High residual prevalence of vaccine-serotype Streptococcus pneumoniae carriage after introduction of a pneumococcal conjugate vaccine in Malawi: a prospective serial cross-sectional study

Background: There are concerns that pneumococcal conjugate vaccines (PCV) in sub-Saharan Africa sub-optimally interrupt vaccine-serotype (VT) carriage and transmission, thus limiting vaccine-induced direct and indirect protection. We assessed carriage in vaccinated children and unvaccinated populations targeted for indirect protection, between 4 and 7 years after Malawi’s November 2011 introduction of PCV13 using a 3+0 schedule. / Methods: We conducted sequential prospective nasopharyngeal carriage surveys between 2015 and 2018 among healthy PCV-vaccinated and PCV-unvaccinated children, and HIV-infected adults. VT and NVT carriage risk by age was analysed by non-linear regression. / Results: Among PCV-vaccinated children, there was a 24% relative reduction in carriage, from a mean 21.1% to 16.1%; 45% reduction among older PCV-unvaccinated children, from 27.5% to 15.2%; 41.4% reduction among adults, from 15.2% to 8.9%. Using carriage data from children 3.6 to 10 years of age, VT carriage probability declined with age, with a similar prevalence half-life among PCV-vaccinated (3.34 years) and PCV-unvaccinated (3.26 years) children. / Conclusion: Compared to high-income settings, the 3+0 schedule in Malawi has led to a sub-optimal reduction in pneumococcal carriage prevalence. This is likely due to recolonisation of vaccinated children with waning vaccine-induced immunity, resulting in insufficient indirect protection of unvaccinated populations. Rigorous evaluation of strategies to augment vaccine-induced control of carriage, including alternative schedules and catch-up campaigns is required

Design and operating experience of the cryogenic system of the U. S. SCMS as incorporated into the bypass loop of the U-25 MHD generator facility

The design features and accumulated operating experience, from a cryogenics point of view, of the United States Superconducting Magnet System (U.S. SCMS) are presented. The principal cryogenic system design parameters are enumerated. Details of the cryogenic aspects of magnetic system commissioning, standby mode, and operation with MHD generators are discussed. Included are system operation, problems encountered and corrective actions taken, and measured operating parameters which include liquid helium boiloff, cryostat pressure and level versus time, etc. The aspects of the transition between operation in the laboratory and in an MHD plant are elaborated

Cryogenic aspects of the experience in operating the U-25 superconducting MHD magnet in conjunction with the MHD generator

In order to facilitate the rapid development of MHD technology for the generation of electrical energy, the U.S. and U.S.S.R. are jointly conducting research within the framework of the Program of Scientific and Technical Cooperation. The Institute for High Temperature (IVTAN) of the U.S.S.R. has designed and fabricated a special MHD facility which uses as its base much of the equipment of the existing U-25 Facility. The new MHD fow train consisting of a combustor, magnet, channel, and diffuser is named U-25B. The U.S. has provided a superconducting magnet system for the U-25B MHD Facility. As a result of these joint efforts, a unique and broad range of experimental test conditions similar to those that will exist in operation of commercial MHD generators has been created. The United States Superconducting Magnet System (U.S. SCMS) was designed, fabricated, and delivered to the U-25B Facility by the Argonne National Laboratory (ANL) under the sponsorship of the U.S. Department of Energy. The following description focuses on the cryogenic-related aspects of the magnet system commissioning and operation in the U.S.S.R

Human resources requirements for highly active antiretroviral therapy scale-up in Malawi

<p>Abstract</p> <p>Background</p> <p>Twelve percent of the adult population in Malawi is estimated to be HIV infected. About 15% to 20% of these are in need of life saving antiretroviral therapy. The country has a public sector-led antiretroviral treatment program both in the private and public health sectors. Estimation of the clinical human resources needs is required to inform the planning and distribution of health professionals.</p> <p>Methods</p> <p>We obtained data on the total number of patients on highly active antiretroviral treatment program from the Malawi National AIDS Commission and Ministry of Health, HIV Unit, and the number of registered health professionals from the relevant regulatory bodies. We also estimated number of health professionals required to deliver highly active antiretroviral therapy (HAART) using estimates of human resources from the literature. We also obtained data from the Ministry of Health on the actual number of nurses, clinical officers and medical doctors providing services in HAART clinics. We then made comparisons between the human resources situation on the ground and the theoretical estimates based on explicit assumptions.</p> <p>Results</p> <p>There were 610 clinicians (396 clinical officers and 214 physicians), 44 pharmacists and 98 pharmacy technicians and 7264 nurses registered in Malawi. At the end of March 2007 there were 85 clinical officer and physician full-time equivalents (FTEs) and 91 nurse FTEs providing HAART to 95,674 patients. The human resources used for the delivery of HAART comprised 13.9% of all clinical officers and physicians and 1.1% of all nurses. Using the estimated numbers of health professionals from the literature required 15.7–31.4% of all physicians and clinical officers, 66.5–199.3% of all pharmacists and pharmacy technicians and 2.6 to 9.2% of all the available nurses. To provide HAART to all the 170,000 HIV infected persons estimated as clinically eligible would require 4.7% to 16.4% of the total number of nurses, 118.1% to 354.2% of all the available pharmacists and pharmacy technicians and 27.9% to 55.7% of all clinical officers and physicians. The actual number of health professionals working in the delivery of HAART in the clinics represented 44% to 88.8% (for clinical officers and medical doctors) and 13.6% and 47.6% (for nurses), of what would have been needed based on the literature estimation.</p> <p>Conclusion</p> <p>HAART provision is a labour intensive exercise. Although these data are insufficient to determine whether HAART scale-up has resulted in the weakening or strengthening of the health systems in Malawi, the human resources requirements for HAART scale-up are significant. Malawi is using far less human resources than would be estimated based on the literature from other settings. The impact of HAART scale-up on the overall delivery of health services should be assessed.</p

