurred. One pneumonitis (G3), one pneumothorax (G3) and two pericardial effusion (G2) were the late toxicities observed. There were no G4 toxicities or treatment-related deaths., Conclusions: Concurrent chemoradiotherapy without intracavitary brachytherapy was effective and safe for superficial esophageal cancer, even in elderly patients., (© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Importance: Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis., Objectives: To examine whether a sedation strategy with dexmedetomidine can improve clinical outcomes in patients with sepsis undergoing ventilation., Design, Setting, and Participants: Open-label, multicenter randomized clinical trial conducted at 8 intensive care units in Japan from February 2013 until January 2016 among 201 consecutive adult patients with sepsis requiring mechanical ventilation for at least 24 hours., Interventions: Patients were randomized to receive either sedation with dexmedetomidine (n = 100) or sedation without dexmedetomidine (control group; n = 101). Other agents used in both groups were fentanyl, propofol, and midazolam., Main Outcomes and Measures: The co-primary outcomes were mortality and ventilator-free days (over a 28-day duration). Sequential Organ Failure Assessment score (days 1, 2, 4, 6, 8), sedation control, occurrence of delirium and coma, intensive care unit stay duration, renal function, inflammation, and nutrition state were assessed as secondary outcomes., Results: Of the 203 screened patients, 201 were randomized. The mean age was 69 years (SD, 14 years); 63% were male. Mortality at 28 days was not significantly different in the dexmedetomidine group vs the control group (19 patients [22.8%] vs 28 patients [30.8%]; hazard ratio, 0.69; 95% CI, 0.38-1.22; P = .20). Ventilator-free days over 28 days were not significantly different between groups (dexmedetomidine group: median, 20 [interquartile range, 5-24] days; control group: median, 18 [interquartile range, 0.5-23] days; P = .20). The dexmedetomidine group had a significantly higher rate of well-controlled sedation during mechanical ventilation (range, 17%-58% vs 20%-39%; P = .01); other outcomes were not significantly different between groups. Adverse events occurred in 8 (8%) and 3 (3%) patients in the dexmedetomidine and control groups, respectively., Conclusions and Relevance: Among patients requiring mechanical ventilation, the use of dexmedetomidine compared with no dexmedetomidine did not result in statistically significant improvement in mortality or ventilator-free days. However, the study may have been underpowered for mortality, and additional research may be needed to evaluate this further., Trial Registration: clinicaltrials.gov Identifier: NCT01760967.

We conducted an epidemiological study of intestinal parasitic infection in 572 schoolchildren aged 4 to 12 years old from six elementary schools in Sakon Nakhon Province, Thailand from June 2013 to August 2014. We collected fecal, blood, and urine samples to investigate parasitic infection and conducted a questionnaire survey. Soil samples were examined for egg contamination. Fecal examination, using the formalin-ether sedimentation method, revealed that 39% of schoolchildren were infected with eight genera and eight species of parasites; three nematodes, two trematodes, one cestode, and two protozoa. Prevalence rates across the six schools (schools A through F) were: A (13%), B (15%), C (53%), D (11%), E (20%), and F (43%). Schools C and F showed significantly higher prevalence rates than the other schools (p<0.05). In school C, Necator americanus was detected in 49% of schoolchildren tested, while in school F a high prevalence of Opisthorchis viverrini and Heterophyes heterophyes, at a rate of 23% and 21%, respectively, was detected. The questionnaire survey revealed that health, hygiene practices and awareness were poor in school C. However, school F showed high levels of cognizance and practices relating to the prevention of infection. The schoolchildren ate a staple diet of undercooked river fish and the results revealed a high rate of fish-borne parasites. Soil samples showed Toxocara sp. contamination in and around the campus. Toxocara antibodies were detected in over 6% of schoolchildren. The use of urine samples, as opposed to serum samples, was found to be effective for antibody testing.

