Pneumococcal conjugate vaccine implementation in middle-income countries

Since 2000, the widespread adoption of pneumococcal conjugate vaccines (PCVs) has had a major impact in the prevention of pneumonia. Limited access to international financial support means some middle-income countries (MICs) are trailing in the widespread use of PCVs. We review the status of PCV implementation, and discuss any needs and gaps related to low levels of PCV implementation in MICs, with analysis of possible solutions to strengthen the PCV implementation process in MICs

Uncertainty and Surprise Jointly Predict Musical Pleasure and Amygdala, Hippocampus, and Auditory Cortex Activity

Listening to music often evokes intense emotions [1, 2]. Recent research suggests that musical pleasure comes from positive reward prediction errors, which arise when what is heard proves to be better than expected [3]. Central to this view is the engagement of the nucleus accumbens—a brain region that processes reward expectations—to pleasurable music and surprising musical events [4, 5, 6, 7, 8]. However, expectancy violations along multiple musical dimensions (e.g., harmony and melody) have failed to implicate the nucleus accumbens [9, 10, 11], and it is unknown how music reward value is assigned [12]. Whether changes in musical expectancy elicit pleasure has thus remained elusive [11]. Here, we demonstrate that pleasure varies nonlinearly as a function of the listener’s uncertainty when anticipating a musical event, and the surprise it evokes when it deviates from expectations. Taking Western tonal harmony as a model of musical syntax, we used a machine-learning model [13] to mathematically quantify the uncertainty and surprise of 80,000 chords in US Billboard pop songs. Behaviorally, we found that chords elicited high pleasure ratings when they deviated substantially from what the listener had expected (low uncertainty, high surprise) or, conversely, when they conformed to expectations in an uninformative context (high uncertainty, low surprise). Neurally, we found using fMRI that activity in the amygdala, hippocampus, and auditory cortex reflected this interaction, while the nucleus accumbens only reflected uncertainty. These findings challenge current neurocognitive models of music-evoked pleasure and highlight the synergistic interplay between prospective and retrospective states of expectation in the musical experience

The 'harpe organisée', 1720-1840 : rediscovering the lost pedal techniques on harps with a single-action pedal mechanism

While preparing for a concert in 2014, I found certain passages impossible to play in Louis Spohr’s Opp. 115 and 118. I consulted Backofen’s methods for harp, where I knew that he had written about double-pedalling. I explored all aspects of pedalling on the single-action harp. The research extended across five historical areas of research: treatises and methods, musical sources where a special solution is written by the composer/publisher, scores with no instructions but where multi-pedalling is implied by the music, historical shoes, and finally images of harpists pedalling. To play Spohr’s music, the harpist uses the heel and toe independently and over thirty-seven complex moves are part of his music. When a pedal is folded or unfolded during a piece, Spohr writes at least one bar’s rest for the harpist. Historical pedalling employs the whole foot, completely off the floor, where most pedals are not fixed. Pedals were moved at the moment where an accidental is written in the music and then released. Pedal markings are unnecessary, as pedalling becomes an inherent part of the musical gesture. The physicality of pedalling creates tensions and resolutions that mirror the musical line.Research in and through artistic practic

Current practice in the introduction of solid foods for preterm infants

Objective: The present study compared the age of first solid foods in a cohort of preterm infants with term infants and identified factors influencing timing of solid food introduction. Design: Structured interviews on infant feeding practices, growth and medical status at term equivalence and at 3, 6, 9 and 12 months corrected postnatal age. The age of solid food introduction was compared between term and preterm infants, and the influence of maternal, infant and milk feeding factors was assessed. Setting: This prospective longitudinal study recruited primary carers of preterm and term infants from a regional metropolitan referral hospital in eastern Australia.Participants: One hundred and fifty infants (preterm, n 85; term, n 65). Results: When corrected for prematurity, preterm infants received solid foods before the recommended age for the introduction of solid foods for term infants. Median introduction of solid foods for preterm infants was 14 weeks corrected age (range 12-17 weeks). This was significantly less than 19 weeks (range 17-21 weeks) for term infants (P < 0·001). Lower maternal education and male gender were associated with earlier introduction of solid foods among preterm infants. Conclusions: Preterm infants are introduced to solid foods earlier than recommended for term infants, taking account of their corrected age. Further research is needed to assess any risk or benefit associated with this pattern and thus to develop clear evidence-based feeding guidelines for preterm infants

