1H-NMR studies on the volume phase transition of DNA-modified pNipmam microgels

DNA functionalized pNipmam microgels, which have recently been introduced, are examined at different concentrations of sodium chloride and in PBS solutions via temperature dependent 1H-NMR measurements and are compared to pure pNipmam microgels. We show that the DNA modification shifts the volume phase transition temperature towards lower temperatures and the addition of salt and PBS further supports this effect in both materials. Thermodynamic values, i.e. enthalpy, entropy and Gibbs free energy, are determined via a non-linear fit which can be applied directly to the measurement data without further linearization.

Benefit-cost analysis of coordinated strategies for control of rabies in Africa

Previous research suggests that dog mass vaccination campaigns can eliminate rabies locally, resulting in large human and animal life gains. Despite these demonstrated benefits, dog vaccination programs remain scarce on the African continent. We conducted a benefit-cost analysis to demonstrate that engaging into vaccination campaigns is the dominant strategy for most countries even in the absence of coordinated action between them. And quantify how coordinated policy measures across countries in Africa could impact rabies incidence and associated costs. We show that coordinated dog mass vaccination between countries and PEP would lead to the elimination of dog rabies in Africa with total welfare gains of USD 9.5 billion (95% CI: 8.1 - 11.4 billion) between 2024 and 2054 (30 years). Coordinated disease control between African countries can lead to more socially and ecologically equitable outcomes by reducing the number of lost human lives to almost zero and possibly eliminating rabies.

The effect of mycophenolate mofetil on podocytes in nephrotoxic serum nephritis

Mycophenolate mofetil (MMF) is applied in proteinuric kidney diseases, but the exact mechanism of its effect on podocytes is still unknown. Our previous in vitro experiments suggested that MMF can ameliorate podocyte damage via restoration of the Ca2+-actin cytoskeleton axis. The goal of this study was to characterize podocyte biology during MMF treatment in nephrotoxic serum (NTS) nephritis (NTN). NTN was induced in three-week old wild-type mice. On day 3, half of the mice were treated with MMF (100 mg/kgBW/d p.o.) for one week. On day 10, we performed proteomic analysis of glomeruli as well as super-resolution imaging of the slit diaphragm. For multiphoton imaging of Ca2+ concentration ([Ca2+]i), the experimental design was repeated in mice expressing podocyte-specific Ca2+ sensor. MMF ameliorated the proteinuria and crescent formation induced by NTS. We identified significant changes in the abundance of proteins involved in Ca2+ signaling and actin cytoskeleton regulation, which was further confirmed by direct [Ca2+]i imaging in podocytes showing decreased Ca2+ levels after MMF treatment. This was associated with a tendency to restoration of podocyte foot process structure. Here, we provide evidence that MPA has a substantial direct effect on podocytes. MMF contributes to improvement of [Ca2+]i and amelioration of the disorganized actin cytoskeleton in podocytes. These data extend the knowledge of direct effects of immunosuppressants on podocytes that may contribute to a more effective treatment of proteinuric glomerulopathies with the least possible side effects.

The need for systematic quality controls in implementing N95 reprocessing and sterilization

BACKGROUND

Due to increased requirement for personal protective equipment during the coronavirus disease 2019 pandemic, many medical centres utilized sterilization systems approved under Food and Drug Administration Emergency Use Authorization for single-use N95 mask re-use. However, few studies have examined the real-world clinical challenges and the role of ongoing quality control measures in successful implementation.

AIMS

To demonstrate successful implementation of quality control measures in mask reprocessing, and the importance of continued quality assurance.

METHODS

A prospective quality improvement study was conducted at a tertiary care medical centre. In total, 982 3M 1860 masks and Kimberly-Clark Tecnol PFR95 masks worn by healthcare workers underwent sterilization using a vaporized hydrogen peroxide gas plasma-based reprocessing system. Post-processing qualitative fit testing (QFT) was performed on 265 masks. Mannequin testing at the National Institute for Occupational Safety and Health (NIOSH) laboratory was used to evaluate the impact of repeated sterilization on mask filtration efficacy and fit. A locally designed platform evaluated the filtration efficiency of clinically used and reprocessed masks.

