Modeling the public health impact of malaria vaccines for developers and policymakers

Efforts to develop malaria vaccines show promise. Mathematical model-based estimates of the potential demand, public health impact, and cost and financing requirements can be used to inform investment and adoption decisions by vaccine developers and policymakers on the use of malaria vaccines as complements to existing interventions. However, the complexity of such models may make their outputs inaccessible to non-modeling specialists. This paper describes a Malaria Vaccine Model (MVM) developed to address the specific needs of developers and policymakers, who need to access sophisticated modeling results and to test various scenarios in a user-friendly interface. The model's functionality is demonstrated through a hypothetical vaccine.; The MVM has three modules: supply and demand forecast; public health impact; and implementation cost and financing requirements. These modules include pre-entered reference data and also allow for user-defined inputs. The model includes an integrated sensitivity analysis function. Model functionality was demonstrated by estimating the public health impact of a hypothetical pre-erythrocytic malaria vaccine with 85% efficacy against uncomplicated disease and a vaccine efficacy decay rate of four years, based on internationally-established targets. Demand for this hypothetical vaccine was estimated based on historical vaccine implementation rates for routine infant immunization in 40 African countries over a 10-year period. Assumed purchase price was $5 per dose and injection equipment and delivery costs were$0.40 per dose.; The model projects the number of doses needed, uncomplicated and severe cases averted, deaths and disability-adjusted life years (DALYs) averted, and cost to avert each. In the demonstration scenario, based on a projected demand of 532 million doses, the MVM estimated that 150 million uncomplicated cases of malaria and 1.1 million deaths would be averted over 10 years. This is equivalent to 943 uncomplicate cases and 7 deaths averted per 1,000 vaccinees. In discounted 2011 US dollars, this represents $11 per uncomplicated case averted and$1,482 per death averted. If vaccine efficacy were reduced to 75%, the estimated uncomplicated cases and deaths averted over 10 years would decrease by 14% and 19%, respectively.; The MVM can provide valuable information to assist decision-making by vaccine developers and policymakers, information which will be refined and strengthened as field studies progress allowing further validation of modeling assumptions

The hypoxia marker CAIX is prognostic in the UK phase III VorteX-Biobank cohort: an important resource for translational research in soft tissue sarcoma

BACKGROUND: Despite high metastasis rates, adjuvant/neoadjuvant systemic therapy for localised soft tissue sarcoma (STS) is not used routinely. Progress requires tailoring therapy to features of tumour biology, which need exploration in well-documented cohorts. Hypoxia has been linked to metastasis in STS and is targetable. This study evaluated hypoxia prognostic markers in the phase III adjuvant radiotherapy VorteX trial. METHODS: Formalin-fixed paraffin-embedded tumour biopsies, fresh tumour/normal tissue and blood were collected before radiotherapy. Immunohistochemistry for HIF-1α, CAIX and GLUT1 was performed on tissue microarrays and assessed by two scorers (one pathologist). Prognostic analysis of disease-free survival (DFS) used Kaplan-Meier and Cox regression. RESULTS: Biobank and outcome data were available for 203 out of 216 randomised patients. High CAIX expression was associated with worse DFS (hazard ratio 2.28, 95% confidence interval: 1.44-3.59, P<0.001). Hypoxia-inducible factor-1α and GLUT1 were not prognostic. Carbonic anhydrase IX remained prognostic in multivariable analysis. CONCLUSIONS: The VorteX-Biobank contains tissue with linked outcome data and is an important resource for research. This study confirms hypoxia is linked to poor prognosis in STS and suggests that CAIX may be the best known marker. However, overlap between single marker positivity was poor and future work will develop an STS hypoxia gene signature to account for tumour heterogeneity

Implementing a new mathematics curriculum in England: district Research Lesson Study as a driver for student learning, teacher learning and professional dialogue.

Against a backdrop of a transformation in teacher professional development and learning and state school organisation in England this century, this chapter describes a project which harnessed six cycles of Research Lesson Study at school and district level over two years to tailor the implementation of a new statutory curriculum in England to address the professional development needs of teachers and classroom learning needs of London students. It also reports the findings of research carried out during the project into how these teachers learned and developed this new curricular expertise and practice- knowledge through lesson study dialogues that supported student learning. It concludes by proposing future directions for teacher professional learning research and practice

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Doppler-shifted auroral H &#x03b2; emission: a comparison between observations and calculations

Two sounding rockets equipped with photometers and particle detectors have been flown into proton auroras. The measured altitude dependence of the proton flux is compared with calculations based upon known energy-range relations for protons in air. Expressions suitable for numerical calculations of Doppler profiles at arbitrary angles to the geomagnetic field and at different heights within an aurora are developed. Profiles due to some typical proton spectra have been calculated and it is shown that altitude profiles at some wavelengths are more sensitive to the shape of the proton spectrum than are profiles at other wavelengths. Variations in the H&#x03B2; Doppler profile versus height for several angles with the magnetic field is studied. Profiles, as generated by the actually measured protons in the energy range 1 keV to 1 MeV, have been calculated and are compared with direct optical measurements made by ground and rocket photometers. The rocket photometers took measurements at different wavelengths within the Doppler profile. The correspondence between calculations and measurements is generally good. The total H&#x03B2; is calculated and fair agreement with the measured intensity is found

Doppler-shifted auroral H &#x03b2; emission: a comparison between observations and calculations

Two sounding rockets equipped with photometers and particle detectors have been flown into proton auroras. The measured altitude dependence of the proton flux is compared with calculations based upon known energy-range relations for protons in air. Expressions suitable for numerical calculations of Doppler profiles at arbitrary angles to the geomagnetic field and at different heights within an aurora are developed. Profiles due to some typical proton spectra have been calculated and it is shown that altitude profiles at some wavelengths are more sensitive to the shape of the proton spectrum than are profiles at other wavelengths. Variations in the <i>H&#x03B2;</i> Doppler profile versus height for several angles with the magnetic field is studied. Profiles, as generated by the actually measured protons in the energy range 1 keV to 1 MeV, have been calculated and are compared with direct optical measurements made by ground and rocket photometers. The rocket photometers took measurements at different wavelengths within the Doppler profile. The correspondence between calculations and measurements is generally good. The total <i>H&#x03B2;</i> is calculated and fair agreement with the measured intensity is found

Simultaneous measurements of X-rays and electrons during a pulsating aurora

The PULSAUR II rocket was launched from Andøya Rocket Range at 23.43 UT on 9 February 1994 into a pulsating aurora. In this paper we focus on the observations of precipitating electrons and auroral X-rays. By using models it is possible to deduce the electron energy spectrum from X-ray measurements. Comparisons are made between the deduced electron fluxes and the directly measured electron fluxes on the rocket. We found the shape of the observed and the deduced electron spectra to fit very well, with almost identical e-folding energies in the energy range from 10 ke V to ~60–80 ke V. For the integrated fluxes from 10.8 to 250 ke V, we found a discrepancy of 30% . By combining two models, we have found a good method of deducing the electron precipitation from X-ray measurements. The discrepancies between calculations and measurements are in the range of the uncertainties in the measurements.Key words. Ionospheric particle precipitation · Magnetospheric physics · Annual phenomena · Energetic particl