Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030

Vaccine-preventable diseases pose a significant threat to children under five globally, creating disparities in immunization coverage. Despite its cost-effectiveness and life-saving potential, immunization faces challenges in achieving equitable coverage. Gender inequalities deeply influence access to healthcare, affecting immunization rates. This study examines the action plans submitted by participants of the World Health Organization's (WHO) IA2030 Scholar Level 1 certification course in 2021. A qualitative analysis was conducted on a subset of 111 action plans that scored above 75%, employing narrative thematic analysis to categorize and explore gender incorporation and identified barriers based on the IA2030 Gender Guide. Among the 111 analyzed action plans, gender considerations were present in almost all plans, underscoring the effectiveness of integrating gender perspectives in the course curriculum. The most frequently cited barriers included low education and health literacy, issues related to accessing quality immunization services, gendered dynamics in decision-making within households, and limited access to resources and mobility, predominantly impacting women. The findings confirm that gender inequalities significantly contribute to suboptimal immunization coverage. An intersectional approach, recognizing diverse social markers impacting immunization, is vital to address disparities effectively. Moreover, the need for gender-sensitive data and deeper understanding of intersectional dynamics was emphasized. The study highlights the importance of gender-transformative interventions, including community engagement and efforts targeting both men and women to enhance immunization coverage. While acknowledging limitations, such as potential biases in peer evaluations and the need for wider inclusivity in gender perspectives, this analysis underscores the significance of mainstreaming gender in immunization capacity-building programs. The integration of gender considerations not only raises awareness but also equips professionals to create more gender-responsive immunization programs. Continuous efforts to incorporate gender perspectives can lead to more effective, equitable, and gender-transformative immunization initiatives at various levels.

A review of health worker vaccination programs in low, middle and upper middle-income countries

Objectives

Health workers (HW) are at risk of contracting vaccine preventable diseases when caring for patients and communities. This study aims to evaluate the existing literature on the routine vaccination of health workers against a variety of antigens in low and middle income countries, focusing on facilitators, barriers, and considerations in the implementation of immunization programs and campaigns.

Study design

A PubMed Literature search.

Methods

A PubMed search was conducted to find articles that addressed vaccination programs and policies for HW in low-income countries (LIC), lower middle-income countries (LMIC), and upper middle-income countries (UMIC). Original articles, meta-analyses, and reviews published in English between January 2000 and July 2022 were included in the search. Inductive content analysis was used to identify themes that illustrate facilitators, barriers, and considerations in the implementation of immunization programs and campaigns.

Results

The search identified 4240 studies, 90 were used for analysis as they provided antigen specific details on immunization policies or programs. Hepatitis B was the most frequently discussed antigen, followed by Influenza, then Measles, Rubella and Mumps. With considerable variability by vaccine and country, in most cases the vaccination was not offered free to HW or included in a regular vaccination schedule. Utilizing existing immunization infrastructure such as the Expanded Programme on Immunization (EPI) and having effective management of vaccination programs were found to be key facilitators to vaccinate HW.

Conclusions

The low vaccination coverage of health workers in LMIC is of concern; attention towards the key considerations, barriers and facilitators of immunization implementation is central to the advancement of health worker vaccination coverage in LMIC's. The COVID-19 pandemic necessitated the swift vaccination of HW. Many LIC countries lacking established HW immunization infrastructure are now administering COVID-19 vaccines. As we move beyond the pandemic's acute phase, there is a chance for those countries to enhance their immunization initiatives and policies for HW concerning other antigens, even if it is not a standard practice currently.

Directional control of neurite outgrowth: emerging technologies for Parkinson's disease using magnetic nanoparticles and magnetic field gradients

A challenge in current stem cell therapies for Parkinson's disease (PD) is controlling neuronal outgrowth from the substantia nigra towards the targeted area where connectivity is required in the striatum. Here we present progress towards controlling directional neurite extensions through the application of iron-oxide magnetic nanoparticles (MNPs) labelled neuronal cells combined with a magnetic array generating large spatially variant field gradients (greater than 20 T m-1). We investigated the viability of this approach in both two-dimensional and organotypic brain slice models and validated the observed changes in neurite directionality using mathematical models. Results showed that MNP-labelled cells exhibited a shift in directional neurite outgrowth when cultured in a magnetic field gradient, which broadly agreed with mathematical modelling of the magnetic force gradients and predicted MNP force direction. We translated our approach to an ex vivo rat brain slice where we observed directional neurite outgrowth of transplanted MNP-labelled cells from the substantia nigra towards the striatum. The improved directionality highlights the viability of this approach as a remote-control methodology for the control and manipulation of cellular growth for regenerative medicine applications. This study presents a new tool to overcome challenges faced in the development of new therapies for PD.

