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Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35 °C, 60% relative humidity) or thermo-neutral (20 °C, 20% relative humidity) conditions. In this pilot phase to determine the feasibility of study procedures, HCWs in PPE were non-randomly allocated to hot or thermo-neutral conditions to perform peripheral intravenous (PIV) and midline catheter (MLC) insertion and endotracheal intubation (ETI) on mannequins. Eighteen HCWs (13 physicians, 4 nurses, 1 nurse practitioner, 2 with prior ETU experience, 10 in hot conditions) spent 69 (10) (mean (SD)) minutes in the simulated ETU. Mean (SD) task completion times were 16 (6) min for PIV insertion, 33 (5) min for MLC insertion, and 16 (8) min for ETI. Satisfactory task completion was numerically higher for physicians vs. nurses. Participants’ blood pressure was similar, but heart rate was higher (p = 0.0005) post-simulation vs. baseline. Participants had a median (range) of 2.0 (0.0–10.0) minor PPE breaches, 2.0 (0.0–6.0) near-miss incidents, and 2.0 (0.0–6.0) health symptoms and concerns. There were eight health-assessment triggers in five participants, of whom four were in hot conditions. We terminated the simulation of two participants in hot conditions due to thermal discomfort. In summary, study tasks were suitable for physician participants, but they require redesign to match nurses’ expertise for the subsequent randomized phase of the study. One-quarter of participants had a health-assessment trigger. This research model may be useful in future training and research regarding clinical care for patients with highly infectious pathogens in austere settings.

Dielectric liquids, in combination with solids, have been used for insulating power transformers for more than a century. While mineral oils have dominated the market, new liquids with different molecular structures are now in common use. This brochure addresses the dielectric performance of the liquids as used in a transformer - including the potential influence of solid insulation on the behaviour of prebreakdown streamers in the liquid. Topics discussed include how the chemical composition of liquids influences the streamer velocities and breakdown, and how the electric field configuration may govern breakdown modes. The aim of this brochure is to review the dielectric requirements and test standards of dielectric liquids as seen from a transformer designer, to review the behaviour of dielectric liquids.

We estimate a global vector autoregression model to examine the effects of euro area and US monetary policy stances, together with the effect of euro area consumer prices, on economic activity and prices in non-euro EU countries using monthly data from 2001-2016. Along with some standard macroeconomic variables, our model contains measures of the shadow monetary policy rate to address the zero lower bound and the implementation of unconventional monetary policy by the European Central Bank and the US Federal Reserve. We find that these monetary shocks have the expected qualitative effects but their magnitude differs across countries, with southeastern EU economies being less affected than their peers in Central Europe. Euro area monetary shocks have a greater effect than those that emanate from the US. We also find certain evidence that the effects of unconventional monetary policy measures are weaker than those of conventional measures. The spillovers of euro area price shocks to non-euro EU countries are limited, suggesting that the law of one price materializes slowly.

The opioid crisis and complications related to injection drug use are a public health emergency. The combination of addiction and injection drug use is a devastating double-edged sword: it predisposes patients to severe life-threatening infections like endocarditis, and epidural abscess, as well as to disorganized behaviour and impaired decision-making that interferes with the completion of prolonged courses of required antibiotic therapy. Poverty and stigma add further fuel to the fire. The Community Transitional Care Team (CTCT) is a revolutionary community-based short-term residence where people who inject drugs can stay to complete their course of antibiotics. We present the case of a young woman struggling with addiction, tremendous social barriers to health, and life threating Staphylococcus aureus infection that highlights the benefits of strong, community-based, and individualized models of patient care.

BACKGROUND: Established in the Americas since late 2013, chikungunya is an emerging infection among travellers. OBJECTIVE: To examine demographic and travel correlates of chikungunya among Canadian travellers to establish a detailed epidemiological framework of this infection for Canadian practitioners encountering prospective and returned travellers. METHODS: Data regarding ill returned Canadian travellers presenting to a CanTravNet site between 2006 and 2015 were analyzed. RESULTS: During the study period, 22,387 ill travellers and immigrants presented to a CanTravNet site and, of these, 118 (0.5%) received a diagnosis of chikungunya. Those travelling for tourism were the most well-represented (n=49, 41.5%), followed by those travelling to visit friends and relatives (n=36, 30.5%). The Caribbean was the most likely source region, accounting for 64 (54.2%) diagnoses, followed by South Central Asia (n=18, 15.3%). Haiti was the most well-represented source country, accounting for 22 (18.6%) cases. India, a high-volume destination for Canadians and the next most well-represented source country, accounted for 15 cases (12.7%), as did Jamaica. Median trip duration of those with chikungunya was 14 days, with 51.7% (n=61) having a trip duration of ≤2 weeks and 21.2% (n=25) ≤1 week. Musculoskeletal complaints at presentation were noted in 89% (n=105), followed by fever in 54.2% (n=64). CONCLUSIONS: The present analysis provides an epidemiological framework of chikungunya for Canadian practitioners encountering prospective and returned travellers. It reflects the emergence of chikungunya in the Americas, the risk associated with short-duration travel and substantiates efforts to educate travellers about the need for mosquito avoidance.

