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The aim of this paper is to propose optimal strategies for dengue reduction and prevention in Cali, Colombia. For this purpose, we consider two variants of a simple dengue transmission model, epidemic and endemic, each of which is amended with two control variables. These variables express feasible control actions to be taken by an external decision-maker. First control variable stands for the insecticide spraying and thus targets to suppress the vector population. The second one expresses the protective measures (such as use of repellents, mosquito nets, and insecticide-treated clothes) that are destined to reduce the number of contacts (bites) between female mosquitoes (principal dengue transmitters) and human individuals. We use the Pontryagin's maximum principle in order to derive the optimal strategies for dengue control and then perform the cost-effectiveness analysis of these strategies in order to choose the most sustainable one in terms of cost–benefit relationship. Copyright © 2016 John Wiley & Sons, Ltd.

Determining the electronic properties of nanoscopic, low-dimensional materials free of external influences is key to the discovery and understanding of new physical phenomena. An example is the suspension of graphene, which has allowed access to their intrinsic charge transport properties. Furthermore, suspending thin films enables their application as membranes, sensors, or resonators, as has been explored extensively. While the suspension of covalently bound, electronically active thin films is well established, semiconducting thin films composed of functional molecules only held together by van der Waals interactions could only be studied supported by a substrate. In the present work, it is shown that by utilizing a surface-crystallization method, electron conductive films with thicknesses of down to 6 nm and planar chiral optical activity can be freely suspended across several hundreds of nanometers. The suspended membranes exhibit a Young's modulus of 2-13 GPa and are electronically decoupled from the environment, as established by temperature-dependent field-effect transistor measurements.

Please cite this paper as: Moss J, Cooper K, Khaund A, Murray L, Murray G, Wu O, Craig L, Lumsden M. Randomised comparison of uterine artery embolisation (UAE) with surgical treatment in patients with symptomatic uterine fibroids (REST trial): 5-year results. BJOG 2011;118:936–944. Objective To compare the long-term results of uterine artery embolisation (UAE) with surgery for women with symptomatic uterine fibroids. Design Pragmatic, open, multicentre, randomised trial. Setting Twenty-seven participating UK secondary care centres. Sample Women aged ≥18 years with symptomatic fibroids who were considered to justify surgical treatment. Methods In total, 157 women were randomised (in a 2:1 ratio): 106 to UAE and 51 to surgery (hysterectomy 42; myomectomy nine). Main outcome measures Quality of life at 5 years, as assessed by the Short Form General Health Survey (SF-36). Secondary measures included complications, adverse events and the need for further intervention. Results There were no significant differences between groups in any of the eight components of the SF-36 scores at 5 years (minimum P = 0.45). Symptom score reduction and patient satisfaction with either treatment was very high, with no group difference. Rates of adverse events were similar in both groups (19% embolization and 25% surgery; P = 0.40). The 5-year intervention rate for treatment failure or complications was 32% (UAE arm) and 4% (surgery arm), respectively. The initial cost benefit of UAE over surgery at 12 months was substantially reduced because of subsequent interventions, with treatments being cost neutral at 5 years. Conclusions We have found that UAE is a satisfactory alternative to surgery for fibroids. The less invasive nature of UAE needs to be balanced against the need for re-intervention in almost a third of patients. The choice should lie with the informed patient.

Please cite this paper as: Rashid S, Khaund A, Murray L, Moss J, Cooper K, Lyons D, Murray G, Lumsden M. The effects of uterine artery embolisation and surgical treatment on ovarian function in women with uterine fibroids. BJOG 2010;117:985–989. Objective The aim of this study was to evaluate and compare both ovarian function and menstrual characteristics following uterine artery embolisation (UAE) and surgery. Design Subgroup of women from a randomised controlled trial. Setting Gynaecology and radiology units in Scotland, UK. Population Ninety-six women from the randomised controlled trial comparing embolisation with surgery as a treatment for fibroids (REST), which recruited 157 patients (106 UAE; 51 surgery). Methods Seventy-three women undergoing UAE and 23 women undergoing surgery (with ovarian conservation) had serum follicle-stimulating hormone (FSH) measurements taken on day 3 of the menstrual cycle prior to treatment, and at 6 and 12 months post-treatment. Data on menstrual cycle characteristics was also collected. Main outcome measures Ovarian failure, as defined by an FSH level of >40 iu/l, and change in duration of menses and length of menstrual cycle. Results There was no significant difference in the rate of ovarian failure at 12 months between UAE (11%) and surgical patients (18%) (P = 0.44). This finding was not influenced by age. The mean duration of menstrual flow decreased significantly, from baseline to 12 months, by 1.7 days (SD 3.8), (95% CI 0.8–2.6). There was no statistically significant change in mean cycle length at 12 months (0.7 days [SD 4.9]; 95% CI [−0.5, 1.9]). Conclusions There is no evidence for UAE accelerating a deterioration in ovarian function at 1 year, when compared with surgery. UAE is associated with a decrease in the duration of menstrual flow at 1 year.

