Acceptability to general practitioners of national health insurance and capitation as a reimbursement mechanism

Objective. To determine general practitioners' attitudes to national health insurance (NHI) and to capitation as a mechanism of reimbursement. To explore determinants of these attitudes.Design. Cross-sectional survey by means of telephone interviews; four focus group discussions.Setting. Cape Peninsula.Participants. 174 GPs randomly sampled from a total population of 874.Main outcome measures. Acceptance of NHI, acceptance of capitation.Main results. 63,3% approved of NHI. More than 81 % approved of NHI if GPs would be able to maintain their independent status, e.g. own premises and working hours;82,3% said NHI would be a more equitable system of health care, 88% approved of the fact that NHI would make care by GPs more accessible, and 73% said they would have the capacity to treat more patients. However, 61,3% of GPs disapproved of capitation as a form of reimbursement.Conclusions. Most GPs in the Cape Peninsula were amenable to some form of NHI. However, the proportion of GPs who approved the introduction of NHI varied depending on details of the NHI system such as payment mechanisms, workload, income and effects on professional autonomy. A national survey of medical practitioners is recommended. The implications of GPs' preferences concerning the reimbursement mechanism for the feasibility of implementing a NHI system in SouthAfrica require serious consideration by policy-makers

SARS-CoV-2 structural features may explain limited neutralizing-antibody responses.

Neutralizing antibody responses of SARS-CoV-2-infected patients may be low and of short duration. We propose here that coronaviruses employ a structural strategy to avoid strong and enduring antibody responses. Other viruses induce optimal and long-lived neutralizing antibody responses, thanks to 20 or more repetitive, rigid antigenic epitopes, spaced by 5–10 nm, present on the viral surface. Such arrays of repetitive and highly organized structures are recognized by the immune system as pathogen-associated structural patterns (PASPs), which are characteristic for pathogen surfaces. In contrast, coronaviruses are large particles with long spikes (S protein) embedded in a fluid membrane. Therefore, the neutralizing epitopes (which are on the S protein) are loosely “floating” and widely spaced by an average of about 25 nm. Consequently, recruitment of complement is poor and stimulation of B cells remains suboptimal, offering an explanation for the inefficient and short-lived neutralizing antibody responses

Screening attendance, age group and diabetic retinopathy level at first screen

AIMS: To report on the relationships between age at diagnosis of diabetes, time from registration with the screening programme to first diabetic eye screening and severity of diabetic retinopathy. METHODS: Data were extracted from four English screening programmes and from the Scottish, Welsh and Northern Irish programmes. Time from diagnosis of diabetes to first screening and age at diagnosis were calculated. RESULTS: Time from registration with the screening programme to first screening episode is strongly related to age at registration. Within 18 months of registration 89% of 3958 young people under 18 years of age and 81% of 391 293 people over 35 years of age were seen. In 19 058 people between 18 and 34 years of age, 80% coverage was not reached until 2 years and 9 months. The time from diagnosis of diabetes to first screening is positively associated with severity of disease (P < 0.0001). CONCLUSIONS: This report is the first that to demonstrate that those in the 18-34 year age group are least likely to attend promptly for screening after registration with a higher risk of referable diabetic retinopathy being present at the time of first screen. Date of diagnosis should be recorded and prodigious efforts made to screen all people promptly after diagnosis. Screening programmes should collect data on those who have not attended within one year of registration

The templated growth of a chiral transition metal chalcogenide

We demonstrate that an intrinsically chiral, high Miller index surface of an achiral metal can be used to template the enantioselective growth of chiral transition metal chalcogenide films. Specifically, Cu(643)R can be used as a template for the enantioselective growth of a chiral copper telluride alloy surface. Beyond a critical alloy thickness the chiral influence of the Cu(643)R surface diminishes and an achiral surface forms. Our work demonstrates a new method of producing chiral transition metal chalcogenide surfaces, with potential applications in the study of structurally chiral topological insulators

Contamination in trials of educational interventions

Objectives: To consider the effects of contamination on the magnitude and statistical significance (or precision) of the estimated effect of an educational intervention, to investigate the mechanisms of contamination, and to consider how contamination can be avoided. Data sources: Major electronic databases were searched up to May 2005. Methods: An exploratory literature search was conducted. The results of trials included in previous relevant systematic reviews were then analysed to see whether studies that avoided contamination resulted in larger effect estimates than those that did not. Experts’ opinions were elicited about factors more or less likely to lead to contamination. We simulated contamination processes to compare contamination biases between cluster and individually randomised trials. Statistical adjustment was made for contamination using Complier Average Causal Effect analytic methods, using published and simulated data. The bias and power of cluster and individually randomised trials were compared, as were Complier Average Causal Effect, intention-to-treat and per protocol methods of analysis. Results: Few relevant studies quantified contamination. Experts largely agreed on where contamination was more or less likely. Simulation of contamination processes showed that, with various combinations of timing, intensity and baseline dependence of contamination, cluster randomised trials might produce biases greater than or similar to those of individually randomised trials. Complier Average Causal Effect analyses produced results that were less biased than intention-to-treat or per protocol analyses. They also showed that individually randomised trials would in most situations be more powerful than cluster randomised trials despite contamination. Conclusions: The probability, nature and process of contamination should be considered when designing and analysing controlled trials of educational interventions in health. Cluster randomisation may or may not be appropriate and should not be uncritically assumed always to be a solution. Complier Average Causal Effect models are an appropriate way to adjust for contamination if it can be measured. When conducting such trials in future, it is a priority to report the extent, nature and effects of contamination.We are grateful to the National Health Service Research and Development National Coordinating Centre for Research Methodology for funding this research

Correction: Zika virus-derived e-diii protein displayed on immunologically optimized vlps induces neutralizing antibodies without causing enhancement of dengue virus infection. vaccines 2019, 7, 72

The authors wish to make the following correction to their paper [1]. The same image was mistakenly selected for Figures 2 and 3. The image became replaced as you see in Figure 3 below

Vaccination with nanoparticles combined with micro-adjuvants protects against cancer.