BACKGROUND: Widespread transmission of Zika virus in the Americas has occurred since late 2015. We examined demographic and travel-related characteristics of returned Canadian travellers with Zika infection acquired in the Americas to illuminate risk factors for acquisition and the clinical spectrum. METHODS: We analyzed demographic and travel-related data for returned Canadian travellers who presented to a CanTravNet site between October 2015 and September 2016 for care of Zika virus acquired in the Americas. Data were collected with use of the GeoSentinel Surveillance Network data platform. RESULTS: During the study period, 1118 travellers presented to a CanTravNet site after returning from the Americas, 41 (3.7%) of whom had Zika infection. Zika infection from the Americas was diagnosed at CanTravNet sites as often as dengue ( n = 41) over the study period. In the first half of the study period, Zika virus burden was borne by people visiting friends and relatives in South America. In the latter half, coincident with the increased spread of Zika throughout the Caribbean and Central America, Zika virus occurred more often in tourists in the Caribbean. Forty (98%) of the travellers with Zika infection acquired it through probable mosquito exposure, and 1 had confirmed sexual acquisition. Congenital transmission occurred in 2 of 3 pregnancies. Two (5%) of those with Zika had symptoms resembling those of Guillain–Barre syndrome, 1 of whom also had Zika viral meningitis. INTERPRETATION: Even in this small cohort, we observed the full clinical spectrum of acute Zika virus, including adverse fetal and neurologic outcomes. Our observations suggest that complications from Zika infection are underestimated by data arising exclusively from populations where Zika is endemic. Travellers should adhere to mosquito-avoidance measures and barrier protection during sexual activity.

Background: Herpes zoster can be associated with severe neurological complications.Case presentation: In this article, we describe the case of a 54-year-old man with herpes zoster affecting his right upper chest and neck region complicated by phrenic nerve palsy and respiratory compromise. The diagnosis of herpes zoster was made based on the classic appearance of the rash and associated neuropathic-type pain. The diagnosis of phrenic nerve palsy was made by chest x-ray and ultrasound.Conclusion: Clinicians should be aware of the possibility of phrenic nerve palsy occurring in patients who have herpes zoster affecting the region of C3,4,5 dermatomes. Although symptoms of unilateral diaphragmatic paresis are usually mild, in patients with obesity or comorbid lung disease, new onset phrenic nerve palsy can lead to significant respiratory compromise.Keywords: Herpes zoster, neurologic complication, phrenic nerve palsy, case report.

Background Management of Ebola virus disease (EVD) has historically focused on infection prevention, case detection and supportive care. Several specific anti-Ebola therapies have been investigated, including during the 2014–2016 West African outbreak. Our objective was to conduct a systematic review of the effect of anti-Ebola virus therapies on clinical outcomes to guide their potential use and future evaluation. Methods We searched PubMed, EMBASE, Global Health, Cochrane Library, African Index Medicus, WHOLIS (inception-9 April 2018), and trial registries for observational studies or clinical trials, in any language, that enrolled patients with confirmed EVD who received therapy targeting Ebola virus and reported on mortality, symptom duration, or adverse effects. Results From 11,257 citations and registered trials, we reviewed 55 full-text citations, of which 35 met eligibility criteria (1 randomized clinical trial (RCT), 8 non-randomized comparative studies, 9 case series and 17 case reports) and collectively examined 21 anti-Ebola virus agents. The 31 studies performed during the West African outbreak reported on 4.8% (1377/28616) of all patients with Ebola. The only RCT enrolled 72 patients (0.25% of all patients with Ebola) and compared the monoclonal antibody ZMapp vs. standard care (mortality, 22% vs. 37%; 95% confidence interval for risk difference, − 36 to 7%). Studies of convalescent plasma, interferon-β-1a, favipiravir, brincidofovir, artesunate-amodiaquine and TKM-130803 were associated with at least moderate risk of bias. Conclusions Research evaluating anti-Ebola virus agents has reached very few patients with EVD, and inferences are limited by non-randomized study designs. ZMapp has the most promising treatment signal. Electronic supplementary material The online version of this article (10.1186/s12879-019-3980-9) contains supplementary material, which is available to authorized users.

