Skin Prick Automated Test device offers more reliable allergy test results compared to a manual skin prick test.

BACKGROUND: The skin prick test (SPT) is the gold standard for identifying allergic sensitization in individuals suspected of inhalant allergy. A novel device, SPAT or Skin Prick Automated Test, that enables more standardized allergy testing has been developed. Previous research has shown reduced intra-subject variability of histamine wheals by SPAT. OBJECTIVE: This study aimed to evaluate within-test agreement (% of patients with consistent test results) to detect sensitization to common inhalant allergens when a SPT is executed automated by SPAT or by manual SPT (SPMT) procedure. METHODS: The 110 volunteers prospectively enrolled underwent both SPAT and SPMT with 3 pricks of house dust mite, timothy grass and birch, 2 pricks of histamine and 1 prick of glycerol. The proportion of consistent (3x positive â€" 3 x negative) and inconsistent (2x positive/negative â€" 1x positive/negative) test results were analysed. RESULTS: The proportion of inconsistent test results was significantly lower in the SPAT compared to the SPMT group. The delta histamine to control pricks was significantly higher in SPAT compared to SPMT group. Coefficient of variation was lower in SPAT compared to SPMT for house dust mite, timothy grass, birch pollen. Visual analogue scale for discomfort was significantly lower in SPAT compared to SPMT group. CONCLUSION: SPAT showed a 34% reduction in the number of inconsistent test results compared to manual SPT with common inhalant allergens. Patient experience is significantly improved when an allergy test is performed by SPAT compared to a manual SPT.

Elimination of dog-mediated human rabies: the burden of human rabies in Africa.

Hope exists for the elimination of dog-mediated human rabies in Africa. Momentum is gathering towards this goal, with an increasing number of successful demonstration projects showing that elimination is feasible. The Pan African Rabies Control Network is bringing Africa together against rabies, supported by the World Health Organization, the World Organisation for Animal Health and the Food and Agriculture Organization of the United Nations, which have a combined resolution to eliminate human deaths from dog-transmitted rabies by 2030. Furthermore, the inspiring examples of both rinderpest and smallpox eradication hold all the elements necessary to have confidence that this momentum can lead to success. Smallpox and rinderpest, whose last battles were fought on the African continent, highlight the simple fact that once the primary tools are available (such as vaccines), by far the greatest challenges lie within the realm of implementation. Science can effectively argue the subtleties of virology, immunology, vaccinology, etc. but it often fails to describe the science of implementation. In the face of other major diseases and socio-economic difficulties, rabies is not perceived as a threat by many African countries, despite the fact that the burden of the disease has been shown to be extensive. The challenge of mobilising mass interventions requires leadership and fortitude within resource-poor, infrastructurally challenged, politically uninterested and often bureaucratically restricted environments. Continent-wide elimination remains a daunting prospect for investors, who often lack insight into environmental disease dynamics, which is essential for enabling the implementation of strategic, community-based interventions. Implementation in Africa needs to be seen through African eyes. It needs local community support, and it needs effective transport and procurement systems and systems of self-development with a view to sustainability. The Aidto- Africa model needs to be replaced by a model that empowers communities to act, demonstrates that success is possible and stimulates the expansion of control efforts.

