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By: Marieke Kruidering-Hall PhD

• Academy Chair in Pharmacology Education
• Associate Professor, Department of Cellular and Molecular Pharmacology
• University of California, San Francisco

http://cmp.ucsf.edu/faculty/marieke-kruidering-hall

Special consideration ought to be given to cheap anacin 525 mg fast delivery joint pain treatment for dogs the uncovered furry areas of the physique where ticks often attach anacin 525 mg with visa pain medication for dogs tramadol dosage, together with the head anacin 525mg online period pain treatment uk, neck 525mg anacin with visa pain treatment mayo clinic, and behind the ears in kids (Dermacentor ticks). Ticks (especially Ixodes ticks) also may attach at areas of tight clothes (eg, belt line, axillae, groin). For removal, a tick ought to be grasped with a fne tweezers close to the pores and skin and gently pulled straight out without twisting motions. Although not recommended, if fngers are used to take away ticks, they need to be professional tected with a barrier such as tissue and washed after removal of the tick. The chew website ought to be washed with cleaning soap and water to scale back the chance of secondary pores and skin infections. Daily inspection of pets and removal of ticks are indicated, as is the routine use of applicable veterinary merchandise to forestall ticks on pets. Prevention of Mosquitoborne Infections Mosquitoborne infectious ailments within the United States are brought on by arboviruses (eg, West Nile, La Crosse, St. Louis encephalitis, japanese equine encephalitis, and western equine encephalitis viruses [see Arboviruses, p 232]). International vacationers may encounter other arboviral (eg, Yellow fever, dengue, Japanese encephalitis) or other mosquitoborne infections (eg, malaria) during travel (also see illness specifc chapters in Section three). Physicians should pay attention to the epidemiology of arbovirus infections in their local areas. In areas with arbovirus transmission, safety of youngsters is recommended during outdoor actions, together with actions related to faculty, youngster care, or tenting. Education of households and other caregivers is a vital element of prevention. Often, massive numbers of mosquitoes are produced from sources at or very close to the home. Under sure circumstances, massive scale mosquito management measures may be conducted by neighborhood mosquito management packages or public well being offcials. These efforts embody drainage of standing water, use of larvicides in waters which are sources of mosquitoes, and use of pesticides to management biting grownup mosquitoes. Avoiding mosquito bites by limiting outdoor actions at times of excessive mosquito activity, which primarily occur at nightfall and dawn, and screening of home windows and doorways can help scale back exposure to mosquitoes. Many components of the United States even have mosquitoes that chew during the day, and some of these have been found to transmit La Crosse, dengue, and West Nile virus. Barriers embody mosquito nets and screens for baby strollers or other areas where immobile kids are positioned. Additional safety could be gained, when practical, through the use of clothes to cowl uncovered pores and skin (ie, long sleeves, long pants, socks, footwear, and hats). Mosquitoes are interested in individuals by odors on the pores and skin and by carbon dioxide from the breath. Repellents ought to be used during outdoor actions when mosquitoes are present, especially in areas with arbovirus transmission, and may at all times be used according to the label directions. Products containing these active components have been shown to have good repellent activity. Products with the next focus of active ingredi ents shield longer and are applicable for people who might be uncovered to mosquitoes during outdoor actions lasting many hours. Products with decrease concentrations of active components may be used when more transient safety is required, however they may require repeated purposes to present a longer duration of safety. Studies in human volunteers doc the association of active ingredient focus with duration of repellent activity. For instance, outcomes of 1 study demonstrated an aver age duration of safety of 5 hours, 4 hours, 2 hours, and 1. All other plant prod ucts studied, together with those based mostly on citronella, protected for lower than 20 minutes. Ingestion of garlic or vitamin B, wearing devices that emit sounds, and impregnated 1 wristbands are ineffective measures. Urticaria and get in touch with dermatitis have been reported in a small num ber of individuals. Reports of encephalopathy have been uncommon, with thirteen cases reported after pores and skin utility in kids. Picaridin containing compounds have been used as an insect repellent for years in Europe and Australia as a 20% formulation with no serious toxicity reported. Recom mendations to be used of any of these insect repellents ought to be adopted for children: No data are available relating to the use of other active repellent components in combination with a sunscreen. Since the mid Nineteen Eighties, the variety of outbreaks related to recreational water activi ties has elevated substantially, particularly outbreaks associated with handled recreational venues (eg, swimming pools). Therefore, preventing recreational water related illness 1 is becoming increasingly essential for the well being of youngsters and adults. Illnesses brought on by recreational water exposure can contain the gastrointestinal tract, respiratory tract, central nervous system, pores and skin, ears, and eyes. During 2007?2008, 134 waterborne illness outbreaks associated with recreational water were reported. Of the 134 outbreaks, 60% involved the gastrointestinal tract, 18% involved the pores and skin, and 18% involved the respiratory tract. The commonest organism associated with handled recreational water venues was Cryptosporidium species (see Cryptosporidiosis, p 296).

