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Background Autoimmune haemolytic anaemia (AIHA) is a rare complication following kidney transplantation and usually occurs early in its course. It is characterised by autoantibodies or alloantibodies directed against red blood cells (RBCs). Case presentation We describe a 44 year old woman who presented 5 years after kidney transplantation with profound transfusion dependent warm AIHA. Investigations confirmed an IgG autoantibody against RBCs and high titre Epstein-Barr virus (EBV) viraemia. The patient was at higher risk for EBV disease being seronegative at the time of transplantation but had detectable EBV capsid IgG antibody at the time of presentation. The haemolysis was refractory to high dose steroid and intravenous immunoglobulin. There was a rapid and complete resolution of both the anaemia and the viraemia following rituximab therapy, with no adverse events. Twenty-six units of blood were required during the course of treatment. Conclusions To our knowledge this is the first reported case of EBV associated AIHA in a renal transplant recipient. It highlights a rare pathology associated with post-transplant EBV infection, of broad interest to transplant physicians, haematologists, and microbiologists, and the effective novel use of monoclonal anti-CD20 therapy. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0096-3) contains supplementary material, which is available to authorized users.

Purpose There is no defined training experience to teach the broad range of professional skills needed to transition from critical care trainee to practitioner. We hypothesized that a durable set of career development skills could be created for critical care medicine (CCM) trainees using a novel curriculum defined by both learners and content experts. Materials and methods We presented a curriculum focused on professional development skills to 8 second-year CCM fellows at a university-based training program. A needs assessment using input from faculty and fellows selected 22 topics for the course. Surveys given precurriculum and postcurriculum and at 3-year follow-up measured the perceived importance of these topics and learner comfort with the skills presented. Results Average class attendance was 77%. Seven subjects (87.5%) responded to each survey time point. Comfort scores increased from precourse to postcourse survey. Scores were maintained across most content areas from postcourse survey to follow-up. Respondents attributed a high level of importance to receiving training of this kind. Conclusions Teaching a broad range of career development skills can result in durable confidence when reinforced by regular use postgraduation. This course fills a critical care educational need, facilitating the transition to practitioner after CCM training.

The Alabama Department of Transportation specifies the Superpave® design system for most of its dense-graded HMA mixes. However, there is concern that the number of design gyrations ( NDesign) may be too high for specified traffic levels. Mixes designed with an NDesign level that is too high would be rut resistant but may be difficult to compact in the field and may suffer from durability problems such as premature cracking and raveling. The objective of this project is to evaluate the performance of Alabama's mixes designed according to Superpave criteria and compare them to the performance of Alabama's Marshall-designed mixes to determine whether current NDesign levels should be adjusted. The following conclusions are based on an evaluation of 25 Marshall and Superpave projects placed about the same time and serving under approximately the same traffic conditions: ( a) Generally, both Marshall and Superpave mixtures are performing quite well with little rutting and cracking after a period of about 4 years. ( b) It is likely that most Marshall and Superpave mixtures will not reach the design air voids of 4.0% during the life of the pavement. After 4 years, the average air voids measured in the wheelpaths was 5.3% for Marshall mixes and 5.9% for Superpave mixtures. ( c) It appears that the durability of Superpave mixtures can be improved, without adversely affecting the rutting resistance, by increasing the asphalt content. Practitioners, however, are cautioned to monitor rutting indicators closely during mixture design, production, and construction.

Isolates of human immunodeficiency virus type 1 (HIV-1) are classified according to the chemokine receptor (coreceptor) used in conjunction with CD4 to target and enter cells: viruses using CCR5 and CXCR4 are classified as R5 and X4, respectively. The major determinant of entry-related HIV-1 phenotypes is known to reside in the third variable region of gp120 (V3). It is clear, however, that positions outside of V3 play some role in influencing phenotype, although marked context dependence and extensive variability among HIV-1 isolates have made the identification of these positions difficult. We used the presence of previously described substitutions in V3 to classify a large set of HIV-1 subtype B gp120 sequences available in public databases as X4-like or R5-like. Using these classifications, we searched for positions outside of V3 where either amino acid composition or variability differed significantly among sequences of different inferred phenotypes. Our approach took the epidemiological relationships among sequences into account. A cluster of positions linked to changes in V3 was identified between amino acids 190 and 204 of gp120, immediately C-terminal of V2; changes at position 440 in C4 were also linked to inferred phenotype. Structural data place these positions at the coreceptor-binding face of gp120 in a surface-exposed location. We also noted a significant increase in net positive charge in a highly variable region of V2. This study both confirms previous observations and predicts specific positions that contribute to a functional relationship between V3, V2, and C4.

Any review of assessment values produced by an assessment authority for taxation purposes must use appropriate statistical methods to ensure that the assessment-to-sale price ratio analysis produces reliable results. Failure to do so can lead the reviewer to draw incorrect conclusions concerning the quality of the assessment base. It is my contention that the review of assessments in Hamilton, Ontario, Canada, conducted by Harris and Lehman and published in Environment and Planning A [“Social and geographic inequities in the residential property tax: a review and case study” 33 (5) 881 – 900] produced inaccurate conclusions because of the methodologies used to analyze assessment results. In this paper I will attempt to point out some of the more common methodological errors that are made when analyzing assessed values and demonstrate methods that should be employed to produce results that are more reliable.