Il existe un espoir de réussir à éliminer la rage humaine transmise par les chiens en Afrique. Nous assistons actuellement à la montée en puissance d'une dynamique vers cet objectif, avec la réalisation d'un nombre croissant de projets de démonstration qui en confirment la faisabilité. Le continent africain a décidé de rassembler ses efforts contre la rage en lançant le Réseau panafricain de contrôle de la rage, soutenu par l'Organisation mondiale de la santé, l'Organisation mondiale de la santé animale et l'Organisation des Nations Unies pour l'alimentation et l'agriculture, c'est-à-dire les trois organisations signataires de la résolution visant à ramener à zéro le nombre de décès humains dans le monde dus à la rage transmise par les chiens à l'horizon 2030. En outre, les exemples édifiants d'éradication réussie de la peste bovine et de la variole offrent tous les éléments nécessaires pour envisager avec confiance le succès de cette entreprise. Les dernières batailles contre la variole et la peste bovine, qui ont été livrées sur le continent africain, mettent en lumière une vérité simple, à savoir qu'une fois garantie l'existence des outils essentiels (par exemple les vaccins), il reste à relever le défi de leur mise en oeuvre, de loin le plus important. Si la science apporte nombre d'éclairages argumentés sur les subtilités en matière de virologie, d'immunologie, de vaccinologie, etc., elle ne parvient pas toujours à expliquer la science de la mise en oeuvre. Face à d'autres maladies majeures et aux difficultés d'ordre socio-économique que traversent les pays, ceux-ci ne perçoivent pas toujours la rage comme une menace malgré le fardeau considérable qu'elle représente pour eux. Les difficultés liées à la mobilisation d'interventions à très grande échelle exigent de la détermination et des capacités de leadership dans un environnement insuffisamment doté en ressources et en infrastructures, peu motivé au plan politique et souvent limité par des contraintes bureaucratiques. L'élimination à l'échelle du continent reste une perspective intimidante pour les investisseurs, qui ne sont pas toujours conscients de la dynamique environnementale de la maladie, facteur pourtant essentiel pour mettre en oeuvre des interventions stratégiques basées sur les communautés locales. La mise en oeuvre en Afrique doit être envisagée dans une optique africaine. Elle nécessite le soutien des populations locales, des systèmes de transport et d'approvisionnement efficaces et des dispositifs de développement autonomes afin d'en assurer la durabilité. Le modèle d'aide à l'Afrique doit être remplacé par un modèle qui repose sur l'autonomisation et la capacité d'action des populations locales et qui puisse à la fois démontrer les perspectives de réussite et promouvoir l'intensification des efforts dédiés à la lutte.

Hay esperanza por lo que respecta a acabar con la rabia humana transmitida por perros en África. La dinámica para lograrlo va ganando impulso, con un creciente número de fructíferos proyectos experimentales que demuestran que es un objetivo factible. La Red Panafricana para el Control de la Rabia está federando a todo el continente en torno a la lucha antirrábica, con apoyo de la Organización Mundial de la Salud (OMS), la Organización Mundial de Sanidad Animal (OIE) y la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO), que tienen suscrita una resolución común en la que afirman la voluntad de poner fin antes de 2030 a la muerte de personas por la rabia transmitida por perros. Además, los estimulantes ejemplos de la erradicación de la peste bovina y la viruela ofrecen todas las razones para confiar en que esta dinámica se vea coronada por el éxito. Las guerras contra esas dos enfermedades, cuyas últimas batallas se libraron en el continente africano, ponen de relieve un hecho simple: una vez están disponibles las herramientas básicas (como las vacunas), los mayores obstáculos, con diferencia, surgen en el terreno de la aplicación práctica. La ciencia puede adentrarse eficazmente en las sutilezas de la virología, la inmunología, la vacunología y demás, pero a menudo es incapaz de describir la ciencia de la aplicación. En comparación con otras importantes enfermedades y dificultades socioeconómicas, muchos países africanos no consideran que la rabia suponga una amenaza, pese a la probada magnitud de la carga que impone. El objetivo de poner en solfa intervenciones masivas exige liderazgo y fortaleza en contextos marcados no solo por la escasez de recursos, sino también por infraestructuras deficientes, desinterés político y, a menudo, cortapisas burocráticas. La eliminación de la rabia en todo el continente sigue pareciendo una empresa abrumadora a los inversores, que no suelen tener una idea clara de la dinámica ambiental de la enfermedad, algo esencial para posibilitar la aplicación de intervenciones estratégicas y enraizadas en el ámbito comunitario. En África este empeño hay que abordarlo desde una óptica africana. Ello pasa por el apoyo de las comunidades locales, por sistemas eficaces de compra y transporte y por sistemas de desarrollo autónomo que hagan posible la sostenibilidad a largo plazo. El modelo de la prestación de ayuda a África debe ser sustituido por un modelo que faculte a las comunidades para pasar a la acción, demuestre que el éxito es posible y estimule la extensión de las actividades de lucha antirrábica.

Baseline gut microbiota predicts clinical response and colitis in metastatic melanoma patients treated with ipilimumab.

