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Photocathode laser pulse shaping is a crucial technology for enhancing the performance of X-ray free-electron lasers by optimizing the quality of electron beams generated from photocathodes within high-gradient radio frequency guns. By precisely shaping these laser pulses, it is possible to significantly reduce the transverse emittance of produced electron bunches. The optimal pulse shape is an ellipsoidal distribution, commonly referred to as the Kapchinskij–Vladimirskij profile. A pulse-shaping scheme utilizing a commercial Yb:KGW laser operating at 514 nm with a repetition rate of 1 MHz and duration of 260 fs has been developed for generating electron bunches with high peak and average power. This study presents the experimental realization of ellipsoidal pulses via three-dimensional amplitude shaping using spatial light modulators at 514 nm, followed by conversion to UV (257 nm) suitable for Cs 2Te photocathodes. The preservation of pulse shape and a high conversion efficiency during this process are investigated and our experiments pave the way for future emittance minimization for X-ray free-electron lasers.

Introduction Online adaptive MR-guided radiotherapy allows for dose escalation to pancreatic cancer while sparing surrounding critical organs. We seek to evaluate the safety of delivering hypofractionated five-fraction, three-fraction and single-fraction MR-guided stereotactic ablative radiotherapy (SABR) to the pancreas.Methods and analysis This is a single-centre three-arm phase 1 non-randomised safety study. Patients with localised pancreatic cancer will receive either 50 Gy in five (biological equivalent dose (BED10)=100 Gy), 39 Gy in three (BED10=90 Gy) or 25 Gy in a single fraction (BED10=87.5 Gy) MR-guided daily online adaptive radiotherapy. Each fractionation regimen will be assessed as independent cohorts to determine tolerability, assessed continuously using Bayesian conjugate posterior beta distributions. The primary endpoint of the study is to establish the safety of five-fraction, three-fraction and single-fraction MR-guided hypofractionation SABR in localised pancreatic cancer by assessing dose-limiting toxicities. Secondary endpoints include overall survival, progression-free survival, local control rates, overall control rate, resection rates, long-term toxicities and freedom from second-line chemotherapy. This study plans to also explore imaging and immune biomarkers that may be useful to predict outcome and personalise treatment. The trial will recruit up to 60 patients with a safety run-in.Ethics and dissemination The trial is approved by the West Midlands—Black Country Research Ethics Committee 22/WM/0122. The results will be disseminated via conference presentations, peer-reviewed scientific journals and submission to regulatory authorities. The data collected for the study, including individual participant data, will be made available to researchers on request to the study team and with appropriate reason, via octo-enquiries@oncology.ox.ac.uk. The shared data will be deidentified participant data and will be available for 3 years following publication of the study. Data will be shared with investigator support, after approval of a proposal and with a signed data access agreement.Trial registration number ISRCTN10557832

A key issue of X-ray free-electron lasers is the quality of the photoelectron beams generated from a photocathode by laser pulses in the high-gradient RF gun. Controlling the shape of these laser pulses can strongly reduce the transverse emittance of the generated electron bunch. For this purpose, a laser pulseshaper at 515 nm is presented that can be used directly with alkali antimonide photocathodes for photoemission. The first results regarding generation and measurement of flattop and parabolic pulses as well as introduction of modulations for THz generation are presented and show the potential for emittance optimization with 3D ellipsoidal pulses with the proposed pulseshaper. The experiments are carried out for Cs2Te photocathodes, which require second harmonic generation of the shaped pulses and thus allow investigation of pulseshape preservation in nonlinear frequency conversion processes.

Abstract Background Chemoradiotherapy remains the standard of care for locally advanced rectal cancer. Efforts to intensify treatment and increase response rates have yet to yield practice changing results due to increased toxicity and/or absence of increased radiosensitization. Enadenotucirev (EnAd) is a tumour selective, oncolytic adenovirus which can be given intravenously. Pre-clinical evidence of synergy with radiation warrants further clinical testing and assessment of safety with radiation. Methods Eligibility include histology confirmed locally advanced rectal cancer that require chemoradiation. The trial will use a Time-to-Event Continual Reassessment Model-based (TiTE-CRM) approach using toxicity and efficacy as co-primary endpoints to recommend the optimal dose and treatment schedule 30 patients will be recruited. Secondary endpoints include pathological complete response the neoadjuvant rectal score. A translational program will be based on a mandatory biopsy during the second week of treatment for ‘proof-of-concept’ and exploration of mechanism. The trial opened to recruitment in July 2019, at an expected rate of 1 per month for up to 4 years. Discussion Chemoradiation with Enadenotucirev as a radiosensitiser in locally Advanced Rectal cancer (CEDAR) is a prospective multicentre study testing a new paradigm in radiosensitization in rectal cancer. The unique ability of EnAd to selectively infect tumour cells following intravenous delivery is an exciting opportunity with a clear translational goal. The novel statistical design will make efficient use of both toxicity and efficacy data to inform subsequent studies. Trial registration ClinicalTrial.gov, NCT03916510 . Registered 16th April 2019.