Objectives The incidence of cutaneous abscesses has increased markedly since the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Injection drug use is a risk factor for abscesses and may affect the microbiology and treatment of these infections. In a cohort of patients hospitalized with cutaneous abscesses in the era of CA-MRSA, the objectives were to compare the microbiology of abscesses between injection drug users and non–injection drug users and evaluate antibiotic therapy started in the emergency department (ED) in relation to microbiologic findings and national guideline treatment recommendations. Methods This was a secondary analysis of two published retrospective cohorts of patients requiring hospitalization for acute bacterial skin infections between January 1, 2007, and May 31, 2012, in seven academic and community hospitals in Colorado. In the subgroup of patients with cutaneous abscesses, microbiologic findings and the antibiotic regimens started in the ED were compared between injection drug users and non–injection drug users. Antibiotic regimens involving multiple agents, lack of activity against MRSA, or an agent with broad Gram-negative activity were classified as discordant with Infectious Diseases Society of America (IDSA) guideline treatment recommendations. Results Of 323 patients with cutaneous abscesses, 104 (32%) occurred in injection drug users. Among the 235 cases where at least one microorganism was identified by culture, S. aureus was identified less commonly among injection drug users compared with non–injection drug users (55% vs. 75%, p = 0.003), with similar patterns observed for MRSA (33% vs. 47%, p = 0.054) and methicillin-susceptible S. aureus (17% vs. 26%, p = 0.11). In contrast to S. aureus, streptococcal species (53% vs. 25%, p

BACKGROUND Detailed modeling and analysis of renal (dys)function trajectories has not been undertaken in kidney transplant recipients. Although previous studies have assumed linear trajectories, this likely represents an oversimplification. METHODS In this study, a Bayesian smoothing technique was undertaken to create 10,000 Monte Carlo samples for each of 158 patients over a median of 88 months. Specific parameters investigated were the prevalence of nonlinear trajectories, periods of nonprogression, and of rapid progression. RESULTS Forty-five (28%) patients displayed high probability (>80%) for a nonlinear trajectory. Periods of nonprogression were also common, present in 110 (70%) patients. A substantial proportion of patients showed deviation from the classic paradigm of progressive linear loss of graft function with 137 (87%) patients displaying nonlinearity or nonprogression. Only nine (6%) patients demonstrated at least one episode of nonprogression after an episode of progression, that is, once progression occurred, a subsequent period of nonprogression was uncommon. Episodes of nonprogression were less common (P < 0.001) in patients whose grafts subsequently failed, whereas episodes of rapid progression were more common (P = 0.04). CONCLUSION This study highlights the often nonlinear and nonprogressive nature of renal function decline after transplantation. Heightened understanding of the factors influencing these trajectories should help inform patients and clinicians alike.

Interprofessional education (IPE) is recommended by many as a means by which to prepare clinicians for collaborative practice and a mechanism by which to improve the overall quality of health care. The objective of this study was to determine the impact of an interprofessional medicine-pharmacy student home visit experience on students' self-assessments of skills and abilities related to team-based care and identification of medication-related problems.Third-year medical and fourth-year pharmacy students completed an interprofessional home visit centered on identification of medication-related problems. Students were surveyed before and after the IPE assignment to assess changes in self-assessed skills and abilities. Survey items consisted of Likert-type statements on a 5-point scale (1=strongly disagree, 5=strongly agree) and free-text responses. Students also completed reflection papers regarding their experiences.Twenty-two medical and 20 pharmacy students conducted medication-focused interviews of 22 patients at home as interprofessional teams. Medical and pharmacy student self-assessments of skills and abilities related to team-based care and identification of medication-related problems improved after completion of the assignment. Both groups of students perceived an improvement in confidence regarding communication skills, both with patients and with other health professions students. Changes were reported on 12 survey items. Student feedback on the IPE experience was positive.Students' self-perception of skills and abilities related to interprofessional team-based care and identification of medication-related problems are improved after IPE medication-focused home visit assignment. Student feedback supports the value of interprofessional patient care clinical experiences.

Among diabetics, complicated skin infections may involve gram-negative pathogens; however, the microbiology of cellulitis and cutaneous abscess is not well established.To compare the microbiology and prescribing patterns between diabetics and nondiabetics hospitalized for cellulitis or abscess.Secondary analysis of 2 published retrospective cohorts.Adults hospitalized for cellulitis or abscess, excluding infected ulcers or deep tissue infections, at 7 academic and community facilities.Microbiological findings and antibiotic use were compared among diabetics and nondiabetics. Multivariable logistic regression was performed to identify factors associated with exposure to broad gram-negative therapy, defined as receipt of at least 2 calendar days of β-lactamase inhibitors, second- to fifth-generation cephalosporins, fluoroquinolones, carbapenems, tigecycline, aminoglycosides, or colistin.Of 770 total patients with cellulitis or abscess, 167 (22%) had diabetes mellitus. Among the 38% of cases with a positive culture, an aerobic gram-positive organism was isolated in 90% of diabetics and 92% of nondiabetics (P = 0.59); aerobic gram-negative organisms were isolated in 7% and 12%, respectively (P = 0.28). Overall, diabetics were more likely than nondiabetics to be exposed to broad gram-negative therapy (54% vs 44% of cases, P = 0.02). By logistic regression, diabetes mellitus was independently associated with exposure to broad gram-negative therapy (odds ratio: 1.66, 95% confidence interval: 1.15-2.40).In cases of cellulitis or abscess associated with a positive culture, gram-negative pathogens were not more common among diabetics compared with nondiabetics. However, diabetics were overall more likely to be exposed to broad gram-negative therapy suggesting this prescribing practice may not be not warranted.

