An economic analysis of a pneumococcal vaccine programme in people aged over 64 years in a developed country setting.

BACKGROUND: Polysaccharide pneumococcal vaccination for older adults is being introduced in developed country settings. Evidence of protection by this vaccine against pneumococcal pneumonia, or confirmation that illness and death from bacteraemia are prevented, is currently limited. Decisions are often made based on partial information. We examined the policy implications by exploring the potential economic benefit to society and the health sector of pneumococcal vaccination in older adults. METHODS: A model to estimate the potential cost savings and cost-effectiveness of a polysaccharide pneumococcal vaccine programme was based on costs collected from patients, the literature, and routine health-services data. The effect of a pneumococcal vaccine (compared with no vaccination) was examined in a hypothetical cohort aged over 64 years. The duration of protection was assumed to be 10 years, with or without a booster at 5 years. RESULTS: If it were effective against morbidity from pneumococcal pneumonia, the main burden from pneumococcal disease, the vaccine could be cost-neutral to society or the health sector at low efficacy (28 and 37.5%, respectively, without boosting and with 70% coverage). If it were effective against morbidity from bacteraemia only, the vaccine's efficacy would need to be 75 and 89%, respectively. If protection against both morbidity and mortality from pneumococcal bacteraemia was 50%, the net cost to society would be 2500 pounds per year of life saved ( 3365 pounds from the health-sector perspective). Results were sensitive to incidence, case-fatality rates, and costs of illness. CONCLUSIONS: A vaccine with moderate efficacy against bacteraemic illness and death would be cost-effective. If it also protected against pneumonia, it would be cost-effective even if its efficacy were low

DNA end-directed and processive nuclease activities of the archaeal XPF enzyme

The XPF/Mus81 family of structure-specific nucleases cleaves branched or nicked DNA substrates and are implicated in a wide range of DNA repair and recombination processes. The structure of the crenarchaeal XPF bound to a DNA duplex has revealed a plausible mechanism for DNA binding, involving DNA distortion into upstream and downstream duplexes engaged by the two helix–hairpin–helix domains that form a dimeric structure at the C-terminus of the enzyme. A flexible linker joins these to the dimeric nuclease domain, and a C-terminal motif interacts with the sliding clamp, which is essential for the activity of the enzyme. Here, we demonstrate the importance of the downstream duplex in directing the endonuclease activity of crenarchaeal XPF, which is similar to that of Mus81-Eme1, and suggest a mechanistic basis for this control. Furthermore, our data reveal that the enzyme can digest a nicked DNA strand processively over at least 60 nt in a 3′–5′ direction and can remove varied types of DNA lesions and blocked DNA termini. This in vitro activity suggests a potential role for crenarchaeal XPF in a variety of repair processes for which there are no clear pathways in archaea

A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database.

BACKGROUND: The effectiveness of influenza vaccination against hospitalization and death can only ethically be assessed in observational studies. A concern is that individuals who are vaccinated are healthier than individuals who are not vaccinated, potentially biasing estimates of effectiveness upward. METHODS: We conducted a historical cohort study of individuals >64 years of age, for whom there were data available in the General Practice Research Database for 1989 to 1999 in England and Wales. Rates of admissions for acute respiratory diseases and rates of death due to respiratory disease were compared over 692,819 person-years in vaccine recipients and 1,534,280 person-years in vaccine nonrecipients. RESULTS: The pooled effectiveness of vaccine against hospitalizations for acute respiratory disease was 21% (95% confidence interval [CI], 17%-26%). The rate reduction attributable to vaccination was 4.15 hospitalizations/100,000 person-weeks in the influenza season. Among vaccine recipients, no important reduction in the number of admissions to the hospital was seen outside influenza seasons. The pooled effectiveness of vaccine against deaths due to respiratory disease was 12% (95% CI, 8%-16%). A greater proportionate reduction was seen among people without medical disorders, but absolute rate reduction was higher in individuals with medical disorders, compared with individuals without such disorders (6.14 deaths due to respiratory disease/100,000 person-weeks vs. 3.12 deaths due to respiratory disease/100,000 person-weeks). Clear protection against death due to all causes was not seen. CONCLUSIONS: Influenza vaccination reduces the number of hospitalizations and deaths due to respiratory disease, after correction for confounding in individuals >64 years of age who had a high risk or a low risk for influenza. For elderly people, untargeted influenza vaccination is of confirmed benefit against serious outcomes

A Global Assessment of Salmon Aquaculture Impacts on Wild Salmonids

Since the late 1980s, wild salmon catch and abundance have declined dramatically in the North Atlantic and in much of the northeastern Pacific south of Alaska. In these areas, there has been a concomitant increase in the production of farmed salmon. Previous studies have shown negative impacts on wild salmonids, but these results have been difficult to translate into predictions of change in wild population survival and abundance. We compared marine survival of salmonids in areas with salmon farming to adjacent areas without farms in Scotland, Ireland, Atlantic Canada, and Pacific Canada to estimate changes in marine survival concurrent with the growth of salmon aquaculture. Through a meta-analysis of existing data, we show a reduction in survival or abundance of Atlantic salmon; sea trout; and pink, chum, and coho salmon in association with increased production of farmed salmon. In many cases, these reductions in survival or abundance are greater than 50%. Meta-analytic estimates of the mean effect are significant and negative, suggesting that salmon farming has reduced survival of wild salmon and trout in many populations and countries

Voices of worth- listening to teachers: A phenomenological study of professional development and instructional change.