Photoinjectors are the main high brightness electron sources for x-ray free electron lasers (XFELs). Photoinjector emittance reduction is one of the key knobs for improving XFEL lasing, so precise emittance measurement is critical. It is well known that rms emittance is very sensitive to low intensity tails of particle distributions in the phase space, whose measurement depends on the signal to noise ratio and image processing procedures. Such sensitivities make the interpretations of beam transverse brightness challenging, leading to different emittance definitions to reduce the impact of tail particles. In this paper, transverse phase space is analyzed in action and phase coordinates for both analytical models and experiments, which gives a more intuitive way to calculate the beam core brightness.

Slice energy spread is one of the key parameters in free electron laser optimizations, but its accurate measurement is not straightforward. Two recent studies from high energy (≥100 MeV) photoinjectors at SwissFEL and European x-ray free electron laser (XFEL) have reported much higher slice energy spread than expected at their XFEL working points (200–250 pC). In this paper, a new method for measuring slice energy spread at lower beam energy (∼20 MeV) is proposed and demonstrated at the PhotoInjector Test facility at DESY Zeuthen, and the results for 250 pC are much lower than those measured at high energy injectors.

The function of Sprouty2 (Spry2) in T cells is unknown. Using 2 different (inducible and T cell-targeted) knockout mouse strains, we found that Spry2 positively regulated extracellular signal-regulated kinase 1/2 (ERK1/2) signaling by modulating the activity of LCK. Spry2-/- CD4+ T cells were unable to activate LCK, proliferate, differentiate into T helper cells, or produce cytokines. Spry2 deficiency abrogated type 2 inflammation and airway hyperreactivity in a murine model of asthma. Spry2 expression was higher in blood and airway CD4+ T cells from patients with asthma, and Spry2 knockdown impaired human T cell proliferation and cytokine production. Spry2 deficiency up-regulated the lipid raft protein caveolin-1, enhanced its interaction with CSK, and increased CSK interaction with LCK, culminating in augmented inhibitory phosphorylation of LCK. Knockdown of CSK or dislodgment of caveolin-1-bound CSK restored ERK1/2 activation in Spry2-/- T cells, suggesting an essential role for Spry2 in LCK activation and T cell function.

Introduction Patients with head and neck squamous cell carcinoma with locally advanced disease often require multimodality treatment with surgery, radiotherapy and/or chemotherapy. Adjuvant radiotherapy with concurrent chemotherapy is offered to patients with high-risk pathological features postsurgery. While cure rates are improved, overall survival remains suboptimal and treatment has a significant negative impact on quality of life.Cell cycle checkpoint kinase inhibition is a promising method to selectively potentiate the therapeutic effects of chemoradiation. Our hypothesis is that combining chemoradiation with a WEE1 inhibitor will affect the biological response to DNA damage caused by cisplatin and radiation, thereby enhancing clinical outcomes, without increased toxicity. This trial explores the associated effect of WEE1 kinase inhibitor adavosertib (AZD1775).Methods and analysis This phase I dose-finding, open-label, multicentre trial aims to determine the highest safe dose of AZD1775 in combination with cisplatin chemotherapy preoperatively (group A) as a window of opportunity trial, and in combination with postoperative cisplatin-based chemoradiation (group B).Modified time-to-event continual reassessment method will determine the recommended dose, recruiting up to 21 patients per group. Primary outcomes are recommended doses with predefined target dose-limiting toxicity probabilities of 25% monitored up to 42 days (group A), and 30% monitored up to 12 weeks (group B). Secondary outcomes are disease-free survival times (groups A and B). Exploratory objectives are evaluation of pharmacodynamic (PD) effects, identification and correlation of potential biomarkers with PD markers of DNA damage, determine rate of resection status and surgical complications for group A; and quality of life in group B.Ethics and dissemination Research Ethics Committee, Edgbaston, West Midlands (REC reference 16/WM/0501) initial approval received on 18/01/2017. Results will be disseminated via peer-reviewed publication and presentation at international conferences.Trial registration number ISRCTN76291951 and NCT03028766.