Malaria vector control relies on toxicity of insecticides used in long lasting insecticide treated nets and indoor residual spraying. This is despite evidence that sub-lethal insecticides reduce human-vector contact and malaria transmission. The impact of sub-lethal insecticides on host seeking and blood feeding of mosquitoes was measured. Taxis boxes distinguished between repellency and attraction inhibition of mosquitoes by measuring response of mosquitoes towards or away from Transfluthrin coils and humans. Protective effective distance of coils and long-term effects on blood feeding were measured in the semi-field tunnel and in a Peet Grady chamber. Laboratory reared pyrethroid susceptible Anopheles gambiae sensu stricto mosquitoes were used. In the taxis boxes, a higher proportion of mosquitoes (67%-82%) were activated and flew towards the human in the presence of Transfluthrin coils. Coils did not hinder attraction of mosquitoes to the human. In the semi-field Tunnel, coils placed 0.3 m from the human reduced feeding by 86% (95% CI [0.66; 0.95]) when used as a "bubble" compared to 65% (95% CI [0.51; 0.76]) when used as a "point source". Mosquitoes exposed to coils inside a Peet Grady chamber were delayed from feeding normally for 12 hours but there was no effect on free flying and caged mosquitoes exposed in the semi-field tunnel. These findings indicate that airborne pyrethroids minimize human-vector contact through reduced and delayed blood feeding. This information is useful for the development of target product profiles of spatial repellent products that can be used to complement mainstream malaria vector control tools.

Background\ud Current malaria vector control programmes rely on insecticides with rapid contact toxicity. However, spatial repellents can also be applied to reduce man-vector contact, which might ultimately impact malaria transmission. The aim of this study was to quantify effects of airborne pyrethroids from coils and DDT used an indoor residual spray (IRS) on entomological parameters that influence malaria transmission.\ud \ud Methods\ud The effect of Transfluthrin and Metofluthrin coils compared to DDT on house entry, exit and indoor feeding behaviour of Anopheles gambiae sensu lato were measured in experimental huts in the field and in the semi-field. Outcomes were deterrence - reduction in house entry of mosquitoes; irritancy or excito-repellency – induced premature exit of mosquitoes; blood feeding inhibition and effect on mosquito fecundity.\ud \ud Results\ud Transfluthrin coils, Metofluthrin coils and DDT reduced human vector contact through deterrence by 38%, 30% and 8%, respectively and induced half of the mosquitoes to leave huts before feeding (56%, 55% and 48%, respectively). Almost all mosquitoes inside huts with Metofluthrin and Transfluthrin coils and more than three quarters of mosquitoes in the DDT hut did not feed, almost none laid eggs and 67%, 72% and 70% of all mosquitoes collected from Transfluthrin, Metofluthrin and DDT huts, respectively had died after 24 hours.\ud \ud Conclusion\ud This study highlights that airborne pyrethroids and DDT affect a range of anopheline mosquito behaviours that are important parameters in malaria transmission, namely deterrence, irritancy/excito-repellency and blood-feeding inhibition. These effects are in addition to significant toxicity and reduced mosquito fecundity that affect mosquito densities and, therefore, provide community protection against diseases for both users and non-users. Airborne insecticides and freshly applied DDT had similar effects on deterrence, irritancy and feeding inhibition. Therefore, it is suggested that airborne pyrethroids, if delivered in suitable formats, may complement existing mainstream vector control tools.

Background Long-Lasting Insecticidal Nets (LLINs) are one of the major malaria vector control tools, with most countries adopting free or subsidised universal coverage campaigns of populations at-risk from malaria. It is essential to understand LLIN durability so that public health policy makers can select the most cost effective nets that last for the longest time, and estimate the optimal timing of repeated distribution campaigns. However, there is limited knowledge from few countries of the durability of LLINs under user conditions. Methods/Design This study investigates LLIN durability in eight districts of Tanzania, selected for their demographic, geographic and ecological representativeness of the country as a whole. We use a two-stage approach: First, LLINs from recent national net campaigns will be evaluated retrospectively in 3,420 households. Those households will receive one of three leading LLIN products at random (Olyset®, PermaNet®2.0 or Netprotect®) and will be followed up for three years in a prospective study to compare their performance under user conditions. LLIN durability will be evaluated by measuring Attrition (the rate at which nets are discarded by households), Bioefficacy (the insecticidal efficacy of the nets measured by knock-down and mortality of mosquitoes), Chemical content (g/kg of insecticide available in net fibres) and physical Degradation (size and location of holes). In addition, we will extend the current national mosquito insecticide Resistance monitoring program to additional districts and use these data sets to provide GIS maps for use in health surveillance and decision making by the National Malaria Control Program (NMCP). Discussion The data will be of importance to policy makers and vector control specialists both in Tanzania and the SSA region to inform best practice for the maintenance of high and cost-effective coverage and to maximise current health gains in malaria control. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1266) contains supplementary material, which is available to authorized users.