BACKGROUND Due to ongoing political instability and conflict in many parts of the world, migrants are increasingly seeking asylum and refuge in Canada. METHODS We examined demographic and travel correlates of illnesses among migrants to Canada to establish a detailed epidemiologic framework of this population for Canadian practitioners. Data on ill-returned Canadian travellers presenting to a CanTravNet site between 1 January 2015 and 31 December 2015 were analyzed. RESULTS During the study period, 2415 ill travellers and migrants presented to a CanTravNet site, and of those, 519 (21.5%) travelled for the purpose of migration. Sub-Saharan Africa (n = 160, 30.8%), southeast Asia (n = 84, 16.2%) and south central Asia (n = 75, 14.5%) were the most common source regions for migrants, while the top specific source countries, of 98 represented, were the Philippines (n = 45, 8.7%), China (n = 36, 6.9%) and Vietnam (n = 31, 6.0%). Compared with non-migrant travellers, migrants were more likely to have a pre-existing immunocompromising medical condition, such as HIV or diabetes mellitus (P < 0.0001), and to require inpatient management of their illness (P < 0.0001). Diagnoses such as tuberculosis (n = 263, 50.7%), hepatitis B and C (n = 78, 15%) and HIV (n = 11, 2.1%) were over-represented in the migrant population compared with non-migrant travellers (P < 0.0001). Most cases of tuberculosis in the migrant population (n = 263) were latent (82% [n = 216]); only 18% (n = 47) were active. CONCLUSIONS Compared with non-migrant travellers, migrants were more likely to present with a communicable infectious disease, such as tuberculosis, potentially complicated by an underlying immunosuppressing condition such as HIV. These differences highlight the divergent healthcare needs in the migrant population, and underscore the importance of surveillance programmes to understand their burden of illness. Intake programming should be adequately resourced to accommodate the medical needs of this vulnerable population of new Canadians.

We examine exchange rate pass-through, or how domestic prices respond to exchange rate shocks, in the Czech Republic from 1998 to 2013 by employing vector autoregression models. Using the aggregate consumer price index and its sub-components, we find that the degree of passthrough is incomplete except for food prices. The peak response occurs between 9 and 13 months after the exchange rate shock. The long-term pass-through is approximately 50% at the aggregate level. The degree of pass-through is greater for tradables than for non-tradables. The results also suggest that the exchange rate pass-through becomes slower but more complete during the financial crisis experienced in period considered.

We use the global vector autoregression model to examine macroeconomic spillovers within the European Union over the period 2000-2014. We investigate how shocks originating in the euro area affect output and prices in the rest of Europe. We examine four different policy relevant shock scenarios: (i) increase in the euro area interest rate; (ii) increase in the euro area industrial production; (iii) decrease in the euro area consumer prices and (iv) decrease in global oil prices. In general, we find that these shocks have an effect of same (and expected) sign but of different size across the European Union. Our results suggest that the response of Central European countries to the euro area shocks is almost as strong as the response of the euro area countries itself. On the other hand, our results indicate that South East Europe is somewhat less sensitive to the euro area shocks and oil price shocks.

BACKGROUND There is a lack of multicentre analyses of the spectrum of dermatologic illnesses acquired by Canadian travellers and immigrants. Our objective for this study was to provide a comprehensive, Canada-specific surveillance summary of travel-related dermatologic conditions in a cohort of returned Canadian travellers and immigrants. METHODS Data for Canadian travellers and immigrants with a primary dermatologic diagnosis presenting to CanTravNet sites between September 2009 and September 2012 were extracted and analyzed. Data were collected using the GeoSentinel data platform. This network comprises 56 specialized travel and tropical medicine clinics, including 6 Canadian sites (Vancouver, Calgary, Toronto, Ottawa and Montreal), that contribute anonymous, de-linked, clinician- and questionnaire-based travel surveillance data on all ill travellers examined to a centralized Structure Query Language database. Results were analyzed according to reason for most recent ravel: immigration (including refugee); tourism; business; missionary/volunteer/research and aid work; visiting friends and relatives; and other, which included students, military personnel and medical tourists. RESULTS During the study period, 6639 patients presented to CanTravNet sites across Canada and 1076 (16.2%) received a travel-related primary dermatologic diagnosis. Arthropod bites (n = 162, 21.5%), rash (n = 141, 18.7%), cutaneous larva migrans (n = 98, 13.0%), and skin and soft tissue infection (n = 92, 12.2%) were the most common dermatologic diagnoses or diagnostic bundles issued to returning Canadian tourists (n = 754, 70.1% of total sample). Patients travelling for the purpose of immigration (n = 63, 5.9%) were significantly more likely to require inpatient management of their dermatologic diagnoses (p