FINDINGS

In total, 255 N95 masks underwent QFT. Of these, 240 masks underwent post-processing analysis: 205 were 3M 1860 masks and 35 were PFR95 masks. Twenty-five (12.2%) of the 3M masks and 10 (28.5%) of the PFR95 masks failed post-processing QFT. Characteristics of the failed masks included mask deformation (N=3, all 3M masks), soiled masks (N=3), weakened elastic bands (N=5, three PFR95 masks), and concern about mask shrinkage (N=3, two 3M masks). NIOSH testing demonstrated that while filter efficiency remained >98% after two cycles, mask strap elasticity decreased by 5.6% after reprocessing.

CONCLUSIONS

This study demonstrated successful quality control implementation for N95 mask disinfection, and highlights the importance of real-world clinical testing beyond laboratory conditions.

The effect of TGF-β1 polymorphisms on pulmonary disease progression in patients with cystic fibrosis

Background

Transforming Growth Factor-β₁ (TGF-β₁) is a genetic modifier in patients with cystic fibrosis (CF). Several single nucleotide polymorphisms (SNPs) of TGF-β₁ are associated with neutrophilic inflammation, lung fibrosis and loss of pulmonary function.

Aim

The aim of this study was to assess the relationship between genetic TGF-β₁ polymorphisms and pulmonary disease progression in CF patients. Furthermore, the effect of TGF-β₁ polymorphisms on inflammatory cytokines in sputum was investigated.

Methods

56 CF-patients and 62 controls were genotyped for three relevant SNPs in their TGF-β₁ sequence using the SNaPshot® technique. Individual “slopes” in forced expiratory volume in 1 s (FEV₁) for all patients were calculated by using documented lung function values of the previous five years. The status of Pseudomonas aeruginosa (Pa) infection was determined. Sputum concentrations of the protease elastase, the serine protease inhibitor elafin and the cytokines IL-1β, IL-8, IL-6, TNF-α were measured after a standardized sputum induction and processing.

Results

The homozygous TT genotype at codon 10 was associated with a lower rate of chronic Pa infection (p < 0.05). The heterozygous GC genotype at codon 25 was associated with lower lung function decline (p < 0.05). Patients with homozygous TT genotype at the promotor SNP showed higher levels of TNF-α (p < 0,05). Higher levels of TGF-β₁ in plasma were associated with a more rapid FEV₁ decline over five years (p < 0.05).

Conclusions

Our results suggest that polymorphisms in the TGF-β₁ gene have an effect on lung function decline, Pa infection as well as levels of inflammatory cytokines. Genotyping these polymorphisms could potentially be used to identify CF patients with higher risk of disease progression. TGF-β₁ inhibition could potentially be developed as a new therapeutic option to modulate CF lung disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01977-1.

Intensive specialists’ consultation combined with antibiotic stewardship programmes

Background

Antibiotic Stewardship Programmes (ASP) combine measures to optimise antibiotic (AB) therapies and ensure high AB prescription quality. Studies have shown that ASP in combination with an infectious disease (ID) consultation, can significantly improve the rational use of AB. This study aims to improve the quality of care and treatment of ID patients after implementing ASP activities, with or without ID consultation.

Methods

This is a study protocol of a prospective, two-arm, clustered intervention study with before-after-analyses conducted in ten hospitals (excl. university hospitals) in Germany over a period of three years. The intervention includes the implementation of ASP, with or without consultation by an ID specialist. We will gather information on ID inpatients (diagnosed with community-acquired pneumonia (CAP) N = 335 and Staphylococcus aureus bacteraemia (SAB) N = 110) aged &gt;18 years. We will compare patient-related outcomes (changes in SAB score as an indicator of difficult-to-treat infections, and CAP score as an indicator of common infections), as well as the quality and quantity of AB prescriptions. Secondary endpoints comprise quality and quantity of AB prescriptions as well as hospital-related and health economic outcomes. The statistical analysis includes a multilevel analysis. In addition, we will conduct a process evaluation, using interviews to analyse the process and the feasibility of the interventions.

Results

The baseline-data collection process started in April 2021. We will provide data for the broader ID and public health research communities, and publish the results in international journals to contribute to the ongoing global effort addressing AB resistance.