Employing a technology called differential immunization for antigen and antibody discovery (DIAAD), we aimed to generate monoclonal antibodies (mAbs) specific to human multiple myeloma (MM) cells. The fundamental principles of DIAAD rely on the induction of high zone tolerance to the "wild type" (normal) antigen. followed by immunization with the modified (diseased) antigen. Because chronic myelogenic leukemia (CML) cells are derived from a lineage closely related to MM, we immunized mice by contrasting a pool of MM cells with CML cells. Monoclonal antibody VAC69 reacted exclusively with MM cells, identifying a membrane molecule composed of a single-chain glycoprotein with a molecular weight of 78-120 kd. This antigen exhibited narrow tissue specificity and was not found on human cancers such as prostate, breast, or cervical carcinoma; leukemia; or lymphoma, nor was it seen on normal human peripheral lymphocytes or on Epstein-Barr virus-transformed B-cell lines. By immunohistochemistry, mAb VAC69 showed no binding to antigens expressed on normal human ovary, breast, prostate, lung or colon tissue, nor did it bind to human breast or prostate cancer. Conversely, mAb VAC69 bound strongly to human MM, although showing only slight binding to histiocytes or inflamed cells in human lymph nodes and human tumors of the colon, lung, and ovary. Monoclonal antibody VAC69 also triggered cancer-specific cytotoxicity in vitro (in the presence of complement) as well as in vivo using a sever combined immunodeficiency model transplanted with human MM. Further studies showed the ability of mAb VAC69 to be specifically internalized by human MM cells, indicating its potential use for therapeutic intervention in MM by delivering drugs into cancer cells.

Dorsal Hippocampal neurons provide an allocentric map of space, characterized by three key properties. First, their firing is spatially selective, termed a rate code. Second, as animals traverse through place fields, neurons sustain elevated firing rates for long periods, however this has received little attention. Third the theta-phase of spikes within this sustained activity varies with animal's location, termed phase-precession or a temporal code. The precise relationship between these properties and the mechanisms governing them are not understood, although distal visual cues (DVC) are thought to be sufficient to reliably elicit them. Hence, we measured rat CA1 neurons' activity during random foraging in two-dimensional VR—where only DVC provide consistent allocentric location information— and compared it with their activity in real world (RW). Surprisingly, we found little spatial selectivity in VR. This is in sharp contrast to robust spatial selectivity commonly seen in one-dimensional RW and VR, or two-dimensional RW. Despite this, neurons in VR generated approximately two-second long phase precessing spike sequences, termed “hippocampal motifs”. Motifs, and “Motif-fields”, an aggregation of all motifs of a neuron, had qualitatively similar properties including theta-scale temporal coding in RW and VR, but the motifs were far less spatially localized in VR. These results suggest that intrinsic, network mechanisms generate temporally coded hippocampal motifs, which can be dissociated from their spatial selectivity. Further, DVC alone are insufficient to localize motifs spatially to generate a robust rate code.

Although reduced biological activity of the obese gene product, leptin, has been associated with obesity, little information is available concerning leptin alterations during anorexia. Therefore, we measured circulating leptin concentrations and hypothalamic leptin binding in anorectic tumor-bearing and pair-fed control rats. Plasma concentrations of leptin decreased in tumor-bearing rats early in the course of tumor growth, and fell to nearly non-detectable levels during severe anorexia. The pair-fed control rats that ate the same amount of food as did the anorectic tumor-bearing rats exhibited a 50% decrease in plasma leptin concentration. Concentrations of free fatty acids were elevated in both tumor-bearing and pair-fed groups, while circulating levels of triglycerides were increased only in anorectic tumor-bearing rats. Leptin receptor density was doubled in the hypothalamus of tumor bearing rats, while binding affinity was decreased by 50%. These results suggest that peripheral leptin production is down-regulated, perhaps due to increased lipolysis in tumor-bearing rats. It appears that hypothalamic leptin systems up-regulate receptor numbers in response to decreased blood leptin level, however, the decrease in binding affinity may compensate for these alterations. Therefore, the influence of leptin on hypothalamic neuropeptide Y feeding systems may be minimal in anorectic tumor-bearing rats.

Leptin and the leptin receptor are key players in the regulation of body weight. In an attempt to dissect the molecular mechanism of the Zucker fatty rat leptin receptor mutation (Gln269 --Pro) we analyzed the effects of this mutation on leptin receptor signaling and expression in three different expression systems: 1) 32D cells expressing leptin/erythropoietin receptor chimeras, 2) COS-7 cells expressing a leptin receptor short form, and 3) 293 cells expressing soluble receptor forms. To determine if the Gln269 --Pro mutation is critical for the observed phenotype, we made a similar Gln --Pro mutation at a vicinal residue two amino acids upstream of the fatty mutation to see if it would have similar effects. Incorporation of either of the Gln --Pro mutations into wild type receptor forms did not interfere with leptin binding, but it resulted in a signaling-incompetent receptor. In addition, the majority of the mutant receptor protein was localized intracellularly. Our results suggest that the obese phenotype resulting from the Gln269 --Pro mutation in the leptin receptor of the Zucker fatty rat may be due not only to a reduced cell surface expression of this form of the leptin receptor, but also to a post-leptin binding malfunction of the receptor that interferes with subsequent signal transduction.