During his time at Duke buy generic anacin from india shoulder pain treatment video, Sam has inspired numerous medical stu dents cheap anacin 525mg line phoenix pain treatment center, pediatric residents trusted 525 mg anacin chronic back pain treatment guidelines, and infectious illnesses fellows with his passion for clinical excel lence buy anacin 525 mg on line pain treatment winnipeg, knowledge each within the lecture corridor and at the bedside, compassion for ill kids, and knowledge as mentor and counselor. He has an enviable reminiscence, each for medical details and for names and attributes of his technology of medical kids,? and he often is seen at conferences giving handshakes, hugs, smiles, and personal greetings. Geme Award from the Federation of Pediatric Organizations, the Bristol Award and a Society Citation from the Infectious Diseases Society of America, the Howland Award from the American Pediatric Society, the Gold Medal from the Albert Sabin Vaccine Institute, the Alfred I. In addition, he has been elected to the Institute of Medicine of the National Academy of Sciences. Sam and Cathy raised 8 little children and now share the joys of spend ing time with their many grandchildren. Sam is devoted to his family, his college students, his patients, and his pals and is a real gentleman and scholar. Sam Katz has left a huge mark on the feld of pediatrics and vaccinology and is a big of twentieth century drugs. This edition of the Red Book is dedicated to Sam to thank him on behalf of all the kids and pediatricians whose lives are better by way of his contributions. With the limited time out there to the practitioner, the power to quickly acquire up to date infor mation about new vaccines and vaccine recommendations, emerging infectious illnesses, new diagnostic modalities, and remedy recommendations is crucial. Another important useful resource is the visual library of Red Book Online, which has been up to date and expanded to embrace more pictures of infectious illnesses, examples of classic radiologic and different fndings, and up to date epidemiology of infectious illnesses. The Committee on Infectious Diseases depends on information and recommendation from many specialists, as evidenced by the prolonged listing of contributors to Red Book. Most important to the success of this edition is the dedication and work of the edi tors, whose dedication to excellence is unparalleled. As noted in earlier editions of the Red Book, some omissions and errors are inevi desk in a e-book of this type. This edition of the Red Book relies on information out there as of February 2012. Information is supplied in hard copy and as digital variations, which may be downloaded to cell units and include links to supplemental information, including visual pictures, graphs, maps, and tables. Seemingly unanswerable scientifc questions, the complexity of medical follow, ongoing revolutionary technology, continuous new information, and inevitable variations of opinion among specialists all are addressed when making ready the Red Book. In some cases, different committees and specialists could differ in their interpretation of data and ensuing recommendations. In certain situations, no single advice may be made because a number of options for management are equally acceptable. In making recommendations within the Red Book, the committee acknowledges variations in viewpoints by use of the phrases most specialists advocate. For many situations, an skilled within the feld of infectious illnesses ought to be consulted. Through this means of lifelong studying, the committee seeks to provide a practical and authoritative information for physicians and different health care professionals in their care of infants, kids, and adolescents. However, this listing solely begins to cowl the many in depth changes which have occurred in every chapter and section. New information inevitably will outdate present information within the Red Book, so health care professionals need to stay knowledgeable of ongoing developments and ensuing changes in recommendations. Throughout the Red Book, Web website addresses allow rapid entry to new information. When using antimicrobial brokers, physicians should evaluation the package deal inserts (product labels) ready by manufacturers, particularly for information concerning contraindications and opposed occasions. As in earlier editions of the Red Book, beneficial dosage schedules for antimicrobial brokers are supplied (see Section four, Antimicrobial Agents and Related Therapy) and may differ from those of the manufac turer as supplied within the package deal insert. Special appreciation is given to Tanya Lennon, assistant to the editor, for her work, persistence, and help. I thank Mimi for always being there and for her persistence, understanding, and by no means ending help. Of particular observe is the particular person to whom this edition of the Red Book is dedicated, Samuel L. Throughout the Red Book, the number of Web websites where extra present and future information may be obtained has elevated. All Web websites are in daring type for ease of reference, and all have been verifed for accuracy and accessibility. Direct links to visual pictures have been added all through the digital version of the Red Book. These embrace pictures of clinical manifestations, maps exhibiting geo graphic areas of specifc illnesses, graphs and tables of disease charges, and micro biologic fndings. Standardized approaches to disease prevention by way of immunizations, antimicro bial prophylaxis, and infection management practices have been up to date all through the Red Book. Reference to use of tetracycline and fuoroquinolone brokers in kids has been standardized all through the e-book, with reference to a standardized approach to use in kids. Policy updates released after publication of this edition of the Red Book shall be posted on Red Book Online. The desk consists of hepatitis A, hepatitis B, invasive pneumococcal disease, rotavirus hospitalizations, and varicella. Web websites for entry to Interactive Web based immunization schedulers for kids, adolescents, and adults have been added.

