Do successful tuberculosis vaccines need to be immunoregulatory rather than merely Th1-boosting?

Tuberculosis vaccine candidates are entering clinical studies in areas where BCG fails. This is a high-risk strategy. We suggest that geographical variation in the efficacy of BCG is related to the presence in developing countries of a cross-reactive background Th2-like response, probably attributable to exposure of mother and infant to helminths and environmental mycobacteria. Such Th2-like activity can stop Mycobacterium tuberculosis from being pushed into a latent state by the Th1 response, impair bactericidal functions and cause toxicity of TNF-alpha and pulmonary fibrosis. A successful vaccine, rather than driving a Th1 response, might need to suppress this pre-existing subversive Th2-like component. (c) 2005 Elsevier Ltd. All rights reserved

JIGSAW: Preference-directed, co-operative scheduling

Techniques that enable humans and machines to cooperate in the solution of complex scheduling problems have evolved out of work on the daily allocation and scheduling of Tactical Air Force resources. A generalized, formal model of these applied techniques is being developed. It is called JIGSAW by analogy with the multi-agent, constructive process used when solving jigsaw puzzles. JIGSAW begins from this analogy and extends it by propagating local preferences into global statistics that dynamically influence the value and variable ordering decisions. The statistical projections also apply to abstract resources and time periods--allowing more opportunities to find a successful variable ordering by reserving abstract resources and deferring the choice of a specific resource or time period

Clinical trials: minimising source data queries to streamline endpoint adjudication in a large multi-national trial

Background: The UK Clinical Trial Regulations and Good Clinical Practice guidelines specify that the study sponsor must ensure clinical trial data are accurately reported, recorded and verified to ensure patient safety and scientific integrity. The methods that are utilised to assess data quality and the results of any reviews undertaken are rarely reported in the literature. We have recently undertaken a quality review of trial data submitted to a Clinical Endpoint Committee for adjudication. The purpose of the review was to identify areas that could be improved for future clinical trials. The results are reported in this paper. Methods: Throughout the course of the study, all data queries were logged. Following study close out, queries were coded and categorised. A descriptive and comparative analysis was conducted to determine the frequency of occurrence for each category by country of origin. Results: From 1595 endpoint packages reviewed, 782 queries were generated. No source data queries were generated for countries with ≤ 25 recruited subjects, but both low recruiting and high recruiting countries had a high number of queries relating to subject identifiers. Conclusions: The implementation of some simple measures could help improve data quality and lead to significant savings.</p

Implementing a centralised pharmacovigilance service in a non-commercial setting in the United Kingdom

The implementation of a pharmacovigilance service compliant with the legal and regulatory responsibilities of clinical trial sponsors presents particular challenges for sponsors in a non-commercial setting. In this paper we examine these challenges in detail. We identify and discuss the key steps in the development of a pharmacovigilance service within a public health service and university setting in the United Kingdom. We describe how we have established a central Pharmacovigilance Office with dedicated staff and resources within our organisation. This office is supported by an electronic pharmacovigilance reporting infrastructure developed to facilitate the receipt and processing of safety information, the onward reporting in compliance with legislation and the provision of sponsor institution oversight of clinical trial participant safety. An education and training programme has also been set up to ensure that all relevant staff in the organisation are fully aware of the pharmacovigilance service and are appropriately trained in its use. We discuss possible alternatives to this approach and why we consider our solution to be the most appropriate to ensure that a non-commercial sponsor organisation and investigators are operating in a fully compliant way

Comments on D-branes in Kazama-Suzuki models and Landau-Ginzburg theories

We study D-branes in Kazama-Suzuki models by means of the boundary state description. We can identify the boundary states of Kazama-Suzuki models with the solitons in N=2 Landau-Ginzburg theories. We also propose a geometrical interpretation of the boundary states in Kazama-Suzuki models.Comment: 28 pages, 2 figure

Are routinely collected NHS administrative records suitable for endpoint identification in clinical trials? Evidence from the West of Scotland coronary prevention study

Background: Routinely collected electronic patient records are already widely used in epidemiological research. In this work we investigated the potential for using them to identify endpoints in clinical trials.&lt;p&gt;&lt;/p&gt; Methods: The events recorded in the West of Scotland Coronary Prevention Study (WOSCOPS), a large clinical trial of pravastatin in middle-aged hypercholesterolaemic men in the 1990s, were compared with those in the record-linked deaths and hospitalisations records routinely collected in Scotland.&lt;p&gt;&lt;/p&gt; Results: We matched 99% of fatal study events by date. We showed excellent matching (97%) of the causes of fatal endpoint events and good matching (.80% for first events) of the causes of nonfatal endpoint events with a slightly lower rate of mismatching of record linkage than study events (19% of first study myocardial infarctions (MI) and 4% of first record linkage MIs not matched as MI). We also investigated the matching of non-endpoint events and showed a good level of matching, with .78% of first stroke/TIA events being matched as stroke/TIA. The primary reasons for mismatches were record linkage data recording readmissions for procedures or previous events, differences between the diagnoses in the routinely collected data and the conclusions of the clinical trial expert adjudication committee, events occurring outside Scotland and therefore being missed by record linkage data, miscoding of cardiac events in hospitalisations data as ‘unspecified chest pain’, some general miscoding in the record linkage data and some record linkage errors.&lt;p&gt;&lt;/p&gt; Conclusions: We conclude that routinely collected data could be used for recording cardiovascular endpoints in clinical trials and would give very similar results to rigorously collected clinical trial data, in countries with unified health systems such as Scotland. The endpoint types would need to be carefully thought through and an expert endpoint adjudication committee should be involved.&lt;p&gt;&lt;/p&gt

Incident venous thromboembolic events in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER)