Background: Paragonimiasis is one of the foodborn trematodiases and number of the patients was estimated to be about 23 million around the world. To obtain good compliance of people for the surveillance of paragonimiasis, an enzyme-linked immunosorbent assay (ELISA) for the diagnosis of paragonimiasis with unconcentrated urine samples was developed., Results: Paragonimus westermani antigen specific IgG and IgG4 were detected in urine samples from paragonimiasis patients and the levels correlated well with those detected in the paired serum samples. Cross-reactions observed among other trematodiasis and a tuberculosis patient with the antigen specific IgG were much reduced by detecting the antigen specific IgG4; 9.2 % to 2.3 %., Conclusions: The ELISA with urine samples, which are collected safely and easily, will be a useful tool for a mass-screening of paragonimiasis.

Human African trypanosomiasis (HAT) is a disease caused by Kinetoplastid infection. Serological tests are useful for epidemiological surveillance. The aim of this study was to develop a multiplex serological assay for HAT to assess the diagnostic value of selected HAT antigens for sero-epidemiological surveillance. We cloned loci encoding eight antigens from Trypanosoma brucei gambiense, expressed the genes in bacterial systems, and purified the resulting proteins. Antigens were subjected to Luminex multiplex assays using sera from HAT and VL patients to assess the antigens' immunodiagnostic potential. Among T. b. gambiense antigens, the 64-kDa and 65-kDa invariant surface glycoproteins (ISGs) and flagellar calcium binding protein (FCaBP) had high sensitivity for sera from T. b. gambiense patients, yielding AUC values of 0.871, 0.737 and 0.858 respectively in receiver operating characteristics (ROC) analysis. The ISG64, ISG65, and FCaBP antigens were partially cross-reactive to sera from Trypanosoma brucei rhodesiense patients. The GM6 antigen was cross-reactive to sera from T. b. rhodesiense patients as well as to sera from VL patients. Furthermore, heterogeneous antibody responses to each individual HAT antigen were observed. Testing for multiple HAT antigens in the same panel allowed specific and sensitive detection. Our results demonstrate the utility of applying multiplex assays for development and evaluation of HAT antigens for use in sero-epidemiological surveillance., (Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

The use of Strongyloides ratti as heterologous antigen for serodiagnosis of strongyloidiasis is preferable to Strongyloides from humans due to the ease and safety of antigen preparation. In Southeast Asia where Opisthorchis viverrini coexists with Strongyloides stercoralis, there has been no report in using S. ratti for serodiagnosis of S. stercoralis. In this study, performance of an enzyme-linked immunosorbent assay (ELISA) based on S. ratti was compared with that based on S. stercoralis for diagnosis of strongyloidiasis in areas where O. viverrini is co-endemic in Thailand. Of the 107 individuals, 50 (46.7 %) were positive for S. stercoralis by agar culture method and by ELISA; 82 (76.6 %) and 81 (75.7 %) were seropositive using S. ratti and S. stercoralis antigens, respectively. The levels of parasite-specific IgG to S. ratti and S. stercoralis antigen were significantly proportionally correlated (P < 0.001). Mixed infections with O. viverrini have little effect on diagnosis of strongyloidiasis. Of 42 subjects who were infected with other parasites, there were no cross-reaction with Angiostrongylus cantonensis, Taenia spp., hookworms, Paragonimus spp., Clonorchis sinensis, Ascaris lumbricoides except for Fasciola spp. (1 of 5), and Opisthorchis viverrini (5 of 20). In spite of cross-reactivities, the results suggest that the S. ratti antigen provides an useful option for diagnosis of strongyloidiasis in an endemic area of opisthorchiasis with high sensitivity comparable to the S. stercoralis antigen and provide a basis for effective control strategies for strongyloidiasis.