A Systematic Review of the Sex and Gender Reporting in COVID-19 Clinical Trials

Sex and gender have implications for COVID-19 vaccine efficacy and adverse effects from the vaccine. As vaccination is one of the key responses to the COVID-19 pandemic, it is vital that sex and gender differences be acknowledged, measured, and analysed in clinical research. Here, we systematically review published COVID-19 vaccine trials, both interventional and observational, to assess the quality of reporting of sex and gender. Of the 75 clinical trials on COVID-19 vaccines included in this review, only 24% presented their main outcome data disaggregated by sex, and only 13% included any discussion of the implications of their study for women and men. Considering the sex differences in adverse events after vaccination, and the gendered aspects of vaccine hesitancy, these oversights in clinical research on vaccines have implications for recovery from the COVID-19 pandemic and for wider public health.

Feasibility assessment of measles and rubella eradication

This report addresses the epidemiological aspects and feasibility of measles and rubella eradication and the potential resource requirements in response to the request of the Director-General at the Seventieth World Health Assembly held on May 31, 2017. A guiding principle is that the path toward measles and rubella eradication should serve to strengthen primary health care, promote universal health coverage, and be a pathfinder for new vision and strategy for immunization over the next decade as laid out in the Immunization Agenda 2030. Specifically, this report: 1) highlights the importance of measles and rubella as global health priorities; 2) reviews the current global measles and rubella situation; 3) summarizes prior assessments of the feasibility of measles and rubella eradication; 4) assesses the progress and challenges in achieving regional measles and rubella elimination; 5) assesses additional considerations for measles and rubella eradication, including the results of modelling and economic analyses; 6) assesses the implications of establishing a measles and rubella eradication goal and the process for setting an eradication target date; 7) proposes a framework for determining preconditions for setting a target date for measles and rubella eradication and how these preconditions should be understood and used; and 8) concludes with recommendations endorsed by SAGE.

Use of tetanus-diphtheria (Td) vaccine in children 4-7 years of age: World Health Organization consultation of experts

For lifetime protection against diphtheria and tetanus, the World Health Organization (WHO) recommends six doses of diphtheria and tetanus containing vaccines. Td (reduced diphtheria toxoid, ≥2-5 IU) vaccines are currently licensed for ages 7 years and older, but use of Td vaccine for ages 4 years and older would have advantages for immunization programs in many low- and middle-income countries. For this reason, WHO convened an expert consultation to review the currently available evidence for the use of Td vaccine from 4 to 7 years of age which concluded: (1) no relevant biological difference in immune response in the relevant age group compared with children over 7 years of age; (2) adequate seroprotection in several studies with Td vaccine in the 4-7 age group and many studies using combination vaccines; (3) durable and protective response of at least 9-11 years duration in several longitudinal and modelling studies, (4) less reactogenicity compared with use of full-dose diphtheria vaccine, potentially improving the vaccination experience; and (5) adequate control of diphtheria in several countries using Td-containing combination vaccines in 4-7 year old children. On this basis, the experts concluded that from a programmatic perspective, Td vaccine given in ages 4-7 years, as a second booster dose in a six-dose series, would provide adequate protection against diphtheria and tetanus and recommended steps to include this change in age extension listed in the package insert.

