A Trial of a 7-Valent Pneumococcal Conjugate Vaccine in HIV-Infected Adults.

BACKGROUND: Streptococcus pneumoniae is a leading and serious coinfection in adults with human immunodeficiency virus (HIV) infection, particularly in Africa. Prevention of this disease by vaccination with the current 23-valent polysaccharide vaccine is suboptimal. Protein conjugate vaccines offer a further option for protection, but data on their clinical efficacy in adults are needed. METHODS: In this double-blind, randomized, placebo-controlled clinical efficacy trial, we studied the efficacy of a 7-valent conjugate pneumococcal vaccine in predominantly HIV-infected Malawian adolescents and adults who had recovered from documented invasive pneumococcal disease. Two doses of vaccine were given 4 weeks apart. The primary end point was a further episode of pneumococcal infection caused by vaccine serotypes or serotype 6A. RESULTS: From February 2003 through October 2007, we followed 496 patients (of whom 44% were male and 88% were HIV-seropositive) for 798 person-years of observation. There were 67 episodes of pneumococcal disease in 52 patients, all in the HIV-infected subgroup. In 24 patients, there were 19 episodes that were caused by vaccine serotypes and 5 episodes that were caused by the 6A serotype. Of these episodes, 5 occurred in the vaccine group and 19 in the placebo group, for a vaccine efficacy of 74% (95% confidence interval [CI], 30 to 90). There were 73 deaths from any cause in the vaccine group and 63 in the placebo group (hazard ratio in the vaccine group, 1.18; 95% CI, 0.84 to 1.66). The number of serious adverse events within 14 days after vaccination was significantly lower in the vaccine group than in the placebo group (3 vs. 17, P=0.002), and the number of minor adverse events was significantly higher in the vaccine group (41 vs. 13, P=0.003). CONCLUSIONS: The 7-valent pneumococcal conjugate vaccine protected HIV-infected adults from recurrent pneumococcal infection caused by vaccine serotypes or serotype 6A. (Current Controlled Trials number, ISRCTN54494731.) Copyright 2010 Massachusetts Medical Society

Depression and anxiety in adolescents and adults with cystic fibrosis in the UK: A cross-sectional study

Background The International Depression/anxiety Epidemiological Study (TIDES) in the UK aimed: (i) to establish the prevalence of anxiety and depression amongst people with CF compared to a normative sample; (ii) to establish the association between mood, demographic and clinical variables; and (iii) to provide guidance for specialist-referral decision-making. Methods Patients (≥ 12 years) completed the Hospital Anxiety and Depression Scale (HADS). CF-HADS scores, expressed as percentiles, were compared with a normative sample. Multiple-regression analysis explored associations between demographic, clinical and mood variables. Results Thirty-nine CF centres recruited 2065 patients. Adults with CF were similar in terms of anxiety and depression to the general population. Adolescents with CF were less anxious and depressed. For adult patients, older age, unemployment for health reasons and poor lung function were associated with disordered mood. Gender-specific CF-percentile scores were calculated. Conclusion Surveillance, with attention to gender and risk factors is advocated. This work provides unique benchmark scores to aid referral decision-making

Revision of the genus Centrophorus (Squaliformes: Centrophoridae): Part 1-Redescription of Centrophorus granulosus (Bloch & Schneider), a senior synonym of C-acus Garman and C-niaukang Teng

The genus Centrophorus is one of the most taxonomically complex and confusing elasmobranch groups. A revision of this group is currently underway and this first paper sets an important foundation in this process by redescribing the type species of the genus-Centrophorus granulosus. This taxon name has been previously applied to two different morphotypes: a large species \u3e 1.5 m TL and a smaller species similar to 1 m TL. Centrophorus acus and C. niaukang are the most commonly used names applied to the larger morphotype. The original description of C. granulosus was based on a large specimen of similar to 1.5 m TL, but subsequent redescriptions were based on either of the large or small morphotypes. Centrophorus granulosus is herein redescribed as a large species and a neotype is designated. Centrophorus acus and C. niaukang are found to be junior synonyms of C. granulosus. Centrophorus granulosus is distinguishable from its congeners by its large size, dermal denticle shape, colouration and a number of morphological and biological characteristics. Ontogenetic changes in morphology, dentition and denticle shape for this species are described in detail

