SummaryBackground-Artemether-lumefantrine is the most widely used artemisinin-based combination therapy for malaria, although treatment failures occur in some regions. We investigated the effect of dosing strategy on efficacy in a pooled analysis from trials done in a wide range of malariaendemic settings.Methods-We searched PubMed for clinical trials that enrolled and treated patients with artemether-lumefantrine and were published from 1960 to December, 2012. We merged individual patient data from these trials by use of standardised methods. The primary endpoint was the PCR-adjusted risk of Plasmodium falciparum recrudescence by day 28. Secondary endpoints consisted of the PCR-adjusted risk of P falciparum recurrence by day 42, PCR-unadjusted risk of P falciparum recurrence by day 42, early parasite clearance, and gametocyte carriage. Risk factors for PCR-adjusted recrudescence were identified using Cox's regression model with frailty shared across the study sites. January, 1998, and December, 2012, and included 14 327 patients in our analyses. The PCR-adjusted therapeutic efficacy was 97·6% (95% CI 97·4-97·9) at day 28 and 96·0% (95·6-96·5) at day 42. After controlling for age and parasitaemia, patients prescribed a higher dose of artemether had a lower risk of having parasitaemia on day 1 (adjusted odds ratio [OR] 0·92, 95% CI 0·86-0·99 for every 1 mg/kg increase in daily artemether dose; p=0·024), but not on day 2 (p=0·69) or day 3 (0·087). In Asia, children weighing 10-15 kg who received a total lumefantrine dose less than 60 mg/kg had the lowest PCR-adjusted efficacy (91·7%, 95% CI 86·5-96·9). In Africa, the risk of treatment failure was greatest in malnourished children aged 1-3 years (PCR-adjusted efficacy 94·3%, 95% CI 92·3-96·3). A higher artemether dose was associated with a lower gametocyte presence within 14 Findings-We included 61 studies done between Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts days of treatment (adjusted OR 0·92, 95% CI 0·85-0·99; p=0·037 for every 1 mg/kg increase in total artemether dose).Interpretation-The recommended dose of artemether-lumefantrine provides reliable efficacy in most patients with uncomplicated malaria. However, therapeutic efficacy was lowest in young children from Asia and young underweight children from Africa; a higher dose regimen should be assessed in these groups.Funding-Bill & Melinda Gates Foundation. IntroductionArtemisinin-based combination therapies are the first-line treatment for uncomplicated Plasmodium falciparum malaria in most malaria-endemic countries, 1 and they have been advocated to counter the threat of antimalarial drug resistance by delaying its emergence and spread. 2 As such, artemisinin-based combination therapies are a key component of malaria elimination efforts. 3The combination of artemether and lumefantrine was originally introduced as a four-dose regimen that proved to be efficacious in studies done in China, 4 Africa, 5 and India; 6 however, after detailed pharmacokinetic-pharmacodynamic assess...

The study assessed changes in nutritional content of some commonly consumed traditional vegetables subjected to postharvest processes. Amaranth (Amaranthus cruentus L.), black nightshade (Solanum scabrum Mill.) and jute mallow (Corchorus olitorius L.) leaves used as vegetables were subjected to blanching, boiling and drying. The proximate composition and β‐carotene content of fresh and processed leaves were determined. Amaranth, black nightshade and jute mallow leaves had 25.21%, 39.74% and 29.18% of protein, respectively. The β‐carotene levels were 16.40, 25.25 and 27.74 mg/100 g for black nightshade amaranth and jute mallow leaves, respectively. The ash content was 10.57% for black nightshade, 12.40% for jute mallow and 16.33% for amaranth. Processing methods caused decreases of β‐carotene and crude lipid content. Boiling for 30 min or more resulted in large loss of β‐carotene. Drying under shade resulted in less loss of β‐carotene than drying in cabinet at 50 and 60°C.

No studies have investigated whether those with poor sleep are aware of being uncomfortable in the dark via subjective inquiry, and no study has evaluated whether poor sleepers have increased fear in the dark using objective indices (e.g., a validated startle paradigm). Good and poor sleepers (N = 108) completed questionnaires about their level of discomfort with the dark and were evaluated for an increased startle reflex by measuring eyeblink latency via electrooculogram in response to unexpected noise in the dark and the light. Participants listened to bursts of unexpected white noise, while in counterbalanced light/dark conditions. Relative to good sleepers, more poor sleepers reported increased discomfort in the dark. There was a significant lighting × time × sleeper status interaction for eyeblink latency. Relative to the first trial in the dark, eyeblink latency in good sleepers increased in the second dark exposure; suggesting habituation in the dark. Eyeblink latency in poor sleepers did not decrease. Thus, poor sleepers reported being uncomfortable in the dark and they remained more easily startled in the dark over the course of the study. It is unclear if the dark may predispose people to sleep problems, or if sleep problems sensitize poor sleepers to fear darkness.

Although most preschool children with ASD residing in urban centres were able to access specialized services shortly after diagnosis, marked variation in services across provinces remains a concern.

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