International round-robin experiment for angle-resolved light scattering measurement

An international round-robin experiment has been conducted to test procedures and methods for the measurement of angle-resolved light scattering. ASTM E2387-05 has been used as the main guide, while the experience gained should also contribute to the new ISO standard of angle-resolved scattering currently under development (ISO/WD 19986:2016). Seven laboratories from Europe and the United States measured the angle-resolved scattering from Al/SiO₂-coated substrates, transparent substrates, volume diffusors, quasi-volume diffusors, white calibration standards, and grating samples at laser wavelengths in the UV, VIS, and NIR spectra. Results were sent to Fraunhofer IOF, which coordinated the experiments and analyzed the data, while ESA-ESTEC, as the project donor, defined conditions and parameters. Depending mainly on the sample type, overall good to reasonable agreements were observed, with largest deviations at scattering angles very close to the specular beam. Volume diffusor characterization unexpectedly turned out to be challenging. Not all participants provided measurement uncertainty ranges according to the Guide to the Expression of Uncertainty in Measurement; often, a single general scatterometer-related measurement uncertainty value was stated. Although relative instrument measurement uncertainties close to 1% are sometimes claimed, the comparison results did not support these claims for specular scattering samples as mirrors, substrates, or gratings.

Optically isolated millimeter-wave detector for the Toroidal Plasma Experiment

We have designed and built an optically isolated millimeter-wave detection system to prevent interference from a nearby, powerful, 2.45 GHz microwave source in millimeter-wave propagation experiments in the TORoroidal Plasma EXperiment (TORPEX). A series of tests demonstrates excellent system noise immunity and the ability to observe effects that cannot be resolved in a setup using a bare Schottky diode detector.

Millimeter-Wave Beam Scattering by Field-Aligned Blobs in Simple Magnetized Toroidal Plasmas

The first direct experimental measurements of the scattering of a millimeter-wave beam by plasma blobs in a simple magnetized torus are reported. The wavelength of the beam is comparable to the characteristic size of the blob. In situ Langmuir probe measurements show that fluctuations of the electron density induce correlated fluctuations of the transmitted power. A first-principles full-wave model, using conditionally sampled 2D electron density profiles, predicts fluctuations of the millimeter-wave power that are in agreement with experiments.

A life-course approach to health: synergy with sustainable development goals

A life-course approach to health encompasses strategies across individuals’ lives that optimize their functional ability (taking into account the interdependence of individual, social, environmental, temporal and intergenerational factors), thereby enabling well-being and the realization of rights. The approach is a perfect fit with efforts to achieve universal health coverage and meet the sustainable development goals (SDGs). Properly applied, a life-course approach can increase the effectiveness of the former and help realize the vision of the latter, especially in ensuring health and well-being for all at all ages. Its implementation requires a shared understanding by individuals and societies of how health is shaped by multiple factors throughout life and across generations. Most studies have focused on noncommunicable disease and ageing populations in high-income countries and on epidemiological, theoretical and clinical issues. The aim of this article is to show how the life-course approach to health can be extended to all age groups, health topics and countries by building on a synthesis of existing scientific evidence, experience in different countries and advances in health strategies and programmes. A conceptual framework for the approach is presented along with implications for implementation in the areas of: (i) policy and investment; (ii) health services and systems; (iii) local, multisectoral and multistakeholder action; and (iv) measurement, monitoring and research. The SDGs provide a unique context for applying a holistic, multisectoral approach to achieving transformative outcomes for people, prosperity and the environment. A life-course approach can reinforce these efforts, particularly given its emphasis on rights and equity.

Ending preventable child deaths from pneumonia and diarrhoea by 2025. Development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea

Despite the existence of low-cost and effective interventions for childhood pneumonia and diarrhoea, these conditions remain two of the leading killers of young children. Based on feedback from health professionals in countries with high child mortality, in 2009, WHO and Unicef began conceptualising an integrated approach for pneumonia and diarrhoea control. As part of this initiative, WHO and Unicef, with support from other partners, conducted a series of five workshops to facilitate the inclusion of coordinated actions for pneumonia and diarrhoea into the national health plans of 36 countries with high child mortality. This paper presents the findings from workshop and post-workshop follow-up activities and discusses the contribution of these findings to the development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea, which outlines the necessary actions for elimination of preventable child deaths from pneumonia and diarrhoea by 2025. Though this goal is ambitious, it is attainable through concerted efforts. By applying the lessons learned thus far and continuing to build upon them, and by leveraging existing political will and momentum for child survival, national governments and their supporting partners can ensure that preventable child deaths from pneumonia and diarrhoea are eventually eliminated.