Quantifying habitat selection and variability in habitat suitability for juvenile white sharks

While adult white sharks (Carcharodon carcharias) are apex predators with a circumglobal distribution, juvenile white sharks (JWS) feed primarily on bottom dwelling fishes and tend to be coastally associated. Despite the assumedly easier access to juveniles compared to large, migratory adults, limited information is available on the movements, environments, and distributions of individuals during this life stage. To quantify movement and understand their distribution in the southern California Bight, JWS were captured and fitted with dorsal fin-mounted satellite transmitters (SPOT tags; n = 18). Nine individuals crossed the U.S. border into Baja California, Mexico. Individuals used shallow habitats (134.96 +/- 191.1 m) close to shore (7.16 +/- 5.65 km). A generalized linear model with a binomial distribution was used to predict the presence of individuals based on several environmental predictors from these areas. Juveniles were found to select shallow habitats (\u3c 1000 m deep) close to land (\u3c 30 km of the shoreline) in waters ranging from 14 to 24 degrees C. Southern California was found to be suitable eight months of the year, while coastal habitats in Baja California were suitable year-round. The model predicted seasonal movement with sharks moving from southern California to Baja California during winter. Additionally, habitat distribution changed inter annually with sharks having a more northerly distribution during years with a higher Pacific Decadal Oscillation index, suggesting sharks may forego their annual fall migrations to Baja California, Mexico, during El Nino years. Model predictions aligned with fishery-dependent catch data, with a greater number of sharks being captured during periods and/or areas of increased habitat suitability. Thus, habitat models could be useful for predicting the presence of JWS in other areas, and can be used as a tool for potentially reducing fishery interactions during seasons and locations where there is increased susceptibility of incidental catch

The impact of COVID-19 on TB: a review of the data.

Early in the COVID-19 pandemic, models predicted hundreds of thousands of additional TB deaths as a result of health service disruption. To date, empirical evidence on the effects of COVID-19 on TB outcomes has been limited. Here we summarise the evidence available at a country level, identifying broad mechanisms by which COVID-19 may modify TB burden and mitigation efforts. From the data, it is clear that there have been substantial disruptions to TB health services and an increase in vulnerability to TB. Evidence for changes in Mycobacterium tuberculosis transmission is limited, and it remains unclear how the resources required and available for the TB response have changed. To advocate for additional funding to mitigate the impact of COVID-19 on the global TB burden, and to efficiently allocate resources for the TB response, requires a significant improvement in the TB data available

An approach for improving the quality of country-level TB modelling.

Mathematical modelling is increasingly used to inform budgeting and strategic decision-making by national TB programmes. Despite the importance of these decisions, there is currently no mechanism to review and confirm the appropriateness of modelling analyses. We have developed a benchmarking, reporting, and review (BRR) approach and accompanying tools to allow constructive review of country-level TB modelling applications. This approach has been piloted in five modelling applications and the results of this study have been used to revise and finalise the approach. The BRR approach consists of 1) quantitative benchmarks against which model assumptions and results can be compared, 2) standardised reporting templates and review criteria, and 3) a multi-stage review process providing feedback to modellers during the application, as well as a summary evaluation after completion. During the pilot, use of the tools prompted important changes in the approaches taken to modelling. The pilot also identified issues beyond the scope of a review mechanism, such as a lack of empirical evidence and capacity constraints. This approach provides independent evaluation of the appropriateness of modelling decisions during the course of an application, allowing meaningful changes to be made before results are used to inform decision-making. The use of these tools can improve the quality and transparency of country-level TB modelling applications

Utilization, retention and bio-efficacy studies of PermaNet® in selected villages in Buie and Fentalie districts of Ethiopia