Conclusions

We highlight the purview, in terms of the multicentre, comprehensive interventions and the mixed-method approach.

Key messages

The study results will shed light on whether ASP+ID consultation improves AB prescription quality. We expect enhanced treatment results of ID patients in the public health sector.

DNA introduces an independent temperature responsiveness to thermosensitive microgels and enables switchable plasmon coupling as well as controlled uptake and release

A novel DNA-microgel hybrid system with dual thermal responsiveness is introduced uitilizing covalent coupling of single stranded DNA (ssDNA) to thermoresponsive microgels (μGs). The spatial distribution of the coupling sites for the ssDNA was characterized with 3D superresolution fluorescence microscopy. The DNA-functionalized μGs remain thermoresponsive and can take up dye-labeled complementary ssDNA, which can be released again by overcoming the dehybridization temperature of the DNA independently of the volume phase transition (VPT) of the μGs. The same holds for nano-objects represented by plasmonic gold nanoparticles (AuNPs), the penetration depth of which was visualized via TEM tomography and 3D reconstruction and which show enhanced plasmonic coupling in the collapsed state of the μG and thus gets switchable. In contrast, if ssDNA was taken up just by non-specific interactions, i.e. into non-functionalized μGs, its release is temperature-independent and can only be induced by increasing the salt concentration. Thus, the incorporated ssDNA represents highly selectice binding sites determined by their base number and sequence, which makes the VPT, beeing determined by the μG composition, and the reversible uptake and release enabled through programmable DNA hybridization are independent features. The combination with the typically high biocompatibility and the retained swellability and permeability hold promise for new fundamental insights as well as for potential applications in biological environments.

Digital support systems to improve child health and development in low income settings

About 250 million children under age five are at risk of not reaching their developmental potential due to continued exposure to ill health, malnutrition and lack of appropriate learning environments. A large number of initiatives have been launched in recent years to support early childhood development, with home visiting programs increasingly being recognized as a key strategy for improving child wellbeing. However, the most effective ways to reach families in low income settings remain unclear due to the large expense associated with personal family visits. In this project, we assess the effectiveness and equity of a newly developed digital platform designed to deliver evidence-based, individualized parenting support through automated services. The Afinidata platform uses state-of-the art machine learning algorithms to allow caregivers to get answers to questions about child health and development, while also identifying and promoting age- and development-appropriate activities for parents to support their children. We will collaborate with partners in Peru to rigorously assess the reach, impact and cost effectiveness of this digital platform in a poor rural population through a randomized controlled trial. Our work will follow a mixed-methods evaluation approach with repeated feedback into the Afinidata system. A total of 2,400 newborns will be enrolled in a randomized controlled trial in San Marcos, Peru, and followed up for two years. The primary study outcome will be children's healthy development at 24 months of age assessed through the Bayley Scales of Infant and Toddler Development (BSID-III). Secondary outcomes will be systems utilization, program coverage and cost-effectiveness, as well as caregiver satisfaction. If proven effective, this innovative digital platform may increase global access to low-cost parental support -a widely recognized key strategy for improving child well-being.

Cost-effectiveness of tuberculosis screening for migrant children in a low-incidence country

<sec id="st1"> <title>BACKGROUND</title> Detection of latent tuberculous infection (LTBI) is important to prevent progression to active tuberculosis (TB), particularly in migrant children. We evaluated the cost-effectiveness of TB screening in migrant children in a low-incidence country. </sec> <sec id="st2"> <title>METHODS</title> Retrospective analysis of a school-based TB screening programme in Switzerland. Migrant children were screened using the tuberculin skin test (TST). TST was considered positive if induration was 10 mm in non-bacille Calmette-Guérin (BCG) vaccinated children, and 15 mm in BCG-vaccinated children. Screening and treatment costs were extracted from hospital records. Cost impact was analysed as the difference between the cost of treatment for active TB and screening plus LTBI treatment. Cost per disability-adjusted life-years (DALY) was assessed based on Global Burden of Disease disability weight estimates. </sec> <sec id="st3"> <title>RESULTS</title> Of 1462 children screened, 1120 (77%; mean age 10.9 years; 46% female) underwent a TST. TST induration of 10 mm was documented in 78 (6.9%), and TST induration of 15 mm in 19 (1.6%). Twenty-one were TST-positive, and 17 children were diagnosed with LTBI; none had active TB. The highest rates of TST induration 10 mm were found in migrant children from Africa (16.6%) and Turkey (15.4%). Screening for LTBI was cost-effective if LTBI prevalence was 14%, with a progression rate of 5%; in case of lower LTBI prevalence, LTBI screening is cost-effective if progression rates to active TB are higher. </sec> <sec id="st4"> <title>CONCLUSION</title> School-based TB screening programmes targeting migrant children are cost-effective if populations with a relatively increased LTBI prevalence and/or high progression rates are included. </sec>.