Effect of intermittent preventive treatment for malaria during infancy on serological responses to measles and other vaccines used in the Expanded Programme on Immunization: results from five randomised controlled trials

BACKGROUND

Intermittent preventive treatment for malaria during infancy (IPTi) is the administration of a full therapeutic course of antimalarial drugs to infants living in settings where malaria is endemic, at the time of routine vaccination in the first year of life. We investigated whether IPTi with sulfadoxine-pyrimethamine or other antimalarial drug combinations adversely affected serological responses to vaccines used in the Expanded Programme on Immunization (EPI).

METHODS

The study was done in a subset of children enrolled in five randomised controlled trials in Navrongo, Ghana; Kilimanjaro, Tanzania; Manhica, Mozambique; Kisumu, Kenya; and Bungoma, Kenya. All infants presenting for the second dose of the diphtheria-tetanus-pertussis vaccination (given at 8-10 weeks of age) were eligible, and analyses included all children who had received measles vaccination (at 9 months of age) and at least one dose of IPTi or placebo. Blood samples were collected before and after vaccination, and antibody titres were measured by plaque reduction neutralisation (measles, yellow fever), microneutralisation (polio serotypes 1 and 3), and ELISA (all other EPI antigens). Laboratory personnel were unaware of the randomisation groups. We compared the proportion of infants in the IPTi and placebo groups who did not attain protective antibody titres after vaccination, using a one-sided significance non-inferiority margin of 5% for measles (the primary endpoint) and 10% for other EPI antigens.

FINDINGS

Between September, 2000, and May, 2008, 8416 children were enrolled in the five studies. Paired samples from 2368 children from sites where sulfadoxine-pyrimethamine was compared with placebo were analysed for measles antibodies. 464 children with detectable measles antibody in their sample before vaccination were excluded, leaving 1904 individuals (934 placebo and 970 sulfadoxine-pyrimethamine) in the study. IPTi with sulfadoxine-pyrimethamine did not have a clinically significant effect on immune responses to measles vaccine; 61 of 970 (6·3%) children who received IPTi did not develop a protective antibody response after measles vaccination compared with 60 of 934 (6·4%) who received placebo, a difference of -0·14% (95% CI -2·3 to 2·1). When other antimalarial drugs were used for IPTi the results were much the same. Among 2396 children from whom serological response data for other EPI antigens were available, we identified no evidence of an adverse effect of IPTi with sulfadoxine-pyrimethamine or other antimalarial drugs on the proportion achieving protective antibody concentrations.

INTERPRETATION

IPTi with sulfadoxine-pyrimethamine does not affect serological responses to EPI vaccines. This analysis, therefore, supports the WHO recommendation for coadministration of IPTi with sulfadoxine-pyrimethamine to infants at the time of the second and third doses of DTP and measles vaccination, in areas of sub-Saharan Africa with moderate to high malaria transmission and where malaria parasites are sensitive to these drugs. It also suggests that treatment of clinical malaria at or around the time of vaccination does not compromise vaccine responsiveness.

FUNDING

Bill & Melinda Gates Foundation.

Note: three-dimensional stereolithography for millimeter wave and terahertz applications

Metal-coated polymers shaped by 3D stereolithography are introduced as a new manufacturing method for passive components for millimeter to terahertz electromagnetic waves. This concept offers increased design capabilities and flexibilities while shortening the manufacturing process of complex shapes, e.g., corrugated horns, mirrors, etc. Tests at 92.5, 140, and 170 GHz are reported.

Young hippocampal neurons are critical for recent and remote spatial memory in adult mice

New granule cells are continuously generated throughout adulthood in the mammalian hippocampus. These newly generated neurons become functionally integrated into existing hippocampal neuronal networks, such as those that support retrieval of remote spatial memory. Here, we sought to examine whether the contribution of newly born neurons depends on the type of learning and memory task in mice. To do so, we reduced neurogenesis with a cytostatic agent and examined whether depletion of young hippocampal neurons affects learning and/or memory in two hippocampal-dependent tasks (spatial navigation in the Morris water maze and object location test) and two hippocampal-independent tasks (cued navigation in the Morris water maze and novel object recognition). Double immunohistofluorescent labeling of the birth dating marker 5-bromo-2'deoxyuridine (BrdU) together with NeuN, a neuron specific marker, was employed to quantify reduction of hippocampal neurogenesis. We found that depletion of young adult-generated neurons alters recent and remote memory in spatial tasks but spares non-spatial tasks. Our findings provide additional evidence that generation of new cells in the adult brain is crucial for hippocampal-dependent cognitive functions.