A pulmonary artery catheter 24 hours before implant is helpful in most sufferers to purchase anacin uk tennova comprehensive pain treatment center north assess the cardiac index and S10 the Journal of Heart and Lung Transplantation buy anacin online the pain treatment center of the bluegrass, Vol 29 cheap 525 mg anacin homeopathic treatment for shingles pain, No 4S purchase generic anacin line pain medication for little dogs, April 2010 quantity status as well as to guide diuretic, vasodilator, and Optimizing renal function pre operatively entails mea inotropic support. Intravenous drips of loop diuretics may be Increasing the cardiac index with vasodilators, inotropes, simpler than an intravenous bolus administration in and using an intra aortic balloon pump will enhance con sufferers who reveal diuretic resistance. Because pre operative use of loon pump support can enhance renal function by rising vasopressor drugs has been shown to be related cardiac output and renal perfusion pressure. When pulmonary function testing may be carried out reliably, and the compelled important Hematology. Thrombocytopenia and a low hematocrit are capacity, compelled expiratory quantity at 1 second, and carbon two hematology parameters related to poor outcomes monoxide diffusing capacity are all lower than 50% predicted, (Table 2). In screening scale for assessing submit implant survival devised by addition, sort and cross matches must be carried out pre 24 Oz et al decided that pre implant mechanical air flow operatively to put together blood products for transfusion throughout presented the best danger for a poor end result. Similar to the assessment of a affected person under going any main surgical procedure, makes an attempt must be Infection. A similar to sufferers with established or suspected infections, controversial problem at current relates to the usage of clopi prolonged intubation, cutaneous lesions at surgical websites, or dogrel in the course of the peri operative period in sufferers who produce other comorbidities, together with multisystem organ dysfunc recently acquired a drug eluting stent. Little information are avail tion, immunosuppression, poorly managed diabetes, renal in a position to guide this choice, thus the risks and bene? Alternative anti coagulants to Neurologic, psychosocial, and psychiatric issues. Routine display mises their capability to use and look after external system ing of all sufferers may be misleading, as can regular laboratory elements, or to ambulate and train, are poor can 61 assays. Scrub affected person with anti septic soap similar to chlorhexidine the night time before surgery and once more the morning of surgery. If constructive, administer mupirocin 2% nasal ointment the evening before surgery after which twice day by day for 5 days. Tunnel the percutane dependable means of transportation for comply with up visits and ous result in maximize the quantity of velour that is a convenient, dependable phone service to call for med inside the body. Mitral stenosis Mitral stenosis to a average degree or larger must be corrected with mitral valve substitute with a bioprosthetic valve. Tricuspid valve restore may be carried out using annuloplasty restore (a ring or DeVega method). Mechanical prosthetic A mechanical prosthesis within the aortic position must be replaced with a bioprosthetic valve or patch valves closure. Managing valvular coronary heart illness or arc, leaving some internal slack for unintentional tugs within the peri operative period. In circumstances where mechanical valve, thereby covering it and excluding it from the pump is eliminated after myocardial restoration, signi? Functioning bioprosthetic or me graft and trim it to appropriate measurement using a valve sizer. Mild to average tricuspid regurgitation and a veloped and resulted in its useful closure. Inserting materials into this house length for attachment to the ascending aorta in an end may be completed extra easily if the material remains to aspect trend. The inexperienced ligature must be cial care must be taken to deliver the sealant into these loosened and hanging freely before the cuff is hooked up. The directions for cuff must be rotated so that the open portion of the ligature is use for these materials must be carefully adopted to ensure going through upward and is easily accessible after the in? Pump placement ligature between the inexperienced ligature and the felt portion of the apical stitching ring to reduce bleeding from the holes via Devices must be placed within the supposed anatomic location which the inexperienced ligature passes. Create a sternotomy with a 4 to 6 cm extension within the muscle, above