Heterolepic β-Ketoiminate Zinc Phenoxide Complexes as Efficient Catalysts for the Ring Opening Polymerization of Lactide

Zinc phenoxide complexes L1ZnOAr 1-4 (L1=Me2NC2H4NC(Me)CHC(Me)O) and L2ZnOAr 5-8 (L2=Me2NC3H6NC(Me)CHC(Me)O) with donor-functionalized β-ketoiminate ligands (L1/2) and OAr substituents (Ar=Ph 1, 5; 2,6-Me2-C6H3 2, 6; 3,5-Me2-C6H3 3, 7; 4-Bu-C6H4 4, 8) with tuneable electronic and steric properties were synthesized and characterized. 1-8 adopt binuclear structures in the solid state except for 5, while they are monomeric in CDCl3 solution. 1-8 are active catalysts for the ring opening polymerization (ROP) of lactide (LA) in CH2Cl2 at ambient temperature and the catalytic activity is controlled by the electronic and steric properties of the OAr substituent, yielding polymers with high average molecular weight (M n) and moderately controlled molecular weight distribution (MWDs). 1 and 5 showed a living polymerization character and kinetic studies on the ROP of L-LA with 1 and 5 proved first order dependencies on the monomer concentration. Homonuclear decoupled 1H-NMR analyses of polylactic acid (PLA) formed with rac-LA proved isotactic enrichment of the PLA microstructure.

Sachet water quality and product registration: a cross-sectional study in Accra, Ghana

The study's objectives were to assess the extent to which packaged water producers follow product registration procedures and to assess the relationship between product registration and drinking water quality in Accra, Ghana. Following preliminary analysis of a national water quality survey, 118 packaged sachet water samples were collected by sampling all brands sold by 66 vendors. A sample of vendors was selected from two high-income and two low-income areas of Accra, Ghana. Sachet packaging and labelling details were recorded and compared to a regulatory database to assess product registration. All samples were weighed and tested for faecal indicator bacteria and selected physico-chemical parameters. Product registration numbers and brand names could be matched to regulatory records for 77 of 118 sachets (65.2%). All samples tested were compliant with national water quality standards for faecal indicator bacteria and nitrate. Brand registration was not associated with any of the quality indicators considered. The results of this study suggest that while a substantial proportion of sachet water is sold without formal product registration, the microbial quality of the unlicensed water is consistently high in Accra, Ghana. Further examination of regulatory enforcement and monitoring will be needed to ensure sustained high water quality over time.

Designed To React: Terminal Copper Nitrenes and Their Application in Catalytic C-H Aminations

Heteroscorpionate ligands of the bis(pyrazolyl)methane family have been applied in the stabilisation of terminal copper tosyl nitrenes. These species are highly active intermediates in the copper-catalysed direct C-H amination and nitrene transfer. Novel perfluoroalkyl-pyrazolyl- and pyridinyl-containing ligands were synthesized to coordinate to a reactive copper nitrene centre. Four distinct copper tosyl nitrenes were prepared at low temperatures by the reaction with SO₂ tBuPhINTs and copper(I) acetonitrile complexes. Their stoichiometric reactivity has been elucidated regarding the imination of phosphines and the aziridination of styrenes. The formation and thermal decay of the copper nitrenes were investigated by UV/Vis spectroscopy of the highly coloured species. Additionally, the compounds were studied by cryo-UHR-ESI mass spectrometry and DFT calculations. In addition, a mild catalytic procedure has been developed where the copper nitrene precursors enable the C-H amination of cyclohexane and toluene and the aziridination of styrenes.

