Immunization coverage and risk factors for failure to immunize within the Expanded Programme on Immunization in Kenya after introduction of new Haemophilus influenzae type b and hepatitis b virus antigens

Background: Kenya introduced a pentavalent vaccine including the DTP, Haemophilus influenzae type b and hepatitis b virus antigens in Nov 2001 and strengthened immunization services. We estimated immunization coverage before and after introduction, timeliness of vaccination and risk factors for failure to immunize in Kilifi district, Kenya. Methods: In Nov 2002 we performed WHO cluster-sample surveys of > 200 children scheduled for vaccination before or after introduction of pentavalent vaccine. In Mar 2004 we conducted a simple random sample (SRS) survey of 204 children aged 9 - 23 months. Coverage was estimated by inverse Kaplan-Meier survival analysis of vaccine- card and mothers' recall data and corroborated by reviewing administrative records from national and provincial vaccine stores. The contribution to timely immunization of distance from clinic, seasonal rainfall, mother's age, and family size was estimated by a proportional hazards model. Results: Immunization coverage for three DTP and pentavalent doses was 100% before and 91% after pentavalent vaccine introduction, respectively. By SRS survey, coverage was 88% for three pentavalent doses. The median age at first, second and third vaccine dose was 8, 13 and 18 weeks. Vials dispatched to Kilifi District during 2001 - 2003 would provide three immunizations for 92% of the birth cohort. Immunization rate ratios were reduced with every kilometre of distance from home to vaccine clinic (HR 0.95, CI 0.91 - 1.00), rainy seasons ( HR 0.73, 95% CI 0.61 - 0.89) and family size, increasing progressively up to 4 children ( HR 0.55, 95% CI 0.41 - 0.73). Conclusion: Vaccine coverage was high before and after introduction of pentavalent vaccine, but most doses were given late. Coverage is limited by seasonal factors and family siz

Transcriptome analysis of peripheral blood mononuclear cells in human subjects following a 36 h fast provides evidence of effects on genes regulating inflammation, apoptosis and energy metabolism.

There is growing interest in the potential health benefits of diets that involve regular periods of fasting. While animal studies have provided compelling evidence that feeding patterns such as alternate-day fasting can increase longevity and reduce incidence of many chronic diseases, the evidence from human studies is much more limited and equivocal. Additionally, although several candidate processes have been proposed to contribute to the health benefits observed in animals, the precise molecular mechanisms responsible remain to be elucidated. The study described here examined the effects of an extended fast on gene transcript profiles in peripheral blood mononuclear cells from ten apparently healthy subjects, comparing transcript profiles after an overnight fast, sampled on four occasions at weekly intervals, with those observed on a single occasion after a further 24 h of fasting. Analysis of the overnight fasted data revealed marked inter-individual differences, some of which were associated with parameters such as gender and subject body mass. For example, a striking positive association between body mass index and the expression of genes regulated by type 1 interferon was observed. Relatively subtle changes were observed following the extended fast. Nonetheless, the pattern of changes was consistent with stimulation of fatty acid oxidation, alterations in cell cycling and apoptosis and decreased expression of key pro-inflammatory genes. Stimulation of fatty acid oxidation is an expected response, most likely in all tissues, to fasting. The other processes highlighted provide indications of potential mechanisms that could contribute to the putative beneficial effects of intermittent fasting in humans

Ion Exchange Chromatography and Mass Bias Correction for Accurate and Precise Zn Isotope Ratio Measurements in Environmental Reference Materials by MC-ICP-MS

Precise and accurate d66/64Zn data for environmental reference materials (RMs) including rocks, sediments, soils and plants are presented in order to improve the metrological traceability and analytical control of Zn isotope ratio determinations in future environmental studies. Previously developed ion exchange chromatography protocols were adjusted to enable faster sample throughput and instrumental mass bias processes were investigated. The improved chromatographic protocol yielded precise and quantitative recoveries (99 ± 7%, σ, n = 16), while the mass bias correction using Cu as external dopant provided precisions better than 0.02‰, 2σ, n = 7. Investigations into spectral and non-spectral interferences identified significant formation of Cr and Ti oxides and hydroxide ionic species. Analysis of six RMs (BHVO-2 basalt (USGS), BCR-2 basalt (USGS), AGV-2 andesite (USGS), 2709 San Joaquin soil (NIST), 1646a estuarine sediment (NIST) and 1573a tomato leaves (NIST)) showed good reproducibility (< 0.01‰, 2s, 5 ≤ n ≥ 1)

Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes.

Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis

Rapid Assessment Tool for Haemophilus influenzae type b Disease in Developing Countries1

Haemophilus influenzae type b disease prevalence in children provides estimates of national disease prevalence

Patient expectations of fair complaint handling in hospitals: empirical data

BACKGROUND: A common finding in several studies is patients' dissatisfaction with complaint handling in health care. The reasons why are for the greater part unknown. The key to an answer may be found in a better understanding of patients' expectations. We investigated patients' expectations of complaint handling in hospitals. METHODS: Subjects were patients who had lodged a complaint at the complaint committees of 74 hospitals in the Netherlands. A total of 424 patients (response 75%) completed a written questionnaire at the start of the complaint procedures. Derived from justice theory, we asked what they expected from fair procedures, fair communication and fair outcome of complaint handling. RESULTS: The predominant reason for complainants to lodge a complaint was to prevent the incident from happening again. Complainants expected fair procedures from the complaint committee, in particular an impartial position. This was most important to 87% of the complainants. They also expected to be treated respectfully. Furthermore, they expected the hospital and the professional involved to respond to their complaint. A change in hospital performances was the most wanted outcome of complaint handling, according to 79% of the complainants. They also expected disclosure from the professionals. Professionals should admit a mistake when it had occurred. More complainants (65%) considered it most important to get an explanation than an apology (41%). Only 32% of complainants expected the professional to make an effort to restore the doctor-patient relationship. A minority of complainants (7%) wanted financial compensation. CONCLUSION: Nearly all complainants want to prevent the incident from happening again, not out of pure altruism, but in order to restore their sense of justice. We conclude that complaint handling that does not allow for change is unlikely to meet patients' expectations. Secondly, complaint handling should not be left exclusively to complaint committees, the responses of hospital and professionals are indispensable

Recoil Polarization Measurements of the Proton Electromagnetic Form Factor Ratio to Q^2 = 8.5 GeV^2

Among the most fundamental observables of nucleon structure, electromagnetic form factors are a crucial benchmark for modern calculations describing the strong interaction dynamics of the nucleon's quark constituents; indeed, recent proton data have attracted intense theoretical interest. In this letter, we report new measurements of the proton electromagnetic form factor ratio using the recoil polarization method, at momentum transfers Q2=5.2, 6.7, and 8.5 GeV2. By extending the range of Q2 for which GEp is accurately determined by more than 50%, these measurements will provide significant constraints on models of nucleon structure in the non-perturbative regime

A Networks-Science Investigation into the Epic Poems of Ossian

In 1760 James Macpherson published the first volume of a series of epic poems which he claimed to have translated into English from ancient Scottish-Gaelic sources. The poems, which purported to have been composed by a third-century bard named Ossian, quickly achieved wide international acclaim. They invited comparisons with major works of the epic tradition, including Homer's Iliad and Odyssey, and effected a profound influence on the emergent Romantic period in literature and the arts. However, the work also provoked one of the most famous literary controversies of all time, colouring the reception of the poetry to this day. The authenticity of the poems was questioned by some scholars, while others protested that they misappropriated material from Irish mythological sources. Recent years have seen a growing critical interest in Ossian, initiated by revisionist and counter-revisionist scholarship and by the two-hundred-and-fiftieth anniversary of the first collected edition of the poems in 1765. Here we investigate Ossian from a networks-science point of view. We compare the connectivity structures underlying the societies described in the Ossianic narratives with those of ancient Greek and Irish sources. Despite attempts, from the outset, to position Ossian alongside the Homeric epics and to distance it from Irish sources, our results indicate significant network-structural differences between Macpherson's text and those of Homer. They also show a strong similarity between Ossianic networks and those of the narratives known as Acallam na Sen\'orach (Colloquy of the Ancients) from the Fenian Cycle of Irish mythology.Comment: Accepted for publication in Advances in Complex system