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Matteelli A.,University of Brescia | Schlagenhauf P.,University of Zurich | Carvalho A.C.C.,University of Brescia | Davis X.M.,Centers for Disease Control and Prevention | And 7 more authors.
The Lancet Infectious Diseases | Year: 2013

Background: Travel is thought to be a risk factor for the acquisition of sexually transmitted infections (STIs), but no multicentre analyses have been done. We aimed to describe the range of diseases and the demographic and geographical factors associated with the acquisition of travel-related STIs through analysis of the data gathered by GeoSentinel travel medicine clinics worldwide. Methods: We gathered data from ill travellers visiting GeoSentinel clinics worldwide between June 1, 1996, and Nov 30, 2010, and analysed them to identify STIs in three clinical settings: after travel, during travel, or immigration travel. We calculated proportionate morbidity for each of the three traveller groups and did logistic regression to assess the association between STIs and demographic, geographical, and travel variables. Findings: Our final analysis was of 112 180 ill travellers-64 335 patients seen after travel, 38 287 patients seen during travel, and 9558 immigrant patients. 974 patients (0·9%) had diagnoses of STIs, and 1001 STIs were diagnosed. The proportionate STI morbidities were 6·6, 10·2, and 16·8 per 1000 travellers in the three groups, respectively. STIs varied substantially according to the traveller category. The most common STI diagnoses were non-gonococcal or unspecified urethritis (30·2%) and acute HIV infection (27·6%) in patients seen after travel; non-gonococcal or unspecified urethritis (21·1%), epididymitis (15·2%), and cervicitis (12·3%) in patients seen during travel; and syphilis in immigrant travellers (67·8%). In ill travellers seen after travel, significant associations were noted between diagnosis of STIs and male sex, travelling to visit friends or relatives, travel duration of less than 1 month, and not having pretravel health consultations. Interpretation: The range of STIs varies substantially according to traveller category. STI preventive strategies should be particularly targeted at men and travellers visiting friends or relatives. Our data suggest target groups for pretravel interventions and should assist in post-travel screening and decision making. Funding: US Centers for Disease Control and Prevention, and International Society of Travel Medicine. © 2013 Elsevier Ltd.

Barnett E.D.,Maxwell Laboratory
Current Infectious Disease Reports | Year: 2013

Children are traveling internationally with increasing frequency, and some are traveling at young ages. While excellent sources of information exist about travel vaccines, malaria prevention, and general advice for children, clinicians may face situations where evidence-based recommendations are lacking. This article discusses some common challenging travel vaccine scenarios and approaches to malaria prevention and general travel advice for children. © 2013 Springer Science+Business Media New York.

Tinley K.E.,Creighton University | Loughlin A.M.,Center for Pediatric and Vaccine Research | Jepson A.,Inverness Medical | Barnett E.D.,Maxwell Laboratory
American Journal of Tropical Medicine and Hygiene | Year: 2010

Rapid determination of glucose-6-phosphate dehydrogenase (G6PD) status is desirable when it is necessary to use a drug contraindicated in G6PD-deficient persons, such as use of primaquine for malaria prevention or treatment. The purpose of this study was to compare a new, rapid, qualitative enzyme chromatographic test for deficiency of G6PD to a standard reference method. Samples from 196 G6PD-normal persons and 50 G6PD-deficient persons were evaluated. The sensitivity of the experimental rapid test was 0.98 and the specificity was 0.98 using specimens preserved in heparin, and 0.98 and 0.97, respectively, for specimens preserved in EDTA. Positive and negative predictive values were 0.72 and 1.00, respectively, for the test for heparinized specimens and 0.65 and 1.00, respectively, for the EDTA-preserved samples. This rapid test for G6PD deficiency is a sensitive method for screening of G6PD deficiency that requires minimal training and equipment and enables rapid identification of G6PD-deficient persons. Copyright ©2010 by The American Society of Tropical Medicine and Hygiene.

Hagmann S.,Yeshiva University | Neugebauer R.,Columbia University | Schwartz E.,Tel Aviv University | Perret C.,Pontifical Catholic University of Chile | And 3 more authors.
Pediatrics | Year: 2010

OBJECTIVE: By using a large, multicenter database, we investigated the characteristics and morbidities of 1591 children returning from 218 global destinations and presenting for care in 19 countries. METHODS: Data reported to the GeoSentinel Surveillance Network between January 1997 and November 2007 were analyzed, to assess demographic features, travel characteristics, and clinical diagnoses of ill pediatric travelers. Data were compared between children and adults and among 3 pediatric age groups (0-5 years, 6-11 years, and 12-17 years). RESULTS: Children were predominantly tourist travelers returning from Asia, sub-Saharan Africa, or Latin America. Compared with adults, children disproportionately presented within 7 days after return, required hospitalization, lacked pretravel health advice, and had traveled for the purpose of visiting friends and relatives. Diarrhea (28%), dermatologic conditions (25%), systemic febrile illnesses (23%), and respiratory disorders (11%) accounted for the majority of diagnoses reported for children. No fatalities were reported. Diarrhea occurred disproportionately among children after exposure to the Middle East/North Africa, dermatologic conditions after exposure to Latin America, systemic febrile illnesses after exposure to sub-Saharan Africa or Asia, and respiratory disorders after exposure to Europe or North America. The proportionate morbidity rates of travel-associated diseases differedamongthe pediatric age groups and between children and adults. CONCLUSIONS: The health care utilization patterns before and after travel and the profiles of travel-associated health problems differed between children and adults. Health professionals providing pretravel advice need to consider destination- and age-specific susceptibility to travel-related morbidities and develop prevention strategies accordingly. © 2010 by the American Academy of Pediatrics.

Maxwell Laboratory | Date: 2013-03-01

A memory apparatus comprising a pathway for conducting electrical energy; a plurality of even number of inverters, each inverter having an input and an output, the inverters being arranged along the pathway such that electrical energy from the output of an inverter is directed into the input of an adjacent inverter; a plurality of nodes coupling the inverters in series to form a closed loop to permit stable storage of a memory state by allowing the inverters to dissipate an amount of transient energy from a level that otherwise would result in a failure to below that level in order to maintain a stable memory state.

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