Self-assembly of [PNbxW12−xO40]n− Keggin anions – a simple way to mixed Nb–W polyoxometalates

This paper summarizes preparations of mixed phosphoniobotungstates [PNb_xW_12−xO₄₀]^(3+x)− (x = 1–3) based on two different ways: incorporation of Nb into pre-existing lacunary-type phosphotungstates and self-assembly reactions.

Collective emotion regulation in an organisation – a plural agency with cognition and affect

Purpose

– While emotions and feelings arise in the singular personality, they may also develop a normative dimensionality in a plural agency. The authors identify the cybernetic systemic principles of how emotions might be normatively regulated and affect plural agency performance. The purpose of this paper is to develop a generic cultural socio-cognitive trait theory of plural affective agency (the emotional organization), involving interactive cognitive and affective traits, and these play a role within the contexts of Mergers and Acquisitions (M & A).

Design/methodology/approach

– The authors integrate James Gross’ model of emotion regulation with the earlier work on normative personality in the context of Mindset Agency Theory. The agency is a socio-cognitive entity with attitude, and operates through traits that control thinking and decision making. These traits are epistemically independent and operate on a bipolar scale; with the alternate poles having an auxiliary function to each other – where the traits may take intermediary “balanced” states between the poles.

Findings

– Processes of affect regulation are supposed to go through three stages: first, identification (affective situation awareness); second, elaboration of affect is constituted through schemas of emotional feeling, which include emotion ideologies generating emotional responses to distinct contextual situations; third, execution: in the operative system primary emotions are assessed through operative intelligence for any adaptive information and the capacity to organize action; and turned into action, i.e. responses, through cultural feeling rules and socio-cultural display rules, conforming to emotion ideologies.

Research limitations/implications

– This new theory provides guidance for framing multilevel interaction where smaller collectives (as social systems) are embedded into larger social systems with a culture, an emotional climate and institutions. Thus, it is providing a generic theoretical frame for M & A analyses, where a smaller social unit (the acquired) is to be integrated into a larger social unit (the acquirer).

Practical implications

– Understanding interdependencies between cognition and emotion regulation is a prerequisite of managerial intelligence, which is at demand during M & A processes. While managerial intelligence may be grossly defined as the capacity of management to find an appropriate and fruitful balance between action and learning orientation of an organization, its affective equivalent is the capacity of management to find a fruitful balance between established emotion expression and learning alternate forms of emotion expression.

Social implications

– Understanding interdependencies between cognition and emotion is a prerequisite of social, cultural and emotional intelligence. The provided theory can be easily linked with empirical work on the emergence of a cultural climate of fear within societies. Thus, “Affective Agency Theory” also has a bearing for political systems’ analysis, what, however, is beyond the scope of this paper.

Originality/value

– The paper builds on the recently developed Mindset Agency Theory, elaborating it through the introduction of the dimension of affect, where cognitive and affective traits interact and become responsible for patterns of behaviour. The model is providing a framework which links emotion expression and emotion regulation with cognitive analysis.

Quantification of vancomycin in human serum by LC-MS/MS

BACKGROUND

The aim of our work was to develop and validate a reliable LC-MS/MS-based measurement procedure for the quantification of vancomycin in serum, to be applied in the context of efforts to standardize and harmonize therapeutic drug monitoring of this compound using routine assays.

METHODS

Sample preparation was based on protein precipitation followed by ultrafiltration. In order to minimize differential modulation of ionization by matrix constituents extended chromatographic separation was applied leading to a retention time of 9.8 min for the analyte. Measurement was done by HPLC-ESI-MS/MS. For internal standardization the derivative vancomycin-glycin (ISTD) prepared by chemical synthesis was used, HPLC conditions ensured coelution of ISTD with the analyte.

RESULTS

In a bi-center validation total CVs of <4% were observed for quality control material ranging from 5.3 mg/L to 79.4 mg/L; accuracy was ±4%. No relevant ion suppression was observed. Comparative measurement of aliquots from 70 samples at the two validation sites demonstrated close agreement.