the posterior rectus sheath (Figure 3). Set the pump below the left rectus muscle, anterior to the or free wall because this will likely trigger partial occlusion of the posterior rectus sheath. The percutaneous lead is positioned in a gentle loop position, though there are anecdotal reviews of intra near the midline leaving some internal slack for acci stomach placement. Percutaneous lead placement across the percutaneous lead and through the perito neum to secure the loop into position. This method Proper placement and externalization of the percutaneous lead maximizes the length of velour covering inside the is of utmost importance to minimize an infection and injury to subcutaneous tunnel and is a preferred method by the percutaneous lead. Site web site created by a punch or incision must be as small as selection might also involve affected person enter, with a discussion of possible. A small exit web site minimizes exposure of the sub affected person habits and preferences similar to waistband or clothes cutaneous tissue and reduces rigidity on the pores and skin. In basic, the space between the pump must be approximately 1 to 2 cm of the velour coated pocket and exit web site is maximized to permit the greatest portion lead outdoors of the pores and skin exit. The lead must be stabilized of the velour covering to be inside the subcutaneous tissue. The percutaneous lead ought to exit the pump housing with a As is emphasised within the submit operative administration in mild curve. Immobilization reduces exit web site trauma, which professional There are two major strategies for tunneling the percu motes wound healing and tissue ingrowth, and this mini taneous lead: mizes the risk of an infection. S18 the Journal of Heart and Lung Transplantation, Vol 29, No 4S, April 2010 Figure 5 (A) the percutaneous lead is tunneled with a U form to increase the quantity of velour covering uncovered to the subcutaneous tissue. It can contribute to right coronary heart be utterly discontinued to permit thorough de airing failure, an infection, and a number of adverse effects related to before the device is activated. De connectors on both aspect of the pump must be acces tailed info on exchange strategies has been pub sible to facilitate detachment and removal. Place the brand new pump in the same position and hooked up may be used, similar to femoral or axillary cannulation. Turn on the pump on at a low speed setting (about placed via the outdated silastic cuff. Pump pocket drains may be required for the residual tion and shut all incisions in normal trend.

Dissemination of S aureus from folks anacin 525mg cheap allied pain treatment center inc, including infants order 525mg anacin pain treatment center franklin tn, with nasal carriage is expounded to buy anacin online from canada pain treatment lexington ky density of colonization purchase anacin 525 mg on-line laser pain treatment utah, and elevated dissemination occurs during viral upper respiratory tract infections. Additional threat components for health care related acquisition of S aureus embrace illness requiring care in neonatal or pediat ric intensive care or burn items; surgical procedures; extended hospitalization; native epi demic of S aureus an infection; and the presence of indwelling catheters or prosthetic devices. Nasal, skin, vaginal, and rectal carriage are the primary reservoirs for S aureus. Although home animals can be colonized, knowledge counsel that colonization is acquired from people. Heavy cutaneous colonization at an insertion website is the single most essential predictor of intravenous catheter related infections for short time period percutaneously inserted cath eters. For hemodialysis patients with S aureus skin colonization, the incidence of central line related bloodstream an infection is sixfold larger than for patients without skin colo nization. A concern is that most automated antimicrobial suscep tibility testing strategies commonly used within the United States were unable to detect van comycin resistance in these isolates. Methicillin resistant strains are resistant to all beta lactam medicine, including cephalosporins, and normally several other drug lessons. Once these strains become endemic in a hospital, eradication is diffcult, even when strict an infection prevention practices are adopted. Isolation of organisms from tradition of otherwise sterile physique fuid is the method for defnitive analysis. For central line affiliation bloodstream an infection, quantitative blood cultures from the catheter will have 5 to 10 instances extra organisms than cultures from a peripheral blood vessel. Specimens for tradition should be obtained from