Summary Background A serogroup A meningococcal polysaccharide–tetanus toxoid conjugate vaccine (PsA–TT, MenAfriVac) was licensed in India in 2009, and pre-qualified by WHO in 2010, on the basis of ...its safety and immunogenicity. This vaccine is now being deployed across the African meningitis belt. We studied the effect of PsA–TT on meningococcal meningitis and carriage in Chad during a serogroup A meningococcal meningitis epidemic. Methods We obtained data for the incidence of meningitis before and after vaccination from national records between January, 2009, and June, 2012. In 2012, surveillance was enhanced in regions where vaccination with PsA–TT had been undertaken in 2011, and in one district where a reactive vaccination campaign in response to an outbreak of meningitis was undertaken. Meningococcal carriage was studied in an age-stratified sample of residents aged 1–29 years of a rural area roughly 13–15 and 2–4 months before and 4–6 months after vaccination. Meningococci obtained from cerebrospinal fluid or oropharyngeal swabs were characterised by conventional microbiological and molecular methods. Findings Roughly 1·8 million individuals aged 1–29 years received one dose of PsA–TT during a vaccination campaign in three regions of Chad in and around the capital N'Djamena during 10 days in December, 2011. The incidence of meningitis during the 2012 meningitis season in these three regions was 2·48 per 100 000 (57 cases in the 2·3 million population), whereas in regions without mass vaccination, incidence was 43·8 per 100 000 (3809 cases per 8·7 million population), a 94% difference in crude incidence (p<0·0001), and an incidence rate ratio of 0·096 (95% CI 0·046–0·198). Despite enhanced surveillance, no case of serogroup A meningococcal meningitis was reported in the three vaccinated regions. 32 serogroup A carriers were identified in 4278 age-stratified individuals (0·75%) living in a rural area near the capital 2–4 months before vaccination, whereas only one serogroup A meningococcus was isolated in 5001 people living in the same community 4–6 months after vaccination (adjusted odds ratio 0·019, 95% CI 0·002–0·138; p<0·0001). Interpretation PSA–TT was highly effective at prevention of serogroup A invasive meningococcal disease and carriage in Chad. How long this protection will persist needs to be established. Funding The Bill & Melinda Gates Foundation, the Wellcome Trust, and Médecins Sans Frontères.
Individuals with congenital blindness due to bilateral anophthalmia offer a unique opportunity to examine cross-modal plasticity in the complete absence of any stimulation of the ‘visual’ pathway ...even during development in utero. Our previous work has suggested that this complete sensory deafferentation results in different patterns of reorganisation compared with those seen in other early blind populations. Here, we further test the functional specialisation of occipital cortex in six well-studied cases with anophthalmia. Whole brain functional MRI was obtained while these human participants and a group of sighted controls performed two experiments involving phonological and semantic processing of words (verbal experiment) and spatial and identity processing of piano chords (nonverbal experiment). Both experiments were predicted to show a dorsal-ventral difference in activity based on the specific task performed. All tasks evoked activation in occipital cortex in the individuals with anophthalmia but not in the sighted controls. For the verbal experiment, both dorsal and ventral occipital areas were strongly activated by the phonological and semantic tasks in anophthalmia. For the nonverbal experiment, both the spatial and the identity task robustly activated the dorsal occipital area V3a but showed inconsistent activity elsewhere in the occipital lobe. V1 was most strongly activated by the verbal tasks, showing greater activity on the left for the verbal task relative to the nonverbal one. For individual anophthalmic participants, however, activity in V1 was inconsistent across tasks and hemispheres with many participants showing activity levels in the control range, which was not significantly above baseline. Despite the homogeneous nature of the cause of blindness in the anophthalmic group, there remain differences in patterns of activation among the individuals with this condition. Investigation at the case level might further our understanding of how post-natal experiences shape functional reorganisation in deafferented cortex.
E
scherichia coli
O157:H7 causes sporadic and epidemic gastrointestinal infections worldwide. In approximately 15 percent of the children in North America who are infected with
E. coli
O157:H7, the ...hemolytic–uremic syndrome develops soon after the onset of diarrhea.
1
–
4
This syndrome is characterized by thrombocytopenia, hemolytic anemia, and nephropathy and is believed to be caused by Shiga toxins elaborated by
E. coli
O157:H7 or other infecting
E. coli
that have been absorbed into the systemic circulation.
