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

Vulnerable diseases affecting child mortality in Sierra Leone: emerging health issue

Child mortality in Sierra Leone is the highest ranked in the world. The main causes for child mortality are maternal factors, environmental factors and health factors. Minimal research has been carried out on health factors in Sierra Leone. The objective of this study is to see how maternal and environmental factors have an effect on health factors, which in turn cause child mortality. The data used were from the 2008 Sierra Leone Demographic and Household Survey (SLDHS). The study showed that child mortality had statistically significant factors associated with it: place of residence, birth number, religion and type of toilet facility. Furthermore, the SLDHS had not given much information regarding the cause of diseases affecting children, so we looked only at the effects they had on children. Acute respiratory infections, diarrhoea and measles each had one variable that was statistically significant. As for pneumonia, there were no variables associated with children contracting the disease

Relative Response Factor for Lamivudine and Zidovudine Related substances by RP-HPLC with DAD detection

A study was conducted to establish the Relative Response Factors for Zidovudine related impurity C, Lamivudine salicylic acid and Zidovudine related impurity B.  A simple and fast isocratic Reverse Phase High Performance Liquid Chromatography (RP-HPLC) method was used for the simultaneous determination of the related impurities. The method consists of a mobile phase combination of Acetonitrile (HPLC grade) and Buffer (0.0680 g of Potassium Dihydrogen Orthophosphate, 0.3 ml of Triethylamine, pH adjusted to 8.0 with Orthophosphoric acid to a final volume preparation of 100 ml) in the ratio 10:90 using Phenomenex Luna 5-µm C18 (2)-250 x 4.6-mm, 5-µm) as a stationary phase, flow rate of 1.0 mL/min with detection at 270 nm. The RRF for Zidovudine related impurity C, Lamivudine salicylic acid and Zidovudine related impurity B were 2.07, 0.13 and 1.28 respectively.   Results obtained for quantification of the related substance in lamivudine and zidovudine single dose oral solid dosage form using the RRF and know standards shows no significant difference at 95 % confidence interval. The RRF can therefore be used for the quantification of know related impurities in lamivudine zidovudine oral dosage form using the stated chromatographic conditions

Resource use data by patient report or hospital records: Do they agree?

Background: Economic evaluations alongside clinical trials are becoming increasingly common. Cost data are often collected through the use of postal questionnaires; however, the accuracy of this method is uncertain. We compared postal questionnaires with hospital records for collecting data on physiotherapy service use. Methods: As part of a randomised trial of orthopaedic medicine compared with orthopaedic surgery we collected physiotherapy use data on a group of patients from retrospective postal questionnaires and from hospital records. Results: 315 patients were referred for physiotherapy. Hospital data on attendances was available for 30% (n = 96), compared with 48% (n = 150) of patients completing questionnaire data (95% Cl for difference = 10% to 24%); 19% (n = 59) had data available from both sources. The two methods produced an intraclass correlation coefficient of 0.54 (95% Cl 0.31 to 0.70). However, the two methods produced significantly different estimates of resource use with patient self report recalling a mean of 1.3 extra visits (95% Cl 0.4 to 2.2) compared with hospital records. Conclusions: Using questionnaires in this study produced data on a greater number of patients compared with examination of hospital records. However, the two data sources did differ in the quantity of physiotherapy used and this should be taken into account in any analysi

Large Representation Recurrences in Large N Random Unitary Matrix Models

In a random unitary matrix model at large N, we study the properties of the expectation value of the character of the unitary matrix in the rank k symmetric tensor representation. We address the problem of whether the standard semiclassical technique for solving the model in the large N limit can be applied when the representation is very large, with k of order N. We find that the eigenvalues do indeed localize on an extremum of the effective potential; however, for finite but sufficiently large k/N, it is not possible to replace the discrete eigenvalue density with a continuous one. Nonetheless, the expectation value of the character has a well-defined large N limit, and when the discreteness of the eigenvalues is properly accounted for, it shows an intriguing approximate periodicity as a function of k/N.Comment: 24 pages, 11 figure

Links between seawater paleoredox and the formation of sediment-hosted massive sulphide (SHMS) deposits — Fe speciation and Mo isotope constraints from Late Devonian mudstones