Prader-Willi syndrome (PWS) is characterized by early childhood obesity, mental deficiency, hypogonadism, hypotonia, hypopigmentation, short stature, small hands and feet, and a characteristic face. It is the most common genetic cause of obesity and obesity is the most significant health problem for PWS patients. Ob protein (leptin), which is produced by adipose tissue, is thought to play a significant role in obesity; thus, unusually low plasma leptin levels, or relative loss of sensitivity to leptin in PWS subjects, could be an important factor in their obesity. We measured plasma leptin levels in 19 obese and 14 non-obese PWS patients [mean body mass index (BMI) 37.2 and 22.0, respectively] and compared these levels to those of 28 obese controls (mean BMI 35.5) and 16 non-obese control individuals (mean BMI 21.6). The mean plasma leptin concentration (ng/ml) for obese PWS subjects was 33.4 and 23.6 for non-obese PWS subjects. Obese control leptin was 36.2 ng/ml and non-obese control was 9.9. Among the control groups, leptin levels in females were significantly higher than those in males; the obese males and females had significantly higher leptin than their respective non-obese counterparts. These differences did not hold true for the PWS subjects. Leptin levels in obese PWS males and females were similar, and the same was true of the non-obese PWS males and females. The differences between obese and non-obese PWS subjects of both sexes were small and not significant. Comparing control groups with their PWS counterparts revealed no significant differences, with one exception: circulating plasma leptin levels in non-obese PWS males were nearly five times higher than in non-obese control males with similar BMI. This difference may reflect a more female pattern of fat distribution and hypogonadism, which are characteristic of PWS males. Leptin levels in PWS patients were not obviously correlated with the chromosome 15 finding seen in the patients.

An architecture for a combinational floating point multiplier and squarer is described for the purpose of producing a low power floating point square with small area requirements. The floating-point multiplier and squarer architecture are compared to demonstrate the power advantage of the squarer. The multiplier and squarer are combined into one circuit in order to take advantage of the squarer power improvements with a minimal increase in area. Shared circuitry among the units provides justification for inclusion of a dedicated squarer since a small amount of additional circuitry is required and the power savings for squaring computations is significant as compared to the use of a general-purpose multiplier to generate a squared value.

Hundreds of millions of people use hand-held devices frequently and control them by touching the screen with their fingers. If this method of operation is being used by people who are driving, the probability of deaths and accidents occurring substantially increases. With a non-contact control interface, people do not need to touch the screen. As a result, people will not need to pay as much attention to their phones and thus drive more safely than they would otherwise. This interface can be achieved with real-time stereovision. A novel Intensity Profile Shape-Matching Algorithm is able to obtain 3-D information from a pair of stereo images in real time. While this algorithm does have a trade-off between accuracy and processing speed, the result of this algorithm proves the accuracy is sufficient for the practical use of recognizing human poses and finger movement tracking. By choosing an interval of disparity, an object at a certain distance range can be segmented. In other words, we detect the object by its distance to the cameras. The advantage of this profile shape-matching algorithm is that detection of correspondences relies on the shape of profile and not on intensity values, which are subjected to lighting variations. Based on the resulting 3-D information, the movement of fingers in space from a specific distance can be determined. Finger location and movement can then be analyzed for non-contact control of hand-held devices.

In recent years, autonomous, micro-unmanned aerial vehicles (micro-UAVs), or more specifically hovering micro- UAVs, have proven suitable for many promising applications such as unknown environment exploration and search and rescue operations. The early versions of UAVs had no on-board control capabilities, and were difficult for manual control from a ground station. Many UAVs now are equipped with on-board control systems that reduce the amount of control required from the ground-station operator. However, the limitations on payload, power consumption and control without human interference remain the biggest challenges. This paper proposes to use a smartphone as the sole computational device to stabilize and control a quad-rotor. The goal is to use the readily available sensors in a smartphone such as the GPS, the accelerometer, the rate-gyros, and the camera to support vision-related tasks such as flight stabilization, estimation of the height above ground, target tracking, obstacle detection, and surveillance. We use a quad-rotor platform that has been built in the Robotic Vision Lab at Brigham Young University for our development and experiments. An Android smartphone is connected through the USB port to an external hardware that has a microprocessor and circuitries to generate pulse-width modulation signals to control the brushless servomotors on the quad-rotor. The high-resolution camera on the smartphone is used to detect and track features to maintain a desired altitude level. The vision algorithms implemented include template matching, Harris feature detector, RANSAC similarity-constrained homography, and color segmentation. Other sensors are used to control yaw, pitch, and roll of the quad-rotor. This smartphone-based system is able to stabilize and control micro-UAVs and is ideal for micro-UAVs that have size, weight, and power limitations.

