Managing atrial fibrillation in the global community: The European perspective.

Atrial fibrillation is a common, global problem, with great personal, economic and social burdens. As populations age it increases in prevalence and becomes another condition that requires careful chronic management to ensure its effects are minimised. Assessment of the risk of stroke using well established risk prediction models is being aided by modern computerised databases and the choice of drugs to prevent strokes is ever expanding to try and improve the major cause of morbidity in AF. In addition, newer drugs for controlling rhythm are available and guidelines are constantly changing to reflect this. As well as medications, modern techniques of electrophysiology are becoming more widely embraced worldwide to provide more targeted treatment for the underlying pathophysiology. In this review we consider these factors to concisely describe how AF can be successfully managed

Radiation Control Coatings Installed on Federal Buildings at Tyndall Air Force Base

The technical objectives of this CRADA comprise technology deployment and energy conservation efforts with the radiation control coatings industry and the utility sector. The results of this collaboration include a high-level data reporting, analysis and management system to support the deployment efforts. The technical objectives include successfully install, commission, operate, maintain and document the performance of radiation control coatings on roofs at Tyndall AFB and the Buildings Technology Center at the Oak Ridge National Laboratory; determine the life cycle savings that can be achieved by using radiation control coatings on entire roofs at Tyndall AFB, based on documented installed cost and operating maintenance costs with and without the coatings; determine if any specific improvements are required in the coatings before they can be successfully deployed in the federal sector; determine the most effective way to facilitate the widespread and rapid deployment of radiation control coatings in the federal sector; and clearly define any barriers to deployment

Dual harm: an exploration of the presence and characteristics for dual violence and self-harm behaviour in prison

Objective: The study aimed to quantify the rate of dual-harm behaviour in comparison with sole self-harm or assault rates; with an analysis of the distinguishing features. Method: Official data on in-prison incidents, demographic and offending information was analysed for two prisons in England. Results: Proportions of up to 42% of offenders who assault others in prison will also engage in self-harm and vice versa. Dual harm prisoners will engage in a broader and greater frequency of prison incidents than either sole group; with dual-harm prisoners reflecting greater proportions of damage to property and fire setting. Connectedly, dual harm prisoners receive a far higher rate of adjudication. There were no differences in their time in prison, presence of serious violent offences or for the dual harm prisoners whether the first incident was self-harm or violence. An index offence of drug supply was less likely in the dual-harm group, with minor violence slightly more likely in longer sentence prisoners. Implications: In-prison behaviour can assist in the identification of prisoners at dual-risk of harm. Greater inclusion of in-prison behaviour and awareness of dual-harm in research methodologies may assist in improving risk management. A wider use of joint risk assessment and single case management approach is suggested for prisoners with dual-harm profile

Hepatitis E in pig-derived food products in Cape Town, South Africa, 2014

Background. Hepatitis E virus (HEV) genotypes 3 and 4 are zoonoses, with domestic pigs being the most important reservoir. A high anti- HEV IgG seroprevalence of 26 - 28% has been found in humans in Cape Town, South Africa (SA). Studies in industrialised countries have indicated a high prevalence of HEV in pigs and their associated food products.Objectives. To determine whether HEV could be found in pig-derived food products in Cape Town.Methods. Pork-containing food products were purchased from supermarkets and butcheries around the Cape Town metropolitan area. HEV detection by polymerase chain reaction (PCR) was performed, and an amplified viral genome fragment was sequenced from positive samples. Phylogenetic analysis was done on the sequenced fragment.Results. HEV was detected by PCR in 2/144 food samples – both were liver spread samples. One genome fragment sequence was obtained, which was closely related to HEV sequences obtained from humans in Cape Town.Conclusions. HEV can be found in pork-containing meat products available for sale in Cape Town, suggesting that these products could be a potential source of HEV transmission in our geographical area. Meat of pig origin should be thoroughly cooked before being consumed

A neglected source of household air pollution: a preliminary, mixed methods study of purposely produced household smoke in Wollo, Ethiopia