Real-time feedback control of millimeter-wave polarization for LHD

Electron cyclotron heating (ECH) is widely used in magnetic fusion devices, and the polarization of the injected millimeter-wave beams plays a crucial role in the propagation and absorption of the beam energy by the plasma. This polarization can be adjusted by grating mirror polarizers placed in the transmission lines which carry the microwaves from the power source to the plasma. In long-pulse devices such as the Large Helical Device (LHD) and ITER, it is desirable to track changes in the plasma and adjust the polarization of the ECH in real time such as to keep the absorption as high as possible and avoid shine-through which may lead to overheating of vessel components. For this purpose a real-time feedback control scheme is envisioned in which a measure of the absorption efficiency can be used to adjust the orientation of the polarizing mirrors toward an optimum. Such a setup has been tested in a low-power test stand as preparation for future implementation in the LHD ECH system. It is shown that a simple search algorithm is efficient and can in principle be used to control either the absorption efficiency or the linear polarization angle.

Roughness of a tilted anharmonic string at depinning

We consider the discretized model of a driven string with an anharmonic elastic energy, in a two-dimensional random potential, as introduced by [Phys. Rev. Lett. 87, 187002 (2001)]]. Using finite size scaling, we numerically compute the roughness of the string in a uniform applied force at the critical depinning threshold. By considering a string with a net average tilt, we demonstrate that the anharmonic elastic energy crosses the model over to the quenched KPZ universality class, in agreement with recent theoretical predictions.

From current-driven to neoclassically driven tearing modes

In the TCV tokamak, the m/n = 2/1 island is observed in low-density discharges with central electron-cyclotron current drive. The evolution of its width has two distinct growth phases, one of which can be linked to a "conventional" tearing mode driven unstable by the current profile and the other to a neoclassical tearing mode driven by a perturbation of the bootstrap current. The TCV results provide the first clear observation of such a destabilization mechanism and reconcile the theory of conventional and neoclassical tearing modes, which differ only in the dominant driving term.

Impact of targeted programs on health systems: a case study of the polio eradication initiative

The results of 2 large field studies on the impact of the polio eradication initiative on health systems and 3 supplementary reports were presented at a December 1999 meeting convened by the World Health Organization. All of these studies concluded that positive synergies exist between polio eradication and health systems but that these synergies have not been vigorously exploited. The eradication of polio has probably improved health systems worldwide by broadening distribution of vitamin A supplements, improving cooperation among enterovirus laboratories, and facilitating linkages between health workers and their communities. The results of these studies also show that eliminating polio did not cause a diminution of funding for immunization against other illnesses. Relatively little is known about the opportunity costs of polio eradication. Improved planning in disease eradication initiatives can minimize disruptions in the delivery of other services. Future initiatives should include indicators and baseline data for monitoring effects on health systems development.

Wilderness mortalities: a 13-year experience

STUDY OBJECTIVE

To analyze the epidemiology of wilderness mortalities in a localized area with diverse terrain.

METHODS

We conducted a retrospective review of the Pima County (Arizona) Sheriff's Office (PCSO) search and rescue logs and case reports, hospital records, and autopsy reports for all wilderness deaths from 1980 to 1992. The study group comprised all victims of injury or illness in Pima County wilderness who died during a 13-year period in a location remote enough so that standard ground-based emergency medical services units could not extract the body.

RESULTS

One hundred fatalities occurred during the 13-year study period. There were 59 unintentional traumas, 18 suicides, 9 homicides, 12 medically related deaths, and 2 deaths of unknown causes. Toxicology tests performed on body fluids yielded positive findings for alcohol in a total of 50 (50%) cases and positive findings for drugs of abuse in 12 (12%) cases. It was estimated that alcohol was "a very probable" or "a probable" causative factor in 23 (40%) of the 59 unintentional trauma deaths, and in 1 (8.3%) of the 12 medically related deaths. Fifty-five (55%) deaths were witnessed events, with 45 (80%) of these victims reported as dying immediately or before arrival of search and rescue personnel. Ten (10%) victims received resuscitation in the field, and according to a review of hospital charts and autopsy reports, only 2 victims had a potentially survivable injury or illness.