5
Treatment with antibiotics does not ameliorate
E. coli
O157:H7 infections,
1
,
6
,
7
and in some studies, it has been associated with worse clinical outcomes. . . .
The acyl-CoA dehydrogenases are a family of multimeric flavoenzymes that catalyze the α,β-dehydrogenation of acyl-CoA esters in fatty acid β-oxidation and amino acid catabolism. Genetic defects have ...been identified in most of the acyl-CoA dehydrogenases in humans. Acyl-CoA dehydrogenase 9 (ACAD9) is a recently identified acyl-CoA dehydrogenase that demonstrates maximum activity with unsaturated long-chain acyl-CoAs. We now report three cases of ACAD9 deficiency. Patient 1 was a 14-year-old, previously healthy boy who died of a Reye-like episode and cerebellar stroke triggered by a mild viral illness and ingestion of aspirin. Patient 2 was a 10-year-old girl who first presented at age 4 mo with recurrent episodes of acute liver dysfunction and hypoglycemia, with otherwise minor illnesses. Patient 3 was a 4.5-year-old girl who died of cardiomyopathy and whose sibling also died of cardiomyopathy at age 21 mo. Mild chronic neurologic dysfunction was reported in all three patients. Defects in
ACAD9 mRNA were identified in the first two patients, and all patients manifested marked defects in ACAD9 protein. Despite a significant overlap of substrate specificity, it appears that ACAD9 and very-long-chain acyl-CoA dehydrogenase are unable to compensate for each other in patients with either deficiency. Studies of the tissue distribution and gene regulation of ACAD9 and very-long-chain acyl-CoA dehydrogenase identify the presence of two independently regulated functional pathways for long-chain fat metabolism, indicating that these two enzymes are likely to be involved in different physiological functions.
Aim
This study explores how scholarship relating to meta‐analytical studies and systematic and integrative reviews can inform nursing’s contribution to universal health coverage.
Introduction
As ...nursing globally embraces the 200th anniversary of the birth of Florence Nightingale, the Nursing Now social movement has called for the profession to improve universal health coverage through increasing nursing’s policy voice.
Methods
In determining how the Nursing Now social movement could pursue the aim of this study, researchers undertook a comparative bibliometric analysis of scholarship relating to the systematic curation of evidence. This study uses a mixed‐method analysis of the bibliometric data available through extracting and synthesizing information from one of the commercially produced indexing and citation databases.
Results
Generally, medicine has contributed far more synthesized contributions than nursing, except in the case of integrative reviews. Co‐occurrence analysis of nursing literature through examination of key terms yielded a complex visualization of 11 specific clusters of scholarship (Care of the Older Person, Nurse Education, Emergency and Critical Care, Occupational Health and Safety, Rural Services, Anxiety and Depression, Measurement, Newborn and Post‐natal Health, Cardiovascular Disease, Preventative Health and Cancer Care).
Discussion and conclusions
Bibliometric analysis of curated evidence demonstrates that there is ample nursing‐relevant material to inform evidence‐based policy change directed towards the attainment of universal health coverage and several of the Sustainable Development Goals.
Implications for policy
Nursing literature is available to support policy change directed towards the pursuit of universal health coverage and sustainable development goals. Leveraging existing networks of research collaboration to increase research capacity through communities of scholarship or by twinning experienced and neophyte contributors is possible. Further work is needed to equip nurses with the competencies to navigate the policy environment and develop and deliver impactful policy messaging.