Background: Ill health associated with household air pollution (HAP) is increasingly recognized as a public health problem in sub-Saharan Africa. To date, attempts to reduce HAP have focussed on smoke from cooking fires and have ignored traditional cultural practices which generate purposely produced smoke (PPS). This study aimed to investigate PPS prevalence, reasons for use and safety perceptions. Methods: The study was conducted in Wollo, Ethiopia, and used a mixed methods approach of quantitative surveys (analysed descriptively) and qualitative interviews with householders and healthcare workers (analysed thematically). Results: PPS use was reported by 99% of survey respondents and it was considered a fundamental part of life. Although reasons for use included housekeeping, culture/religion and well-being, coffee ceremony was most commonly cited (44% of respondents). Both householders and healthcare workers appeared to assume PPS is safe, except for people with certain underlying conditions. Healthcare workers felt the lack of evidence of harm from PPS meant there was no justification for intervention. Conclusion: This study, the first in-depth study of PPS, has shown its use to be widespread, with many perceived benefits and thus a very important part of local culture in this sample Ethiopian community. Consequently, any public health interventions aimed at reducing HAP in this setting need to consider PPS

How do tsetse recognise their hosts? The role of shape in the responses of tsetse (Glossina fuscipes and G. palpalis) to artificial hosts

Palpalis-group tsetse, particularly the subspecies of Glossina palpalis and G. fuscipes, are the most important transmitters of human African trypanomiasis (HAT), transmitting .95% of cases. Traps and insecticide-treated targets are used to control tsetse but more cost-effective baits might be developed through a better understanding of the fly’s host-seeking behaviour.Electrocuting grids were used to assess the numbers of G. palpalis palpalis and G. fuscipes quanzensis attracted to and landing on square or oblong targets of black cloth varying in size from 0.01 m2 to 1.0 m2. For both species, increasing the size of a square target from 0.01 m2 (dimensions = 0.1 x 0.1 m) to 1.0 m2 (1.0 x 1.0 m) increased the catch ,4x however the numbers of tsetse killed per unit area of target declined with target size suggesting that the most cost efficient targets are not the largest. For G. f. quanzensis, horizontal oblongs, (1 m wide x 0.5 m high) caught, 1.8x more tsetse than vertical ones (0.5 m wide x 1.0 m high) but the opposite applied for G. p. palpalis. Shape preference was consistent over the range of target sizes. For G. p. palpalis square targets caught as many tsetse as the oblong; while the evidence is less strong the same appears to apply to G. f. quanzensis. The results suggest that targets used to control G. p. palpalis and G. f. quanzensis should be square, and that the most cost-effective designs, as judged by the numbers of tsetse caught per area of target, are likely to be in the region of 0.25 x 0.25 m2. The preference of G. p. palpalis for vertical oblongs is unique amongst tsetse species, and it is suggested that this response might be related to its anthropophagic behaviour and hence importance as a vector of HAT

Protective Antibody and CD8+ T-Cell Responses to the Plasmodium falciparum Circumsporozoite Protein Induced by a Nanoparticle Vaccine

Background The worldwide burden of malaria remains a major public health problem due, in part, to the lack of an effective vaccine against the Plasmodium falciparum parasite. An effective vaccine will most likely require the induction of antigen specific CD8+ and CD4+ T-cells as well as long-lasting antibody responses all working in concert to eliminate the infection. We report here the effective modification of a self-assembling protein nanoparticle (SAPN) vaccine previously proven effective in control of a P. berghei infection in a rodent model to now present B- and T-cell epitopes of the human malaria parasite P. falciparum in a platform capable of being used in human subjects. Methodology/Principal Findings To establish the basis for a SAPN-based vaccine, B- and CD8+ T-cell epitopes from the P. falciparum circumsporozoite protein (PfCSP) and the universal CD4 T-helper epitope PADRE were engineered into a versatile small protein (∼125 amino acids) that self-assembles into a spherical nanoparticle repetitively displaying the selected epitopes. P. falciparum epitope specific immune responses were evaluated in mice using a transgenic P. berghei malaria parasite of mice expressing the human malaria full-length P. falciparum circumsporozoite protein (Tg-Pb/PfCSP). We show that SAPN constructs, delivered in saline, can induce high-titer, long-lasting (1 year) protective antibody and poly-functional (IFNγ+, IL-2+) long-lived central memory CD8+ T-cells. Furthermore, we demonstrated that these Ab or CD8+ T–cells can independently provide sterile protection against a lethal challenge of the transgenic parasites. Conclusion The SAPN construct induces long-lasting antibody and cellular immune responses to epitope specific sequences of the P. falciparum circumsporozoite protein (PfCSP) and prevents infection in mice by a transgenic P. berghei parasite displaying the full length PfCSP