CONCLUSION

Many wilderness mortalities are related to incidents involving alcohol. Once the accident or injury has occurred, the majority of deaths are immediate, or at least before the arrival of medical personnel. Higher levels of medical care would not have improved the outcomes of those who did survive long enough to receive medical care. Therefore, primary efforts to reduce mortalities in the wilderness should be directed toward prevention, especially diminishing alcohol use in wilderness areas.

Childhood mortality impact and costs of integrating vitamin A supplementation into immunization campaigns

Country-specific activity and coverage data were used to estimate the childhood mortality impact (deaths averted) and costs of integrating vitamin A supplements into immunization campaigns conducted in 1998 and 1999. More than 94 million doses of vitamin A were administered in 41 countries in 1998, helping to avert nearly 169,000 deaths. During 1999, delivery of more than 97 million doses in 50 countries helped avert an estimated 242,000 deaths. The estimated incremental cost per death averted was US$72 (range: 36-142) in 1998 and US$64 (range: 32-126) in 1999. The estimated average total cost of providing supplementation per death averted was US$310 (range: 157-609) in 1998 and US$276 (range: 139-540) in 1999. Costs per death averted varied by campaign, depending on the number and proportion of the child population reached, number of doses received per child, and child mortality rates.

A tragic report of probable high-altitude pulmonary edema in the Himalayas: preventive implications

High-altitude pulmonary edema (HAPE) is a well-recognized disease entity in trekkers to the Nepal Himalayas. We present the case of a patient who had clinical features consistent with HAPE but did not descend the mountain on time, which contributed to his death. The important factors of the diagnosis, the descent, and the follow-up in Kathmandu are examined.

Steady-state fully noninductive current driven by electron cyclotron waves in a magnetically confined plasma

A steady-state, fully noninductive plasma current has been sustained for the first time in a tokamak using electron cyclotron current drive only. In this discharge, 123 kA of current have been sustained for the entire gyrotron pulse duration of 2 s. Careful distribution across the plasma minor radius of the power deposited from three 0. 5-MW gyrotrons was essential for reaching steady-state conditions. With central current drive, up to 153 kA of current have been fully replaced transiently for 100 ms. The noninductive scenario is confirmed by the ability to recharge the Ohmic transformer. The dependence of the current drive efficiency on the minor radius is also demonstrated.

Polio as a platform: using national immunization days to deliver vitamin A supplements

In 1988 the 41st World Health Assembly committed WHO to the goal of global eradication of poliomyelitis by 2000 "in ways which strengthen national immunization programmes and health infrastructure". The successful use of polio National Immunization Days (NIDs) to deliver vitamin A is an example of how polio eradication can serve as a platform to address other problems of child health. Importantly, this integration is helping to achieve the World Summit for Children goal of eliminating vitamin A deficiency by the year 2000. It is estimated that between 140 million and 250 million preschool children are at risk of subclinical vitamin A deficiency. In 1998 more than 60 million children at risk received vitamin A supplements during polio national immunization days (NIDs). While food fortification and dietary approaches are fundamental to combating vitamin A deficiency, the administration of vitamin A supplements during NIDs helps raise awareness, enhance technical capacity, improve assessment and establish a reporting system. Moreover, polio NIDs provide an entry point for the sustainable provision of vitamin A supplements with routine immunization services and demonstrate how immunization campaigns can be used for the delivery of other preventive health services.