BACKGROUND: Ipilimumab, an immune checkpoint inhibitor targeting CTLA-4, prolongs survival in a subset of patients with metastatic melanoma (MM) but can induce immune-related adverse events, including enterocolitis. We hypothesized that baseline gut microbiota could predict ipilimumab anti-tumor response and/or intestinal toxicity. PATIENTS AND METHODS: Twenty-six patients with MM treated with ipilimumab were prospectively enrolled. Fecal microbiota composition was assessed using 16S rRNA gene sequencing at baseline and before each ipilimumab infusion. Patients were further clustered based on microbiota patterns. Peripheral blood lymphocytes immunophenotypes were studied in parallel. RESULTS: A distinct baseline gut microbiota composition was associated with both clinical response and colitis. Compared with patients whose baseline microbiota was driven by Bacteroides (cluster B, n = 10), patients whose baseline microbiota was enriched with Faecalibacterium genus and other Firmicutes (cluster A, n = 12) had longer progression-free survival (P = 0.0039) and overall survival (P = 0.051). Most of the baseline colitis-associated phylotypes were related to Firmicutes (e.g. relatives of Faecalibacterium prausnitzii and Gemmiger formicilis), whereas no colitis-related phylotypes were assigned to Bacteroidetes. A low proportion of peripheral blood regulatory T cells was associated with cluster A, long-term clinical benefit and colitis. Ipilimumab led to a higher inducible T-cell COStimulator induction on CD4+ T cells and to a higher increase in serum CD25 in patients who belonged to Faecalibacterium-driven cluster A. CONCLUSION: Baseline gut microbiota enriched with Faecalibacterium and other Firmicutes is associated with beneficial clinical response to ipilimumab and more frequent occurrence of ipilimumab-induced colitis.

Dog rabies in southern Africa: regional surveillance and phylogeographical analyses are an important component of control and elimination strategies.

In the resource-poor settings where dog rabies remains endemic, the demonstration of a need to divert scarce funds towards exhaustive surveillance activities is no easy task. Here, we investigate a recent case of human rabies in South Africa, which generated much public interest and wide media coverage. One of the factors contributing to the hype was an uncertainty about the geographical origin of the infection. This provided an opportunity to highlight the importance of increased regional surveillance and basic phylogeographical analyses in rabies control and elimination strategies. Our aim was to elucidate the origins of the virus responsible for this case, as the patient was from a well-vaccinated area that had been free from dog rabies cases for many years. The phylogeographical techniques that we applied would also be most useful in any end-stage infectious disease control programme, specifically in verifying the source of novel cases in order to rapidly respond towards maintaining the integrity of disease-free areas. The most likely origin of our case was shown to be from outside the disease-free area and indeed from outside the country of South Africa. We conclude that phylogeographical techniques can provide rapid and statistically rigorous answers to epidemiologically pertinent questions that impact on disease control strategies and resource allocation, but this will require coordinated regional surveillance practices.

TB prevention cascade at a district hospital in rural Eastern Cape, South Africa.

SETTING: Rural Eastern Cape, South Africa. OBJECTIVE: To identify steps in the TB preventive care cascade from routinely collected data among TB patients at a district hospital prior to the implementation of a novel TB program. DESIGN: This was a retrospective study. We adapted the TB prevention cascade to measure indicators routinely collected at district hospitals for TB using a cascade framework to evaluate outcomes in the cohort of close contacts. RESULTS: A total of 1,722 charts of TB patients were reviewed. The majority of patients (87%) were newly diagnosed with no previous episodes of TB. A total of 1,548 (90%) patients identified at least one close contact. A total of 7,548 contacts were identified with a median of 4.9 (range 1-16) contacts per patient. Among all contacts identified, 2,913 (39%) were screened for TB. Only 15 (0.5%) started TB preventive therapy and 122 (4.4%) started TB treatment. Nearly 25% of all medical history and clinical information was left unanswered among the 1,722 TB charts reviewed. CONCLUSION: Few close contacts were screened or started on TB preventive therapy in this cohort. Primary care providers for TB care in district health facilities should be informed of best practices for screening and treating TB infection and disease.