CONCLUSIONS

Employing a closely related homologue molecule for internal standardization and the use of MS/MS following highly efficient sample pre-fractionation by HPLC, the method described here can be considered to offer the highest level of analytical reliability realized so far for the quantification of vancomycin in human serum. Thus, the method is suitable to be used in a comprehensive reference measurement system for vancomycin.

13C NMR-spektroskopische Untersuchungen an Äthylaluminiumverbindungen / 13C NMR Spectroscopic Investigations of Ethylaluminium Compounds

The 13C NMR spectra of the ethylaluminium compounds [Al(C2H5)xCl3_x]2 x = 1, 1,5, 2 and 3 are presented and factors governing the temperature dependence of the line shape are discussed. The exchange reaction of terminal ethyl groups for chlorine ligands and ethyl ligands, resp., in ethylaluminium-sesquichloride was investigated by fitting the calculated line shapes to the observed spectra.

The energy of activation of this exchange process was determined as to be 12,3 ‡ 1,5 kcal/mole. The synthesis of 13C2-[Al(C2H5)Cl2]2 is described.

Ethen/1-Hexen- und 1-Octadecen-Copolymerisation mit dem stereorigiden Zirkon-Katalysatorsystem iPr(CpFlu)ZrCl2/MAO: Einfluß der Temperatur / Copolym erization of Ethene/1-Hexene and 1-Oetadecen with the Stereorigid Zirconium Catalyst System iPr(CpFlu)ZrCl2/MAO : Influence of the Temperature

Ethene was copolymerized with 1-hexene and 1-octadecene at different temperatures to study the influence of the temperature. The stereorigid catalyst [2,4-cyclopentadien-1-yliden- (iso-propyliden)fluoren-9-yliden]zirconium dichloride iPr(CpFlu )ZrCl2 1 in combination with methylalumoxane MAO was used. The polymerization rate of ethene depends in a wide range on the temperature and the com onom er content in solution. In each case a large rate enhancem ent at low ratios [com onom er]/[ethene] was observed. A t 25 °C the polymerization rate of ethene increases continuously with increasing [1-hexene]/[ethene]-ratio. At 40 °C the consumption of ethene is nearly independent of the 1-hexene content in solution. Finally, at 60 °C, similar to the ethene/1-octadecene-copolymerisation at different temperatures, the polymerization rate of ethene decreases with increasing [1-hexene]/[ethene]-ratio. It is suggested that this behavior is caused by the mobility of the side chains in the copolym er near the active center, probably for sterical reasons. W ith increasing temperatures, the side chain becomes more and more flexible and thus the sterical hindrance is increased. This effect is even stronger with long chain α-olefins.

The microstructure of the copolymer was investigated with respect to Marcovian statistic 1. and 2. order. The experimental triad distribution is described satisfactorily only with the second order statistic. Independent of the temperature the r22 parameter is considerably greater than the r12 parameter, the insertion of an α-olefin thus being more favored for he sequence {R -(α-olefine)-(α-olefine)-Kat.} than for {R -(ethene)-(α-olefine)-Kat.}. It therefore appears that both last inserted monomers influence the insertion of the subsequent monomer, especially at high comonomer contents. Furthermore, the parameters for the α-olefin insertions r22 and r12 are nearly independent of the temperature of polymerization, whereas the r11 and r21 parameters increase with increasing temperature.

Ethylene Insertion with Soluble Ziegler Catalysts: Direct Insight into the Reaction Using Enriched 13C2 H4 and 13C NMR Spectroscopy II. The System Cp2TiMeCl/AlMeCl2/13C2H4

The elementary processes involved in the polymerization of ethylene by soluble Ziegler catalysts of the type Cp2TiMeCl/AlMeCl2 have been studied by 13C NMR spectroscopy. Using 13C-enriched ethylene, detailed information was obtained directly on the system in the course of the polymerization. No spectroscopic evidence was found for precoordination of the monomer. The development of the oligomer distribution, which could be followed spectroscopically, proves that the mechanism proposed by Olivé cannot be correct. These experiments show conclusively that the ethylene is inserted into the titanium-carbon bond.