There is limited high-quality evidence available to inform the use of text messaging to improve latent tuberculosis infection (LTBI) treatment adherence.We performed a parallel, randomised controlled trial at two sites to assess the effect of a two-way short message service on LTBI adherence. We enrolled adults initiating LTBI therapy from June 2012 to September 2015 in British Columbia, Canada. Participants were randomised in a 1:1 ratio to standard LTBI treatment (control) or standard LTBI treatment plus two-way weekly text messaging (intervention). The primary outcome was treatment completion, defined as taking ≥80% prescribed doses within 12 months (isoniazid) or 6 months (rifampin) of enrolment. The trial was unblinded except for the data analyst.A total of 358 participants were assigned to the intervention (n=170) and control (n=188) arms. In intention-to-treat analysis, the proportion of participants completing LTBI therapy in the intervention and control arms was 79.4% and 81.9%, respectively (RR 0.97, 95% CI 0.88–1.07; p=0.550). Results were similar for pre-specified secondary end-points, including time-to-completion of LTBI therapy, completion of >90% of prescribed LTBI doses and health-related quality of life.Weekly two-way text messaging did not improve LTBI completion rates compared to standard LTBI care; however, completion rates were high in both treatment arms.

Millions of people worldwide take tenofovir disoproxil fumarate (TDF) for the treatment of human immunodeficiency virus (HIV) and/or hepatitis B infection. Although generally safe and well tolerated, clinicians need to be aware that TDF can cause proximal renal tubular dysfunction and loss of bone mineral density, especially in patients with concomitant renal disease or other risk factors. We present the case of a patient with chronic HIV infection and urethral stricture who developed TDF-related proximal renal tubular dysfunction with hypophosphatemia and osteomalacia, presenting with bone pains, skeletal deformity, and disability. We review risk factors for TDF-related renal tubular toxicity and recommendations for monitoring creatinine, phosphate, alkaline phosphatase, and urinalysis.

We thank Dr. Jansz[1][1] for his interest in our surveillance report.[2][2] We recognize that understanding the intricacies of the CanTravNet data would be difficult without first-hand experience of our network and its patient population. CanTravNet is a consortium of post-travel (not pretravel)

During the Ebola outbreak, mortality reduction was attributed to multiple improvements in supportive care delivered in Ebola treatment units (ETUs). We aimed to identify high-priority supportive care measures, as well as perceived barriers and facilitators to their implementation, for patients with Ebola Virus Disease (EVD). We conducted a cross-sectional survey of key stakeholders involved in the response to the 2014&ndash, 2016 West African EVD outbreak. Out of 57 email invitations, 44 responses were received, and 29 respondents completed the survey. The respondents listed insufficient numbers of health workers (23/29, 79%), improper tools for the documentation of clinical data (n = 22/28, 79%), insufficient material resources (n = 22/29, 76%), and unadapted personal protective equipment (n = 20/28, 71%) as the main barriers to the provision of supportive care in ETUs. Facilitators to the provision of supportive care included team camaraderie (n in agreement = 25/28, 89%), ability to speak the local language (22/28, 79%), and having treatment protocols in place (22/28, 79%). This survey highlights a consensus across various stakeholders involved in the response to the 2014&ndash, 2016 EVD outbreak on a limited number of high-priority supportive care interventions for clinical practice guidelines. Identified barriers and facilitators further inform the application of guidelines.