BACKGROUND: Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are commonly used together in the same households to improve malaria control despite inconsistent evidence on whether such combinations actually offer better protection than nets alone or IRS alone. METHODS: Comparative tests were conducted using experimental huts fitted with LLINs, untreated nets, IRS plus untreated nets, or combinations of LLINs and IRS, in an area where Anopheles arabiensis is the predominant malaria vector species. Three LLIN types, Olyset®, PermaNet 2.0® and Icon Life® nets and three IRS treatments, pirimiphos-methyl, DDT, and lambda cyhalothrin, were used singly or in combinations. We compared, number of mosquitoes entering huts, proportion and number killed, proportions prevented from blood-feeding, time when mosquitoes exited the huts, and proportions caught exiting. The tests were done for four months in dry season and another six months in wet season, each time using new intact nets. RESULTS: All the net types, used with or without IRS, prevented >99% of indoor mosquito bites. Adding PermaNet 2.0® and Icon Life®, but not Olyset® nets into huts with any IRS increased mortality of malaria vectors relative to IRS alone. However, of all IRS treatments, only pirimiphos-methyl significantly increased vector mortality relative to LLINs alone, though this increase was modest. Overall, median mortality of An. arabiensis caught in huts with any of the treatments did not exceed 29%. No treatment reduced entry of the vectors into huts, except for marginal reductions due to PermaNet 2.0® nets and DDT. More than 95% of all mosquitoes were caught in exit traps rather than inside huts. CONCLUSIONS: Where the main malaria vector is An. arabiensis, adding IRS into houses with intact pyrethroid LLINs does not enhance house-hold level protection except where the IRS employs non-pyrethroid insecticides such as pirimiphos-methyl, which can confer modest enhancements. In contrast, adding intact bednets onto IRS enhances protection by preventing mosquito blood-feeding (even if the nets are non-insecticidal) and by slightly increasing mosquito mortality (in case of LLINs). The primary mode of action of intact LLINs against An. arabiensis is clearly bite prevention rather than insecticidal activity. Therefore, where resources are limited, priority should be to ensure that everyone at risk consistently uses LLINs and that the nets are regularly replaced before being excessively torn. Measures that maximize bite prevention (e.g. proper net sizes to effectively cover sleeping spaces, stronger net fibres that resist tears and burns and net use practices that preserve net longevity), should be emphasized.

Background\ud \ud Malaria control methods targeting indoor-biting mosquitoes have limited impact on vectors that feed and rest outdoors. Exploiting mosquito olfactory behaviour to reduce blood-feeding outdoors might be a sustainable approach to complement existing control strategies. Methodologies that can objectively quantify responses to odour under realistic field conditions and allow high-throughput screening of many compounds are required for development of effective odour-based control strategies.\ud \ud Methods\ud \ud The olfactory responses of laboratory-reared Anopheles gambiae in a semi-field tunnel and A. arabiensis females in an outdoor field setting to three stimuli, namely whole human odour, a synthetic blend of carboxylic acids plus carbon dioxide and CO2 alone at four distances up to 100 metres were measured in two experiments using three-chambered taxis boxes that allow mosquito responses to natural or experimentally-introduced odour cues to be quantified.\ud \ud Results\ud \ud Taxis box assays could detect both activation of flight and directional mosquito movement. Significantly more (6-18%) A. arabiensis mosquitoes were attracted to natural human odour in the field up to 30 metres compared to controls, and blended synthetic human odours attracted 20% more A. gambiae in the semi-field tunnel up to 70 metres. Whereas CO2 elicited no response in A. arabiensis in the open field, it was attractive to A. gambiae up to 50 metres (65% attraction compared to 36% in controls).\ud \ud Conclusions\ud \ud We have developed a simple reproducible system to allow for the comparison of compounds that are active over medium- to long-ranges in semi-field or full-field environments. Knowing the natural range of attraction of anopheline mosquitoes to potential blood sources has substantial implications for the design of malaria control strategies, and adds to the understanding of olfactory behaviour in mosquitoes. This experimental strategy could also be extended from malaria vectors to other motile arthropods of medical, veterinary and agricultural significance.

The upper and lower neck loads in the restrained Hybrid III dummy and Test Device for Human Occupant Restraint (THOR) were computed in simulated frontal impact sled tests at low, medium, and high velocities; repeatability performance of the two dummies were evaluated at all energy inputs; peak forces and moments were compared with computed loads at the occipital condyles and cervical-thoracic junctions from tests using post mortem human surrogates (PMHS). A custom sled buck was used to position the surrogates. Repeated tests were conducted at each velocity for each dummy and sufficient time was allowed to elapse between the two experiments. The upper and lower neck forces and moments were determined from load cell measures and its locations with respect to the ends of the neck. Both dummies showed good repeatability for axial and shear forces and bending moments at all changes in velocity inputs. Morphological characteristics in the neck loading responses were similar in all surrogates, although the peak magnitudes of the variables differed. In general, the THOR better mimicked the PMHS response than the Hybrid III dummy, and factors such as neck design and chest compliance were attributed to the observed variations. While both dummies were not designed for use at the two extremes of the tested velocities, results from the present study indicate that, currently the THOR may be the preferred anthropomorphic testing device in crashworthiness research studies and full-scale vehicle tests at all velocities.