Derivatization of antibody Fab fragments: a designer enzyme for native protein modification

Bioconjugates, such as antibody-drug conjugates, have gained recent attention because of their increasing use in therapeutic and diagnostic applications. Commonly used conjugation reactions based upon chemoselective reagents exhibit a number of drawbacks: most of these reactions lack regio- and stereospecificity, thus resulting in loss of protein functionality due to random modifications. Enzymes provide an obvious solution to this problem, but the intrinsic (natural) substrate specificities of existing enzymes pose severe limitations to the kind of modifications that can be introduced. Here we describe the application of the novel trypsin variant trypsiligase for site-specific modification of the C terminus of a Fab antibody fragment via a stable peptide bond. The suitability of this designed biocatalyst was demonstrated by coupling the Her2-specific Fab to artificial functionalities of either therapeutic (PEG) or diagnostic (fluorescein) relevance. In both cases we obtained homogeneously modified Fab products bearing the artificial functionality exclusively at the desired position.

Late presentation to HIV/AIDS testing, treatment or continued care: clarifying the use of CD4 evaluation in the consensus definition

OBJECTIVES

Late presentation to HIV/AIDS services compromises treatment outcomes and misses opportunities for biomedical and behavioural prevention. There has been significant heterogeneity in how the term 'late presentation' (LP) has been used in the literature. In 2011, a consensus definition was reached using CD4 counts to define and measure late presenters and, while it is useful for clinical care, the consensus definition has several important limitations that we discuss in this article.

METHODS

Using the spectrum of engagement in HIV care presented by Gardner and colleagues, this article highlights issues and opportunities associated with use of the consensus definition.

RESULTS

The consensus definition is limited by three principal factors: (1) the CD4 count threshold of 350 cells/μL is being increasingly questioned as the biomedical justification grows for earlier initiation of treatment; (2) CD4 evaluations are conducted at multiple services providing HIV care; thus it remains unclear to which service the patient is presenting late; and (3) the limited availability of CD4 evaluation restricts its use in determining the prevalence of LP in many settings.

CONCLUSIONS

The consensus definition is useful because it describes the level of disease progression and allows for consistent evaluation of the prevalence and determinants of LP. Suggestions are provided for improving the application of the consensus definition in future research.

Changes in daily leptin, ghrelin and adiponectin profiles following a diet with carbohydrates eaten at dinner in obese subjects

BACKGROUND AND AIMS

Our recently published randomised clinical trial evaluated the effect of a low-calorie diet with carbohydrates eaten at dinner. This dietary pattern led to lower hunger scores, and better anthropometric, biochemical and inflammatory outcomes compared to a standard low-calorie diet. In the same study, changes in diurnal secretion patterns of leptin, ghrelin and adiponectin were investigated.

METHODS AND RESULTS

Seventy-eight police officers (body mass index (BMI) > 30) were randomly allocated to experimental (carbohydrates at dinner) or control weight loss diets for 6 months. Sixty-three subjects finished the programme. On days 0, 7, 90 and 180 blood samples and hunger scores were collected every 4 h from 8:00 to 20:00. Hormonal profiles were available for 39. The dietary manipulation led to changes in daylight hormonal profiles in the experimental group. Leptin's secretion curve became convex, with a nadir later in the day (significant difference compared to baseline at morning and evening, p = 0.023, p = 0.021, respectively). Ghrelin's secretion curve became concave, peaking only in the evening hours. Adiponectin's curve was elevated only after the experimental diet (significant difference compared to baseline at afternoon, p = 0.044).

CONCLUSIONS

We propose that a low-calorie diet with carbohydrates eaten at dinner can modulate daytime hormonal profiles. Taken together with our earlier results, we believe this diet regime may prevent mid-day hunger, better support weight loss and improve metabolic outcomes compared to conventional weight loss diets. The trial is registered at controlled-trials.com, ISRCTN37829376, December 2009.