<p>Abstract</p> <p>Background</p> <p>Malaria remains a major public health problem in Ethiopia. Pyrethroid-treated mosquito nets are one of the major tools available for the prevention and control of malaria transmission. PermaNet^®is a long-lasting insecticide-treated net (LLIN) recommended by WHO for malaria control.</p> <p>Objective</p> <p>The objective of the study was to assess utilization and retention of PermaNet^®nets distributed for malaria control in Buie and Fentalie districts and monitor the bio-efficacy of the nets using the WHO cone bioassay test procedures.</p> <p>Methods</p> <p>A cross sectional study was carried out by interviewing household heads or their representative in Buie and Fentalie districts. The two districts were selected based on a priori knowledge of variations on ethnic background and housing construction. Clusters of houses were chosen within each of the study villages for selection of households. 20 households that had received one or more PermaNet^®nets were chosen randomly from the clusters in each village. A total of eight used PermaNet^®nets were collected for the bio-efficacy test. The bio-efficacy of PermaNet^®nets was monitored according to the standard WHO procedures using a susceptible colony of <it>Anopheles arabiensis </it>to deltamethrin.</p> <p>Results</p> <p>A total of 119 household heads were interviewed during the study. The retention rate of nets that were distributed in 2005 and 2006 season was 72%. A total of 62.2% of the interviewees claimed children under five years of age slept under LLIN, while only 50.7% of the nets were observed to be hanged inside houses when used as a proxy indicator of usage of LLIN. For the bio-efficacy test the mean knock-down was 94% and 100%, while the mean mortality rate observed after 24 hr holding period was 72.2% and 67% for Buie and Fentalie districts respectively.</p> <p>Conclusion</p> <p>The study revealed a moderately high retention of PermaNet^®in the study villages and effectiveness of the nets when tested according to the standard WHO procedure.</p

Improving the quality of modelling evidence used for tuberculosis policy evaluation.

Mathematical modelling is commonly used to evaluate policy options for tuberculosis (TB) control in high-burden countries. Although major policy and funding decisions are made based on these analyses, there is concern about the variability of results produced using modelled policy analyses. We discuss new guidance for country-level TB policy modelling. The guidance was developed by the TB Modelling and Analysis Consortium in collaboration with the World Health Organization Global TB Programme, with input from a range of TB stakeholders (funders, modelling groups, country TB programme staff and subject matter experts). The guidance describes principles for country-level TB modelling, as well as good practices for operationalising the principles. The principles cover technical concerns such as model design, parameterisation and validation, as well as approaches for incorporating modelling into country-led policy making and budgeting. For modellers, this guidance suggests approaches to improve the quality and relevance of modelling undertaken to support country-level planning. For non-modellers, this guidance describes considerations for engaging modelling technical assistance, contributing to a modelling exercise and reviewing the results of modelled analyses. If routinely adopted, this guidance should improve the reliability, transparency and usefulness of modelling for country-level TB policy making. However, this guidance will not address all challenges facing modelling, and ongoing work is needed to improve the empirical evidence base for TB policy evaluation and develop stronger mechanisms for validating models. Increasing country ownership of the modelling process remains a challenge, requiring sustained engagement and capacity building

Can disordered mobile phone use be considered a behavioral addiction? An update on current evidence and a comprehensive model for future research

Despite the many positive outcomes, excessive mobile phone use is now often associated with potentially harmful and/or disturbing behaviors (e.g., symptoms of deregulated use, negative impact on various aspects of daily life such as relationship problems, and work intrusion). Problematic mobile phone use (PMPU) has generally been considered as a behavioral addiction that shares many features with more established drug addictions. In light of the most recent data, the current paper reviews the validity of the behavioral addiction model when applied to PMPU. On the whole, it is argued that the evidence supporting PMPU as an addictive behavior is scarce. In particular, it lacks studies that definitively show behavioral and neurobiological similarities between mobile phone addiction and other types of legitimate addictive behaviors. Given this context, an integrative pathway model is proposed that aims to provide a theoretical framework to guide future research in the field of PMPU. This model highlights that PMPU is a heterogeneous and multi-faceted condition