Abstract Prior research highlights that rural populations have been historically underrepresented/excluded from clinical research. The primary objective of this study was to describe the inclusion of rural populations within our research enterprise using Clinical Research Management System demographic information at a large academic medical center in the Southeast. This was a cross‐sectional study using participant demographic information for all protocols entered into our Clinical Research Management System between May 2018 and March 2021. Descriptive statistics were used to analyze the representation of rural and non‐rural participants and demographic breakdown by age, sex, race, and ethnicity for our entire enterprise and at the state level. We also compared Material Community Deprivation Index levels between urban and rural participants. Results indicated that 19% of the research population was classified as rural and 81% as non‐rural for our entire sample, and 17.5% rural and 82.5% urban for our state‐level sample. There were significant differences in race, sex, and age between rural and non‐rural participants and Material Community Deprivation Indices between rural and non‐rural participants. Lessons learned and recommendations for increasing the inclusion of rural populations in research are discussed.

In May 2023, the editorial board of Cosmopolitan Civil Societies hosted an online conference on ‘New Conceptualisations of Cosmopolitanism’. Discussions were rich and varied, across two days and several panels. The event was an experiment for the journal. This Special Issue is the result. There are ten papers in this Special Issue, falling into three broad fields of debate: four on themes of cosmopolitics, ethnonationalism and the national state; three on aspects of work, gender and cosmopolitan identification; and three on issues of climate action, land use and environmentalism. The editorial introduction seeks to summarise papers and draw out some common themes for wider debate.

Empowering the Participant Voice (EPV) is an NCATS-funded six-CTSA collaboration to develop, demonstrate, and disseminate a low-cost infrastructure for collecting timely feedback from research participants, fostering trust, and providing data for improving clinical translational research. EPV leverages the validated Research Participant Perception Survey (RPPS) and the popular REDCap electronic data-capture platform. This report describes the development of infrastructure designed to overcome identified institutional barriers to routinely collecting participant feedback using RPPS and demonstration use cases. Sites engaged local stakeholders iteratively, incorporating feedback about anticipated value and potential concerns into project design. The team defined common standards and operations, developed software, and produced a detailed planning and implementation Guide. By May 2023, 2,575 participants diverse in age, race, ethnicity, and sex had responded to approximately 13,850 survey invitations (18.6%); 29% of responses included free-text comments. EPV infrastructure enabled sites to routinely access local and multi-site research participant experience data on an interactive analytics dashboard. The EPV learning collaborative continues to test initiatives to improve survey reach and optimize infrastructure and process. Broad uptake of EPV will expand the evidence base, enable hypothesis generation, and drive research-on-research locally and nationally to enhance the clinical research enterprise.

Abstract Introduction: Latinx populations are underrepresented in clinical research. Asking Latinx research participants about their research experiences, barriers, and facilitators could help to improve research participation for these populations. Methods: The Salud Estres y Resilencia (SER) Hispano cohort study is a longitudinal cohort study of young adult Latinx immigrants whose design and conduct were tailored for their study population. We administered the Research Participant Perception Survey (RPPS) to SER Hispano participants to assess their experiences in the study. We describe overall results from the RPPS and compare results of surveys administered to SER Hispano participants via email versus telephone. Results: Of 340 participants who were contacted with the RPPS, 142 (42%) responded. Among respondents, 53 (37%) responded by initial email contact; and 89 (63%) responded by subsequent phone contact. The majority of respondents were between 35 and 44 years of age (54%), female (76%), and of Cuban origin (50%). Overall, research participants expressed high satisfaction with their research experience; 84% stated that they would “definitely” recommend research participation to friends and family, with no significant difference by method of survey administration (P = 0.45). The most common factor that was chosen that would influence future research participation was having summary results of the research shared with them (72%). Conclusion: We found that culturally tailored studies can be good experiences for Latinx research participants; and we found that use of the RPPS can be administered successfully, particularly when administered by more than one method, including telephone, to evaluate and to improve research experiences for this population.

