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Background: Febrile illness is frequent among patients in the tropics. It is caused by a wide variety of common diseases such as malaria or gastrointestinal infections but also by less common but highly contagious pathogens with epidemic potential. This study describes the clinical features of adult and paediatric patients with febrile illness in in the largest tertiary referral hospital in south-eastern Guinea, a region at high risk for viral haemorrhagic fever outbreaks. The study further compares their diagnostic characteristics, treatments and outcomes with non-febrile patients in order to contribute to the local epidemiology of febrile illness., Methods: We used retrospective data collection to record demographic and clinical data of all incoming patients during a study period of three months. For the follow-up study of inpatients, we retrospectively reviewed patient charts for diagnostic characteristics, diagnoses and outcomes., Results: Of the 4317 incoming patients during the study period, 9.5% had a febrile illness. The most used diagnostic measures to identify causative agents in febrile patients were point-of-care tests and most treatments relied on antibiotics. Most common discharge diagnoses for febrile inpatients were malaria (9.6% adults, 56.7% children), salmonella gastroenteritis/typhoid (10.6% adults, 7.8% children) and respiratory infection/pneumonia (5.3% adults, 18.7% children). Inpatient mortality for children was significantly higher in febrile than non-febrile children (18.5% vs. 5.1%, p<0.001) and considerably higher in febrile than non-febrile adults (29.8% vs. 25.0%, p = 0.404)., Conclusions: Malaria, respiratory infection and gastroenteritis are considered the main causes for febrile illness. The wide reliance on rapid diagnostic tests to diagnose febrile patients not only risks to over- or under-diagnose certain diseases but also leaves the possibility of highly infectious diseases in febrile patients unexplored. Furthermore, the heavy reliance on antibiotics risks to cause antimicrobial resistance. High mortality rates in febrile patients, especially children, should be of concern to public health authorities., Competing Interests: The authors have declared that no competing interests exist.

Auditory and visual percepts are integrated even when they are not perfectly temporally aligned with each other, especially when the visual signal precedes the auditory signal. This window of temporal integration for asynchronous audiovisual stimuli is relatively well examined in the case of speech, while other natural action-induced sounds have been widely neglected. Here, we studied the detection of audiovisual asynchrony in three different whole-body actions with natural action-induced sounds-hurdling, tap dancing and drumming. In Study 1, we examined whether audiovisual asynchrony detection, assessed by a simultaneity judgment task, differs as a function of sound production intentionality. Based on previous findings, we expected that auditory and visual signals should be integrated over a wider temporal window for actions creating sounds intentionally (tap dancing), compared to actions creating sounds incidentally (hurdling). While percentages of perceived synchrony differed in the expected way, we identified two further factors, namely high event density and low rhythmicity, to induce higher synchrony ratings as well. Therefore, we systematically varied event density and rhythmicity in Study 2, this time using drumming stimuli to exert full control over these variables, and the same simultaneity judgment tasks. Results suggest that high event density leads to a bias to integrate rather than segregate auditory and visual signals, even at relatively large asynchronies. Rhythmicity had a similar, albeit weaker effect, when event density was low. Our findings demonstrate that shorter asynchronies and visual-first asynchronies lead to higher synchrony ratings of whole-body action, pointing to clear parallels with audiovisual integration in speech perception. Overconfidence in the naturally expected, that is, synchrony of sound and sight, was stronger for intentional (vs. incidental) sound production and for movements with high (vs. low) rhythmicity, presumably because both encourage predictive processes. In contrast, high event density appears to increase synchronicity judgments simply because it makes the detection of audiovisual asynchrony more difficult. More studies using real-life audiovisual stimuli with varying event densities and rhythmicities are needed to fully uncover the general mechanisms of audiovisual integration., Competing Interests: The authors have declared that no competing interests exist.

