Background: Vaccines against whooping cough (pertussis) and seasonal-influenza are recommended for pregnant women in England. Uptake however varies regionally and by ethnicity. Pregnant women are ...traditionally vaccinated in primary care, though some hospitals now offer vaccines through antenatal clinics. This mixed-methods evaluation describes the demographic characteristics of women seen in a hospital midwife-led antenatal vaccine clinic and explores vaccine decision making.
Methods: Descriptive statistics of women seen in a London hospital's midwife-led vaccine clinic were generated from electronic routine maternity records, including data on ethnicity, parity, age and deprivation indices. Reasons for vaccine decline given by women to midwives were categorized by themes. Qualitative interviews of women seen in the clinic were also undertaken.
Results: Between 1st April 2017 and 31st March 2018 the vaccine clinic saw 1501 pregnant women. Of these, 83% received pertussis vaccine and (during flu season) 51% received influenza vaccine, from the clinic. Fewer Black Afro-Caribbean women seen by the clinic were vaccinated, compared to other ethnicities with only 68% receiving pertussis and 34% flu vaccines respectively (p < .05). Among all women delivering at the hospital over the year, 42%, (1334/3147) were vaccinated by the clinic. Qualitative interviews found that reassurance from healthcare professionals, particularly midwives, was the most important factor influencing maternal vaccine decisions.
Conclusions: Midwife-led hospital clinics can offer an effective alternative to primary care provision for vaccines in pregnancy. Consistent with previous work, vaccine uptake varied by ethnicity. Midwives play a key role in the provision of vaccine services and influence women's vaccine decisions.
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The alkaloid rutaecarpine and its derivatives have been described as cytotoxic and hold potential as antitumor agents. Nevertheless, their synthesis is demanding and compounds display ...poor water solubility. Herein, we describe the synthesis of two sets of rutaecarpine derivatives with amine functions to improve solubility. Using a classic shake-flask experiment and a potentiometric titration platform, the water solubility of the compounds was determined. Solubility improved significantly with the amine functions connected over the indole-N atom. Reduction of metabolic activity and cell viability on HeLa cells was in the same range or better for these derivatives compared to the chemically unaltered parent compounds prepared in a new synthetic procedure established in our group.
The purpose of this study was to investigate the prevalence, clinical characteristics, and predictors of negative venous leg ultrasound in acute pulmonary embolism (PE). We retrospectively analyzed a ...cohort of 168 patients with acute PE (median age 73 years, 44% women) evaluated with complete venous leg ultrasound. A multivariate logistic regression analysis was performed to identify the independent predictors of negative venous ultrasound in acute PE. Venous leg ultrasound was negative for deep venous thrombosis (DVT) in 78 patients (46.4%). Patients with negative venous ultrasound were less likely to have a history of DVT (7.7% vs. 20.0%,
= 0.0273) and had significantly lower D-dimer levels (median 2.5 vs. 6.2 mg/dL
< 0.0001). Negative venous ultrasound was more frequent in PE diagnosed with V/P-SPECT than in PE diagnosed with CT (66.2% vs. 34.0%,
< 0.0001). The prevalence of negative venous ultrasound increased with more peripherally located PE (29.5% for central/lobar, 43.1% for segmental, and 60.6% for subsegmental PE,
= 0.0049). For the multivariate analysis, a diagnosis of PE with V/P-SPECT rather than CT (OR 3.2,
= 0.0056) and lower D-dimer levels (OR 0.94,
= 0.0266) were independent predictors of negative venous ultrasound. In conclusion, venous leg ultrasound was negative for DVT in almost half of patients with acute PE. Negative venous ultrasound was more common in patients with no history of DVT, lower D-dimer levels, PE diagnosed with V/P-SPECT rather than CT, and more peripherally located PE.
Abstract The development of biomaterials that mimic the physiological binding of growth factors to the extracellular matrix (ECM) is an appealing strategy for advanced growth factor delivery systems. ...In vivo , fibroblast growth factor 2 (FGF-2) binds to the sulfated glycosaminoglycan heparan sulfate, which is a major component of the ECM. Therefore, we tested whether silk fibroin (SF) decorated with a sulfonated moiety could mimic the natural ECM environment and lead to advanced delivery of this heparin-binding growth factor. Using a diazonium coupling reaction, modified SF derivatives containing approximately 20, 40, 55 and 70 sulfonic acid groups per SF molecule were obtained. Films of the SF derivative decorated with 70 sulfonic acid groups per SF molecule resulted in a 2-fold increase in FGF-2 binding as compared to native SF. More than 99% of bound FGF-2 could be retained on all SF derivatives. However, protection of FGF-2 potency was only achieved with at least 40 sulfonic acid groups per SF molecule, as observed by reduced metabolic activity and enhanced levels of phosphorylated extracellular signal-regulated kinases (pERK1/2) in cultured human mesenchymal stem cells (hMSCs). This study introduces a first step towards the development of an ECM-mimicking biomaterial for sustained, non-covalent binding, controlled delivery and preserved potency of biomolecules.