Abstract Introduction Major surgery accounts for a substantial proportion of health service activity, due not only to the primary procedure, but the longer-term health implications of poor short-term outcome. Data from small studies or from outside the UK indicate that rates of complications and failure to rescue vary between hospitals, as does compliance with best practice processes. Within the UK, there is currently no system for monitoring postoperative complications (other than short-term mortality) in major non-cardiac surgery. Further, there is variation between national audit programmes, in the emphasis placed on quality assurance versus quality improvement, and therefore the principles of measurement and reporting which are used to design such programmes. Methods and analysis The PQIP patient study is a multi-centre prospective cohort study which recruits patients undergoing major surgery. Patient provide informed consent and contribute baseline and outcome data from their perspective using a suite of patient-reported outcome tools. Research and clinical staff complete data on patient risk factors and outcomes in-hospital, including two measures of complications. Longer-term outcome data are collected through patient feedback and linkage to national administrative datasets (mortality and readmissions). As well as providing a uniquely granular dataset for research, PQIP provides feedback to participating sites on their compliance with evidence-based processes and their patients’ outcomes, with the aim of supporting local quality improvement. Ethics and dissemination Ethical approval has been granted by the Health Research Authority in the UK. Dissemination of interim findings (non-inferential) will form a part of the improvement methodology and will be provided to participating centres at regular intervals, including near-real time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a comprehensive multi-modal communications strategy including to patients, policy makers and academic audiences as well as clinicians.

Abstract Background Analysis of Medicare data is often used to determine epidemiology, healthcare utilization and effectiveness of disease treatments. We were interested in whether Medicare data could be used to estimate prevalence of tobacco use. Currently, data regarding tobacco use is derived from Behavioral Risk Factor Surveillance System (BRFSS) survey data. We compare administrative claims data for tobacco diagnosis among Medicare beneficiaries to survey (BRFSS) estimates of tobacco use from 2001 to 2014. Methods Retrospective cross-sectional study comparing tobacco diagnoses using International Classification of Disease, Ninth Revision (ICD-9) codes for tobacco use in Medicare data to BRFSS data from 2001 to 2014 in adults age ≥ 65 years. Beneficiary data included age, gender, race, socioeconomic status, and comorbidities. Tobacco cessation counselling was also examined using Healthcare Common Procedure Coding System codes. Results The prevalence of Medicare enrollees aged ≥65 years who had a diagnosis of current tobacco use increased from 2.01% in 2001 to 4.8% in 2014, while the estimates of current tobacco use from BRFSS decreased somewhat (10.03% in 2001 vs. 8.77% in 2014). However, current tobacco use based on Medicare data remained well below the estimates from BRFSS. Use of tobacco cessation counselling increased over the study period with largest increases after 2010. Conclusions The use of tobacco-related diagnosis codes increased from 2001 to 2014 in Medicare but still substantially underestimated the prevalence of tobacco use compared to BRFSS data.

Background: England, and the UK more generally, has a large burden of winter- and cold-related mortality/morbidity in comparison with nearby countries in continental Europe. Improving the energy efficiency of the housing stock may help to reduce this, as well as being important for climate change and energy security objectives. Objectives: To evaluate the impact of home energy efficiency (HEE) interventions on winter- and cold-related mortality/morbidity, including assessing the impact of winter fuel payments (WFPs) and fuel costs. Design: A mixed-methods study – an epidemiological time-series analysis, an analysis of data on HEE interventions, the development and application of modelling methods including a multicriteria decision analysis and an in-depth interview study of householders. Setting: England, UK. Participants: The population of England. In-depth interviews were conducted with 12 households (2–4 participants each) and 41 individuals in three geographical regions. Interventions: HEE interventions. Main outcome measures: Mortality, morbidity and intervention-related changes to the home indoor environment. Data sources: The Homes Energy Efficiency Database, mortality and hospital admissions data and weather (temperature) data. Results: There has been a progressive decline in cold-related deaths since the mid-1970s. Since the introduction of WFPs, the gradient of association between winter cold and mortality [2.00%, 95% confidence interval (CI) 1.74% to 2.28%] per degree Celsius fall in temperature is somewhat weaker (i.e. that the population is less vulnerable to cold) than in earlier years (2.37%, 95% CI 0.22% to 2.53%). There is also evidence that years with above-average fuel costs were associated with higher vulnerability to outdoor cold. HEE measures installed in England in 2002–10 have had a relatively modest impact in improving the indoor environment. The gains in winter temperatures (around +0.09 °C on a day with maximum outdoor temperature of 5 °C) are associated with an estimated annual reduction of ≈280 cold-related deaths in England (an eventual maximum annual impact of 4000 life-years gained), but these impacts may be appreciably smaller than those of changes in indoor air quality. Modelling studies indicate the potential importance of the medium- and longer-term impacts that HEE measures have on health, which are not observable in short-term studies. They also suggest that HEE improvements of similar annualised cost to current WFPs would achieve greater improvements in health while reducing (rather than increasing) carbon dioxide emissions. In-depth interviews suggest four distinct householder framings of HEE measures (as home improvement, home maintenance, subsidised public goods and contributions to sustainability), which do not dovetail with current ‘consumerist’ national policy and may have implications for the uptake of HEE measures. Limitations: The quantification of intervention impacts in this national study is reliant on various indirect/model-based assessments. Conclusions: Larger-scale changes are required to the housing stock in England if the full potential benefits for improving health and for reaching increasingly important climate change mitigation targets are to be realised. Future work: Studies based on data linkage at individual dwelling level to examine health impacts. There is a need for empirical assessment of HEE interventions on indoor air quality. Funding: This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 6, No. 11. See the NIHR Journals Library website for further project information.