CONTEXTE: Le Cap Est rural, le Cap, Afrique du Sud. OBJECTIF: Identifier les étapes de la cascade de soins préventifs de la TB à partir des données de routine recueillies parmi des patients dans un hôpital de district avant la mise en œuvre d'un nouveau programme TB. SCHÉMA: Ceci était une étude rétrospective. Nous avons adapté la cascade de prévention de la TB pour mesurer les indicateurs recueillis en routine dans les hôpitaux de district pour la TB en utilisant un cadre en cascade afin d'évaluer les résultats dans la cohorte des contacts étroits. RÉSULTATS: Un total de 1 722 dossiers de patients TB a été revu. La majorité des patients (87%) avait un diagnostic nouveau sans épisode de TB préalable. Un total de 1 548 (90%) patients ont identifié au moins un contact étroit ; 7 548 contacts ont été identifiés avec une médiane de 4,9 (fourchette 1­16) contacts par patient. Parmi tous les contacts identifiés, 2 913 (39%) ont eu une recherche de TB. Seulement 15 (0,5%) ont initié le traitement préventif et 122 (4,4%) ont mis en route le traitement de TB. Près de 25% de tous les antécédents et autres informations cliniques n'était pas remplis dans les 1 722 dossiers TB revus. CONCLUSION: Peu de contacts étroits ont été dépistés ou mis sous traitement préventif de TB dans cette cohorte. Les prestataires de soins de santé primaires pour la TB dans les structures de santé des districts doivent être informés des meilleures pratiques pour le dépistage et le traitement de la TB infection et maladie.

Anti-IgM-mediated B cell signaling. Molecular analysis of ligand binding requisites for human B cell clonal expansion and tolerance.

The ligand binding requisites for membrane IgM-mediated signaling of human B lymphocyte clonal expansion and B cell tolerance were investigated with a well-characterized set of soluble murine anti-human IgM mAbs. Evaluation of the impact of mu chain domain specificity, affinity, and binding stoichiometry for membrane IgM on antibody-induced regulation of normal and leukemic B cell DNA synthesis revealed that the ligand binding requisites for inducing or, alternatively, suppressing B cell DNA synthesis are significantly different. First, while the induction of S phase entry required micrograms/ml concentrations of ligand, orders of magnitude lower concentrations of ligand sufficed for inhibitory signaling. Second, while an upper affinity threshold for achieving maximal stimulation of B cell DNA synthesis was never detected, inhibitory signaling by bivalent ligands appeared to become relatively affinity independent at Fab binding affinities greater than 7.0 x 10(6) M-1. Third, while a C mu 1-specific mAb with an enhanced incidence of monogamous binding to mIgM was ineffective at inducing B cell DNA synthesis, the antibody was not significantly compromised in ability to initiate inhibitory signals. These differences could be observed in a clonal B cell population which positively or negatively responded to mIgM ligation depending upon its state of activation. The accumulated observations indicate that the ligand binding requisites for inhibitory signal transduction in human B lymphocytes are much less rigorous than those for stimulatory signal transduction and suggest that many physiologically relevant anti-Ig antibodies are more likely to function in the negative feedback regulation of B cell responses than in the direct triggering of human B cell clonal expansion.

[The fight against rabies in Africa: from recognition to action]. / Lutte contre la rage en Afrique: du constat à l'action.

As a follow-up to the first AfroREB (Africa Rabies Expert Bureau) meeting, held in Grand-Bassam (Côte-d'Ivoire) in March 2008, African rabies experts of the Afro-REB network met a second time to complete the evaluation of the rabies situation in Africa and define specific action plans. About forty French speaking rabies specialists from Northern, Western and Central Africa and Madagascar met in Dakar (Senegal), from March 16th to 19th, 2009. With the participation of delegates from Tunisia, who joined the AfroREB network this year, 15 French speaking African countries were represented. Experts from the Institut Pasteur in Paris, the Alliance for Rabies Control, and the Southern and Eastern African Rabies Group (SEARG, a network of rabies experts from 19 English speaking Southern and Eastern African countries) were in attendance, to participate in the discussion and share their experiences. AfroREB members documented 146 known human rabies cases in all represented countries combined for 2008, for a total population of 209.3 million, or an incidence of 0.07 cases per 100,000 people. Even admitting that the experts do not have access to all reported cases, this is far from the WHO estimation of 2 rabies deaths per 100,000 people in urban areas and 3.6 per 100,000 in rural Africa. It was unanimously agreed that the priority is to break the vicious cycle of indifference and lack of information which is the main barrier to human rabies prevention.

Evaluation of real-time nucleic acid sequence-based amplification for detection of Chikungunya virus in clinical samples.