We encountered a probable case of loiasis in a returned traveler from Central Africa. A 52-year-old Japanese woman presented to our hospital complaining of discomfort in her eyes and skin. She reported having frequently visited Central Africa over many years and having been extensively exposed to the rainforest climate and ecosystem. Although no microfilariae were found in her blood, there was an elevated level of IgG antibodies against the crude antigens of Brugia pahangi, which have cross-reactivity with Loa loa. She was treated with albendazole for 21 days, after which the antigen-specific IgG level decreased and no relapse occurred.

Objective: To assess the driving fitness of patients with glaucoma by identifying specific areas and degrees of visual field impairment that threaten safe driving., Design: Case-control study., Setting, and Participants: This prospective study included 36 patients with advanced glaucoma, defined as Humphrey field analyzer (HFA; 24-2 SITA standard program) measurements of mean deviation in both eyes of worse than -12 dB, and 36 age-matched and driving exposure time-matched normal subjects. All participants underwent testing in a novel driving simulator (DS) system. Participants were recruited between September 2010 and January 2012., Main Outcome Measures: The number of collisions with simulated hazards and braking response time in 14 DS scenarios was recorded. Monocular HFA 24-2 test results from both eyes were merged to calculate the binocular integrated visual field (IVF). The position of the IVF subfields in which the collision-involved patients had lower sensitivity than the collision-uninvolved patients was compared with the track of the hazard. The cut-off value to predict an elevated risk of collisions was determined, as were its sensitivity and specificity, with the area under the receiver operating characteristic (AUROC) curve., Results: Patients with advanced glaucoma were involved in a significantly higher number of collisions in the DS than the age-matched and driving exposure time-matched normal subjects (119 vs 40, respectively, p<0.0001), especially in four specific DS scenarios. In these four scenarios, IVF sensitivity was significantly lower in the collision-involved patients than in the collision-uninvolved patients in subfields on or near the track of the simulated hazard (p<0.05). The subfields with the largest AUROC curve had values ranging from 0.72 to 0.91 and were located in the paracentral visual field just below the horizontal., Conclusions: Our novel DS system effectively assessed visual impairment, showing that simulators may have future potential in educating patients., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

New devices are considered intuitive when they allow users to transfer prior knowledge. Drawing upon fundamental psychology experiments that distinguish prior knowledge transfer from new schema induction, a procedure was specified for assessing intuitive use. This procedure was tested with 31 participants who, prior to using an on-board computer prototype, studied its screenshots in reading vs. schema induction conditions. Distinct patterns of transfer or induction resulted for features of the prototype whose functions were familiar or unfamiliar, respectively. Though moderated by participants' cognitive style, these findings demonstrated a means for quantitatively assessing transfer of prior knowledge as the operation that underlies intuitive use. Implications for interface evaluation and design, as well as potential improvements to the procedure, are discussed., (Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

A 43-year-old Japanese Bolivian male had been suffering from a right leg ulcer after an insect bite during his residence in Bolivia. The ulcer healed after herbal medicine treatment. Ten years later, the patient had symptoms of nasal obstruction, nasal bleeding, and pharyngodynia, which were accompanied by a destructive ulcer with surrounding erythema involving the right nostril apex and columella. Papillary, irregular mucosal lesions were seen on the soft palate. Giemsa staining and polymerase chain reaction (PCR) using biopsy specimens of the papillary mucosal lesions on the soft palate failed to identify Leishmania parasites. However, the IgG antibody test was positive for Leishmania (Leishmania) donovani, and the dot enzyme-linked immunosorbent assay (dot-ELISA) using five Leishmania antigens L. (L.) mexicana, L. (L.) amazonensis, Leishmania (Viannia) guyanensis, L. (V.) braziliensis, and L. (V.) panamensis was positive. Combined, the findings suggested mucocutaneous leishmaniasis. Treatment with liposomal amphotericin B was started but was soon terminated because of palpitation, epigastralgia and facial flushing. It is sometimes difficult to identify the parasites in lesions of mucocutaneous leishmaniasis and serological tests are useful for such occasions., (© 2014 Japanese Dermatological Association.)