In 2017 the Australian Government announced a raft of measures designed to combat ‘foreign interference’ in the Australian political system. The measures propose new constraints on civil society advocacy and threaten to seriously curtail democratic rights. They form part of global trend towards the increased regulation of International Non-Government Organisations (INGOs), driven by fears of ‘foreign’ political influence. In response to the shrinking ‘civic space’, NGOs are defining new agendas. Recently in Australia and elsewhere NGO advocates have gained some traction in extending the legitimacy and scope for political advocacy. The new rhetoric of countering ‘foreign interference’ threatens NGO advocacy, but also creates new political possibilities. This article surveys the international trends and Australian contexts; it analyses recent legislative proposals in Australia to combat ‘foreign interference’, and outlines the public debate. The double standard for INGOs and multinational corporations is highlighted as a key theme, and the article ends with a concluding discussion about emerging possibilities for new political obligations for corporations in Australia

Problem Ghana’s population is ageing. In 2011, the Government of Ghana requested technical support from the World Health Organization (WHO) to help revise national policies on ageing and health. Approach We applied WHO’s knowledge translation framework on ageing and health to assist evidence based policy-making in Ghana. First, we defined priority problems and health system responses by performing a country assessment of epidemiologic data, policy review, site visits and interviews of key informants. Second, we gathered evidence on effective health systems interventions in low- middle- and high-income countries. Third, key stakeholders were engaged in a policy dialogue. Fourth, policy briefs were developed and presented to the Ghana Health Services. Local setting Ghana has a well-structured health system that can adapt to meet the health care needs of older people. Relevant changes Six problems were selected as priorities, however after the policy dialogue, only five were agreed as priorities by the stakeholders. The key stakeholders drafted evidence-based policy recommendations that were used to develop policy briefs. The briefs were presented to the Ghana Health Service in 2014. Lessons learnt The framework can be used to build local capacity on evidence-informed policy-making. However, knowledge translation tools need further development to be used in low-income countries and in the field of ageing. The terms and language of the tools need to be adapted to local contexts. Evidence for health system interventions on ageing populations is very limited, particularly for low- and middle-income settings.

The 2001 invasion and subsequent occupation consolidated ethnicity as a political force in Afghanistan. Inter-ethnic elite bargaining instituted an ethnocratic oligarchy, grounded in the occupation. Against this, everyday politics in Afghanistan has centred on social clientelism, founded on kinship networks rather than ethnicity. At the same time, formal political structures, expressed in the 2004 Constitution, are grounded in Islam and nationalist statehood rather than ethnicity. In recent years sharp disjunctures have emerged between ethnic elites and would-be constituents, creating some electoral fluidity and ethnic de-alignment. The paper addresses the relationship between occupation and ethnocracy in Afghanistan. It takes an historical perspective on the present, debating contending foundations for political solidarity and identification in the country.

Remote sensing shows potential for assessing biodiversity of coral reefs. Important steps in achieving this objective are better understanding the spectral variability of various reef components and correlating these spectral characteristics with field-based ecological assessments. Here we analyze >9400 coral reef field spectra from southwestern Puerto Rico to evaluate how spectral variability and, more specifically, spectral similarity between species influences estimates of biodiversity. Traditional field methods for estimating reef biodiversity using photoquadrats are also included to add ecological context to the spectral analysis. Results show that while many species can be distinguished using in situ field spectra, the addition of the overlying water column significantly reduces the ability to differentiate species, and even groups of species. This indicates that the ability to evaluate biodiversity with remote sensing decreases with increasing water depth. Due to the inherent spectral similarity amongst many species, including taxonomically dissimilar species, remote sensing underestimates biodiversity and represents the lower limit of actual species diversity. The overall implication is that coral reef ecologists using remote sensing need to consider the spatial and spectral context of the imagery, and remote sensing scientists analyzing biodiversity need to define confidence limits as a function of both water depth and the scale of information derived, e.g., species, groups of species, or community level.