Background Bio-efficacy and residual activity of insecticides used for indoor residual spraying (IRS) and long-lasting insecticide nets (LLINs) were assessed against laboratory-reared and wild populations of the malaria vector, Anopheles arabiensis in south eastern Tanzania. Implications of the findings are examined in the context of potential synergies and redundancies where IRS and LLINs are combined. Methods Bioassays were conducted monthly for six months on three LLIN types (Olyset® PermaNet 2.0®,and Icon Life®) and three IRS treatments (2 g/m2 pirimiphos-methyl, 2 g/m2 DDT and 0.03 g/m2 lambda-cyhalothrin, sprayed on mud walls and palm ceilings of experimental huts). Tests used susceptible laboratory-reared An. arabiensis exposed in cones (nets and IRS) or wire balls (nets only). Susceptibility of wild populations was assessed using WHO diagnostic concentrations and PCR for knock-down resistance (kdr) genes. Results IRS treatments killed ≥ 85% of mosquitoes exposed on palm ceilings and ≥ 90% of those exposed on mud walls, but up to 50% of this toxicity decayed within 1–3 months, except for DDT. By 6th month, only 7.5%, 42.5% and 30.0% of mosquitoes died when exposed to ceilings sprayed with pirimiphos-methyl, DDT or lambda-cyhalothrin respectively, while 12.5%, 36.0% and 27.5% died after exposure to mud walls sprayed with the same insecticides. In wire-ball assays, mortality decreased from 98.1% in 1st month to 92.6% in 6th month in tests on PermaNet 2.0®, from 100% to 61.1% on Icon Life® and from 93.2% to 33.3% on Olyset® nets. In cone bioassays, mortality reduced from 92.8% in 1st month to 83.3% in 6th month on PermaNet 2.0®, from 96.9% to 43.80% on Icon Life® and from 85.6% to 14.6% on Olyset®. Wild An. arabiensis were 100% susceptible to DDT, 95.8% to deltamethrin, 90.2% to lambda cyhalothrin and 95.2% susceptible to permethrin. No kdr gene mutations were detected. Conclusions In bioassays where sufficient contact with treated surfaces is assured, LLINs and IRS kill high proportions of susceptible An. arabiensis mosquitoes, though these efficacies decay gradually for LLINs and rapidly for IRS. It is, therefore, important to always add intact nets in sprayed houses, guaranteeing protection even after the IRS decays, and to ensure accurate timing, quality control and regular re-spraying in IRS programmes. By contrast, adding IRS in houses with intact LLINs is unlikely to improve protection relative to LLINs alone, since there is no guarantee that unfed vectors would rest long enough on the sprayed surfaces, and because of the rapid IRS decay. However, there is need to clarify these effects using data from observations of free flying mosquitoes in huts. Physiological susceptibility of An. arabiensis in the area remains 100% against DDT, but is slightly reduced against pyrethroids, necessitating caution over possible spread of resistance. The loss of LLIN toxicity, particularly Olyset® nets suggests that protection offered by these nets against An. arabiensis may be primarily due to physical bite prevention rather than insecticidal efficacy.

OBJECTIVES Serum phosphate concentrations have been shown to predict graft loss in prevalent, but not incident, kidney transplant populations. The reasons for this are unknown. We investigated whether serum phosphate at 6 or 12 months posttransplant was associated with graft loss in the same cohort. MATERIALS AND METHODS Data were collected for 325 patients transplanted and followed up at a single center (1996-2004). The association between serum phosphate at 6 and 12 months posttransplant and graft failure was analyzed. RESULTS Univariable associations with death-censored graft failure were seen for serum phosphate at 6 and 12 months (hazard ratio [HR] 1.33; 95% confidence interval [CI] 1.20-1.48; P < .001, and HR 1.40; CI 1.27-1.54; P < .001). On bivariable analysis (phosphate at 6 vs 12 mo), a significant association remained for both variables and increased graft failure rate (HR 1.19; CI 1.07-1.34; P = .002, and HR 1.37; CI 1.21-1.55; P < .001). These associations persisted in multivariable models (HR 1.27; CI 1.07-1.51; P = .007, and HR 1.34; CI 1.14-1.57; P < .001 for phosphate at 6 and 12 mo). CONCLUSIONS Serum phosphate at 6 and 12 months posttransplant is an independent predictor of graft loss. Any future trial designed to investigate the benefits of phosphate lowering should consider recruiting patients as early as 6 months posttransplant.

Background Vapour phase spatial repellents deter mosquitoes from attacking one or more humans in a protected space. Simulation models indicate that high coverage of spatial repellents can enhance the impact of long - lasting insecticide nets (LLINs) and indoor residual spraying (IRS) where mosquito vectors commonly bite humans outdoors. Here we report a preliminary evaluation of an effective, user-friendly prototype product for delivering spatial repellents to protect against malaria vector mosquitoes. Findings Protective efficacy of a 4.0 × 0.3 m strip of hessian sacking treated with 10 ml of transfluthrin was evaluated in a 60 m × 2 m ×2.5 m netting tunnel with malaria-free insectary-reared Anopheles arabiensis Patton mosquitoes. Personal protection, in terms of proportional reduction of exposure to bites, was measured by comparing human landing catches of volunteers with treated and untreated strips. A freshly treated hessian strip reduced mosquito attack rate on human volunteers by > 99% and consistently conferred > 90% protective efficacy for a period of 6 months. Over the entire study period, only 22 out of 1400 released mosquitoes bit volunteers using the treated sacking strip while 894 out of 1400 mosquitoes released into cages containing volunteers using an untreated strip fed upon them. Conclusion Locally available natural fibers may be promising absorbent substrates for delivering spatial repellents, such as transfluthrin, to protect against mosquitoes in tropical settings. However, these observations relate to a single prototype specimen of this particular device, therefore, much more detailed, well replicated studies are essential to establish long-term efficacy, effectiveness, practicability and affordability.