Many models of sediment hosted massive sulphide (SHMS) deposit formation invoke basin restriction events that resulted in long-term stagnation and anoxia, in which sulphidic (euxinic) conditions ultimately prevailed. Euxinic conditions are then thought to provide a chemical trap for hydrothermally exhaled base metals. Here, we present Fe speciation and Mo isotope data for organic-rich mudstones from two drill-holes intersecting Upper Devonian strata, deposited along the passive margin of ancestral North America. One drill-hole intersects a 35 m thick sequence of SHMS mineralisation, while the other intersects correlative, un-mineralised strata. All samples have high FeHR/FeT values (>0.38), indicating water-column anoxia. For the majority of samples in the un-mineralised drill-hole, the levels of pyritisation fall below the threshold typically used to define euxinic conditions (FePY/FeHR ≤ 0.70). In contrast, higher levels of pyritisation in the mineralised drill-hole (median FePY/FeHR = 0.86) likely developed via diagenetic pyrite enrichment. Whereas Pb and Zn are negatively correlated with Mo, Mo-U co-variation is consistent with Fe (oxyhydr)oxide particulate shuttling in the water-column. In addition, a weak correlation between TOC/P and Mo provides further evidence that Mo was sourced via authigenic, rather than hydrothermal, processes. The δ98Mo values (+0.66 to +1.02‰) are uniform between both drill-holes, and substantially lower than constraints for Late Devonian seawater (+1.5 to +2.0‰), consistent with Mo adsorption to Fe (oxyhydr)oxides. Collectively, the data provide evidence that local seawater was dominantly ferruginous (anoxic, non-sulphidic) at Macmillan Pass. Regional variability in the extent of ferruginous (low TOC/P) and euxinic (high TOC/P) conditions likely contributed to a balance between P regeneration and P enrichment that maintained nutrient availability and productivity in the Selwyn Basin during the Late Devonian. We argue that high primary productivity and enhanced organic carbon burial are key variables for promoting sulphate reduction in the sub-surface. Moreover, how such conditions are maintained over long periods of basin evolution is more important for producing effective metal traps in SHMS systems, rather than a specific, localised redox condition of seawater (i.e. euxinia)

A microRNA focus on acne

Acne (syn. acne vulgaris) is a common inflammatory skin disorder associated with puberty and adolescence. Driven by complex interactions between the pilosebaceous unit and Cutibacterium acnes (C. acnes) bacteria, the disease is characterised by comedonal lesions, papules, pustules and nodules that appear predominantly on the face. Acne and sequelae such as scarring and pigment changes affect health-related quality of life negatively. Approvals for nucleic acid therapies (NATs) such as short-interfering RNA (siRNA) drugs and antisense oligonucleotides (ASOs) have surged in recent years, for rare disorders with little or no effective treatments. These advances, along with clinical trials for microRNA (miRNA) modulation in skin contexts, raise the possibility that NATs may have potential for future acne treatment regimens. In this review, we highlight potential miRNA targets for anti-acne therapy. We provide a brief overview of acne pathophysiology and highlight roles of C. acnes. We then focus on recently discovered differential effects of planktonic and biofilm C. acnes on a Toll-like receptor 2 (TLR2) axis spanning miR-146a-5p. We appraise miR-146a-5p in sebocytes before addressing the putative contributions of miR-21-5p, miR-233-3p and miR-150-5p to inflammatory axes in acne. We conclude with translational perspectives and considerations of patient involvement in miRNA-related research for acne

Electric-field controlled spin reversal in a quantum dot with ferromagnetic contacts

Manipulation of the spin-states of a quantum dot by purely electrical means is a highly desirable property of fundamental importance for the development of spintronic devices such as spin-filters, spin-transistors and single-spin memory as well as for solid-state qubits. An electrically gated quantum dot in the Coulomb blockade regime can be tuned to hold a single unpaired spin-1/2, which is routinely spin-polarized by an applied magnetic field. Using ferromagnetic electrodes, however, the properties of the quantum dot become directly spin-dependent and it has been demonstrated that the ferromagnetic electrodes induce a local exchange-field which polarizes the localized spin in the absence of any external fields. Here we report on the experimental realization of this tunneling-induced spin-splitting in a carbon nanotube quantum dot coupled to ferromagnetic nickel-electrodes. We study the intermediate coupling regime in which single-electron states remain well defined, but with sufficiently good tunnel-contacts to give rise to a sizable exchange-field. Since charge transport in this regime is dominated by the Kondo-effect, we can utilize this sharp many-body resonance to read off the local spin-polarization from the measured bias-spectroscopy. We show that the exchange-field can be compensated by an external magnetic field, thus restoring a zero-bias Kondo-resonance, and we demonstrate that the exchange-field itself, and hence the local spin-polarization, can be tuned and reversed merely by tuning the gate-voltage. This demonstrates a very direct electrical control over the spin-state of a quantum dot which, in contrast to an applied magnetic field, allows for rapid spin-reversal with a very localized addressing.Comment: 19 pages, 11 figure