This Special Issue of Cosmopolitan Civil Societies Journal focuses on the domination of social and political relations by Ethnocracy – rule or would-be rule by an ethnic group or ethnos, as distinct from Democracy or rule by the demos of all the people. Ethnocracy encompasses state regimes and associated political movements and parties that discriminate systematically in favour of a particular ethnic group (or groups) and against others. When we proposed the Special Issue in late 2014 ethnocratic practices were as prevalent as they had ever been; and now two years later they appear to be on the increase with an ethno-populist upsurge and the election or threatened election of governments pursuing ethnocratic agendas. From India to the USA, from Russia to Hungary, leading politicians openly discriminate against ethnic ‘others’ to attract support from ‘their own’ ethnic groups; across the European Union and in other liberal democracies they increasingly scapegoat ‘immigrants’ to hide their own inadequacies and further their political objectives. Now, more than ever, it is critical that the dynamics of ethnocracy are more clearly understood. This Issue documents the logics of ethnocracy in a variety of different contexts, posing questions about how it develops and how it can be challenged.

Ixmyelocel-T is an investigational patient-specific, expanded, multicellular therapy produced from a patient's own bone marrow. It is produced by selectively expanding two key types of bone marrow mononuclear cells (BM-MNCs), CD90 + mesenchymal stem cells (MSCs), and CD45 + CD14 + autofluorescent, alternatively activated macrophages. Earlier clinical trials suggested that intramyocardial ixmyelocel-T might improve clinical, functional, symptomatic, and quality of life outcomes in patients with ischemic dilated cardiomyopathy (IDCM). This ongoing randomized, double-blinded, placebo-controlled phase 2b trial (ixCELL-DCM) was designed to assess the efficacy, safety, and tolerability of catheter-based transendocardial injection of ixmyelocel-T in patients with heart failure due to IDCM. Patients ( N = 114) with New York Heart Association class III or IV symptomatic heart failure due to IDCM, who have left ventricular ejection fraction ≤35% and an automatic implantable cardioverter defibrillator, but are ineligible for revascularization procedures, were randomly assigned (1:1 ratio) to ixmyelocel-T or placebo (vehicle control). The primary efficacy endpoint is a composite of the total number of deaths, cardiovascular hospitalizations, or unplanned clinic visits to treat acutely decompensated heart failure during the 12 months following treatment administration. Secondary endpoints include the win ratio analysis for hierarchical occurrences of clinical events in the primary endpoint, total numbers of clinical events, left ventricular structure and function, and quality-of-life assessments. ixCELL-DCM is one of the largest cell therapy trials in heart failure patients to date and the first double-blinded, placebo-controlled study of ixmyelocel-T administered via transendocardial catheter-based injections in patients with heart failure secondary to IDCM.

INTRODUCTION: vaccine hesitancy and refusal continue to be a global challenge to reaching immunization targets, especially among those in traditional or fundamentalist religions. The apostolic faith in Zimbabwe has been historically associated with objection to most medical interventions, including immunization. METHODS: we conducted a descriptive analysis of socio-demographic characteristics and vaccine coverage among apostolic and non-apostolic adults aged 15-49 years and children aged 12-23 months using the Demographic and Health Survey conducted in Zimbabwe during 2010-2011. We used logistic regression models to estimate associations between the apostolic religion and receipt of all four basic childhood vaccinations in the Expanded Program on Immunization, receipt of no vaccinations, and availability of child vaccination card. RESULTS: among children aged 12-23 months, 64% had received all doses of the four basic vaccinations, and 12% had received none of the recommended vaccines. A vaccination card was available for 68% of children. There was no significant association between Apostolic faith and completion of all basic vaccinations (aOR=0.90, 95% CI: 0.69-1.17), but apostolic children were almost twice as likely to have received no basic vaccinations (aOR=1.83, 95% CI: 1.22-2.77) than non-Apostolic children, and they were 32% less likely to have a vaccination card that was available and seen by the interviewer (aOR=0.68, 95% CI: 0.52-0.89). CONCLUSION: disparities in childhood vaccination coverage and availability of vaccination cards persist for apostolic in Zimbabwe. Continued collaboration with apostolic leaders and additional research to better understand vaccine hesitancy and refine interventions and messaging strategies are needed.