The present study investigated the effects of transcutaneous vagus nerve stimulation on cardiac vagal activity, the activity of the vagus nerve regulating cardiac functioning. We applied stimulation on the left cymba conchae and tested the effects of different stimulation intensities on a vagally-mediated heart rate variability pagerameter (i.e., the root mean square of successive differences) as well as on subjective ratings of strength of perceived stimulation intensity and unpleasantness due to the stimulation. Three experiments (within-subject designs, M = 61 healthy participants each) were carried out: In Experiment 1, to choose one fixed stimulation intensity for the subsequent studies, we compared three preset stimulation intensities (i.e., 0.5, 1.0 and 1.5 mA) with each other. In Experiment 2, we compared the set stimulation method with the free stimulation method, in which the participants were instructed to freely choose an intensity. In Experiment 3, to control for placebo effects, we compared both methods (i.e., set stimulation vs. free stimulation) with their respective sham stimulations. In the three experiments, an increase of cardiac vagal activity was found from resting to the stimulation phases. However, this increase in cardiac vagal activity was not dependent on stimulation intensity (Experiment 1), the method used to stimulate (i.e., set vs. free; Experiment 2), or whether stimulation was active or sham (Experiment 3). This pattern of results was solidly supported by Bayesian estimations. On the subjective level, higher stimulation intensities were perceived as significantly stronger and a stronger stimulation was generally also perceived as more unpleasant. The results suggest that cardiac vagal activity may be similarly influenced by afferent vagal stimuli triggered by active and sham stimulation with different stimulation intensities. Potential explanations for these findings and its implications for future research with tVNS are discussed., Competing Interests: The authors have declared that no competing interests exist.

Background: Quality of care is a difficult parameter to measure. With the introduction of digital algorithms based on the Integrated Management of Childhood Illness (IMCI), we are interested to understand if the adherence to the guidelines improved for a better quality of care for children under 5 years old., Methods: More than one year after the introduction of digital algorithms, we carried out two cross sectional studies to assess the improvements in comparison with the situation prior to the implementation of the project, in two Basic Health Centres in Kabul province. One survey was carried out inside the consultation room and was based on the direct observation of 181 consultations of children aged 2 months to 5 years old, using a checklist completed by a senior physicians. The second survey queried 181 caretakers of children outside the health facility for their opinion about the consultation carried out through the tablet and prescriptions and medications given., Results: We measured the quality of care as adherence to the IMCI's guidelines. The study evaluated the quality of the physical examination and the therapies prescribed with a special attention to antibiotic prescription. We noticed a dramatic improvement (p<0.05) of several indicators following the introduction of digital algorithms. The baseline physical examination was appropriate only for 23.8% [IC% 19.9-28.1] of the patients, 34.5% [IC% 30.0-39.2] received a correct treatment and 86.1% [IC% 82.4-89.2] received at least one antibiotic. With the introduction of digital algorithms, these indicators statistically improved respectively to 84.0% [IC% 77.9-88.6], >85% and less than 30%., Conclusions: Our findings suggest that digital algorithms improve quality of care by applying the guidelines more effectively. Our experience should encourage to test this tool in different settings and to scale up its use at province/state level., Competing Interests: The authors have declared that no competing interests exist.

Embodied cognition posits that abstract conceptual knowledge such as mental representations of time and space are at least partially grounded in sensorimotor experiences. If true, then the execution of whole-body movements should result in modulations of temporal and spatial reference frames. To scrutinize this hypothesis, in two experiments participants either walked forward, backward or stood on a treadmill and responded either to an ambiguous temporal question (Experiment 1) or an ambiguous spatial question (Experiment 2) at the end of the walking manipulation. Results confirmed the ambiguousness of the questions in the control condition. Nevertheless, despite large power, walking forward or backward did not influence the answers or response times to the temporal (Experiment 1) or spatial (Experiment 2) question. A follow-up Experiment 3 indicated that this is also true for walking actively (or passively) in free space (as opposed to a treadmill). We explore possible reasons for the null-finding as concerns the modulation of temporal and spatial reference frames by movements and we critically discuss the methodological and theoretical implications.