Seed dispersal by small primates may be particularly relevant in areas where populations of larger frugivores have been reduced or extinguished by hunting and/or habitat disturbance. In this context, the aim of this study was to evaluate the role of the golden-headed lion tamarin Leontopithecus chrysomelas as a seed disperser in Atlantic forest remnants in Brazil. To this end, we opportunistically collected feces deposited during observations on the feeding behavior of two groups of golden-headed lion tamarins ranging in the degraded areas of the Una Biological Reserve, Bahia, Brazil, from February 2006 to January 2007. We collected 587 fecal samples, of which 524 contained seeds from 24 plant species, distributed over 13 families. Disregarding seeds of < 3 mm, the majority of seeds recovered were bromeliad seeds. In general, ingestion of seeds by golden-headed lion tamarins did not improve the germination proportion or decrease the germination delay of seeds, with the exception of Aechmea spp. seeds. The tamarins encountered different habitats during their daily activity period, while feeding and defecating. Consequently, some seeds were transported to different habitats including disturbed areas. Thus, the role of seed dispersal in combination with the daily movement pattern of L. chrysomelas contributes to the persistence of fruit plants and epiphyte species and to the natural regeneration process within Atlantic forest remnants.

Failure of ductal closure is common in extremely low birth weight infants with significant postnatal morbidities from both pulmonary overcirculation (i.e. chronic lung disease) and/or systemic hypoperfusion (i.e. necrotizing enterocolitis). Early clinical signs of a hemodymanically significant ductus may be non-specific (i.e. hypotension, increasing ventilator requirements, metabolic acidosis) necessitating early screening by echocardiography. Cyclooxygenase inhibitors remain the first-line treatment option. Indomethacin remains the most commonly used agent, despite comparable efficacy and reduced risk of adverse events with ibuprofen. Surgical intervention is recommended after failure of medical therapy, contraindications to medical treatment or fulminating duct-related cardiorespiratory deterioration. Wherever possible, surgical intervention in ELBW infants should be avoided in the first week of life due to the potential risks of ischemia-reperfusion cerebral hemorrhage. The postoperative course is often complicated by left ventricular failure, pulmonary edema, and/or hemodynamic instability requiring close monitoring and physiologically relevant therapeutic interventions.

The preparation of nanocomposites of poly (ethylene terephthalate) (PET) and lamellar zirconium phosphorous compounds by melt extrusion was investigated. Two types of zirconium phosphorous compounds were synthesized by the direct precipitation reaction method: α-zirconium bis(monohydrogen orthophosphate) monohydrate (ZrP) and organic–inorganic hybrid layered zirconium phenylphosphonate (ZrPP). Composites containing 2 and 5 wt % ZrP and ZrPP were prepared in a twin-screw extruder and specimens were obtained by injection molding. The extent of dispersion of the layered filler in the composite matrix was investigated by X-ray diffraction and transmission electron microscopy (TEM). The crystallization and thermal properties were analyzed by differential scanning calorimetry and thermogravimetry, and the mechanical properties were evaluated by tensile tests. Whereas ZrP-containing composites showe characteristic diffraction peaks at 2θ 11.7° (d = 7.54 A), indicative of no delamination, ZrPP showed practically no low-angle diffraction peak at 2θ 5.5° (d = 15.24 A), indicating loss of the layered order. TEM images of ZrPP particles indicated the formation of an intercalated/partially delaminated nanocomposite. The behavior was attributed to the higher affinity of the polyester with phenyl groups on the platelet surface of ZrPP. In both cases, the addition of the fillers increased the crystallization rate and the modulus. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 102: 3868–3876, 2006

Traumatic brain injury (TBI) is an important cause of mortality and disability in children and teenagers. A particular feature of the neuropathology at post-mortem is brain swelling. The cause of the swelling in some cases is not known, while in others it is associated with traumatic axonal injury or hypoxia. Apolipoprotein E (APOE) 4 allele is known to be an important genetic determinant of outcome in children after TBI. We hypothesized a relationship between possession of APOE4 and diffuse traumatic brain swelling. A total of 165 cases aged between 2 and 19 years were identified from the department's tissue archive. APOE genotype was determined by polymerase chain reaction (PCR) in 106 cases. Bilateral swelling was present in 44 cases (11 with APOE4), unilateral swelling in 25 cases (7 with APOE4) and in 36 cases (9 with APOE4) there was no evidence of brain swelling. There was no significant relationship between possession of APOE4 and the presence of cerebral swelling (?2 = 0.09, df = 2, P = 0.96). The 95% confidence interval for difference in proportions with swelling in those with and without the APOE4 is ?19% to 22%. Thus, a significant relationship was not found between diffuse brain swelling and possession of APOE4, and in this cohort of patients there was an identifying cause of the brain swelling in all cases.