Background and Aims: Some studies suggest that increased arsenic methylation ability may reduce the risk of skin cancer, though previous studies failed to differentiate between basal cell carcinoma...

Despite comorbidity associated with chronic kidney disease, little data exist applying comorbidity scoring systems to renal transplant recipients. This study compared the performance of 7 established comorbidity scores in predicting mortality after kidney transplantation.We retrospectively analyzed prospectively collected data from 2033 incident renal transplant recipients. Comorbidity was assessed at baseline, and the following scores were derived: Recipient Risk Score, Charlson Comorbidity Index, Age-adjusted Charlson Comorbidity Index, Modified End-Stage Renal Disease Charlson Comorbidity Index, Foley Score, Wright-Khan Index, and Davies Index. Cox models investigated the association of each comorbidity score with mortality; performance characteristics were tested using receiver operating characteristic curve analysis.Age-stratified Cox analyses showed the Recipient Risk Score-based model displayed the best fit, and receiver operating characteristic curve analysis showed the Recipient Risk Score demonstrated greatest predictive use (5-year mortality c-statistic: 0.787). The independent effect of age on mortality was demonstrated after analysis of scores not containing age as a component (the Charlson Comorbidity Index, the Modified End-Stage Renal Disease Charlson Comorbidity Index, the Davies Index); addition of age to these scores improved fit.Of the currently available comorbidity scores, the Recipient Risk Score demonstrated greatest use. This has implications for deceased-donor allocation algorithms, assessment of confounders in clinical research, and potentially, individual patient management.

The forkhead gene (FKH) regulates morphogenesis in Drosophila. It is the prototype of a new family of transcriptional activators. Partially degenerate oligonucleotides to two conserved amino acid sequences of this family were used to prime a polymerase chain reaction (PCR) amplification of HEL cell cDNA. Two unique clones, designated H3 and H8, were isolated that contained homologies to FKH. A third novel clone, 5–3, was isolated by low stringency screening of a chronic myelogenous leukemia cDNA library using H8 as a probe. H3 and 5–3 are preferentially expressed in restricted hematopoietic lineages, while the expression of H8 was ubiquitous. Southern analysis showed that FKH 5–3 is conserved through yeast, which is rare among tissue-specific transcription factors. The H3 and 5–3 clones provide evidence that FKH family members are present in a tissue-restricted manner in humans.

The impact of disordered mineral and bone metabolism following kidney transplantation is not well defined. We studied the association of serum phosphate and calcium concentrations, and surrogate measures of arterial stiffness (augmentation index: AIx and Timing of the reflected wave: Tr), with long-term kidney transplant recipient and allograft survival. Prevalent adult renal transplant patients (n = 270) were prospectively studied over a median 88-month follow-up. Detailed demographic, clinical and laboratory data, in addition to both peripheral and central non-invasive blood pressure measurements, were recorded. Higher serum phosphate and calcium levels were associated with increased all-cause mortality (HR: 1.21; 95% CI 1.09,1.35, p0.001 and HR: 1.22; 95% CI 1.01,1.48; p0.04, respectively; adjusted Cox model) and death-uncensored graft loss (p0.001 and p = 0.03, respectively). In addition, serum calcium and phosphate were associated with death-censored graft loss on univariable analysis (p0.001 and p = 0.02, respectively), but did not retain significance on multivariable analysis. AIx and Tr were not associated with mortality or graft loss on multivariable analysis. This is the first report to demonstrate that both higher serum phosphate and calcium levels are associated with increased mortality in kidney transplant recipients. It highlights the need for randomized trials assessing current interventions available for improving disordered mineral-bone metabolism post transplantation.

Catches of Anopheles gambiae and An. arabiensis with the Ifakara Tent Trap-model B (ITT-B) correlate better with human landing catches than any other method but fail to reduce the proportion of blood-fed mosquito caught, which indicates that users are exposed to bites during collection. An improved C model (ITT-C) was developed and evaluated by comparing with ITT-B in semi-field and full-field conditions in southern Tanzania. The sensitivity of the ITT-C was approximately two times that of the ITT-B: relative rate (95% confidence interval) = 1.92 (1.52–2.42), 1.90 (1.48–2.43), and 2.30 (1.54–3.30) for field populations of An. arabiensis, Culex spp., and Mansonia spp., respectively. The ITT-C caught 73% less blood-fed An. arabiensis than the ITT-B in open field experiments and none in semi-field experiments, which confirmed that the C design is a safe trapping method. Validation of ITT-C by comparison with human landing catches and parasitologic measures of human infection status may be necessary to confirm that this design produces consistent and epidemiologically meaningful results.