The purpose of this phenomenological study was to describe and explain teachers' perceptions about effective professional development as well as to identify the environmental factors that affect the teacher participants' ability to engage in and implement various behaviors and beliefs transferred from the professional development experience. Four teachers were studied in depth for one school year, and data collected included in-depth interviews and classroom observations. Findings indicate three main themes related to the research questions, which sought to understand how teachers perceive and describe their experiences of participating in professional development and the factors that support or constrain their instructional decision-making as it relates to new knowledge and skills acquired through professional development. These themes are that: (a) Effective professional development must have a supportive context and meaningful purpose which: meets the physical and cognitive needs of participants; focuses on improving practice, content knowledge, and pedagogy; provides participants with choice, adequate time and ownership of learning experiences; and includes opportunities for sustained learning and accountability; (b) Learning experiences are greatly affected by interpersonal relationships and opportunities for social learning and should be built upon the principles of: taking risks in the learning environment; sharing beliefs in a community of practice with effective support structures; involving all members, including the leaders, in the community of practice; and including opportunities for dialogue and the sharing of best practices as tools for learning, and (c) Implementation efforts are influenced by multiple sources, including: collegial and administrator support; curriculum and standardized testing; and time. Effective professional development must include attention to assisting teachers in dealing with these influences when they become barriers to implementation efforts

Entrapment of Bacteria in Fluid Inclusions in Laboratory-Grown Halite

This is the publisher's version, also available electronically from "http://online.liebertpub.com".Cells of the bacterium Pseudomonas aeruginosa, which were genetically modified to produce green fluorescent protein, were entrapped in fluid inclusions in laboratory-grown halite. The bacteria were used to inoculate NaCl-saturated aqueous solutions, which were allowed to evaporate and precipitate halite. The number, size, and distribution of fluid inclusions were highly variable, but did not appear to be affected by the presence of the bacteria. Many of the inclusions in crystals from inoculated solutions contained cells in populations ranging from two to 20. Microbial attachment to crystal surfaces was neither evident nor necessary for entrapment. Cells occurred exclusively within fluid inclusions and were not present in the crystal matrix. In both the inclusions and the hypersaline solution, the cells fluoresced and twitched, which indicates that the bacteria might have remained viable after entrapment. The fluorescence continued up to 13 months after entrapment, which indicates that little degradation of the bacteria occurred over that time interval. The entrapment, fluorescence, and preservation of cells were independent of the volume of hypersaline solution used or whether the solutions were completely evaporated prior to crystal extraction. The results of this study have a wide range of implications for the long-term survival of microorganisms in fluid inclusions and their detection through petrography. The results also demonstrate the preservation potential for microbes in hypersaline fluid inclusions, which could allow cells to survive harsh conditions of space, the deep geologic past, or burial in sedimentary basins

Deliberative quality and expertise:Uses of evidence in citizens’ juries on wind farms

When addressing socio-scientific wicked problems, there is a need to negotiate across and through multiple modes of evidence, particularly technical expertise and local knowledge. Democratic innovations, such as deliberative citizens’ juries, have been proposed as a means of managing these tensions and as a way of creating representative, fairer decision making. But there are questions around participatory processes, the utilization of expertise, and deliberative quality. This paper considers forms of argumentation in the 2013-2014 “Citizens’ juries on wind farm development in Scotland.” Through a critical-interpretative research methodology drawing on rhetoric and argumentation, we demonstrate that arguments relating to the topoi of the environment and health functioned as de facto reasoning, whereas arguments using social scientific evidence around economics more prominently interacted with local knowledge. The findings offer implications for process design to improve and promote deliberative quality in mini-publics and other forms of participatory engagement on socio-scientific issues

Higher order Rab programming in phagolysosome biogenesis

Phagosomes offer kinetically and morphologically tractable organelles to dissect the control of phagolysosome biogenesis by Rab GTPases. Model phagosomes harboring latex beads undergo a coordinated Rab5–Rab7 exchange, which is akin to the process of endosomal Rab conversion, the control mechanisms of which are unknown. In the process of blocking phagosomal maturation, the intracellular pathogen Mycobacterium tuberculosis prevents Rab7 acquisition, thus, providing a naturally occurring tool to study Rab conversion. We show that M. tuberculosis inhibition of Rab7 acquisition and arrest of phagosomal maturation depends on Rab22a. Four-dimensional microscopy revealed that phagosomes harboring live mycobacteria recruited and retained increasing amounts of Rab22a. Rab22a knockdown in macrophages via siRNA enhanced the maturation of phagosomes with live mycobacteria. Conversely, overexpression of the GTP-locked mutant Rab22aQ64L prevented maturation of phagosomes containing heat-killed mycobacteria, which normally progress into phagolysosomes. Moreover, Rab22a knockdown led to Rab7 acquisition by phagosomes harboring live mycobacteria. Our findings show that Rab22a defines the critical checkpoint for Rab7 conversion on phagosomes, allowing or disallowing organellar transition into a late endosomal compartment. M. tuberculosis parasitizes this process by actively recruiting and maintaining Rab22a on its phagosome, thus, preventing Rab7 acquisition and blocking phagolysosomal biogenesis

The efficacy and safety of adrenergic blockade post burn injury: a systematic review and meta-analysis

BACKGROUND The hypermetabolic state after severe burns is a major problem that can lead to several pathophysiologic changes and produce multiple sequelae. Adrenergic blockade has been widely used to reverse these changes and improve outcomes in burned patients but has not been rigorously evaluated. The aim of this systematic review was to investigate the efficacy and safety of the use of adrenergic blockade after burn injury