Induction of strong T cell responses, in particular cytotoxic T cells, is a key for the generation of efficacious therapeutic cancer vaccines which yet, remains a major challenge for the vaccine developing world. Here we demonstrate that it is possible to harness the physiological properties of the lymphatic system to optimize the induction of a protective T cell response. Indeed, the lymphatic system sharply distinguishes between nanoscale and microscale particles. The former reaches the fenestrated lymphatic system via diffusion, while the latter either need to be transported by dendritic cells or form a local depot. Our previously developed cucumber-mosaic virus-derived nanoparticles termed (CuMV &lt;sub&gt;TT&lt;/sub&gt; -VLPs) incorporating a universal Tetanus toxoid epitope TT830-843 were assessed for their draining kinetics using stereomicroscopic imaging. A nano-vaccine has been generated by coupling p33 epitope as a model antigen to CuMV &lt;sub&gt;TT&lt;/sub&gt; -VLPs using bio-orthogonal Cu-free click chemistry. The CuMV &lt;sub&gt;TT&lt;/sub&gt; -p33 nano-sized vaccine has been next formulated with the micron-sized microcrystalline tyrosine (MCT) adjuvant and the formed depot effect was studied using confocal microscopy and trafficking experiments. The immunogenicity of the nanoparticles combined with the micron-sized adjuvant was next assessed in an aggressive transplanted murine melanoma model. The obtained results were compared to other commonly used adjuvants such as B type CpGs and Alum. Our results showed that CuMV &lt;sub&gt;TT&lt;/sub&gt; -VLPs can efficiently and rapidly drain into the lymphatic system due to their nano-size of ~ 30 nm. However, formulating the nanoparticles with the micron-sized MCT adjuvant of ~ 5 μM resulted in a local depot for the nanoparticles and a longer exposure time for the immune system. The preclinical nano-vaccine CuMV &lt;sub&gt;TT&lt;/sub&gt; -p33 formulated with the micron-sized MCT adjuvant has enhanced the specific T cell response in the stringent B16F10p33 murine melanoma model. Furthermore, the micron-sized MCT adjuvant was as potent as B type CpGs and clearly superior to the commonly used Alum adjuvant when total CD8 &lt;sup&gt;+&lt;/sup&gt; , specific p33 T cell response or tumour protection were assessed. The combination of nano- and micro-particles may optimally harness the physiological properties of the lymphatic system. Since the nanoparticles are well defined virus-like particles and the micron-sized adjuvant MCT has been used for decades in allergen-specific desensitization, this approach may readily be translated to the clinic

Observation of the Decay Ξb- →pK-K-

Decays of the Ξb- and Ωb- baryons to the charmless final states ph-h′-, where h(′) denotes a kaon or pion, are searched for with the LHCb detector. The analysis is based on a sample of proton-proton collision data collected at center-of-mass energies s=7 and 8 TeV, corresponding to an integrated luminosity of 3 fb-1. The decay Ξb-→pK-K- is observed with a significance of 8.7 standard deviations, and evidence at the level of 3.4 standard deviations is found for the Ξb-→pK-π- decay. Results are reported, relative to the B-→K+K-K- normalization channel, for the products of branching fractions and b-hadron production fractions. The branching fractions of Ξb-→pK-π- and Ξb-→pπ-π- relative to Ξb-→pK-K- decays are also measured

Study of the lineshape of the chi(c1) (3872) state

A study of the lineshape of the chi(c1) (3872) state is made using a data sample corresponding to an integrated luminosity of 3 fb(-1) collected in pp collisions at center-of-mass energies of 7 and 8 TeV with the LHCb detector. Candidate chi(c1)(3872) and psi(2S) mesons from b-hadron decays are selected in the J/psi pi(+)pi(-) decay mode. Describing the lineshape with a Breit-Wigner function, the mass splitting between the chi(c1 )(3872) and psi(2S) states, Delta m, and the width of the chi(c1 )(3872) state, Gamma(Bw), are determined to be (Delta m=185.598 +/- 0.067 +/- 0.068 Mev,)(Gamma BW=1.39 +/- 0.24 +/- 0.10 Mev,) where the first uncertainty is statistical and the second systematic. Using a Flatte-inspired model, the mode and full width at half maximum of the lineshape are determined to be (mode=3871.69+0.00+0.05 MeV.)(FWHM=0.22-0.04+0.13+0.07+0.11-0.06-0.13 MeV, ) An investigation of the analytic structure of the Flatte amplitude reveals a pole structure, which is compatible with a quasibound D-0(D) over bar*(0) state but a quasivirtual state is still allowed at the level of 2 standard deviations