INTRODUCTION: despite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes. METHODS: we conducted a descriptive epidemiological analysis using measles immunization and surveillance data to understand the causes of the measles resurgence and to develop recommendations for elimination efforts in DRC. RESULTS: during 2004-2012, performance indicator targets for case-based surveillance and routine measles vaccination were not met. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. Phased supplementary immunization activities (SIAs) were conducted starting in 2002, in some cases with sub-optimal coverage (d"95%). In 2010, SIAs in five of 11 provinces were not implemented as planned, resulting in a prolonged interval between SIAs, and a missed birth cohort in one province. During July 1, 2010-December 30, 2012, high measles attack rates (100 cases per 100,000 population) occurred in provinces that had estimated MCV1 coverage lower than the national estimate and did not implement planned 2010 SIAs. The majority of confirmed case-patients were aged =10 years (87%) and unvaccinated or with unknown vaccination status (75%).Surveillance detected two genotype B3 and one genotype B2 measles virus strains that were previously identified in the region. CONCLUSION: the resurgence was likely caused by an accumulation of unvaccinated, measles-susceptible children due to low MCV1 coverage and suboptimal SIA implementation. To achieve the regional goal of measles elimination by 2020, efforts are needed in DRC to improve case-based surveillance and increase two-dose measles vaccination coverage through routine services and SIAs.

DOI: http://dx.doi.org/10.5130/ccs.v6i1.3924

Theorisations of global governance invariably conceive of it as bringing order to disorder, whether by increasing the ‘density’ of interstate society, or by expressing the leverage of global civil society. This paper seeks to invert the frame, and to take seriously the active disordering of governance, as a generative challenge, that creates new justice claims, and opens-up new fields of public deliberation. Global climate governance is a particularly powerful context in which to track these dynamics. Climate change imposes its own pace of policy reform, forcing new imperatives; it also imposes its own remarkable scope, in terms of global reach and all-encompassing depth. The paper seeks-out generative disjunctures, where existing justice principles that underpin climate governance are challenged, disestablished, and reordered. The paper explores these themes as a way of mapping contending and conflicting trajectories in the development of climate justice as a principle of governance. The disordering effects of climate governance, the social and political forces that arise out of them and their roles in producing contender principles and practices are highlighted. We may then arrive at a conceptualization of climate governance as a necessarily disorderly process, which addresses cumulative and unanticipated challenges of climate change through successive reorientations in its modus operandi. As such, climate governance may be enabled to proceed through and beyond immediate accommodations, to offer new possibilities grounded in new rules of the game that widen realms of engagement and more effectively apprehend the challenges posed.

The article explores the interaction between legal and political strategy in producing social change. It centres on a long-running dispute in Australia over whether charities can have a dominant political purpose. The focus is on the strategising of the small activist charity that successfully pursued the case over a five-year period. As an 'insider' account, the article charts the in-practice process of translating activisms across legal and political fields. With a stress on contingency and agency, the account affirms a 'politics of rights' approach to legal activism. It shows how the case opened-up new grounds for political contestation, and as such offered prospects for 'non-reformist reform'. It also demonstrates how this occurred more by strategic engagement with unintended effects, than necessarily by design.

Theorisations of global governance invariably conceive of it as bringing order to disorder, whether by increasing the ‘density’ of interstate society, or by expressing the leverage of global civil society. This paper seeks to invert the frame, and to take seriously the active disordering of governance, as a generative challenge, that creates new justice claims, and opens-up new fields of public deliberation. Global climate governance is a particularly powerful context in which to track these dynamics. Climate change imposes its own pace of policy reform, forcing new imperatives; it also imposes its own remarkable scope, in terms of global reach and all-encompassing depth. The paper seeks-out generative disjunctures, where existing justice principles that underpin climate governance are challenged, disestablished, and reordered. The paper explores these themes as a way of mapping contending and conflicting trajectories in the development of climate justice as a principle of governance. The disordering effects of climate governance, the social and political forces that arise out of them and their roles in producing contender principles and practices are highlighted. We may then arrive at a conceptualization of climate governance as a necessarily disorderly process, which addresses cumulative and unanticipated challenges of climate change through successive reorientations in its modus operandi. As such, climate governance may be enabled to proceed through and beyond immediate accommodations, to offer new possibilities grounded in new rules of the game that widen realms of engagement and more effectively apprehend the challenges posed.