The use of a P. falciparum specific coiled-coil domain to construct a self-assembling protein nanoparticle vaccine to prevent malaria.

The parasitic disease malaria remains a major global public health concern and no truly effective vaccine exists. One approach to the development of a malaria vaccine is to target the asexual blood stage that results in clinical symptoms. Most attempts have failed. New antigens such as P27A and P27 have emerged as potential new vaccine candidates. Multiple studies have demonstrated that antigens are more immunogenic and are better correlated with protection when presented on particulate delivery systems. One such particulate delivery system is the self-assembling protein nanoparticle (SAPN) that relies on coiled-coil domains of proteins to form stable nanoparticles. In the past we have used de novo designed amino acid domains to drive the formation of the coiled-coil scaffolds which present the antigenic epitopes on the particle surface. Here we use naturally occurring domains found in the tex1 protein to form the coiled-coil scaffolding of the nanoparticle. Thus, by engineering P27A and a new extended form of the coiled-coil domain P27 onto the N and C terminus of the SAPN protein monomer we have developed a particulate delivery system that effectively displays both antigens on a single particle that uses malaria tex1 sequences to form the nanoparticle scaffold. These particles are immunogenic in a murine model and induce immune responses similar to the ones observed in seropositive individuals in malaria endemic regions. We demonstrate that our P27/P27A-SAPNs induce an immune response akin to the one in seropositive individuals in Burkina Faso. Since P27 is highly conserved among different Plasmodium species, these novel SAPNs may even provide cross-protection between Plasmodium falciparum and Plasmodium vivax the two major human malaria pathogens. As the SAPNs are also easy to manufacture and store they can be delivered to the population in need without complication thus providing a low cost malaria vaccine

Whatever the Weather: Ambient Temperature Does Not Influence the Proportion of Males Born in New Zealand

BACKGROUND: The proportion of male births has been shown to be over 50% in temperate climates around the world. Given that fluctuations in ambient temperature have previously been shown to affect sex allocation in humans, we examined the hypothesis that ambient temperature predicts fluctuations in the proportion of male births in New Zealand. METHODOLOGY/PRINCIPAL FINDINGS: We tested three main hypotheses using time series analyses. Firstly, we used historical annual data in New Zealand spanning 1876-2009 to test for a positive effect of ambient temperature on the proportion of male births. The proportion of males born ranged by 3.17%, from 0.504 to 0.520, but no significant relationship was observed between male birth rates and mean annual temperature in the concurrent or previous years. Secondly, we examined whether changes in annual ambient temperature were negatively related to the proportion of male stillbirths from 1929-2009 and whether the proportion of male stillbirths negatively affected the proportion of male live births. We found no evidence that fewer male stillbirths occurred during warmer concurrent or previous years, though a declining trend in the proportion of male stillbirths was observed throughout the data. Thirdly, we tested whether seasonal ambient temperatures, or deviations from those seasonal patterns, were positively related to the proportion of male births using monthly data from 1980-2009. Patterns of male and female births are seasonal, but very similar throughout the year, resulting in a non-seasonal proportion of male births. However, no cross correlations between proportion of male births and lags of temperature were significant. CONCLUSIONS: Results showed, across all hypotheses under examination, that ambient temperatures were not related to the proportion of male births or the proportion of male stillbirths in New Zealand. While there is evidence that temperature may influence human sex allocation elsewhere, such effects of temperature are not universal