Testosterone Induces an All-or-None, Exponential Increase in Arginine Vasopressin mRNA in the Bed Nucleus of Stria Terminalis of the Hypogonadal Mouse

The bed nucleus of the stria terminalis (BNST) in rodents contains arginine vasopressin (AVP) neurons which project to the lateral septum (LS) and habenula (LH) and are thought to be important for social recognition or memory. In previous studies we demonstrated that AVP immunoreactivity in the LS and LH is absent in the hypogonadal (hpg) mouse and that AVP immunoreactivity in the LH and LS of this mutant can be induced by testosterone. The aim of the present study was to determine whether this action of testosterone was due to the induction of AVP gene expression in BNST neurons and if so the time taken for testosterone to exert its effect. We found that exposure to supraphysiological concentrations of testosterone for 6-12 days caused an exponential, 50-fold increase in the number of cells that expressed AVP mRNA in the BNST in hpg mice. The action of testosterone is "all-or-none" in that the level of AVP mRNA in the AVP-positive cells was similar at all times after testosterone implantation and also similar or less than that in the few AVP-positive cells in animals not treated with testosterone. The relatively long time taken for testosterone to exert its effect on AVP mRNA in BNST neurons is comparable to its effects on AVP immunoreactivity in the LH and LS and on behaviour and suggests that the action of testosterone may be mediated by indirect or slow intracellular transduction mechanisms.

The health of the poor: women living in informal settlements

OBJECTIVES

A large share of the urban population in developing countries lives in informal settlements or "slums" today. This study investigates the association between slum residence and health among adult Ghanaian women residing in the Accra Metropolitan Area.

METHODS

Health data collected as part of the Women's Health Study of Accra round II (WHSA-II) was combined with data from the Household and Welfare Study of Accra (HAWS) to compare the health of female slum dwellers to the health of female non-slum dwellers living in the Accra Metropolitan Area. Group means were calculated and multivariate linear regression models were estimated to compare eight domains of health as measured by the short-form 36 (SF-36) questionnaire.

RESULTS

Women living in informal settlements were found to display consistently better health. Conditional on all observable characteristics, women living in informal settlements scored higher on all self-reported health outcomes than women living in non-slum areas. The differences appear largest for general health as well as for the physical role functioning domains, and appear smallest for the social role functioning and bodily pain domains.

CONCLUSIONS

The results presented suggest that slum residence does not have a negative effect on self-reported health among women in Accra. Three factors may contribute to the generally positive association between slum residence and observed outcomes: i) self-selection of individuals with strong health into informal settlements and an accordingly small impact of environmental factors on health ii) self-selection of more driven and ambitious individuals into slum neighborhoods who may have a generally more positive view of their health and iii) the geographic placement of slum neighborhoods in central neighborhoods with relatively easy access to health facilities.

The effect of Ghana's National Health Insurance Scheme on health care utilisation

OBJECTIVES

The study investigates the effect of Ghana's National Health Insurance Scheme (NHIS) on health care utilisation.

METHODS

We provide a short history of health insurance in Ghana, and briefly discuss general patterns of enrolment in Ghana as well as in Accra in a first step. In a second step, we use data from the Women's Health Study of Accra wave II to evaluate the effect of insurance on health seeking behaviour using propensity score matching.

RESULTS

We find that on average individuals enrolled in the insurance scheme are significantly more likely to obtain prescriptions, visit clinics and seek formal health care when sick.

CONCLUSION

These results suggest that the government's objective to increase access to the formal health care sector through health insurance has at least partially been achieved.

Hartmann-Hahn 2D-map to optimize the RAMP-CPMAS NMR experiment for pharmaceutical materials

Cross polarization-magic angle spinning (CPMAS) is the most used experiment for solid-state NMR measurements in the pharmaceutical industry, with the well-known variant RAMP-CPMAS its dominant implementation. The experimental work presented in this contribution focuses on the entangled effects of the main parameters of such an experiment. The shape of the RAMP-CP pulse has been considered as well as the contact time duration, and a particular attention also has been devoted to the radio-frequency (RF) field inhomogeneity. (13)C CPMAS NMR spectra have been recorded with a systematic variation of (13)C and (1)H constant radiofrequency field pair values and represented as a Hartmann-Hahn matching two-dimensional map. Such a map yields a rational overview of the intricate optimal conditions necessary to achieve an efficient CP magnetization transfer. The map also highlights the effects of sweeping the RF by the RAMP-CP pulse on the number of Hartmann-Hahn matches crossed and how RF field inhomogeneity helps in increasing the CP efficiency by using a larger fraction of the sample. In the light of the results, strategies for optimal RAMP-CPMAS measurements are suggested, which lead to a much higher efficiency than constant amplitude CP experiment.