Determinants of high residual post-PCV13 pneumococcal vaccine-type carriage in Blantyre, Malawi:a modelling study

Background In November 2011, Malawi introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into the routine infant schedule. Four to 7 years after introduction (2015–2018), rolling prospective nasopharyngeal carriage surveys were performed in the city of Blantyre. Carriage of Streptococcus pneumoniae vaccine serotypes (VT) remained higher than reported in high-income countries, and impact was asymmetric across age groups. Methods A dynamic transmission model was fit to survey data using a Bayesian Markov-chain Monte Carlo approach, to obtain insights into the determinants of post-PCV13 age-specific VT carriage. Results Accumulation of naturally acquired immunity with age and age-specific transmission potential were both key to reproducing the observed data. VT carriage reduction peaked sequentially over time, earlier in younger and later in older age groups. Estimated vaccine efficacy (protection against carriage) was 66.87% (95% CI 50.49–82.26%), similar to previous estimates. Ten-year projected vaccine impact (VT carriage reduction) among 0–9 years old was lower than observed in other settings, at 76.23% (CI 95% 68.02–81.96%), with sensitivity analyses demonstrating this to be mainly driven by a high local force of infection. Conclusions There are both vaccine-related and host-related determinants of post-PCV13 pneumococcal VT transmission in Blantyre with vaccine impact determined by an age-specific, local force of infection. These findings are likely to be generalisable to other Sub-Saharan African countries in which PCV impact on carriage (and therefore herd protection) has been lower than desired, and have implications for the interpretation of post-PCV carriage studies and future vaccination programs.</p

Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review

Background: HIV and AIDS are significant and growing public health concerns in southern Africa. The majority of countries in the region have national adult HIV prevalence estimates exceeding 10 percent. The increasing availability of highly active antiretroviral therapy (HAART) has potential to mitigate the situation. There is however concern that women may experience more barriers in accessing treatment programs than men. Methods: A systematic review of the literature was carried out to describe the gender distribution of patients accessing highly active antiretroviral therapy (HAART) in Southern Africa. Data on number of patients on treatment, their mean or median age and gender were obtained and compared across studies and reports. Results: The median or mean age of patients in the studies ranged from 33 to 39 years. While female to male HIV infection prevalence ratios in the southern African countries ranged from 1.2:1 to 1.6:1, female to male ratios on HAART ranged from 0.8: 1 to 2.3: 1. The majority of the reports had female: male ratio in treatment exceeding 1.6. Overall, there were more females on HAART than there were males and this was not solely explained by the higher HIV prevalence among females compared to males. Conclusion: In most Southern African countries, proportionally more females are on HIV antiretroviral treatment than men, even when the higher HIV infection prevalence in females is accounted for. There is need to identify the factors that are facilitating women's accessibility to HIV treatment. As more patients access HAART in the region, it will be important to continue assessing the gender distribution of patients on HAART.Peer Reviewe

Study of the formation and effects of sigma phase in 21-6-9 stainless steel

Work performed to date on the study of the formation and effects of sigma phase in 21-6-9 stainless steel is summarized in this report. Sigma phase was identified in forgings and as-rolled plate by color etching and microprobe analysis. In as-rolled plate sigma was found to start transforming from delta ferrite within 30 minutes at 1500/sup 0/F, with almost complete transformation after 24 hours at 1500/sup 0/F. The effect of sigma phase on room temperature mechanical properties was evaluated by tensile testing, Charpy impact testing, and impact shear testing. Sigma phase was found to severely reduce transverse ductility and longtudinal and transverse impact resistance. The greater the amount of sigma present, the greater was its effect on mechanical properties. Vendor contacts indicated that controlling delta ferrite to a minimum in the as-rolled plate is both possible and practical

Elevated temperature stress strain behavior of beryllium powder product

Several grades of beryllium powder product were tested under isothermal conditions in compression over a temperature range of room temperature to 1000 C and a strain rate range from 0.001 s{sup {minus}1} to 1 s{sup {minus}1}. Samples were compressed to a total strain of 1 (64% reduction in height). It is shown that all the grades are strain rate sensitive and that strain rate sensitivity increases with temperature. Yield points were exhibited by some grades up to a temperature of 500 C, and appeared to be primarily dependent on prior thermal history which determined the availability of mobile dislocations. Serrated flow in the form of stress drops was seen in all the materials tested and was most pronounced at 500 C. The appearance and magnitude of the stress drops were dependent on accumulated strain, strain rate, sample orientation, and composition. The flow stress and shape of the flow curves differed significantly from grade to grade due to variations in alloy content, the size and distribution of BeO particles, aging precipitates, and grain size. The ductile-brittle transition temperature (DBTT) was determined for each grade of material and shown to be dependent on composition and thermal treatment. Structure/property relationships are discussed using processing history, microscopy (light and transmission), and property data