an identifed website of an infection, as a result of these websites normally will yield the organism. However, when a mother or father strain is cultured on methicillin containing media, resistant subpopulations are apparent. Cells expressing heteroresistance develop extra slowly than the oxacillin susceptible cells and can be missed at growth situations above 35?C (95?F). Typing, in conjunction with epidemio logic information, can facilitate identifcation of the supply, extent, and mechanism of transmission in an outbreak. Antimicrobial susceptibility testing is essentially the most readily avail able methodology for typing by a phenotypic characteristic. First or second technology cephalosporins (eg, cefazolin or cefuroxime) or vancomycin are effective however less so than nafcillin or oxacillin, especially for some websites of an infection (eg, endocarditis, meningitis). Drainage of abscesses and removal of international our bodies is desirable and almost always is required for medical deal with ment to be effective. Initial antimicrobial therapy should embrace a parentally administered beta lac tam antistaphylococcal antimicrobial agent and a protein synthesis inhibiting drug, corresponding to clindamycin, at maximum dosages. Once the organism is identifed and susceptibility is known, therapy for S aureus should be modifed, however an energetic antimicrobial agent should be con tinued for 10 to 14 days. Administration of antimicrobial agents can be modified to the oral route once the patient is tolerating oral alimentation. The total duration of therapy relies on the same old duration of established foci of an infection (eg, pneumonia, osteomyeli tis). Aggressive drainage and irrigation of accessible websites of purulent an infection should be performed as soon as attainable. All international our bodies, including these recently inserted during surgery, should be eliminated if attainable. Skin and gentle tissue infections, corresponding to impetigo or cellulitis attributable to S aureus, can be handled with oral penicillinase resistant beta lactam medicine, corresponding to cloxacillin, dicloxacillin, or a frst or second technology cephalospo rin. In this case, or for the penicillin allergic patient, trimethoprim sulfamethoxazole, doxycycline in youngsters 8 years of age and older, or clindamycin can be utilized if the isolate is susceptible. Infections are extra diffcult to deal with when associ ated with a thrombus, thrombophlebitis, or intra atrial thrombus. A longer course (eg, 7 to 10 days) is suggested if the patient is immunocompromised or the organism is S aureus; consultants differ on beneficial duration, however many counsel 14 days. If the patient wants a brand new central line, waiting 48 to seventy two hours after bacteremia apparently has resolved earlier than insertion is perfect. If a tunneled catheter is required for ongoing care, in situ remedy of the an infection can be tried. If the patient responds to antimicrobial therapy with quick decision of the S aureus bacteremia, remedy should be continued for 10 to 14 days parenterally. If blood cultures remain positive for staphylococci for greater than 3 to 5 days or if the scientific illness fails to improve, the central line should be eliminated, parenteral therapy should be continued, and the patient should be evaluated for metastatic foci of an infection. Vegetations or a thrombus within the heart or nice vessels always should be considered when a central line becomes infected. Transesophageal echocardiography, if feasible, is essentially the most sensitive technique for figuring out vegetations. Prophylactic admin istration of an antimicrobial agent intraoperatively lowers the incidence of an infection after cardiac surgery and implantation of synthetic vascular grafts and prosthetic devices and sometimes has been used on the time of cerebrospinal fuid shunt placement. Measures to stop and control S aureus infections can be con sidered separately for folks and for health care services. However, methods focusing on hand hygiene and wound care have been effective at lim iting transmission of S aureus and stopping unfold of infections in community settings. Specifc methods embrace applicable wound care, minimizing skin trauma and hold ing abrasions and cuts covered, optimizing hand hygiene and private hygiene practices (eg, shower after actions involving skin to skin contact), avoiding sharing of non-public objects (eg, towels, razors, clothing), cleansing shared equipment between uses, and regu lar cleansing of incessantly touched environmental surfaces. Another promising technique is the use of bleach within the tub water 2 to 3 instances every week (?