The Chikungunya virus (CHIKV) is a member of the genus Alphavirus that is transmitted to humans by Aedes mosquitoes. In 2005 and 2006, the Indian Ocean island of La Réunion was hit with an unprecedented CHIKV fever outbreak that infected 300 000 people. In the present study, we describe the evaluation of real-time nucleic acid sequence-based amplification (RT-NASBA) for the detection of CHIKV in clinical samples. A co-extracted and co-amplified chimerical CHIKV RNA sequence was used as an internal control to eliminate false-negative results. The detection threshold of the assay was determined from quantified CHIKV-positive plasma, and estimated to be 200 copies per NASBA reaction. The specificity of the assay was determined using blast analyses and non-cross-reactivity using an O'nyong-nyong virus culture and 250 CHIKV RT-PCR-negative plasma samples. A 100 % specificity was found and no invalid result was obtained, showing the good quality of the nucleic acid extraction. The assay was then evaluated using 252 CHIKV-positive RT-PCR plasma samples. The samples were all tested positive, including those with low viral load. This evaluation showed that the RT-NASBA is a rapid (5 h from sample nucleic acid extraction to detection), sensitive, specific and reliable method for the routine diagnosis of CHIKV in clinical samples.

Soluble human complement receptor type 1: in vivo inhibitor of complement suppressing post-ischemic myocardial inflammation and necrosis.

The complement system is an important mediator of the acute inflammatory response, and an effective inhibitor would suppress tissue damage in many autoimmune and inflammatory diseases. Such an inhibitor might be found among the endogenous regulatory proteins of complement that block the enzymes that activate C3 and C5. Of these proteins, complement receptor type 1 (CR1; CD35) has the most inhibitory potential, but its restriction to a few cell types limits its function in vivo. This limitation was overcome by the recombinant, soluble human CR1, sCR1, which lacks the transmembrane and cytoplasmic domains. The sCR1 bivalently bound dimeric forms of its ligands, C3b and methylamine-treated C4 (C4-ma), and promoted their inactivation by factor I. In nanomolar concentrations, sCR1 blocked complement activation in human serum by the two pathways. The sCR1 had complement inhibitory and anti-inflammatory activities in a rat model of reperfusion injury of ischemic myocardium, reducing myocardial infarction size by 44 percent. These findings identify sCR1 as a potential agent for the suppression of complement-dependent tissue injury in autoimmune and inflammatory diseases.

Evaluation of a rapid immunodiagnostic test kit for detection of African lyssaviruses from brain material.

A rapid immunodiagnostic test kit was evaluated against a selection of isolates of lyssavirus genotypes occurring in Africa. The test was carried out in parallel comparison with the fluorescent antibody test (FAT) and isolates representing previously established phylogenetic groups from each genotype were included. The specificity of the rapid immunodiagnostic test compared favourably with the FAT and was found to detect all representatives of genotypes 1, 2, 3 and 4 in brain samples of either field cases or suckling mouse brain inoculates.

Pistachio vicilin, Pis v 3, is immunoglobulin E-reactive and cross-reacts with the homologous cashew allergen, Ana o 1.

BACKGROUND: Patients allergic to cashew nuts often report allergy to pistachio, which could be a result of cross-reactivity between the two as both are members of the Anacardiaceae family. OBJECTIVE: Because cashew 7S globulin (vicilin, Ana o 1) is a recognized major allergen, we cloned the pistachio homologue and assayed it for IgE reactivity and cross-reactivity with Ana o 1. METHODS: Degenerate primers for 7S globulin were used in PCR to amplify DNA from a pistachio cDNA library. An isolate was sequenced, cloned and expressed in Escherichia coli. Reactivity to the allergen was screened by dot blot using 19 pistachio and/or cashew-allergic patients' sera. Cross-reactivity was investigated by inhibition dot- and Western immunoblot assays using pistachio/cashew-allergic patients' sera, and monoclonal antibodies (MAbs) raised against recombinant Ana o 1 (rAna o 1). RESULTS: An isolate was found that coded for a 7S vicilin-like protein, designated Pis v 3. IgE reactivity to Pis v 3 was found in the serum of seven of the 19 (37%) patients with histories of allergy to both pistachio and cashew or who were allergic to cashew but had never eaten pistachio. The seven patients with IgE that recognized rPis v 3 also recognized rAna o 1. Six of nine anti-rAna o 1 MAbs also showed reactivity to rPis v 3 on dot blots. CONCLUSION: Of the 37% of pistachio/cashew-allergic patients' sera that recognized the pistachio allergen, rPis v 3, all showed complete cross-reactivity with rAna o 1. The data does not identify the primary sensitizing agent but suggests that IgE reactivity to rPis v 3 and rAna o 1 is focused on the most conserved regions of the proteins. Clinical histories suggest that in some cases, cashew was the sensitizing agent. rPis v 3 is a likely contributor to the observed co-sensitivity to pistachio and cashew in some patients.