Epidemiological studies have identified a history of head injury as a risk factor for Alzheimer's disease. However, the neuropathological mechanism underlying this relationship is as yet unclear. Neuronal cytoskeletal changes in the form of neurofibrillary tangles and neuropil threads have recently been demonstrated in young men who had sustained repetitive head injury and subsequently died in their 20s. In addition, recent experimental studies have found accumulation of tau within neuronal somata and damaged axons following diffuse brain injury. We hypothesized that tau-immunoreactive tangles may be present in the brains of patients who died after a single acute blunt head injury. A total of 45 cases of fatal head injury were immunostained for tau. They comprised nine groups (n=5 for each group) separated by age (0-19 years, 20-50 years, 50+ years) and survival time (

Alzheimer’s disease (AD), the most common cause of dementia, is estimated to affect 5% of those more than 65 years of age and 40% of those more than 80 years of age, or a total of approximately 20 million people worldwide. The neuropathological characteristics of AD include (β-amyloid plaques that are diagnostic when associated with dystrophic neurites,1 neurofibrillary tangles, loss of neurons and synapses, and proliferation of glial cells. There has been substantial progress, in the last few years, in unraveling the genetic influences in AD. A small proportion of AD cases are inherited as an autosomal dominant trait and are attributable to point mutations in genes that encode the β-amyloid precursor protein (βAPP),2 presenilin 1,3 or presenilin 2.4 A major genetic risk factor for the much more common sporadic AD is possession of the apolipoprotein E (ApoE) e4 allele.5 However, possession of ApoE e4 is neither necessary nor sufficient for the development of AD, leaving scope for other potential genetic or environmental influences. Interleukin-1 (IL-1) is a potent proinflammatory cytokine that is markedly overexpressed in the brains of patients with AD, predominantly in microglia,6 which suggests a role for inflammatory processes in AD pathogenesis.7 This idea has received support from epidemiological studies that show that the use of anti-inflammatory agents, in particular nonsteroidal anti-inflammatory drugs, is associated with delayed onset or slowed progression of disease.8 IL-1 has two structurally distinct forms, IL-1α and IL-1β, encoded by separate genes (IL-1A and IL-1B, respectively) located in a cluster on the long arm of chromosome 2 that also includes the IL-1 receptor antagonist gene.9 Common polymorphisms have been described in both genes and there is evidence that they have functional significance. A polymorphism of the IL-1B gene (+3953), for instance, which introduces a TaqI restriction site, results in two alleles, designated allele 1 and allele 2.10 Homozygosity for allele 2 of IL-1B is associated with a fourfold increase in production of IL-1β compared with homozygosity for allele 1.10 A polymorphism in the 5′ regulatory region of the IL-1A gene (a C-to-T transition at position −889 relative to the start site of transcription) again results in two alleles, also designated allele 1 and allele 2.11 Both of these IL-1 polymorphisms have been associated with inflammatory diseases. For instance, IL-1A allele 2 has been associated with juvenile rheumatoid arthritis.11 In view of the evidence that suggests a role for inflammatory processes, and for IL-1 in particular in AD, we hypothesized that these IL-1 polymorphisms modulate susceptibility to AD.

Aims This study assessed the use of systolic time intervals (STI) as a potential noninvasive marker of the haemodynamic eVects of sumatriptan, a 5HT1 receptor agonist. Methods Twenty-six patients undergoing diagnostic cardiac catheterization participated. STIs were derived from haemodynamic pressure tracings at baseline, following placebo injection and following either subcutaneous (n=18) or intravenous injection (n=8) of sumatriptan. Results Sumatriptan (i.v. or s.c.) was associated with significant increases in mean arterial pressure (95% C.I. 9,14mmHg, P=0.0001), total electromechanical systole (95% C.I.8,36ms, P