Background: A strategy to combat infectious diseases, including neglected tropical diseases (NTDs), will depend on the development of reliable epidemiological surveillance methods. To establish a simple and practical seroprevalence detection system, we developed a microsphere-based multiplex immunoassay system and evaluated utility using samples obtained in Kenya., Methods: We developed a microsphere-based immuno-assay system to simultaneously measure the individual levels of plasma antibody (IgG) against 8 antigens derived from 6 pathogens: Entamoeba histolytica (C-IgL), Leishmania donovani (KRP42), Toxoplasma gondii (SAG1), Wuchereria bancrofti (SXP1), HIV (gag, gp120 and gp41), and Vibrio cholerae (cholera toxin). The assay system was validated using appropriate control samples. The assay system was applied for 3411 blood samples collected from the general population randomly selected from two health and demographic surveillance system (HDSS) cohorts in the coastal and western regions of Kenya. The immunoassay values distribution for each antigen was mathematically defined by a finite mixture model, and cut-off values were optimized., Findings: Sensitivities and specificities for each antigen ranged between 71 and 100%. Seroprevalences for each pathogen from the Kwale and Mbita HDSS sites (respectively) were as follows: HIV, 3.0% and 20.1%; L. donovani, 12.6% and 17.3%; E. histolytica, 12.8% and 16.6%; and T. gondii, 30.9% and 28.2%. Seroprevalences of W. bancrofti and V. cholerae showed relatively high figures, especially among children. The results might be affected by immunological cross reactions between W. bancrofti-SXP1 and other parasitic infections; and cholera toxin and the enterotoxigenic E. coli (ETEC), respectively., Interpretation: A microsphere-based multi-serological assay system can provide an opportunity to comprehensively grasp epidemiological features for NTDs. By adding pathogens and antigens of interest, optimized made-to-order high-quality programs can be established to utilize limited resources to effectively control NTDs in Africa.

Controversy persists as to whether helminth infections cause or protect against asthma and atopy. The aim of this study was to investigate the effects of helminth infection on asthma and atopy among Bangladeshi children. A total of 912 children aged 4.5 years (mean = 54.4, range = 53.5-60.8 months) participated in a cross-sectional study nested into a randomized controlled trial in Bangladesh. Ever-asthma, ever-wheezing and current wheezing were identified using the International Study of Asthma and Allergies in Childhood questionnaire. Current helminth infection was defined by the presence of helminth eggs in stools, measured by routine microscopic examination. Repeated Ascaris infection was defined by the presence of anti-Ascaris IgE ≥ 0.70 UA/ml in serum measured by the CAP-FEIA method. Atopy was defined by specific IgE to house dust mite (anti-DP IgE) ≥ 0.70 UA/ml measured by the CAP-FEIA method and/or positive skin prick test (≥ 5 mm). Anti-Ascaris IgE was significantly associated with ever asthma (odds ratio (OR) = 1.86, 95% CI: 1.14-3.04, highest vs. lowest quartile; P for trend 0.016). Anti-Ascaris IgE was also significantly associated with positive anti-DP IgE (OR = 9.89, 95% CI: 6.52-15.00, highest vs. lowest; P for trend < 0.001) and positive skin prick test (OR = 1.69, 95% CI: 1.01-2.81, highest vs. lowest, P for trend 0.076). These findings suggest that repeated Ascaris infection is a risk factor for asthma and atopy in rural Bangladeshi children. Further analysis is required to examine the mechanism of developing asthma and atopy in relation to helminth infection.