Failure to perform assisted deliveries is resulting in an increased neonatal and maternal morbidity and mortality: An expert opinion.

The need to perform assisted vaginal delivery (AVD) has been regarded as self-evident. In high-income countries, rates of AVD range between 5% and 20% of all births. In South Africa, the rate of AVD is only 1%. This has resulted in increased neonatal morbidity and mortality due to intrapartum asphyxia, and increased maternal morbidity and mortality due to a rise in second-stage caesarean deliveries. In this article, we address the possible causes leading to a decrease in AVD and propose measures to be taken to increase the rates of AVD and subsequently reduce morbidity and mortality.

MARCKS Is Necessary for Netrin-DCC Signaling and Corpus Callosum Formation.

Axons of the corpus callosum (CC), the white matter tract that connects the left and right hemispheres of the brain, receive instruction from a number of chemoattractant and chemorepulsant cues during their initial navigation towards and across the midline. While it has long been known that the CC is malformed in the absence of Myristoylated alanine-rich C-kinase substrate (MARCKS), evidence for a direct role of MARCKS in axon navigation has been lacking. Here, we show that MARCKS is necessary for Netrin-1 (NTN1) signaling through the DCC receptor, which is critical for axon guidance decisions. Marcks null (Marcks-/-) neurons fail to respond to exogenous NTN1 and are deficient in markers of DCC activation. Without MARCKS, the subcellular distributions of two critical mediators of NTN1-DCC signaling, the tyrosine kinases PTK2 and SRC, are disrupted. Together, this work establishes a novel role for MARCKS in axon dynamics and highlights the necessity of MARCKS as an organizer of DCC signaling at the membrane.

Elements for optimizing a one-step enzymatic bio-refinery process of shrimp cuticles: Focus on enzymatic proteolysis screening.

This article complements an earlier work published in 2015 Baron et al. (2015) that showed the interest of a shrimp shells bio-refining process. We compare here the effect of eleven commercial proteases at pH 3.5 or 4.0 on a residual amount of shrimp shells proteins after 6 h at 50 °C. The two pH are obtained when respectively 40 and 25 mmol of formic acid are added to 5 g of mild dried shell. Deproteinisation yield above 95% are obtained. Residual amino acids profile in the solid phase was identical for the eleven proteases except for pepsin which was similar to the raw material profile. A significant relative increase in the proportion of Glycine is observed for the ten other cases. Likewise, shapes of size exclusion chromatograms of the dissolved phase are similar except with pepsin.

[Lemierre syndrome variant: Hepatic abscesses and hepatic venous thrombosis due to Fusobacterium nucleatum septicemia]. / Un variant du syndrome de Lemierre: abcès hépatiques et thrombose veineuse sus-hépatique secondaire à une septicémie à Fusobacterium nucleatum.

INTRODUCTION: Like Fusobacterium necrophorum, Fusobacterium nucleatum is capable causing Lemierre's syndrome. Various locations of venous thrombosis have been described associated with Fusobacterium sp. septicemia. EXEGESIS: We describe a 43-year old alcoholic patient with F.nucleatum septicemia complicated with hepatic abscesses, middle hepatic venous thrombosis, osteomyelitis and infiltrative pneumonia. A pancreatic prosthesis was the only potentially identified infectious entrance. CONCLUSION: Our patient showed an alternative presentation of Lemierre's syndrome, a "digestive variant". To the best of our knowledge, this is the first report of Fusobacterium septicemia associated with hepatic venous thrombosis. This report is close to the cases of portal thrombosis and opens the clinical sphere of the lemierre's syndrome, whose incidence is increasing.

Immunisation coverage in the rural Eastern Cape - are we getting the basics of primary care right? Results from a longitudinal prospective cohort study.

