Meningitis in an Irish community

A series of 26 cases of meningitis occurring in one year in a defined area is presented. The clinical features, and complications are reviewed. Neisseria meningitidis occurred twice as commonly as Haemophilus influenzae, suggesting that the pattern of infection differs from that reported in England and Wales. An incidence of 4·6/100,000 for N. meningitidis is reported exceeding rates of infection in previous UK “epidemics”

Boosting BCG with recombinant modified vaccinia ankara expressing antigen 85A: Different boosting intervals and implications for efficacy trials

Objectives. To investigate the safety and immunogenicity of boosting BCG with modified vaccinia Ankara expressing antigen 85A (MVA85A), shortly after BCG vaccination, and to compare this first with the immunogenicity of BCG vaccination alone and second with a previous clinical trial where MVA85A was administered more than 10 years after BCG vaccination. Design. There are two clinical trials reported here: a Phase I observational trial with MVA85A; and a Phase IV observational trial with BCG. These clinical trials were all conducted in the UK in healthy, HIV negative, BCG naı¨ve adults. Subjects were vaccinated with BCG alone; or BCG and then subsequently boosted with MVA85A four weeks later (short interval). The outcome measures, safety and immunogenicity, were monitored for six months. The immunogenicity results from this short interval BCG prime–MVA85A boost trial were compared first with the BCG alone trial and second with a previous clinical trial where MVA85A vaccination was administered many years after vaccination with BCG. Results. MVA85A was safe and highly immunogenic when administered to subjects who had recently received BCG vaccination. When the short interval trial data presented here were compared with the previous long interval trial data, there were no significant differences in the magnitude of immune responses generated when MVA85A was administered shortly after, or many years after BCG vaccination. Conclusions. The clinical trial data presented here provides further evidence of the ability of MVA85A to boost BCG primed immune responses. This boosting potential is not influenced by the time interval between prior BCG vaccination and boosting with MVA85A. These findings have important implications for the design of efficacy trials with MVA85A. Boosting BCG induced anti-mycobacterial immunity in either infancy or adolescence are both potential applications for this vaccine, given the immunological data presented here. Trial Registration. ClinicalTrials.Oxford University was the sponsor for all the clinical trials reported here

Care, control and the electroconvulsive therapy (ECT) ritual: Making sense of polarised patient narratives

Despite evidence of short-term effectiveness of ECT (electroconvulsive therapy), both positive and negative patient reports are common. However, research examining these polarized accounts has not adequately elucidated why such divergences occur. We thus sought to examine opposing patient narratives to better understand underlying meanings. Eighteen interviews were conducted with UK-based people who had experienced the treatment. Our analysis revealed that the quality of relations with staff, ECT artefacts (e.g. the ECT suite), and perceived outcomes all play a role in divergent accounts. Positive reflections on ECT emerged alongside narratives of trust in staff, comfort with ECT, and perception of sufficient personal control. Conversely, where negative evaluations of ECT predominated, there was anger associated with a lack of control, and a belief that ECT made little sense, and was linked to past abuses and/or the unacceptability of side effects. We discuss the implications of our findings for professionals

Diagnostic Tests for Alzheimer's Disease: Rationale, Methodology, and Challenges

There has been a large increase in the amount of research seeking to define or diagnose Alzheimer's disease before patients develop dementia. If successful, this would principally have clinical benefits both in terms of treatment as well as risk modification. Moreover, a better method for diagnosing predementia disease would assist research which seeks to develop such treatments and risk modification strategies. The evidence-based definition of a diagnostic test's accuracy is fundamental to achieve the above goals and to address this, the Cochrane Collaboration has established a Diagnostic Test Accuracy group dedicated to examining the utility and accuracy of proposed tests in dementia and cognitive impairment. We present here the assumptions and observations underpinning the chosen methodology as well as the initial methodological approach decided upon

Mucosal delivery of tuberculosis vaccines: a review of current approaches and challenges.

Introduction: Tuberculosis (TB) remains a major health threat and it is now clear that the current vaccine, BCG, is unable to arrest the global TB epidemic. A new vaccine is needed to either replace or boost BCG so that a better level of protection could be achieved. The route of entry of Mycobacterium tuberculosis, the causative organism, is via inhalation making TB primarily a respiratory disease. There is therefore good reason to hypothesize that a mucosally delivered vaccine against TB could be more effective than one delivered via the systemic route.Areas covered: This review summarizes the progress that has been made in the area of TB mucosal vaccines in the last few years. It highlights some of the strengths and shortcomings of the published evidence and aims to discuss immunological and practical considerations in the development of mucosal vaccines.Expert opinion: There is a growing body of evidence that the mucosal approach to vaccination against TB is feasible and should be pursued. However, further key studies are necessary to both improve our understanding of the protective immune mechanisms operating in the mucosa and the technical aspects of aerosolized delivery, before such a vaccine could become a feasible, deployable strategy

