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33 and 3.07, respectively. The probability of facility birth increased by 9.8% (95% CI 2.1-17.5%) for every additional physician per 1,000 people and 8.9% (95% CI 7.1-9.7%) for every additional nurse/midwife per 1,000 people. HCW densities were also associated with increased likelihood of ANC by the respective provider type, and with antenatal testing for preeclampsia (urine and blood pressure checks). Other ANC services demonstrated variable relationships with HCW densities based on provider type. In 35 SSA countries, HCW density was positively associated with many key measures of maternal health service utilization including facility birth and ANC testing for preeclampsia.Hemoglobin C is the second most common structural hemoglobinopathy in Africa, and carriers have a reduced risk of severe malaria. However, the effect of HbAC on the antibody response to malaria antigens in pregnancy has not been studied. Here, we measured PfEMP1-specific antibodies in plasma samples from 74 Beninese pregnant women with either HbAA or HbAC. IgG-mediated inhibition of VAR2CSA+ infected erythrocytes adhesion to chondroitin sulfate A (CSA) was also tested. PfEMP1-specific IgG levels to VAR2CSA were significantly lower in HbAC women, suggesting less exposure to VAR2CSA. In contrast, the percentage of VAR2CSA+-infected erythrocytes adhesion to CSA was not different between HbAA and HbAC women. Moreover, IgG levels to PfEMP1 variants associated with severe malaria were not significantly different between groups. The findings indicate similar exposure to Plasmodium falciparum parasites expressing PfEMP1 variants causing severe malaria, and justify more comprehensive studies of hemoglobinopathy-related qualitative and quantitative differences in PfEMP1-specific antibody responses.Rapid diagnostic tests (RDTs) for Plasmodium falciparum commonly detect histidine-rich protein 2 (HRP-2), but HRP-2 deletions are increasingly recognized. We evaluated a prototype test detecting parasite lactate dehydrogenase (pLDH) and compared it to commercially available RDTs at a health facility in Uganda, using quantitative polymerase chain reaction as a gold standard. The prototype pLDH test had a high sensitivity for infections with at least 100 parasites/µL (98%), comparable to HRP-2, and greater than an existing pLDH RDT (89%). Specificity for the prototype test was 99.5%, which is greater than the HRP-2 tests (93-95%). Therefore, the prototype pLDH test may be an attractive alternative malaria diagnostic.Vector surveillance is important to control mosquito-borne diseases. read more We compared the efficacies of three mosquito-trapping devices the CDC light trap with incandescent light (CDC_I), the CDC light trap with ultraviolet light (CDC_UV), and the Biogents-sentinel (BG) trap, to identify a suitable and cost-effective surveillance tool for key vectors of neglected zoonotic arboviral diseases in Papua New Guinea (PNG). Of 13,788 female mosquitoes, CDC_I caught 7.9%, BG caught 14.5%, and CDC_UV caught 77.6%. Culex was the most predominant genus caught in all the traps. Centers for Disease Control light trap with ultraviolet light trap captured the highest abundance, highest species richness of mosquitoes and exhibited the highest overall Culex mosquito capture rates compared with BG and CDC_l. This study represents the first assessment of trapping devices for zoonotic arbovirus vectors in PNG. We recommend the CDC _UV trap for future monitoring and surveillance of infectious arboviral vector programs in PNG.Food web structure plays an important role in determining ecosystem stability against perturbations. High-latitude marine ecosystems are being affected by environmental stressors and biological invasions. In the West Antarctic Peninsula these transformations are mainly driven by climate change, while in the sub-Antarctic region by anthropogenic activities. Understanding the differences between these areas is necessary to monitor the changes that are expected to occur in the upcoming decades. Here, we compared the structure and stability of Antarctic (Potter Cove) and sub-Antarctic (Beagle Channel) marine food webs. We compiled species trophic interactions (predator-prey) and calculated complexity, structure and stability metrics. Even if both food webs presented the same connectance, we found important differences between them. The Beagle Channel food web is more complex, but less stable and sensitive to the loss of its most connected species, while the Potter Cove food web presented lower complexity and greater stability against perturbations.Limpet shells can harbour a high diversity of species. Individuals of four limpet species (Patella depressa, Patella ulyssiponensis, Patella vulgata and Siphonaria pectinata) were collected monthly during one year in southern Portugal. Epibiont organisms were identified, counted and the percentage cover of facilitator taxa was also recorded. A total of 86 taxa were identified with abundance reaching 674 epibionts on a single basibiont shell. P. ulyssiponensis showed the highest epibiont species diversity and richness while P. depressa and P. vulgata showed similar diversity and richness. P. depressa had a more even epibiotic community mainly due to higher densities of Chthamalus sp. Overall, basibiont species was the key factor determining the epibiotic community, followed by month/season and erect algae. The presence of erect algae potentiated the epibionts diversity on limpet shells, whereas the occurrence of barnacles tended to decrease it and the presence of crustose algae had no significant effect on epibionts diversity. These findings shed further light on the biological and ecological complex relationships among keystone species inhabiting intertidal rocky shores.