Multiple sclerosis (MS) is a chronic demyelinating disease often displaying a relapsing-remitting course of neurological manifestations that is mimicked by experimental autoimmune encephalomyelitis (EAE) in animal models of MS. In particular, NOD mice immunized with myelin oligodendrocyte glycoprotein peptide 35-55 develop chronic relapsing-remitting EAE (CREAE). To elucidate the mechanisms that cause MS relapse, we investigated the histopathology and cytokine production of spleen cells and mRNA expression levels in the central nervous system (CNS) of CREAE mice. During the first attack, inflammatory cell infiltration around small vessels and in the subarachnoid space was observed in the spinal cord. Spleen cell production and mRNA expression in the CNS of several cytokines, including IFN-γ, TNF-α, IL-6, IL-17, and CC chemokine ligand 2 (CCL2), were higher in CREAE mice than in controls. Afterwards, parenchymal infiltration and demyelination were observed histologically in the spinal cord and corresponded with the more severe clinical symptoms of the first and second relapses. IL-17 and CCL2, but not IFN-γ, TNF-α, or IL-6, were also produced by spleen cells during recurrences. Our results suggested that the immune mechanisms in relapses were different from those in the first attack for CREAE. Further investigation of CREAE mechanisms may provide important insights into successful therapies for human relapsing-remitting MS., (Copyright © 2014 Elsevier B.V. All rights reserved.)

For the declaration of elimination of lymphatic filariasis, reliable epidemiological data in all parts of a country are required. In Sri Lanka, due to social disturbance, there are 3 provinces whose endemicity has been declared unknown. Further, a recent report revealed an endemic pocket, which is on the border with the district that was not covered by the national elimination program. These facts indicate the necessity of more extensive studies to discover hidden endemic foci. To facilitate such studies, we evaluated 2 methods of Rapid Assessment Procedure (RAP) in Hambantota district, where the filariasis endemicity was low: (1) indirect questioning by mailing a questionnaire to each local leader (IndQ), asking about the presence of clinical cases, and (2) focus group discussion (FGD) by villagers. The information given by people was validated with clinical examination by doctors (CE) and IgG4 ELISA using urine samples. In the results: there was a strong positive correlation between CE and ELISA rates. The hydrocele rates obtained by FGD or IndQ were associated significantly with CE rates. The rates by FGD or Cluster-IndQ ('modified' IndQ) were also associated significantly with ELISA rates. The IndQ was most cost-effective. Based on these findings, we have concluded that screening by IndQ and confirmation by the ELISA would be an effective and practical way in Sri Lanka to locate endemic foci in hitherto unsurveyed districts., (© 2013 Elsevier Ireland Ltd. All rights reserved.)

This paper discusses the design of a driver assistance system for avoiding collisions with vehicles in blind spots. The following three types of support systems are compared: (1) a warning system that provides the driver with an auditory alert, (2) a 'soft' protection system that makes the steering wheel stiffer to tell the driver that a lane-change manoeuvre is not recommended and (3) a 'hard' protection system that cancels the driver's input and controls the tyre angle autonomously to prevent lane departure. The results of an experiment showed that the hard protection system was more effective for collision avoidance than either the warning or the soft protection system. The warning and soft protection systems were almost the same in terms of collision avoidance. The results suggest that the human-centred automation principle, which requires the human to have the final authority over the automation, can be violated depending on the context.

In Sri Lanka, urine ELISA showed high sensitivity and specificity in detecting filaria-specific IgG4. It also produced much higher positive rates than antigen tests in prevalence studies with young children. In this study, we have confirmed the usefulness of urine ELISA in the field of Bangladesh. The ELISA detected 89 of 105 (85%) ICT antigen test positive subjects in endemic areas. With both ICT and microfilaria positives, the sensitivity was 97% (30/31). All of 104 ICT negative people in a non-endemic area were ELISA negative (100% specificity). In a prevalence study with 319 young children (5-10 years) from a low endemic area after five rounds of MDA, seven (2.2%) were detected by the present urine test, but only one (0.3%) by ICT (P=0.075). The satisfactorily high sensitivity, 100% specificity and effective case detection among young ages along with scope for analyzing the titers will indicate urine ELISA to be an effective tool in the post-MDA surveys to confirm elimination or to detect resurgence in Bangladesh., (© 2013.)

