A new combined DTP-HBV HiB vaccine- strategy for incorporation of HIB vaccination into childhood immunisation programmes

Objectives. To evaluate the immunogenicity and reactogenicity of a pentavalent vaccine prepared by extemporaneously mixing diphtheria-tetanus pertussis-hepatitis B vaccine (DTPHBV) and lyophilised Haemophilus influenzae type B (Hib)tetanus conjugate vaccines in the same syringe, compared with the same vaccines given as separate, concomitant administrations.Design. Open, randornised comparative study.Setting. Durban, South Africa.Subjects. A total of 120 healthy male and female infants were enrolled in the trial and randomised into two groups; group 1 received the combined administration (DTP-HBV-Hib), and group 2 received separate administrations of DTP-HBV and Hib vaccines. Vaccines were given as a three-dose primary vaccination course at 6,10 and 14 weeks of age.Outcome measures. Antibody levels were measured using standard techniques and local and general solicited symptoms were recorded using diary cards.Results. All subjects had seroprotective titres against diphtheria and tetanus; and antipolyribose-ribitol phosphate (PRP) titres ≥ 0.15 )μg/ ml 1 month after the final dose. A vaccine response (defined as post-vaccination titres ≥ 15 ELISA (EL).U/ ml in initially seronegative subjects; and as post- vaccination titres ≥ pre-vaccination titres in ini tially seropositive subjects) against the pertussis component was seen in 83% and 85% of subjects in the groups receiving combined and separate administration. No differences were  seen in any of the geometric mean titres (GMTs) between the two administrations either 2 months after the second dose or 1 month after the final dose. There was no observed increase in reactogenicity in the group receiving the mixed administration.Conclusions. The results demonstrate that combined DTPHBV- Hib vaccine is well tolerated and immunogeni

Sustainability of Global Golden Inland Waterways

Sustainable inland waterways should meet the needs of navigation without compromising the health of riverine ecosystems. Here we propose a hierarchical model to describe sustainable development of the Golden Inland Waterways (GIWs) which are characterized by great bearing capacity and transport need. Based on datasets from 66 large rivers (basin area > 100,000 km2) worldwide, we identify 34 GIWs, mostly distributed in Asia, Europe, North America, and South America, typically following a three-stage development path from the initial, through to the developing and on to the developed stage. For most GIWs, the exploitation ratio, defined as the ratio of actual to idealized bearing capacity, should be less than 80% due to ecological considerations. Combined with the indices of regional development, GIWs exploitation, and riverine ecosystem, we reveal the global diversity and evolution of GIWs' sustainability from 2015 to 2050, which highlights the importance of river-specific strategies for waterway exploitation worldwide

What Lies behind the Wish to Hasten Death? A Systematic Review and Meta-Ethnography from the Perspective of Patients

BACKGROUND: There is a need for an in-depth approach to the meaning of the wish to hasten death (WTHD). This study aims to understand the experience of patients with serious or incurable illness who express such a wish. METHODS AND FINDINGS: Systematic review and meta-ethnography of qualitative studies from the patient's perspective. Studies were identified through six databases (ISI, PubMed, PsycINFO, CINAHL, CUIDEN and the Cochrane Register of Controlled Trials), together with citation searches and consultation with experts. Finally, seven studies reporting the experiences of 155 patients were included. The seven-stage Noblit and Hare approach was applied, using reciprocal translation and line-of-argument synthesis. Six main themes emerged giving meaning to the WTHD: WTHD in response to physical/psychological/spiritual suffering, loss of self, fear of dying, the desire to live but not in this way, WTHD as a way of ending suffering, and WTHD as a kind of control over one's life ('having an ace up one's sleeve just in case'). An explanatory model was developed which showed the WTHD to be a reactive phenomenon: a response to multidimensional suffering, rather than only one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of WTHD are total suffering, loss of self and fear, which together produce an overwhelming emotional distress that generates the WTHD as a way out, i.e. to cease living in this way and to put an end to suffering while maintaining some control over the situation. CONCLUSIONS: The expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one's death. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans

Reforming the Westminster Model of Agency Governance: Britain and Ireland after the Crisis

Conventional understandings of what the Westminster model implies anticipate reliance on a top-down, hierarchical approach to budgetary accountability, reinforced by a post-New Public Management emphasis on re-centralizing administrative capacity. This paper, based on a comparative analysis of the experiences of Britain and Ireland, argues that the Westminster model of bureaucratic control and oversight itself has been evolving, hastened in large part due to the global financial crisis. Governments have gained stronger controls over the structures and practices of agencies, but agencies are also key players in securing better governance outcomes. The implication is that the crisis has not seen a return to the archetypal command-and-control model, nor a wholly new implementation of negotiated European-type practices, but rather a new accountability balance between elements of the Westminster system itself that have not previously been well understood