As of 20 May 2016 there have been 28,646 cases and 11,323 deaths resulting from the West African Ebola virus disease (EVD) outbreak reported to the World Health Organization. There continue to be sporadic flare-ups of EVD cases in West Africa. EVD presentation is nonspecific and characterized initially by onset of fatigue, myalgias, arthralgias, headache, and fever; this is followed several days later by anorexia, nausea, vomiting, diarrhea, and abdominal pain. Anorexia and gastrointestinal losses lead to dehydration, electrolyte abnormalities, and metabolic acidosis, and, in some patients, acute kidney injury. Hypoxia and ventilation failure occurs most often with severe illness and may be exacerbated by substantial fluid requirements for intravascular volume repletion and some degree of systemic capillary leak. Although minor bleeding manifestations are common, hypovolemic and septic shock complicated by multisystem organ dysfunction appear the most frequent causes of death. Males and females have been equally affected, with children (0–14 years of age) accounting for 19 %, young adults (15–44 years) 58 %, and older adults (≥45 years) 23 % of reported cases. While the current case fatality proportion in West Africa is approximately 40 %, it has varied substantially over time (highest near the outbreak onset) according to available resources (40–90 % mortality in West Africa compared to under 20 % in Western Europe and the USA), by age (near universal among neonates and high among older adults), and by Ebola viral load at admission. While there is no Ebola virus-specific therapy proven to be effective in clinical trials, mortality has been dramatically lower among EVD patients managed with supportive intensive care in highly resourced settings, allowing for the avoidance of hypovolemia, correction of electrolyte and metabolic abnormalities, and the provision of oxygen, ventilation, vasopressors, and dialysis when indicated. This experience emphasizes that, in addition to evaluating specific medical treatments, improving the global capacity to provide supportive critical care to patients with EVD may be the greatest opportunity to improve patient outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1325-2) contains supplementary material, which is available to authorized users.

Flavonoids are known to modulate catalytic activity and expression of various enzymes. Glutathione S-transferases (GSTs) are the important biotransformation enzymes defending cells against potentially toxic xenobiotics. Therefore, the modulation of GST activity may influence detoxification of xenobiotics. The aim of this study was to evaluate the in vitro inhibitory activity of several dietary flavonoids towards purified equine liver cytosolic GST. Pure GST was incubated in the presence or absence of flavonoids (10 nM-100 µM), its activity was assayed using 1-chloro-2,4-dinitrobenzene (CDNB) as a substrate, and half maximal inhibitory concentrations (IC(50)) were determined. The obtained results were confirmed by GST activity staining of native polyacrylamide gel electrophoresis (PAGE) gels. For the most potent inhibitor, the inhibition kinetics study was performed. From 24 flavonoids tested, the most potent GST inhibitor was gallocatechin gallate (IC(50) = 1.26 µM). The inhibition kinetics of this compound followed noncompetitive mechanism versus both glutathione (K(i) = 35.9 µM) and CDNB (K(i) = 34.1 µM). The inhibitory potency of different flavonoids for GST activity depended mainly on the pattern of hydroxylation and number of hydroxyl groups in the ring B. Especially, pyrogallol-type catechins with 3-OH group esterified with gallic acid showed strong potential to inhibit GST in vitro.

Eriocheir sinensis is a habitat for invertebrates living externally and internally. It may transport native and non-native species to new habitats. Present studies on the Chinese mitten crab from Lake Dąbie add four new taxonomic units to the number of pathogens: Ichthyophonus hoferi, Epistylis sp., Branchiobdella sp. and Digenea gen. sp., which until now have not been found in this host.

This study investigated the efficacy of tea tree oil (TTO) as an anaesthetic for common carp, Cyprinus carpio L., by estimation of behaviour changes and responsiveness to being taken out of the water. All applied concentrations (from 0.2 to 0.6 mL L⁻¹) resulted in sedation and immobilization. The lowest effective concentration (induction time ≤3 min, recovery time ≤10 min after 15 min of exposure) was 0.5 mL L⁻¹. Exposure in excess of 30 min at a concentration of 0.5 mL L⁻¹ caused mortality. TTO displayed distinct general anaesthetic-like properties, fulfilling the basic requirements for a potent fish anaesthetic.

We evaluated the impact of intravascular iodinated contrast medium on residual diuresis in hemodialyzed patients. Two groups of clinically stable hemodialyzed patients with residual diuresis minimally 500 ml of urine per day were studied. The patients from the first group were given iso-osmolal contrast agent iodixanol (Visipaque, GE Healthcare, United Kingdom) in concentration of iodine 320 mg/ml with osmolality 290 mOsm/kg of water during the endovascular procedure. The second control group was followed without contrast medium administered. Residual diuresis and residual renal excretory capacity expressed as 24-h calculated creatinine clearance were evaluated in the both groups after 6 months. The evaluated group included 42 patients who were given 99.3 ml of iodixanol in average (range, 60-180 ml). The control group included 45 patients. There was no statistically significant difference found between both groups in daily volume of urine (P = 0.855) and calculated clearance of creatinine (P = 0.573). We can conclude that residual diuresis is not significantly influenced by intravascular administration of iso-osmolal iodinated contrast agent (iodixanol) in range of volume from 60 to 180 ml in comparison to natural course of urinary output and residual renal function during end-stage renal disease. This result can help the nephrologist to decide which imaging method/contrast medium to use in dialyzed patients in current practice.