NSAID-induced gastrointestinal toxicity

Recommendations that can be made to decrease the incidence of untoward NSAID-induced GI events include identification of the high-risk patient (Table 3). If it is important to treat these high-risk patients with NSAIDs, either the lowest possible dose of the NSAID, an alternative non-NSAID analgesic, or the nonacetylated salicylates should be used. If that is impossible and a nonsalicylate NSAID is required in the high-risk patient, one should treat concomitantly with tolerable doses of misoprostol and prescribe that the NSAID be taken with food. If the patient is intolerant of misoprostol, H2 antagonists or omeprazole should be considered to decrease the risk of developing an NSAID-induced duodenal ulcer. If patients are not in the defined high-risk groups, given the present costs of H2 antagonists, omeprazole, and misoprostol, there seems to be little justification in treating the patient prophylactically. However, if the patient develops progressive iron-deficiency anemia or occult fecal blood loss not due to an obvious malignancy, endoscopy can be recommended to determine the cause. If there is evidence of a significant NSAID-induced gastric or duodenal ulcer, the NSAID should be stopped and the ulcer treated. If that is impossible, the NSAID dosage should be as low as possible, and the ulcer treated. If an ulcer is found, either a biopsy for H. pylori or a serum assay for the organism should be obtained. Once the ulcer is healed through appropriate therapy, and if NSAIDs are still to be used, prophylaxis with misoprostol should be considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Beta 2 (CD18) mutations abolish ligand recognition by I domain integrins LFA-1 (alpha L beta 2, CD11a/CD18) and MAC-1 (alpha M beta 2, CD11b/CD18)

The "I" domains of the beta 2 (CD18) leukocyte integrins are implicated in ligand binding function. Moreover, rather than recognizing linear peptide sequences, this class of integrins generally recognizes multiple discontinuous sites on immunoglobulin superfamily adhesion receptors. A conserved cluster of oxygenated residues is involved in ligand recognition by beta 1 and beta 3 integrins. In the present study, we evaluated the role of this region in the I domain-containing beta 2 integrins. Recombinant alpha L beta 2 (LFA-1, CD11a/CD18) and alpha M beta 2 (MAC-1, CD11b/CD18) were expressed on COS cells, and function was assessed by adhesion to ICAM-1 or iC3b, respectively. Alanine substitution at position Asp134 or Ser136 in beta 2 produced a complete loss in the capacity of both alpha L beta 2 and alpha M beta 2 to support cell adhesion. In contrast, substitution at Asp128 or Ser138 resulted in loss of beta 2 surface expression when co-transfected with alpha L (CD11a) or alpha M (CD11b). These data provide the first evidence for involvement of the beta 2 subunit in ligand binding to I domain integrins.

Retroreflecting ellipsometer for measuring the birefringence of optical disk substrates

A retroreflecting ellipsometer has been constructed for measuring the birefringence of optical disk substrates. In contrast to conventional ellipsometers with two mechanical arms, this system has only one arm along which both the incident and reflected beams travel. This construction eliminates the mechanical limitations of conventional ellipsometers, thereby permitting normal incidence on the sample. In addition, the single arm is adjustable in two dimensions, with the polar incident angle, θ(inc), varying from 0° to 70°, and the azimuthal incident angle, Φ(inc), varying from 0° to 360°. The condition of normal incidence permits accurate measurement of in-plane birefringence. The adjustability of both θ(inc) and Φ(inc) is necessary for the measurement of possible tilts of the index ellipsoid, and also for the variation of birefringence through the substrate thickness. Measurement results showing the useful features of the equipment are presented. The optics of the hemispherical assembly used for retroreflection as well as for the elimination of undesirable refractions are also studied by use of the ZEMAX lens design program.

Transcultural nursing. A personal and professional challenge

The traveling nurse is a guest in the host country. It is wise to remember that we represent our country and our culture--we are the only Americans many of the locals have even seen. Be sure that foreigners see in us the very best example of American citizens. After work, there is often opportunity to spend time with the local people. They are usually extremely hospitable and anxious to share their culture. A nurse who can get involved with the local people has the chance to learn so much--different values, priorities, and customs. The culture may be rich in history and folklore. Their approach to health care can be fascinating--very different from our own, yet effective in many ways. There are often highly skilled craftsmen among the people are, producing wonderfully sophisticated things from nearly nothing. It is a source of real joy to bring back treasures from a culture one has come to know. In addition to the opportunity for clinical growth and the refinement of team skills, foreign travel provides an opportunity to grow personally. Adapting to new and more primitive surroundings requires patience and understanding. Interacting with people of a different culture also gives one the opportunity to evaluate ones own beliefs and attitudes. Sometimes it is surprising to realize that we are more snobbish or prejudiced than we believed; that revelation can be an opportunity for growth and change and a new source of pride in our country, our profession, and ourselves.