During coma purchase anacin in india pain treatment center colorado springs co, mice become unresponsive to 525mg anacin joint pain treatment at home most stimuli purchase anacin online back pain treatment yoga, both external and bodily generic anacin 525mg mastercard pain treatment medicine, however will nonetheless exhibit the tail pinch reflex. This can be decided and quantified by intravenous injection of Evans Blue prior to sacrificing the animal: Induction of Experimental Cerebral Malaria susceptibility by transfer of mature lymphocyte populations. This protocol relies on pre sensitizing donor mice with irradiated blood stage parasites earlier than cell transfer. Opsonization as an effector mechanism in human safety in opposition to asexual blood phases of Plasmodium falciparum: functional role of IgG subclasses. Mechanisms of malarial anaemia: Potential involvement of the Plasmodium falciparum low molecular weight rhoptry associated proteins Acta Tropica, 112:295 302. Opsonization and phagocytosis of Plasmodium falciparum merozoites measured by flow cytometry. Vigorous washings could destroy cell monolayer especially cells which might be loosely adhered. It is recommended to set up an applicable confluence, which by no means exceeds ninety ninety five% until you end the experiments. Proceedings of the National Academy of Sciences of the United States of America, 108(30), 12485?12490. Chondroitin sulfate A adhering Plasmodium falciparum infected erythrocytes express functionally essential antibody epitopes shared by multiple variants. Use the next tips to set annealing temperature and extension time based on primer and product concerns. Either repeat the therapy or simply expose the filter to check that the probe is basically eliminated. Notes to the above procedure: 1: Use needle if engaged on later phases or if the parasitemia could be very excessive. The absorbance ratio of 260/230nm indicates other contamination, such as residual phenol. Notes to the above procedure: 5: Especially for rings, cells pellet much more effectively in 15 mL tubes than in 50 mL tubes. Subsequent steps are also easiest in 15 mL tubes, so harvest large volumes of cells directly in 15 mL tubes. Do the 37 C incubation earlier than freezing the samples to guarantee complete complexing of nucleoproteins. Snap cap tubes are likely to leak and make a horrible mess of the within of the centrifuge. It is less complicated to recuperate more of the aqueous layer from 15 mL tubes than from 50 mL tubes. Keeping pipette tip away from the putative pellet (directly beneath hinge, at backside of tube), remove practically all the supernatant. Remove final bits of supernatant, as much as potential, taking care to avoid touching the very tiny, glassy pellet. Split the whole formamide quantity among the many microfuge tubes if it was a large sample split to a number of tubes. If this of great concern, on the level marked *above, add the seventy five% ethanol wash step. There should be two major ribosomal bands and a few minor bands of unknown provenance. Finally, if your sample had human white blood cells in it, you?ll see greater than two ribosomal bands! If your samples are in water, add an equal quantity of formamide (final 50% formamide or higher). Further changes in these general firm protocols? have been outlined under to facilitate Plasmodium falciparum library development. Cell preparations at desired cell stage(s) 2 Grow parasites in seventy five cm large flasks (12 mL per flask). One needs to have entry to the next water bathtub temperatures: 12 C overnight (subsequent day at 16 C) room temperature 37 C 65 C Optional: dry ice for dry ice/ethanol bathtub. Cool the lyophilizer entice and have spin columns ready in autoclaved, sterile Corex tubes. Phage dilutions of 1:10 and 1:a hundred of the primary libraries are recommended to titer. The major libraries have 2 to three% of phage which might be blue (darkish or gentle blue) indicating no insert. L of chloroform, along with some larger aliquots saved in screw cap glass tubes with some chloroform at four C for library screening. Testing excision of inserts from libraries To get an concept of insert sizes in the libraries, we used recombinant phage directly from the libraries to excise, or release, clones as phagemids. Perform the reverse transcription at 42 C for 30 min and inactivate the reverse transcriptase at ninety three C for three min. For detection of the biotinylated probes use avidin conjugate with rhodamine (Roche Applied Science). Comments this protocol permits a dramatic lower of the background generated by the erythrocyte membranes as a result of the saponin lysis, and better preservation of nuclear architecture since the fixation step is finished in suspension. Constructing Plasmodium berghei gene focusing on vectors utilizing recombineering by: Claudia Pfander, Burcu Bronner Anar, Gareth Girling, Ellen S C Bushell, Frank Schwach, Julian C Rayner, Oliver Billker Sanger Malaria Programme, Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom e mail: ellen.

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