Important gaps remain in our knowledge of the infectious diseases people acquire while travelling and the impact of pathogens imported by Canadian travellers.To provide a surveillance update of illness in a cohort of returned Canadian travellers and new immigrants.Data on returning Canadian travellers and new immigrants presenting to a CanTravNet site between September 2011 and September 2012 were extracted and analyzed by destination, presenting symptoms, common and emerging infectious diseases and disease severity.During the study period, 2283 travellers and immigrants presented to a CanTravNet site, 88% (N=2004) of whom were assigned a travel-related diagnosis. Top three destinations for non-immigrant travellers were India (N=132), Mexico (N=103) and Cuba (N=89). Fifty-one cases of malaria were imported by ill returned travellers during the study period, 60% (N=30) of which were Plasmodium falciparum infections. Individuals travelling to visit friends and relatives accounted for 83% of enteric fever cases (15/18) and 41% of malaria cases (21/51). The requirement for inpatient management was over-represented among those with malaria compared to those without malaria (25% versus 2.8%; p0.0001) and those travelling to visit friends and relatives versus those travelling for other reasons (12.1% versus 2.4%; p0.0001). Nine new cases of HIV were diagnosed among the cohort, as well as one case of acute hepatitis B. Emerging infections among travellers included hepatitis E virus (N=6), chikungunya fever (N=4) and cutaneous leishmaniasis (N=16). Common chief complaints included gastrointestinal (N=804), dermatologic (N=440) and fever (N=287). Common specific causes of chief complaint of fever in the cohort were malaria (N=47/51 total cases), dengue fever (14/18 total cases), enteric fever (14/17 total cases) and influenza and influenza-like illness (15/21 total cases). Animal bites were the tenth most common diagnosis among tourist travellers.Our analysis of surveillance data on ill returned Canadian travellers provides a recent update to the spectrum of imported illness among travelling Canadians. Preventable travel-acquired illnesses and injuries in the cohort include malaria, enteric fever, HIV, hepatitis B, hepatitis A, influenza and animal bites. Strategies to improve uptake of preventive interventions such as malaria chemoprophylaxis, immunizations and arthropod/animal avoidance may be warranted.

I read with interest the excellent CMAJ commentary by Campbell and colleagues,[1][1] in which the authors highlight the limitations of current tuberculosis (TB) control strategies for immigration screening. There has been some recent progress. A new short-course regimen for latent TB infection

Introduction Interventions to improve adherence to treatment for latent tuberculosis infection (LTBI) are necessary to improve treatment completion rates and optimise tuberculosis (TB) control efforts. The high prevalence of cell phone use presents opportunities to develop innovative ways to engage patients in care. A randomised controlled trial (RCT), WelTel Kenya1, demonstrated that weekly text messages improved antiretroviral adherence and clinical outcomes among patients initiating HIV treatment. The aim of this study is to determine whether the WelTel intervention can improve treatment completion among patients with LTBI and to evaluate the intervention's cost-effectiveness. Methods and analysis This open, two-site, parallel RCT (WelTel LTBI) will be conducted at TB clinics in Vancouver and New Westminster, British Columbia, Canada. Over 2 years, we aim to recruit 350 individuals initiating a 9-month isoniazid regimen. Participants will be randomly allocated to an intervention or control (standard care) arm in a 1:1 ratio. Intervention arm participants will receive a weekly text-message ‘check-in’ to which they will be asked to respond within 48 h. A TB clinician will follow-up instances of non-response and problems that are identified. Participants will be followed until treatment completion (up to 12 months) or discontinuation. The primary outcome is self-reported treatment completion (taking ≥80% of doses within 12 months). Secondary outcomes include daily adherence (percentage of days participants used medication as prescribed) and time to treatment completion. Patient satisfaction with the intervention will be evaluated, and the intervention's cost-effectiveness will be analysed through decision-analytic modelling. Ethics and dissemination Ethical approval has been obtained from the University of British Columbia. This trial will test the efficacy and cost-effectiveness of the WelTel intervention to improve treatment completion among patients with LTBI. Trial results and economic evaluation will help inform policy and practice on the use of WelTel in this population. Trial registration number ClinicalTrials.gov NCT01549457.