After almost two decades of development, modern Security Information and Event Management (SIEM) systems still face issues with normalisation of heterogeneous data sources, high number of false ...positive alerts and long analysis times, especially in large-scale networks with high volumes of security events. In this paper, we present our own prototype of SIEM system, which is capable of dealing with these issues. For efficient data processing, our system employs in-memory data storage (SAP HANA) and our own technologies from the previous work, such as the Object Log Format (OLF) and high-speed event normalisation. We analyse normalised data using a combination of three different approaches for security analysis: misuse detection, query-based analytics, and anomaly detection. Compared to the previous work, we have significantly improved our unsupervised anomaly detection algorithms. Most importantly, we have developed a novel hybrid outlier detection algorithm that returns ranked clusters of anomalies. It lets an operator of a SIEM system to concentrate on the several top-ranked anomalies, instead of digging through an unsorted bundle of suspicious events. We propose to use anomaly detection in a combination with signatures and queries, applied on the same data, rather than as a full replacement for misuse detection. In this case, the majority of attacks will be captured with misuse detection, whereas anomaly detection will highlight previously unknown behaviour or attacks. We also propose that only the most suspicious event clusters need to be checked by an operator, whereas other anomalies, including false positive alerts, do not need to be explicitly checked if they have a lower ranking. We have proved our concepts and algorithms on a dataset of 160 million events from a network segment of a big multinational company and suggest that our approach and methods are highly relevant for modern SIEM systems.
The animated feature Up (Pete Docter, 2009) tells the story of wilderness explorer Charles Muntz in search of a rare species of bird in the South American valley of Paradise Falls and widower Carl ...Frederickson hoping to mend the pain of losing his wife by fulfilling their lifelong dream of traveling to the same valley. Both men pursue their fantasies of adventure in South America. I situate this narrative within discourses of imperialism and the Monroe Doctrine. Whereas Charles has usurped Paradise Falls in his zealous decades-long hunt the film offers an alternative to his imperial fixation by portraying the redemptive experience of Carl during his travels. As the latter learns to define adventure as a spiritual endeavor, Carl sheds his imperial obsession and rescues his South American friends from Charles. I argue that Up attempts to critique the damaging effects of imperialism ‐ and by extension the ‘War on Terror’ ‐ through the figure of the fallen hero Charles but disavows the ‘informal’ qualities of U.S. empire embodied by Carl. This disavowal of the informal features of (U.S.) imperialism in Up allows me to explore the persistence of the ‘tenacious grasp’ of U.S. exceptionalism, while the imagery of a queer, transnational community also suggests alteration in the tropes of U.S. imperialism.
Sustainable land use development requires a reporting system, which compares the actual development with the formulated goals and guiding principles of a sustainable land use policy. The current ...official land survey in Germany cannot longer meet the growing requirements on land use statistics regarding accuracy, reliability, timeliness, and relevance. Both, the use of cadastral data as primary data source of the statistical land survey, and also the sole computation of total areas of selected types of land use should be reviewed in this context. This paper highlights the problems of the database of current land use statistics, which are increasing significantly by technological changes of the cadastre. The benefits of using topographic geo-based data for the calculation are discussed. The monitor of the settlement and open space development (IÖR-Monitor) analysed this data and provides the indicator-based results in form of interactive maps and tables on the Internet. In addition, analysis of building structure and its change could be made based on real estate cadastre data. So land political sustainability goals as “inside before outside” would be verifiable. The contribution of this paper is to initiate a broad debate in this complex, interdisciplinary field between statistics, surveying, real estate management, geoinformatics and spatial development policy.
Challenges and special aspects related to the management and prognosis of pulmonary hypertension (PH) in middle- to low-income regions (MLIRs) range from late presentation to comorbidities, lack of ...resources and expertise, cost, and rare options of lung transplantation. Expert consensus recommendations addressing the specific challenges for prevention and therapy of PH in MLIRs with limited resources have been lacking. To date, 6 MLIR-PH registries containing mostly adult patients with PH exist. Importantly, the global prevalence of PH is much higher in MLIRs compared with high-income regions: group 2 PH (left heart disease), pulmonary arterial hypertension associated with unrepaired congenital heart disease, human immunodeficiency virus, or schistosomiasis are highly prevalent. This consensus statement provides selective, tailored modifications to the current PH guidelines to address the specific challenges faced in MLIRs, resulting in the first pragmatic and cost-effective consensus recommendations for PH care providers, patients, and their families.
Background This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence ...risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemic stroke. Methods and Results Single-center cohort study including consecutive patients with TIA, stroke mimics, and acute ischemic stroke, with available magnetic resonance imaging from January 2015 to December 2017. Blinded raters adjudicated WMH (age-related white matter changes score) and CBI according to established definitions. A total of 2112 patients (median Q1-Q3 age 71 59-80 years, 43% women, National Institutes of Health Stroke Scale score of 2 1-7, 80% ischemic stroke, 18% TIA, 2% stroke mimics) were included. While CBIs were present in only 10% of patients with stroke mimic, they were detected in 28% of TIAs and 38% of ischemic strokes (
<0.001). WMHs were less pronounced (0, 0-1) in patients with stroke mimic, but there was no difference between TIA (1, 1-2) and ischemic stroke (0, 1-2) patients. CBIs (adjusted odds ratio, 0.3; 95% CI, 0.1-0.9) were associated with a lower rate of stroke mimic as the final diagnosis, while WMHs were not (adjusted odds ratio per point, 1.3; 95% CI, 0.7-2.2). WMH (β per point, 0.4; 95% CI, 0.3-0.6) and presence of CBI (β, 0.6; 95% CI, 0.3-0.9) were associated with a higher cardiovascular risk profile according to the ABCD3-I score. The accuracy of prediction was good for high-risk TIA (cross-validated area under the receiver operating characteristic curve, 0.89; 95% CI, 0.79-0.93) on the basis of brain imaging, age, and sex. Conclusions CBI and WMH differ between patients with stroke mimic and patients with TIA/ischemic stroke and are closely associated with established recurrence risk scores. Prospective studies need to clarify whether including brain frailty markers may contribute to the refinement of current management algorithms and risk stratifications.
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