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Sustaining the impact of hepatitis B virus (HBV) vaccination on incidence and prevalence of HBV infection requires increasing and maintaining the uptake of vaccine among those at risk. In recent years, the level of vaccine uptake among people who inject drugs (PWID) in the UK has levelled-off. Data (2015–2016) from the national unlinked-anonymous monitoring survey of PWID, an annual survey that collects data from PWID across England, Wales and Northern Ireland, were used to examine HBV vaccine uptake. Data from participants who had injected drugs during the previous year were used to investigate sources of hepatitis B vaccine doses as well as factors associated with vaccine uptake. Among the 3175 anti-HBc-negative participants, 3138 (99%) reported their vaccination status; 23% (714) reported no vaccine uptake. Among those not vaccinated, 447 (63%) reported being sexually active and 116 (16%) reported sharing needles and syringes. Majority of those not vaccinated reported accessing services in the previous year that could have provided hepatitis B vaccine doses. These missed opportunities for vaccinating of PWID indicate a need for additional targeted interventions.
UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The ‘Going Viral’ campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus ⩾1 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 <350, APRI (AST-to-Platelet Ratio Index) >1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
Northeastern North America has produced an incredible number of late Pleistocene faunal remains; however, many of these were discovered and excavated prior to the development of radiocarbon dating. Moreover, many of the 14C dates that do exist for such specimens were assayed prior to the development of purified collagen extraction methods, were performed on botanical remains of unspecified association with the faunal remains, or were accepted without concerns of young-carbon contamination from museum preservatives. Here, we present a set of high-precision accelerator mass spectrometry (AMS) dates obtained on Pleistocene faunal specimens from Connecticut, New Jersey, and Pennsylvania. Our data contain both newly discovered specimens and specimens that have resided in museum collections for over a century.
The association between harmful use of alcohol and HIV infection is well documented. To address this dual epidemic, the US President's Emergency Plan for AIDS Relief (PEPFAR) developed and implemented a multi-pronged approach primarily in Namibia and Botswana. We present the approach and preliminary results of the public health investigative and programmatic activities designed, initiated and supported by PEPFAR to combat the harmful use of alcohol and its association as a driver of HIV morbidity and mortality from 2008 to 2013.
PEPFAR supported comprehensive alcohol programming using a matrix model approach that combined the socio-ecological framework and the Alcohol Misuse Prevention and Intervention Continuum. This structure enabled seven component objectives: (1) to quantify harmful use of alcohol through rapid assessments; (2) to develop and evaluate alcohol-based interventions; (3) to promote screening programs and alcohol abuse resource services; (4) to support stakeholder networks; (5) to support policy interventions and (6) structural interventions; and (7) to institutionalize universal prevention messages.
Targeted PEPFAR support for alcohol activities resulted in several projects to address harmful alcohol use and HIV. Components are graphically conceptualized within the matrix model, demonstrating the intersections between primary, secondary and tertiary prevention activities and individual, interpersonal, community, and societal factors. Key initiative successes included leveraging alcohol harm prevention activities that enabled projects to be piloted in healthcare settings, schools, communities, and alcohol outlets. Primary challenges included the complexity of multi-sectorial programming, varying degrees of political will, and difficulties monitoring outcomes over the short duration of the program.
Children in care often have poor outcomes. There is a lack of evaluative
research into intervention options.
To examine the efficacy of Multidimensional Treatment Foster Care for
Adolescents (MTFC-A) compared with usual care for young people at risk in
foster care in England.
A two-arm single (assessor) blinded randomised controlled trial (RCT)
embedded within an observational quasi-experimental case–control study
involving 219 young people aged 11–16 years (trial registration: ISRCTN
68038570). The primary outcome was the Child Global Assessment Scale
(CGAS). Secondary outcomes were ratings of educational attendance,
achievement and rate of offending.
The MTFC-A group showed a non-significant improvement in CGAS outcome in
both the randomised cohort (n = 34, adjusted mean
difference 1.3, 95% CI −7.1 to 9.7, P = 0.75) and in the
trimmed observational cohort (n = 185, adjusted mean
difference 0.95, 95% CI −2.38 to 4.29, P = 0.57). No
significant effects were seen in secondary outcomes. There was a possible
differential effect of the intervention according to antisocial
There was no evidence that the use of MTFC-A resulted in better outcomes
than usual care. The intervention may be more beneficial for young people
with antisocial behaviour but less beneficial than usual treatment for
In this paper we shall look at a technique, known as impurity free vacancy diffusion (IFVD) for selectively altering the optoelectronic response of quantum well material after growth with a view to monolithic device integration. We will discuss the mechanism, practical considerations and some possible applications.
The aim of this study was to estimate the amount of childhood hepatitis B virus transmission in children born in the UK, a very low-prevalence country, that is preventable only by universal hepatitis B immunization of infants. Oral fluid specimens were collected from schoolchildren aged 7–11 years in four inner city multi-ethnic areas and tested for the presence of antibody to hepatitis B core antigen (anti-HBc). Those found positive or indeterminate were followed up with testing on serum to confirm their hepatitis B status. The overall prevalence of anti-HBc in children was low [0·26%, 95% confidence interval (CI) 0·14–0·44]. The estimated average annual incidence of hepatitis B was estimated to be 29·26/100 000 children (95% CI 16·00–49·08). The total incidence that is preventable only by a universal infant immunization programme in the UK was estimated to be between 5·00 and 12·49/100 000. The study demonstrates that the extent of horizontal childhood hepatitis B virus transmission is low in children born in the UK and suggests that schools in the UK are an uncommon setting for the transmission of the virus. Targeted hepatitis B testing and immunization of migrants from intermediate- and high-prevalence countries is likely to be a more effective measure to reduce childhood transmission than a universal infant immunization programme.