Alveolar echinococcosis (AE) is one of the most lethal zoonotic parasitic infections. The diagnosis is based on the combination of the abdominal imaging including CT, MRI and PET, and serology. To develop a new diagnostic tool for AE with urine as samples, mouse-Echinococcus multilocularis (Em) model and then human cases were studied. The antibody levels of urine and serum samples from the infected mice and AE cases were well correlated with each other. The sensitivity and specificity of the method with urine were 91% and 98%, respectively, when IgG4 to crude Em was examined. Comparing with serum samples, the collection of urine is easier and safer and the urine diagnostic tool makes surveys of this silent disease easier., (© 2013.)

This paper proposes a semi-autonomous collision avoidance system for the prevention of collisions between vehicles and pedestrians and objects on a road. The system is designed to be compatible with the human-centered automation principle, i.e., the decision to perform a maneuver to avoid a collision is made by the driver. However, the system is partly autonomous in that it turns the steering wheel independently when the driver only applies the brake, indicating his or her intent to avoid the obstacle. With a medium-fidelity driving simulator, we conducted an experiment to investigate the effectiveness of this system for improving safety in emergency situations, as well as its acceptance by drivers. The results indicate that the system effectively improves safety in emergency situations, and the semi-autonomous characteristic of the system was found to be acceptable to drivers., (Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

The use of urine for the immunodiagnosis of lymphatic filariasis has a definite advantage: the sample collection is not invasive and thus well accepted by people. Urine-based ELISA to detect filaria-specific IgG4 has been used successfully. However, ELISA requires equipment such as a microplate reader, which is often not available in most endemic areas. We have developed a new visual immunodiagnosis that detects urinary IgG4 using red-colored latex beads (bead test). The sensitivity was 87.2% when ICT antigen test positive people were regarded as the standard (136/156), and the specificity was 97.2% with the non-endemic people in Japan and Bangladesh, and the urine ELISA negatives in Sri Lanka (1264/1300). In a prevalence study, the bead test could detect filarial infection more effectively than ICT test among young children in Sri Lanka, indicating the usefulness of the visual test in epidemiological studies., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

More than 20 million people in Bangladesh are considered at risk of developing visceral leishmaniasis (VL). A community-based active surveillance was conducted in eight randomly selected villages in a highly endemic area of Bangladesh from 2006 to 2008. A total of 6,761 individuals living in 1,550 mud-walled houses were included in the active surveillance. Rapid rK39 dipstick tests were conducted throughout the study period to facilitate the case diagnosis. Individuals with previous or current clinical leishmaniasis were identified on the basis of the case definition of the VL elimination program. Untreated cases of suspected VL were referred to the hospital for treatment. Socioeconomic and environmental information including bed net use was also collected. In 2006, the annual incidence of clinical leishmaniasis in the study area was 141.9 cases per 10,000 population, which was significantly increased by the following year owing to community-based active surveillance for case detection and reporting. However, early case detection and early referral for treatment led to a significant decrease in incidence in 2008. This study suggests that community-based active surveillance using a simple diagnostic tool might play a role in achieving the goal of the VL elimination program.

A prospective observational study to test the effects of risedronate 17.5 mg/week treatment on quality of life (QOL) of 1,363 Japanese female patients with osteoporosis showed QOL improvement after 12 weeks of administration. Comorbid factors such as ischemic heart disease, hip osteoarthritis, and higher values of FRAX blunted the effects of QOL of the treatment. Few studies have investigated the effect of osteoporosis treatment on QOL in relationship to comorbid factors other than osteoporosis and fracture. Efficacy was determined by changes over time in EQ-5D at baseline, at 12 and 24 weeks, and at the final assessment. Factors affecting changes in EQ-5D were evaluated with a multivariate analysis. Safety was determined by assessing the incident rate of adverse events. The improvement of EQ-5D compared to baseline was observed as significant after 12 weeks of treatment (p < 0.001). The greatest improvement was observed in the dimension of "pain/discomfort" by the multivariate analysis (p < 0.001). Factors affecting QOL improvement were FRAX value without BMD, age, glucocorticoid use, ischemic heart disease, hip osteoarthritis, and pain. The incidence rate of drug-related adverse events was 4.72 % (95 % confidence interval 3.63-6.02 %). Risedronate at 17.5 mg/week improved the QOL in patients with osteoporosis among Japanese women, and comorbidity factors decreased the effects.