&lt;p&gt;Background: Venous thromboembolic events (VTE), including deep venous thrombosis and pulmonary embolism, are common in older age. It has been suggested that statins might reduce the risk of VTE however positive results from studies of middle aged subjects may not be generalisable to elderly people. We aimed to determine the effect of pravastatin on incident VTE in older people; we also studied the impact of clinical and plasma risk variables.&lt;/p&gt; &lt;p&gt;Methods: This study was an analysis of incident VTE using data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER), a randomized, double-blind, placebo-controlled trial of pravastatin in men and women aged 70-82. Mean follow-up was 3.2 years. Risk for VTE was examined in non-warfarin treated pravastatin (n = 2834) and placebo (n = 2865) patients using a Cox's proportional hazard model, and the impact of other risk factors assessed in a multivariate forward stepwise regression analysis. Baseline clinical characteristics, blood biochemistry and hematology variables, plasma levels of lipids and lipoproteins, and plasma markers of inflammation and adiposity were compared. Plasma markers of thrombosis and hemostasis were assessed in a nested case (n = 48) control (n = 93) study where the cohort was those participants, not on warfarin, for whom data were available.&lt;/p&gt; &lt;p&gt;Results: There were 28 definite cases (1.0%) of incident VTE in the pravastatin group recipients and 20 cases (0.70%) in placebo recipients. Pravastatin did not reduce VTE in PROSPER compared to placebo [unadjusted hazard ratio (95% confidence interval) 1.42 (0.80, 2.52) p = 0.23]. Higher body mass index (BMI) [1.09 (1.02, 1.15) p = 0.0075], country [Scotland vs Netherlands 4.26 (1.00, 18.21) p = 0.050 and Ireland vs Netherlands 6.16 (1.46, 26.00) p = 0.013], lower systolic blood pressure [1.35 (1.03, 1.75) p = 0.027] and lower baseline Mini Mental State Examination (MMSE) score [1.19 (1.01, 1.41) p = 0.034] were associated with an increased risk of VTE, however only BMI, country and systolic blood pressure remained significant on multivariate analysis. In a nested case control study of definite VTE, plasma Factor VIII levels were associated with VTE [1.52 (1.01, 2.28), p = 0.044]. However no other measure of thrombosis and haemostasis was associated with increased risk of VTE.&lt;/p&gt; &lt;p&gt;Conclusions: Pravastatin does not prevent VTE in elderly people at risk of vascular disease. Blood markers of haemostasis and inflammation are not strongly predictive of VTE in older age however BMI, country and lower systolic blood pressure are independently associated with VTE risk.&lt;/p&gt

Naturally Rehearsing Passwords

We introduce quantitative usability and security models to guide the design of password management schemes --- systematic strategies to help users create and remember multiple passwords. In the same way that security proofs in cryptography are based on complexity-theoretic assumptions (e.g., hardness of factoring and discrete logarithm), we quantify usability by introducing usability assumptions. In particular, password management relies on assumptions about human memory, e.g., that a user who follows a particular rehearsal schedule will successfully maintain the corresponding memory. These assumptions are informed by research in cognitive science and validated through empirical studies. Given rehearsal requirements and a user's visitation schedule for each account, we use the total number of extra rehearsals that the user would have to do to remember all of his passwords as a measure of the usability of the password scheme. Our usability model leads us to a key observation: password reuse benefits users not only by reducing the number of passwords that the user has to memorize, but more importantly by increasing the natural rehearsal rate for each password. We also present a security model which accounts for the complexity of password management with multiple accounts and associated threats, including online, offline, and plaintext password leak attacks. Observing that current password management schemes are either insecure or unusable, we present Shared Cues--- a new scheme in which the underlying secret is strategically shared across accounts to ensure that most rehearsal requirements are satisfied naturally while simultaneously providing strong security. The construction uses the Chinese Remainder Theorem to achieve these competing goals

Spin dynamics and exchange interactions in CuO measured by neutron scattering

The magnetic properties of CuO encompass several contemporary themes in condensed matter physics, including quantum magnetism, magnetic frustration, magnetically-induced ferroelectricity and orbital currents. Here we report polarized and unpolarized neutron inelastic scattering measurements which provide a comprehensive map of the cooperative spin dynamics in the low temperature antiferromagnetic (AFM) phase of CuO throughout much of the Brillouin zone. At high energies ($E \gtrsim 100$\,meV) the spectrum displays continuum features consistent with the des Cloizeax--Pearson dispersion for an ideal $S=\frac{1}{2}$ Heisenberg AFM chain. At lower energies the spectrum becomes more three-dimensional, and we find that a linear spin-wave model for a Heisenberg AFM provides a very good description of the data, allowing for an accurate determination of the relevant exchange constants in an effective spin Hamiltonian for CuO. In the high temperature helicoidal phase, there are features in the measured low-energy spectrum that we could not reproduce with a spin-only model. We discuss how these might be associated with the magnetically-induced multiferroic behavior observed in this phase

D-branes on a Deformation of SU(2)

We discuss D-branes on a line of conformal field theories connected by an exact marginal deformation. The line contains an SU(2) WZW model and two mutually T-dual SU(2)/U(1) cosets times a free boson. We find the D-branes preserving a U(1) isometry, an F-flux quantization condition and conformal invariance. Away from the SU(2) point a U(1) times U(1) symmetry is broken to U(1) times Z_k, i.e. continuous rotations of branes are accompanied by rotations along the branes. Requiring decoupling of the cosets from the free boson at the endpoints of the deformation breaks the continuous rotation of branes to Z_k. At the SU(2) point the full U(1) times U(1) symmetry is restored. This suggests the occurrence of phase transitions for branes at angles in the coset model, at a semiclassical level. We also discuss briefly the orientifold planes along the deformation line.Comment: 19 pages, latex, 5 figures, references adde