Delayed-Bang Approach Towards More Sustainable Critical Infrastructure Risk Management

This article describes the Delayed Bang Approach for determining the value of risk management alternatives in critical infrastructure security. The discussion includes (1) the need for sustainable risk management (2) the importance of time valuation in evaluating competing loss prevention and loss reduction alternatives, (3) the convergence of deterministic engineering economics, survivability analysis, and probabilistic analysis, and (4) hypothetical examples of the Delayed-Bang Approach and significance towards more sustainable risk management

Slope Stability Evaluation and Equipment Setback Distances for Burial Ground Excavations

After 1970 Transuranic (TRU) and suspect TRU waste was buried in the ground with the intention that at some later date the waste would be retrieved and processed into a configuration for long term storage. To retrieve this waste the soil must be removed (excavated). Sloping the bank of the excavation is the method used to keep the excavation from collapsing and to provide protection for workers retrieving the waste. The purpose of this paper is to document the minimum distance (setback) that equipment must stay from the edge of the excavation to maintain a stable slope. This evaluation examines the equipment setback distance by dividing the equipment into two categories, (1) equipment used for excavation and (2) equipment used for retrieval. The section on excavation equipment will also discuss techniques used for excavation including the process of benching. Calculations 122633-C-004, 'Slope Stability Analysis' (Attachment A), and 300013-C-001, 'Crane Stability Analysis' (Attachment B), have been prepared to support this evaluation. As shown in the calculations the soil has the following properties: Unit weight 110 pounds per cubic foot; and Friction Angle (natural angle of repose) 38{sup o} or 1.28 horizontal to 1 vertical. Setback distances are measured from the top edge of the slope to the wheels/tracks of the vehicles and heavy equipment being utilized. The computer program utilized in the calculation uses the center of the wheel or track load for the analysis and this difference is accounted for in this evaluation

Count Models Based on Weibull Interarrival Times

The widespread popularity and use of both the Poisson and the negative binomial models for count data arise, in part, from their derivation as the number of arrivals in a given time period assuming exponentially distributed interarrival times (without and with heterogeneity in the underlying base rates, respectively). However, with that clean theory come some limitations including limited flexibility in the assumed underlying arrival rate distribution and the inability to model underdispersed counts (variance less than the mean). Although extant research has addressed some of these issues, there still remain numerous valuable extensions. In this research, we present a model that, due to computational tractability, was previously thought to be infeasible. In particular, we introduce here a generalized model for count data based upon an assumed Weibull interarrival process that nests the Poisson and negative binomial models as special cases. The computational intractability is overcome by deriving the Weibull count model using a polynomial expansion which then allows for closed-form inference (integration term-by-term) when incorporating heterogeneity due to the conjugacy of the expansion and a commonly employed gamma distribution. In addition, we demonstrate that this new Weibull count model can (1) model both over- and underdispersed count data, (2) allow covariates to be introduced in a straightforward manner through the hazard function, and (3) be computed in standard software

Advancing the business and human rights agenda: Dialogue, empowerment, and constructive engagement

As corporations are going global, they are increasingly confronted with human rights challenges. As such, new ways to deal with human rights challenges in corporate operations must be developed as traditional governance mechanisms are not always able to tackle them. This article presents five different views on innovative solutions for the relationships between business and human rights that all build on empowerment, dialogue and constructive engagement. The different approaches highlight an emerging trend toward a more active role for corporations in the protection of human rights. The first examines the need for enhanced dialogue between corporations and their stakeholders. The next three each examine a different facet of empowerment, a critical factor for the respect and protection of human rights: empowerment of the poor, of communities, and of consumers. The final one presents a case study of constructive corporate engagement in Myanmar (Burma). Altogether, these research projects provide insight into the complex relationships between corporate operations and human rights, by highlighting the importance of stakeholder dialogue and empowerment. All the five projects were presented during the Second Swiss Master Class in Corporate Social Responsibility, held in Lausanne, Switzerland on December 12, 2008. The audience for this conference, which examined business and human rights, was composed of researchers, governmental representatives, and business and non-governmental organization practitioners

Paravertebral block as a sole technique for the anaesthetic management of a patient with myalgic encephalomyelitis undergoing breast cancer surgery

Myalgic encephalomyelitis (ME) is a multifaceted organic disease which, owing to its non-specific multiple symptoms that include incapacitating fatigue, deeply affects the quality of life of diseased patients. It carries a perceived risk of an adverse reaction to drugs, including anaesthetics. However, there is very little information in the medical literature on the anaesthetic management and outcomes of patients with this condition. According to current scientific literature, there is no causal relationship between ME relapse and anaesthesia, surgery or both. We present the anaesthetic management of a ME patient who underwent breast cancer surgery.Keywords: breast cancer surgery, chronic fatigue syndrome, myalgic encephalomyelitis, paravertebral bloc