Many seabirds are killed or injured by fishing gear, contributing to the high proportion of threatened seabirds. This study estimates the impact of the South African deep-water hake Merluccius spp. ...trawl fishery on seabirds. At least 30 birds were killed in 190 h of dedicated observations of trawl warps during 2004 and 2005. Most were killed when their wings were entangled around the trawl warp and they were dragged under by the force of the water passing over the warp. Albatrosses were killed most frequently: shy albatrosses Thalassarche cauta (43% of all birds killed) and black-browed albatrosses Thalassarche melanophrys (37%), with smaller numbers of white-chinned petrels Procellaria aequinoctialis (10%), Cape gannets Morus capensis (7%) and sooty shearwaters Puffinus griseus (3%). Mortalities occurred mainly during dumping of fishery wastes, and were more frequent in winter, when more birds attended fishing vessels. Average mortality rates were 0.56 (95% confidence interval 0.32-0.82) birds killed per hour during dumping in winter, 0.21 (0.07-0.38) during dumping in summer and 0.09 (0.02-0.19) when not dumping in winter. No birds were killed in the absence of dumping in summer. Albatrosses suffered a disproportionately high mortality rate, with 15% of birds dragged under drowning, compared with 4% of all other species. Deaths resulting from entanglement in fishing nets mainly affected Cape gannets M. capensis, and occurred at an average rate of 3.0 (0.9-5.4) birds per 100 trawls (n=331 trawls). Serious warp incidents were independent of age among albatrosses, but there was a tendency for immature gannets to have a higher interaction rate than adults. Crude extrapolation suggests that total mortality is c. 18 000 (8000-31 000) birds per year, of which 85% are killed on warps and 15% entangled in nets. These estimates are of the same order of magnitude as estimates of long-line bycatch in South African waters. Mitigation measures have been implemented to reduce mortality in this fishery.
AbstractThis study investigated rice irrigation water use in the University of Arkansas Rice Research Verification Program between the years of 2003 and 2012. Annual irrigation water use averaged ...763 mm (30.0 in.) over 10 years. A significant (40%) water savings was found for rice grown using a zero-grade irrigation system 486 mm (19.1 in.) compared to contour-levee or straight-levee systems. No differences in irrigation water use were found between contour-levee systems 814 mm (32.1 in.) and straight-levee systems 822 mm (32.4 in.). Surface water irrigators used significantly less irrigation water 624 mm (24.6 in.) than groundwater well fields 786 mm (30.7 in.) and cost US$77.51 less per hectare (US$31.37 less per acre) to operate. Diesel pumps cost significantly more $88.38/acre ($218.29/ha) to operate than electric pumps $58.69/acre (145.96/ha) (P=0.02), although fields that used diesel as an energy source averaged 152 mm (6.0 in.) less irrigation water than electric pumps. Arkansas producers implementing the multiple-inlet water delivery practice on contour-levee or straight-levee systems, irrespective of soil type, did not realize a water savings but did realize improved yields. These results are in contrast to those in earlier studies and suggest that an educational effort may be necessary if the field research–proven multiple-inlet water savings are to be realized.
In this letter, we present the performance of a 100 μm × 400 μm × 40 nm W Transition-Edge Sensor with a critical temperature of 40 mK. This device has a noise equivalent power of 1.5×10-18 W/Hz, in a ...bandwidth of 2.6 kHz, indicating a resolution for Dirac delta energy depositions of 40 ± 5 meV (rms). The performance demonstrated by this device is a critical step toward developing a O(100) meV threshold athermal phonon detector for low-mass dark matter searches.
CONTEXT Despite the substantial amount of health-related information available
on the Internet, little is known about the accessibility, quality, and reading
grade level of that health information. ...OBJECTIVE To evaluate health information on breast cancer, depression, obesity,
and childhood asthma available through English- and Spanish-language search
engines and Web sites. DESIGN AND SETTING Three unique studies were performed from July 2000 through December
2000. Accessibility of 14 search engines was assessed using a structured search
experiment. Quality of 25 health Web sites and content provided by 1 search
engine was evaluated by 34 physicians using structured implicit review (interrater
reliability >0.90). The reading grade level of text selected for structured
implicit review was established using the Fry Readability Graph method. MAIN OUTCOME MEASURES For the accessibility study, proportion of links leading to relevant
content; for quality, coverage and accuracy of key clinical elements; and
grade level reading formulas. RESULTS Less than one quarter of the search engine's first pages of links led
to relevant content (20% of English and 12% of Spanish). On average, 45% of
the clinical elements on English- and 22% on Spanish-language Web sites were
more than minimally covered and completely accurate and 24% of the clinical
elements on English- and 53% on Spanish-language Web sites were not covered
at all. All English and 86% of Spanish Web sites required high school level
or greater reading ability. CONCLUSION Accessing health information using search engines and simple search
terms is not efficient. Coverage of key information on English- and Spanish-language
Web sites is poor and inconsistent, although the accuracy of the information
provided is generally good. High reading levels are required to comprehend
Web-based health information.
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