Aims To investigate the relationship in patients with heart failure between BP response to the first dose of ACE inhibitor and (1) plasma drug concentration and (2) baseline clinical and laboratory variables. Methods We studied individual placebo-corrected BP responses to initiation of treatment with one of a number ACE inhibitor preparations in 132 patients with mild to moderate CHF. Various pharmacokinetic/pharmacodynamic models were compared. We assessed the strength of association between baseline physiological and laboratory variables and the BP response as assessed directly from the AUC(0,10 h) and indirectly from the slope of the PK/PD relationship. Predictive models for response variables were developing using regression analysis. Results BP response was primarily related to plasma drug concentration. The association between the fall in BP and baseline variables was weak. The strongest single predictor of BP response was baseline mean arterial pressure (r2=5.8%, P=0.02). The best combinations of predictor variables contained mean arterial pressure, plasma renin activity, creatinine concentration and age (r2=14.4%, P=0.37). When the choice of ACE inhibitor was added, the predictive power of the model increased (r2=23.6%, P

In studies using strain-gauge forearm plethysmography to measure changes in forearm blood flow (FBF) during intra-arterial infusions of vasoactive substances, measurements are often made in both arms simultaneously and the change in ratio of the infused and control arms used to express responses. However, the reproducibility of bilateral plethysmography in this setting has not been addressed in published studies. The unilateral technique remains in use, and forearm vascular resistance (FVR), an alternative method of expressing responses, is used by some investigators. We have assessed: (a) the intra-subject variability of bilateral FBF measurements (FBF ratios) at rest, after unilateral forearm exercise, and during intra-arterial infusions of vasoconstrictor substances; (b) whether bilateral plethysmography is more reproducible than unilateral plethysmography; and (c) the reproducibility of FVR (unilateral and bilateral).Study 1 Nine healthy subjects attended 3 study days, 1 week apart. FBF was measured at rest and after 2 min of standardized unilateral forearm exercise; between-day intra-subject variability was expressed as coefficients of variation (CV) calculated using two-way analysis of variance (ANOVA). Study 2 Five healthy subjects attended 2 study days when FBF was measured during incremental infusions of noradrenaline (15, 30, 150, 300 pmol min[-1]) and angiotensin II (1, 5, 10, 50 pmol min[-1]); for each individual subject at each dose intra-subject variability was assessed using the difference between responses (percentage change from baseline) on days 1 and 2.Study 1 At rest, intra-subject variability (CV) of baseline FBF ratios was 19% compared with 31% (left) and 39% (right) for unilateral FBF measurements. After ipsilateral exercise, unilateral FBF measurements were more reproducible (32 vs 17%) than FBF ratios; by 20 min after exercise, the previous pattern had been re-established (19 vs 27%). Intra-subject variability (CV) of baseline FVR ratio and post-exercise FVR was 14%. Study 2 Inter-quartile ranges of the differences between responses on days 1 and 2 (FBF ratios vs FBF) were: angiotensin II 14 vs 18%; noradrenaline 16 vs 27%.FBF ratios are more reproducible than unilateral FBF measurements at rest (CV 19% vs 39%) and for measuring responses to intra-arterial infusions of vasoconstrictor substances. FVR may have a small reproducibility advantage. Non-experimental stimuli can cause significant and misleading changes in measured responses if unilateral measurements are used; it is therefore recommended that responses to intra-arterial infusions should be measured using bilateral forearm plethysmography with the results expressed as FBF ratios.

Introduction: Previous studies have found that polymorphisms of the apolipoprotein E gene (APOE) influences the outcome from head injury, with possession of APOE e4 being associated with an unfavourable outcome (Teasdale et al. Lancet 1997; 350: 1069–1071). In this study we correlated the pathological features of traumatic brain injury with the presence or absence of APOE e4. Materials and methods: During the 13-year period 1987–99, 238 brains were examined from cases of traumatic brain injury (TBI) in the Department of Neuropathology, Glasgow. APOE genotype was determined by PCR. For each case a number of pathological features were recorded ‘blind’ to the APOE e4 status. Results: Of the 238 cases examined, 83 (35%) had the APOE e4 allele, while 155 (65%) did not. Possession of APOE e4 was associated with a greater incidence of severe hypoxic brain damage (e4+ 54%, e4– 42%) and with a greater incidence of moderate or severe contusion index (e4+ 42%, e4– 30%). No significant differences were noted between the other pathological features examined. Conclusions: Possession of APOE e4 is associated with a greater incidence of moderate/severe contusional injury and severe hypoxic brain damage in fatal cases of TBI. This may be relevant to the relatively poor outcome from TBI in patients with an APOE e4 allele identified in clinical studies.