Natural polyphenol compounds are often good antioxidants, but they also cause damage to cells through more or less specific interactions with proteins. To distinguish antioxidant activity from cytotoxic effects we have tested four structurally related hydroxyflavones (baicalein, mosloflavone, negletein, and 5,6-dihydroxyflavone) at very low and physiologically relevant levels, using two different cell lines, L-6 myoblasts and THP-1 monocytes. Measurements using intracellular fluorescent probes and electron paramagnetic resonance spectroscopy in combination with cytotoxicity assays showed strong antioxidant activities for baicalein and 5,6-dihydroxyflavone at picomolar concentrations, while 10 nM partially protected monocytes against the strong oxidative stress induced by 200 mu M cumene hydroperoxide. Wide range dose-dependence curves were introduced to characterize and distinguish the mechanism and targets of different flavone antioxidants, and identify cytotoxic effects which only became detectable at micromolar concentrations. Analysis of these dose-dependence curves made it possible to exclude a protein-mediated antioxidant response, as well as a mechanism based on the simple stoichiometric scavenging of radicals. The results demonstrate that these flavones do not act on the same radicals as the flavonol quercetin. Considering the normal concentrations of all the endogenous antioxidants in cells, the addition of picomolar or nanomolar levels of these flavones should not be expected to produce any detectable increase in the total cellular antioxidant capacity. The significant intracellular antioxidant activity observed with 1 pM baicalein means that it must be scavenging radicals that for some reason are not eliminated by the endogenous antioxidants. The strong antioxidant effects found suggest these flavones, as well as quercetin and similar polyphenolic antioxidants, at physiologically relevant concentrations act as redox mediators to enable endogenous antioxidants to reach and scavenge different pools of otherwise inaccessible radicals.

FINANCIAL SUPPORT AND DISCLOSURES: No financial support was obtained for this article. All authors declare no conflicts of interest. TK is supported in part by a Career Award in the Biomedical Sciences from the Burroughs Wellcome Fund and by a CIHR Training Grant from the Canadian Child Health Clinician Scientist Program, in partnership with Sick Kids Foundation, Child & Family Research Institute (British Columbia), Women & Children’s Health Research Institute (Alberta) and the Manitoba Institute of Child Health. AUTHOR CONTRIBUTIONS: MCMM drafted the manuscript. JC, PT, JH and TK critically revised the manuscript for content. All authors saw and approved the final manuscript.

Plasmodium falciparum malaria and human immunodeficiency virus (HIV)-1 adversely interact in the context of pregnancy, however little is known regarding the influence of co-infection on the risk of congenital malaria. We aimed to determine the prevalence of placental and congenital malaria and impact of HIV co-infection on trans-placental malaria transmission in 157 parturient women and their infants by microscopy and by quantitative real-time polymerase chain reaction (PCR) in western Kenya. The prevalence of placental and cord blood infections were 17.2% and 0% by microscopy, and 33.1% and 10.8% by PCR. HIV co-infection was associated with a significant increase in placental parasite density (P < 0.05). Cord blood malaria prevalence was increased in co-infected women (odds ratio [OR] = 5.42; 95% confidence interval [CI] = 1.90-15.47) and correlated with placental parasite density (OR = 2.57; 95% CI = 1.80-3.67). A 1-log increase in placental monocyte count was associated with increased risk of congenital infection (P = 0.001) (OR = 48.15; 95% CI = 4.59-505.50). The HIV co-infected women have a significantly increased burden of placental malaria that increases the risk of congenital infection.

Raccoon roundworm (Baylisascaris procyonis) is a cause of devastating neural and ocular disease. The first documented case of raccoon roundworm encephalitis in Canada, in a seven-year-old boy who presented with severe neurological impairment, is presented. His significant recovery illustrates the importance of clinical suspicion and the benefit of early treatment.

HFE is a non-typical MHC class 1-type protein that is mutated in hereditary hemochromatosis. The purpose of this study was to identify possible splice variants of HFE mRNA and investigate the regulation of these isoforms in duodenum and liver of patients with normal and altered iron stores. RT-PCR was performed using HFE specific primers and duodenal RNA obtained from patients with hemochromatosis, iron deficiency, secondary iron overload and normal controls. The reaction products were visualized by Southern blot and identified by DNA sequence analysis. Additional studies were performed on RNA isolated from liver and a range of human tissues. A truncated (soluble) form of HFE protein was identified that lacks the transmembrane domain and occurs as a result of alternative splicing. Soluble HFE was found predominantly in the duodenum, spleen, breast, skin and testicle. In hereditary hemochromatosis full length HFE was the predominant isoform present in the duodenum similar to iron deficiency. Alternate splicing produces soluble HFE that may have a unique function to regulate cellular iron transport.