We modeled the clinical course of a cohort of diffuse large B-cell lymphoma (DLBCL) patients with no prior cardiovascular diseases (CVDs) using a multistate modeling framework.

Data on 2600 patients with DLBCL diagnosed between 2000 and 2018 and had received chemotherapy with or without radiotherapy were obtained from a population-wide electronic health database of Hong Kong. We used the Markov illness-death model to quantify the impact of doxorubicin and various risk factors (therapeutic exposure, demographic, comorbidities, cardiovascular risk factors, and lifestyle factors which included smoking) on the clinical course of DLBCL (transitions into incident CVD, lymphoma death, and other causes of death).

A total of 613 (23.6%) and 230 (8.8%) of 2600 subjects died of lymphoma and developed incident CVD, respectively. Median follow-up was 7.0 years (interquartile range 3.8-10.8 years). Older ages [hazard ratio (HR) for >75 versus ≤60 years 1.88; 95% confidence interval (CI) 1.25-2.82 and HR for 61-75 at incident CVDs can occur soon after DLBCL treatment and continued to occur throughout survivorship. Clinicians are advised to balance the risks and benefits of treatment choices to minimize the risk of CVD.Immunotherapy has been a milestone in combatting cancer, by complementing or even replacing classic treatments like surgery, chemotherapy, radiation, and anti-hormonal therapy. In 15%-30% of breast cancers, overexpression of the human epidermal growth factor receptor 2 (Her-2/neu) is associated with more aggressive tumor development. Passive immunization/immunotherapy with the recombinantly produced Her-2/neu-targeting monoclonal antibodies (mAbs) pertuzumab and trastuzumab has been shown to effectively treat breast cancer and lead to a significantly better prognosis. However, allergic and hypersensitivity reactions, cardiotoxicity, development of resistance, lack of immunological memory which results in continuous application over a long period, and cost-intensiveness are among the drawbacks associated with this treatment. Furthermore, intrinsic or acquired resistance is associated with the application of therapeutic mAbs, leading to the disease recurrence. Conversely, these drawbacks could be potentially overcome by vaccination, i.e. an active immunization/immunotherapy approach by activating the patient's own immune system to target cancer, along with inducing immunological memory. This review aims to summarize the main approaches investigated and undertaken for the production of Her-2/neu vaccine candidates, with the main focus on peptide-based vaccines and their evaluation in clinical settings.

The management of foreign body aspirations (FBA) is dreaded by pediatric physicians due to the high risk of respiratory distress and a potential fatal outcome, favored by a lack of experience of young specialists. Furthermore, there has been an increasing requirement for low-cost simulation. The aim was to describe the step-by-step manufacturing process and to validate a low-cost, easily home-made training model of pediatric tracheo-bronchial tree (pTBT) for simulation-based training in order to teach young physicians to practice foreign body (FBA) extractions.

A simulator was designed in order to reproduce the physical and esthetic properties of a pTBT. The production cost of a single simulator was estimated. The simulator was then tested by experienced physicians using a rigid bronchoscope. A manufacturing manual of the simulator is hereby presented. A group of 7 experienced pediatric otolaryngologists performed a FBA extraction in the conditions of installation of an operating room.

The result of the survey showed a high fidelity of the simulator in mimicking the biological esthetics and physical properties of a pTBT during a FBA extraction (mean 4.3±0.8). The total cost of the custom-made simulator is about 20.5 € ($23.4) for the production of the first simulator.

A highly realistic and easily reproducible pediatric tracheo-bronchial tree simulator is presented and can therefore be used during simulation-based training.

A highly realistic and easily reproducible pediatric tracheo-bronchial tree simulator is presented and can therefore be used during simulation-based training.There is a worldwide focus on reducing the environmental impacts of livestock manure management. In China, there are different manure treatment and application modes, including complete treatment to remove nitrogen (N) for direct discharge into watercourses. But we lack a systematic quantitative comparison of the environmental losses that occur from different management modes. We used an example farm of 10,000 finisher pigs to quantitatively analyze the annual N losses from land application (LA) and treatment to remove N from manure to the level of discharge consent (DS) under 24 sub-modes. This is an important study to unravel the effect of choice of different manure management systems on subsequent N losses. The results showed that the N losses from the LA mode (52.6% of total N excretion) were significantly lower than that from the DS mode (75.9%). Compared with other sub-modes, N emission from whole slurry injection was the smallest, accounting for 43.2% of total N excretion. NH3-N was the main source of N loss which accounted for 72.9% and 50.2% in LA and DS mode, respectively. The lowest N emission of LA mode with mitigation options, including slurry store covers, composting with bio-filter deodorization and injection application, was 28.8% of total N excretion, which is only 42.2% of N emission from DS mode with mitigation options. Insights from this systematic study of different manure management modes in China show the imperative of control ammonia emission for China, and provide guidance to the sustainable manure management in rapidly developing countries.