BACKGROUND: Immunisations are one of the most cost-effective public health interventions available and South Africa (SA) has implemented a comprehensive immunisation schedule. However, there is disagreement about the level of immunisation coverage in the country and few studies document the immunisation coverage in rural areas. OBJECTIVE: To examine the successful and timely delivery of immunisations to children during the first 2 years of life in a deeply rural part of the Eastern Cape Province of SA. METHODS: From January to April 2013, a cohort of sequential births (N=470) in the area surrounding Zithulele Hospital in the OR Tambo District of the Eastern Cape was recruited and followed up at home at 3, 6, 9, 12 and 24 months post birth, up to May 2015. Immunisation coverage was determined using Road-to-Health cards. RESULTS: The percentages of children with all immunisations up to date at the time of interview were: 48.6% at 3 months, 73.3% at 6 months, 83.9% at 9 months, 73.3% at 12 months and 73.2% at 24 months. Incomplete immunisations were attributed to stock-outs (56%), lack of awareness of the immunisation schedule or of missed immunisations by the mother (16%) and lack of clinic attendance by the mother (19%). Of the mothers who had visited the clinic for baby immunisations, 49.8% had to make multiple visits because of stock-outs. Measles coverage (of at least one dose) was 85.2% at 1 year and 96.3% by 2 years, but 20.6% of babies had not received a second measles dose (due at 18 months) by 2 years. Immunisations were often given late, particularly the 14-week immunisations. CONCLUSIONS: Immunisation rates in the rural Eastern Cape are well below government targets and indicate inadequate provision of basic primary care. Stock-outs of basic childhood immunisations are common and are, according to mothers, the main reason for their children's immunisations not being up to date. There is still much work to be done to ensure that the basics of disease prevention are being delivered at rural clinics in the Eastern Cape, despite attempts to re-engineer primary healthcare in SA.

Overview of the negative ion based neutral beam injectors for ITER.

The ITER baseline foresees 2 Heating Neutral Beams (HNB's) based on 1 MeV 40 A D(-) negative ion accelerators, each capable of delivering 16.7 MW of deuterium atoms to the DT plasma, with an optional 3rd HNB injector foreseen as a possible upgrade. In addition, a dedicated diagnostic neutral beam will be injecting ≈22 A of H(0) at 100 keV as the probe beam for charge exchange recombination spectroscopy. The integration of the injectors into the ITER plant is nearly finished necessitating only refinements. A large number of components have passed the final design stage, manufacturing has started, and the essential test beds-for the prototype route chosen-will soon be ready to start.

Final design of the beam source for the MITICA injector.

The megavolt ITER injector and concept advancement experiment is the prototype and the test bed of the ITER heating and current drive neutral beam injectors, currently in the final design phase, in view of the installation in Padova Research on Injector Megavolt Accelerated facility in Padova, Italy. The beam source is the key component of the system, as its goal is the generation of the 1 MeV accelerated beam of deuterium or hydrogen negative ions. This paper presents the highlights of the latest developments for the finalization of the MITICA beam source design, together with a description of the most recent analyses and R&D activities carried out in support of the design.

Serologic and biochemical analysis of latent a1 IgG.

Immunization of rabbits with anti-allotype antibody (Ab) induces at least two populations of highly cross-reactive molecules. One of these populations bears the nominal VHa allotype of the producing rabbit and is designated the VHa-positive anti-IdX Ab. The other population lacks the expected nominal allotype and thus could represent an induced latent allotype-bearing Ig. To define better the putative latent allotypes, they were subjected to serologic, electron microscopic and biochemical analyses. The induced latent-like population was compared to nominal a1 and found to be indistinguishable in inhibition assays incorporating both rabbit anti-a1 Ab and mouse monoclonal anti-a1 Ab. In contrast, the latent-like Ig was less inhibitory than normal a1 Ig in assays with goat and guinea-pig anti-a1 Ab. The isolated anti-IdX population was less inhibitory than either nominal or latent a1 Ig in all assays. Immunoelectron microscopic analysis indicates that complexes composed of latent-like a1 molecules and Fab anti-a1 ab resemble allotype/anti-allotype (i.e. a1/anti-a1) complexes. Tryptic digests of the putative latent a1 H-chains reveals that these molecules share an a1-specific peptide with digests of nominal a1 H-chain. The peptides from both nominal and latent a1 IgG appear to have blocked N-terminal residues and have a similar though not identical amino acid composition. The composition of these peptides is correlated with the first nine amino acids of the nominal a1 H-chain. The data suggest that the induced latent a1-like molecules share the same major a1 epitope with nominal a1 but may differ in some subtle respects. The possible genetic bases for these observations are discussed.