Successful treatment of latent tuberculosis infection (LTBI) is critical to reduce the impact of TB; however, treatment completion in North America is less than 50%. Evidence has shown that weekly text messages can improve treatment adherence in HIV. One of these evidence-based interventions is WelTel, a service involving weekly text-message ‘‘check-ins’’ with patients. The aim of this study was to determine the feasibility of adopting the WelTel intervention, originally developed and tested in Kenya, for use in the context of TB care in British Columbia (BC). (1) Determine prevalence of mobile phone ownership, text-message use, and patient attitudes towards receiving text messages from the clinic. (2) Determine the technological feasibility of the WelTel mobile health intervention, and patient and healthcare provider acceptability of the service. A descriptive cross-sectional survey was undertaken at a provincial TB control clinic in BC. A clinician administered a questionnaire focused on demographics, mobile phone ownership and use, and attitudes towards receiving text messages from the clinic. The WelTel intervention was then implemented in a small group of LTBI patients for 12 weeks. On Monday morning, an SMS gateway sent ‘‘How are you?’’ text messages to patients, to which they were to respond either ‘‘OK’’ or ‘‘Not OK’’ within 48 hours. A clinician phoned those who responded ‘Not OK’’ and those who did not respond. Participants completed baseline and follow-up questionnaires, and semi-structured interviews. Of 82 participants who completed the survey between September 2011 and December 2011, 68 owned a mobile phone and 58 used text messaging weekly. Participants were receptive to receiving treatment-related communication from the clinic via text messaging (n 80) but preferred not to have language relating to TB in the message content. Of 16 patients who received the intervention, 14 completed the study. After overcoming initial difficulties, the technological platform was an efficient way to deliver the intervention. The greatest participant-perceived benefits were that it enabled them to report side effects quickly (n 6), reminded them to take their medication (n 4), and imparted a feeling that their healthcare providers cared (n 2). Interview data supported these findings. Barriers included cost (n 3) and network coverage (n 2). Patients have the means to communicate with their healthcare providers via text-messaging and were receptive to doing so. The intervention was well-received by participants and the healthcare provider; however, research on its effectiveness to improve TB treatment adherence is required. MHIMSS 2013 ABSTRACT #JOURNAL OF MOBILE TECHNOLOGY IN MEDICINE VOL. 2 | ISSUE 4S | DECEMBER 2013 5

Successful treatment of latent tuberculosis infection (LTBI) is critical to reduce the impact of TB; however, in North America, fewer than half of individuals starting LTBI treatment complete therapy. While existing TB treatment adherence interventions have not yet proven consistently successful, evidence has shown that weekly text messages can improve treatment adherence in HIV. One of these evidence-based interventions is WelTel, a service involving weekly text-message ‘‘check-ins’’ with patients. The aim of this study is to determine the effectiveness of the WelTel intervention on adherence to LTBI treatment. The objectives of this study are to: 1) determine the effect of the WelTel intervention on completion of LTBI treatment; 2) determine the effect of the WelTel intervention on daily adherence to LTBI treatment; 3) measure patient satisfaction with the WelTel intervention; 4) evaluate the cost-effectiveness of the WelTel intervention. A multi-site randomized controlled trial will be conducted at three TB control clinics in British Columbia, Canada. Over two years, we expect to enroll 486 individuals diagnosed with LTBI and initiating isoniazid (INH) (300mg daily for nine months). Participants will be randomly allocated to an intervention or control arm (standard care) at a 1:1 ratio. Intervention arm participants will receive a weekly SMS ‘check-in’, ‘‘Are you OK?’’, to which they will be instructed to respond within 48 hours either ‘‘yes’’ or ‘‘no’’. A TB clinician will follow-up and triage any problems that are identified. Participants will be followed for one year, with a primary endpoint of treatment completion, defined as having taken at least 80% of prescribed doses within 12 months. Follow-up questionnaires will be used to assess participant satisfaction with the intervention. Costeffectiveness will be analyzed through decision-analytic modeling. Data will be analyzed according to intention to treat principles. Chi-squared tests will be used for categorical outcomes; and t-tests or MannWhitney U tests for continuous outcomes