Advanced telerobotics: Dual-handed and mobile remote manipulation

This work presents an advanced dual-handed, mobile telerobotic system developed at the High-Fidelity Telepresence and Teleaction Research Centre, Munich, Germany. To the authors' best knowledge, it is the first attempt to integrate mobile and multi-robot strategies in one physical and logical framework. In order to exploit human manipulation capabilities, a high fidelity telemanipulation system was developed. It consists of two redundant human-scaled anthropomorphic telemanipulator arms controlled by two redundant haptic interfaces providing a large, convex workspace and force feedback in a wide range of human perception. To provide a multi modal immersion, the haptic modality is augmented by 3D visual and audio channels. The main research issues are the control of devices with dissimilar kinematics, redundancy resolution methods, and six DOF compliance control. To extend the accessible workspace in remote environments, mobile robots are used as transporting platform extending the functionality of both the input devices and the telerobot. Mechatronic design topics and experimental results of six degree of freedom telemanipulation tasks and mobile telemanipulation are presented. The motion compression concept is exploited to cover large remote environments on a relatively small local area. Finally, architectures for collaborative telemanipulation are classified and corresponding interaction schemes are discussed. © 2007 Springer-Verlag Berlin Heidelberg

Monocarboxylate transporter 1 deficiency and ketone utilization

Contains fulltext : 138921.pdf (publisher's version ) (Open Access)Ketoacidosis is a potentially lethal condition caused by the imbalance between hepatic production and extrahepatic utilization of ketone bodies. We performed exome sequencing in a patient with recurrent, severe ketoacidosis and identified a homozygous frameshift mutation in the gene encoding monocarboxylate transporter 1 (SLC16A1, also called MCT1). Genetic analysis in 96 patients suspected of having ketolytic defects yielded seven additional inactivating mutations in MCT1, both homozygous and heterozygous. Mutational status was found to be correlated with ketoacidosis severity, MCT1 protein levels, and transport capacity. Thus, MCT1 deficiency is a novel cause of profound ketoacidosis; the present work suggests that MCT1-mediated ketone-body transport is needed to maintain acid-base balance

Patients with Chronic Obstructive Pulmonary Disease harbour a variation of <i>Haemophilus</i> species

H. haemolyticus is often misidentified as NTHi due to their close phylogenetic relationship. Differentiating between the two is important for correct identification and appropriate treatment of infective organism and to ensure any role of H. haemolyticus in disease is not being overlooked. Speciation however is not completely reliable by culture and PCR methods due to the loss of haemolysis by H. haemolyticus and the heterogeneity of NTHi. Haemophilus isolates from COPD as part of the AERIS study (ClinicalTrials NCT01360398) were speciated by analysing sequence data for the presence of molecular markers. Further investigation into the genomic relationship was carried out using average nucleotide identity and phylogeny of allelic and genome alignments. Only 6.3% were identified as H. haemolyticus. Multiple in silico methods were able to distinguish H. haemolyticus from NTHi. However, no single gene target was found to be 100% accurate. A group of omp2 negative NTHi were observed to be phylogenetically divergent from H. haemolyticus and remaining NTHi. The presence of an atypical group from a geographically and disease limited set of isolates supports the theory that the heterogeneity of NTHi may provide a genetic continuum between NTHi and H. haemolyticus

The rise and fall of pneumococcal serotypes carried in the PCV era

Streptococcus pneumoniae is a major cause of meningitis, sepsis and pneumonia worldwide. Vaccination using pneumococcal conjugate vaccines (PCV) has therefore been part of the UK's childhood immunisation programme since 2006. Here we describe pneumococcal carriage rates in children under five years of age attending the paediatric department of a large UK hospital in response to vaccine implementation over seven winter seasons from 2006 to 2013. S. pneumoniae (n=696) were isolated from nasopharyngeal swabs (n=2267) collected during seven consecutive winters, October to March, 2006/7 to 2012/13. This includes the period immediately following the introduction of the seven-valent pneumococcal conjugate vaccine (PCV7) in 2006 in addition to pre- and post-PCV13 introduction in 2010. We show a decrease in PCV13 vaccine serotypes (VT) in the three years following PCV13 vaccine implementation (2010/11 to 2012/13). Serotype 6A represented the only observed VT following PCV13 implementation with all others (including PCV7 serotypes) absent from carriage. Overall pneumococcal carriage, attributable to non-VT (NVT), was consistent across all sampling years with a mean of 31·1%. The ten most frequently isolated NVTs were 6C, 11A, 15B, 23B, 15A, 21, 22F, 35F, 23A and 15C. Fluctuations in the prevalence of each were however noted. Comparing prevalence at 2006/07 with 2012/13 only 15A was shown to have increased significantly (p value of 0·003) during the course of PCV implementation. These data support the increasing evidence that the primary effect of PCVs is due to population immunity by reducing or eliminating the carriage of invasive VT serotypes. With IPD being increasingly attributed to non-vaccine serotypes, surveillance of carriage data continues to act as an early warning system for vaccine design and public health policy that require continual data of both carried pneumococcal serotypes and IPD attributed serotype data.</p