A high temperature, elemental boron evaporation source has been used for the study of the boron doping behaviour in Si as a function of growth temperature and doping level. Significant profile smearing of boron at doping levels below 5×1018cm−3 is observed. Profile smearing is more severe in higher doped samples for growth temperatures above 600°C at a growth rate of 0.28 nms−1. This is interpreted as arising from the formation of a surface phase of boron at higher doping levels. The marked improvement in profile abruptness at low temperatures suggests significant benefits associated with the use of an elemental boron source for the growth of high resolution Si/Si1−xGex device structures.
The performance of many Si/SiGe devices, particularly those involving modulation doped quantum wells, will depend on the quality of the matrix and doping interfaces involved. These may be adversely affected by profile smearing of Ge and the dopant. A study of boron incorporation in SiGe, as a function of substrate temperature and Ge fraction, shows a marked difference in profile smearing for boron in Si and in the SiGe alloy. This is shown to be associated with a reduction in the temperature for transition from equilibrium to kinetically limited accumulation in the alloy.
Superionic PbSnF4 can be prepared using a variety of different methods. It crystallizes in various different unit-cells. All structures are closely related to that of the fluorite type structure, with various degrees of order/disorder and different types of superstructures. Reaction of lead(ll) nitrate and stannous fluoride in water gives highly stressed and highly oriented tetragonal α-PbSnF4, however, in HF/H2O, it gives orthorhombic O-PbSnF4, which is also stressed but less. Reactions of solid α-PbF2 with an aqueous solution of SnF2, in excess SnF2, also gives stressed α-PbSnF4. Solid state reactions of SnF2 and PbF2 give unstressed and much less oriented α-PbSnF4 at 250°C, whereas tetragonal β-PbSnF4 is obtained above 270°C and is quenchable to ambient temperature. At 390°C, cubicy-PbSnF4 is obtained, however, this is not quenchable. Ball milling of o-PbSnF4 gives stressed α-PbSnF4, and ball milling of a- and β-PbSnF4 gives microcrystalline γ-PbSnF4. Annealing the latter gives unstressed and non oriented α-PbSnF4. Stirring a slurry of microcrystalline γ-PbSnF4 in water gives α-PbSnF4 except the one originating from o-PbSnF4, which gives back o-PbSnF4. The texture of these phases, and therefore the macroscopic properties related to it, can be drastically modified by modifying the method of preparation.
We have studied the emission from LEDs based on GaInNAs Quantum Wells (QWs) and InAs Quantum Dots (QDs) as a function of temperature and current. It is found that the carrier loss in GaInNAs QWs is dominated by non-radiative monomolecular and Auger processes resulting in an external quantum efficiency of only 0.08 % at 10 °C and 1000 A cm-2. In contrast, the InAs QDs have a higher external quantum efficiency, peaking at 0.8 % at 10 °C and 5 A cm-2, but this value rapidly decreases as the excited states of the QDs are filled and Auger-like processes become dominant. These results highlight the issues that must be addressed if these materials are to find commercial application: namely, the areal density of QDs must be increased and the material quality of the GaInNAs QWs must be improved.
Stress/Strain fields associated with thin film buckling induced by compressive stresses or blistering due to the presence of gas bubbles underneath single crystal surfaces are difficult to measure owing to the microscale dimensions of these structures. In this work, we show that micro Scanning X-ray diffraction is a well suited technique for mapping the strain/stress tensor of these damaged structures.
The degerming effect of a 3 min handwash with 2% triclosan, or 4% chlorhexidine, in detergent and enhanced efficacy of either antiseptic in isopropyl alcohol, was evaluated in volunteers. Handwashing with either antiseptic preparation reduced the normal flora by a factor of 10; alcohol rubbing by approximately a factor of 1000. Both regimens eliminated Micrococcus roseus, artificially inoculated before every procedure. The sustained action of the same detergent preparations was further studied in gloved and ungloved hands by the Vinson's ‘finger imprint test’. In the gloved hand both antiseptics inhibited Staphylococcus epidermidis for 4 h. In the ungloved hand however, triclosan remained active longer than chlorhexidine. Whilst the activity of chlorhexidine was short-lived against a clinical isolate of S. aureus, particularly in the ungloved hand, the sustained effect of triclosan against the same strain persisted for 4 h on either hand.
Two isolations of Arizona from humans were made in Sheffield in 1966. The first was from a 3-year-old girl with a history of gastro-enteritis; the second was from her 5-year-old brother who was a symptomless excretor. Infection was traced to pet terrapins recently purchased from a local pet shop. The relative epidemiological significance of Arizona infection and the potential hazard of pet terrapins has been reviewed.
We wish to thank Dr V. G. S. Damms for his help and co-operation and for allowing us to publish details of his patients, Dr J. G. Wallace for his work on the preliminary identification of the organism, and Dr Joan Taylor and Dr E. H. Gillespie for their helpful advice and criticism.
A comparison of homologous and heterologous rates of neutralization demonstrated that antigenic relationships of foot-and-mouth disease virus strains could be differentiated quantitatively by the kinetics of neutralization method described previously (Rweyemamu, Booth & Pay, 1977). Conventional formulae for r, R and D values could be applied to results obtained by this method. It was demonstrated that results analysed this way gave R values which were similar to those obtained with other neutralization test methods but which were generally smaller than those obtained with complement fixation test results. It was demonstrated that there were wide differences between the vaccine strains tested as demonstrated by R value relationships. An examination of r values, however, demonstrated that antisera to the Moz 1/70 strain were highly reactive with most of the virus strains from Central and Southern Africa. The selection of FMD virus strains with a wide serological range for vaccine production is discussed.