The chemical composition of donors in AM CVn stars and ultra-compact X-ray binaries: observational tests of their formation

We study the formation of ultra-compact binaries (AM CVn stars and ultra-compact X-ray binaries) with emphasis on the surface chemical abundances of the donors in these systems. Hydrogen is not convincingly detected in the spectra of these systems. Three different proposed formation scenarios involve different donor stars, white dwarfs, helium stars or evolved main-sequence stars. Using detailed evolutionary calculations we show that the abundances of helium WD donors and evolved main-sequence stars are close to equilibrium CNO-processed material, and the detailed abundances correlate with the core temperature and thus mass of the MS progenitors. Evolved MS donors typically have traces of H left. For hybrid or CO white dwarf donors, the carbon and oxygen abundances depend on the temperature of the helium burning and thus on the helium core mass of the progenitors. For helium star donors in addition to their mass, the abundances depend strongly on the amount of helium burnt before mass transfer starts and can range from unprocessed and thus almost equal to CNO-processed matter, to strongly processed and thus C/O rich and N-deficient. We briefly discuss the relative frequency of these cases for helium star donors, based on population synthesis results. Finally we give diagnostics for applying our results to observed systems and find that the most important test is the N/C ratio, which can indicate the formation scenario as well as, in some cases, the mass of the progenitor of the donor. In addition, if observed, the N/O, O/He and O/C ratios can distinguish between helium star and WD donors. Applied to the known systems we find evidence for WD donors in the AM CVn systems GP Com, CE 315 and SDSS J0804+16 and evidence for hybrid WD or very evolved helium star donors in the UCXBs 4U 1626-67 and 4U 0614+09. [Abridged]Comment: Accepted for publication in MNRA

Deep Brain Stimulation of Nucleus Accumbens Region in Alcoholism Affects Reward Processing

The influence of bilateral deep brain stimulation (DBS) of the nucleus nucleus (NAcc) on the processing of reward in a gambling paradigm was investigated using H2[15O]-PET (positron emission tomography) in a 38-year-old man treated for severe alcohol addiction. Behavioral data analysis revealed a less risky, more careful choice behavior under active DBS compared to DBS switched off. PET showed win- and loss-related activations in the paracingulate cortex, temporal poles, precuneus and hippocampus under active DBS, brain areas that have been implicated in action monitoring and behavioral control. Except for the temporal pole these activations were not seen when DBS was deactivated. These findings suggest that DBS of the NAcc may act partially by improving behavioral control

Polymer nanofilms with enhanced microporosity by interfacial polymerization

Highly permeable and selective membranes are desirable for energy-efficient gas and liquid separations. Microporous organic polymers have attracted significant attention in this respect owing to their high porosity, permeability, and molecular selectivity. However, it remains challenging to fabricate selective polymer membranes with controlled microporosity which are stable in solvents. Here we report a new approach to designing crosslinked, rigid polymer nanofilms with enhanced microporosity by manipulating the molecular structure. Ultra-thin polyarylate nanofilms with thickness down to 20 nm were formed in-situ by interfacial polymerisation. Enhanced microporosity and higher interconnectivity of intermolecular network voids, as rationalised by molecular simulations, are achieved by utilising contorted monomers for the interfacial polymerisation. Composite membranes comprising polyarylate nanofilms with enhanced microporosity fabricated in-situ on crosslinked polyimide ultrafiltration membranes show outstanding separation performance in organic solvents, with up to two orders of magnitude higher solvent permeance than membranes fabricated with nanofilms made from noncontorted planar monomers

Insulin-resistance and metabolic syndrome are related to executive function in women in a large family-based study

While type 2 diabetes is well-known to be associated with poorer cognitive performance, few studies have reported on the association of metabolic syndrome (MetS) and contributing factors, such as insulin-resistance (HOMA-IR), low adiponectin-, and high C-reactive protein (CRP)- levels. We studied whether these factors are related to cognitive function and which of the MetS components are independently associated. The study was embedded in an ongoing family-based cohort study in a Dutch population. All participants underwent physical examinations, biomedical measurements, and neuropsychological testing. Linear regression models were used to determine the association between MetS, HOMA-IR, adiponectin levels, CRP, and cognitive test scores. Cross-sectional analyses were performed in 1,898 subjects (mean age 48 years, 43% men). People with MetS had significantly higher HOMA-IR scores, lower adiponectin levels, and higher CRP levels. MetS and high HOMA-IR were associated with poorer executive function in women (P = 0.03 and P = 0.009). MetS and HOMA-IR are associated with poorer executive function in women