The hot-hand phenomenon, according to which a player's performance is significantly elevated during certain phases relative to the expected performance based on the player's base rate, has left many researchers and fans in basketball puzzled: The vast majority of players, coaches and fans believe in its existence but statistical evidence supporting this belief has been scarce. It has frequently been argued that the hot hand in basketball is unobservable because of strategic adjustments and defensive interference of the opposing team. We use a dataset with novel metrics, such as the number of defenders and the defensive intensity for each shot attempt, which enable us to directly measure defensive pressure. First, we examine how the shooting percentage of NBA players changes relative to the attributes of each metric. We find that it is of lesser importance by how many defenders a player is guarded but that defensive intensity, e.g., whether a defender raises his hand when his opponent shoots, has a larger impact on shot difficulty. Second, we explore how the underlying metrics and shooting accuracy change as a function of streak length. Our results indicate that defensive pressure and shot difficulty increase (decrease) during hot (cold) streaks, so that defenders seem to behave according to the hot-hand belief and try to force hot players into more difficult shots. However, we find that shooting percentages of presumably hot players do not increase and that shooting performance is not related to streakiness, so that the defenders' hot-hand behavior cannot be considered ecologically rational. Therefore, we are unable to find evidence in favor of the hot-hand effect even when accounting for defensive pressure.

The yips is a multi-etiological phenomenon consisting of involuntary movements during the execution of a skill (e.g., a golf putt). Reinvestment, the conscious control of a movement that detrimentally affects automated movements, is thought to be a potential mechanism leading to the yips. Preventing yips-affected golfers from consciously controlling their movement, therefore, should be beneficial. The aim of the study was to be the first to empirically test in a laboratory whether reinvestment causes the yips and to explore if the tendency to reinvest can explain yips behavior. Nineteen yips-affected golfers participated in a lab experiment. They putted with the dominant arm in a skill-focus and an extraneous condition, in which they had to perform different dual tasks designed either to direct their focus on their own skill or to distract them from it. The tendency to reinvest was estimated via the Movement-Specific Reinvestment Scale. Yips behavior was assessed by putting performance and movement variability. Although the dual-task performance showed that the attentional manipulation worked, the tendency to reinvest did not predict the behavior of the yips-affected golfers in either putting condition. The yips-affected golfers also showed no difference in yips behavior between the skill-focus and the extraneous condition. In other words, the attentional manipulation did not change yips behavior. The data do not support the assumption that there is a link between the yips and reinvestment, likely because of the multi-etiological nature of the yips. Other psychological or neurological mechanisms such as conditioned reactions may better explain the yips and should be investigated.

While the adaptor SKAP-55 mediates LFA-1 adhesion on T-cells, it is not known whether the adaptor regulates other aspects of signaling. SKAP-55 could potentially act as a node to coordinate the modulation of adhesion with downstream signaling. In this regard, the GTPase p21(ras) and the extracellular signal-regulated kinase (ERK) pathway play central roles in T-cell function. In this study, we report that SKAP-55 has opposing effects on adhesion and the activation of the p21(ras) -ERK pathway in T-cells. SKAP-55 deficient primary T-cells showed a defect in LFA-1 adhesion concurrent with the hyper-activation of the ERK pathway relative to wild-type cells. RNAi knock down (KD) of SKAP-55 in T-cell lines also showed an increase in p21(ras) activation, while over-expression of SKAP-55 inhibited activation of ERK and its transcriptional target ELK. Three observations implicated the p21(ras) activating exchange factor RasGRP1 in the process. Firstly, SKAP-55 bound to RasGRP1 via its C-terminus, while secondly, the loss of binding abrogated SKAP-55 inhibition of ERK and ELK activation. Thirdly, SKAP-55-/- primary T-cells showed an increased presence of RasGRP1 in the trans-Golgi network (TGN) following TCR activation, the site where p21(ras) becomes activated. Our findings indicate that SKAP-55 has a dual role in regulating p21(ras)-ERK pathway via RasGRP1, as a possible mechanism to restrict activation during T-cell adhesion.