We reported a highly sensitive and specific enzyme-linked immunosorbent assay (ELISA) that detects immunoglobulin G (IgG) in urine using rKRP42 antigen for the diagnosis of visceral leishmaniasis (VL). The ELISA was applied to study chronological change in antibody titers in five study areas in Rajshahi district, Bangladesh. A total of 585 subjects without a past VL history were examined at least three times in the 30-month follow-up period; of these subjects, 137 (23.4%) subjects became ELISA-positive at least one time during the study. Among the positive cases, 40 (29.2%) subjects developed clinical VL, and 31 (77.5%) of these subjects showed IgG titers of ≥ 1,000 U more than one time in the study period. Considering only the first ELISA results, 22 subjects with IgG titers of ≥ 1,000 U could be found, and 21 (95.5%) of these subjects turned out to be clinical cases. The high urinary IgG titers (≥ 1,000 U) will help predict possible clinical VL cases and thus, identify an outbreak in its earlier stage.

Mymensingh is the most endemic district for kala-azar in Bangladesh. Phlebotomus argentipes remains the only known vector although a number of sand fly species are prevalent in this area. Genotyping of sand flies distributed in a VL endemic area was developed by a PCR and restriction-fragment-length polymorphism (RFLP) of 18S rRNA gene of sand fly species. Using the RFLP-PCR analysis with AfaI and HinfI restriction enzymes, P. argentipes, P. papatasi, and Sergentomyia species could be identified. Among 1,055 female sand flies successfully analyzed for the species identification individually, 64.4% flies was classified as Sergentomyia species, whereas 35.6% was identified as P. argentipes and no P. papatasi was found. Although infection of Leishmania within the sand flies was individually examined targeting leishmanial minicircle DNA, none of the 1,055 sand flies examined were positive for Leishmania infection. The RFLP-PCR could be useful tools for taxonomic identification and Leishmania infection monitoring in endemic areas of Bangladesh.

Successful mass drug administration (MDA) campaigns have brought several countries near the point of Lymphatic Filariasis (LF) elimination. A diagnostic tool is needed to determine when the prevalence levels have decreased to a point that MDA campaigns can be discontinued without the threat of recrudescence. A six-country study was conducted assessing the performance of seven diagnostic tests, including tests for microfilariae (blood smear, PCR), parasite antigen (ICT, Og4C3) and antifilarial antibody (Bm14, PanLF, Urine SXP). One community survey and one school survey were performed in each country. A total of 8,513 people from the six countries participated in the study, 6,443 through community surveys and 2,070 through school surveys. Specimens from these participants were used to conduct 49,585 diagnostic tests. Each test was seen to have both positive and negative attributes, but overall, the ICT test was found to be 76% sensitive at detecting microfilaremia and 93% specific at identifying individuals negative for both microfilariae and antifilarial antibody; the Og4C3 test was 87% sensitive and 95% specific. We conclude, however, that the ICT should be the primary tool recommended for decision-making about stopping MDAs. As a point-of-care diagnostic, the ICT is relatively inexpensive, requires no laboratory equipment, has satisfactory sensitivity and specificity and can be processed in 10 minutes-qualities consistent with programmatic use. Og4C3 provides a satisfactory laboratory-based diagnostic alternative.