Global warming poses very directly the question of human agency. In this video ethnography of climate agency we explore dimensions of subjectivity in climate activism. Through a longitudinal study we track activist strategising as a reflexive process of creating climate agency. Activist reflection is presented as a balance between involvement and detachment, and analysed drawing on videoed interviews and on our own participation in organisations and events. Visual artefacts are deployed to deepen insights into the interview process, and into the contexts for climate action. In terms of the analysis, there are three themes. First we look at trajectories – how people come to identify with the climate movement and engage in its direct action wing. Second, we explore the hopes and fears of climate activists in the face of profound challenges. Third, we address political antidotes, and the role of direct action in precipitating large-scale systemic change. Across these themes there is much diversity and debate: what unifies is a common engagement in the broad field of direct climate action. This visual documentation helps us reflect on the conflicts and possibilities that thereby arise in contexts of climate activist praxis.

Maraviroc treatment for HIV-1 infected patients results in larger CD4(+) T cell rises than are attributable to its antiviral activity alone. We investigated whether this is due to modulation of T cell activation and inflammation.Thirty maraviroc-treated patients from the Maraviroc versus Efavirenz Regimens as Initial Therapy (MERIT) study were randomly selected from among those who had CCR5-tropic (R5) HIV on screening and achieved undetectable HIV RNA (2 µg/mL increased from 45% to 66% in the efavirenz arm, but remained constant in the maraviroc arm (P = 0.033). Decreases in CD38 expression on CD8(+) T cells were correlated with CD4(+) T cell rises for maraviroc treatment (r = -0.4, P = 0.048), but not for treatment with efavirenz.Maraviroc-treated patients had earlier, modest decreases in certain markers of immune activation and inflammation, although in this small study, many of the differences were not statistically significant. Levels of high-sensitivity C-reactive protein remained constant in the maraviroc arm and increased in the efavirenz arm. Decreases in immune activation correlated with increased CD4(+) T cell gains.ClinicalTrials.gov NCT00098293.

Political and social movements are both empowering and power-seeking: they seek both to mobilize civil society and overwhelm state institutions. As organisations they mobilize collective power, generating solidarities and transforming social structures. As such, political organisations both challenge power and exercise power. This article addresses organizational vehicles for political change in Australia, drawing out limits and possibilities. Three organizational forms are discussed - the political party, the non-government organization (NGO), and the social movement - in terms of their capacity and limits. The social solidarities and social structures that frame political organization are debated, highlighting the impact of political conflicts over ecological change. The article ends with a discussion of the proceeding four articles, drawing out shared themes and implications in terms of the relationships post-Howard, between the Australian state, political parties, NGOs and movements.

PORTAL opens 2006 with a special selection of papers focusing on the transformative power of social movements. In an age of globalisation and of ideologies of globalism, we debate sources and potential for alternative scenarios, for ‘other worlds.’ Many commentators have proclaimed this the global age, where humanity lives under one world power, one world market, and one world order. Yet many other worlds find new and fertile ground in this age, flourishing against the norm. Social movements set new agendas, inspire participation and crystalise solidarity. At the centre of contestation, they can create emancipatory knowledges—knowledges for change. In this issue of PORTAL we ask how social movements generate new ways of being, new subjectivities, or new modes of existence. We debate the role of affective meaning, of symbolic action and collective conscience, and discuss the place of reflective action. Contributors debate the dialectics between power and counter-power, and the role of strategic conflict and dialogue. They analyse sources of revolutionary and transformative change, discussing the praxis of counter-globalism.

PORTAL opens 2006 with a special selection of papers focusing on the transformative power of social movements. In an age of globalisation and of ideologies of globalism, we debate sources and potential for alternative scenarios, for ‘other worlds.’ Many commentators have proclaimed this the global age, where humanity lives under one world power, one world market, and one world order. Yet many other worlds find new and fertile ground in this age, flourishing against the norm. Social movements set new agendas, inspire participation and crystalise solidarity. At the centre of contestation, they can create emancipatory knowledges—knowledges for change. In this issue of PORTAL we ask how social movements generate new ways of being, new subjectivities, or new modes of existence. We debate the role of affective meaning, of symbolic action and collective conscience, and discuss the place of reflective action. Contributors debate the dialectics between power and counter-power, and the role of strategic conflict and dialogue. They analyse sources of revolutionary and transformative change, discussing the praxis of counter-globalism.

Globalism is a contested concept, but perhaps best understood as a spatial strategy, which disempowers those unable to transcend the fixity of place and social context. Under globalism fluidity becomes a key source of power, enabling the powerful to liquefy assets, to disembed, and thereby displace, political, social or ecological impacts. The infrastructures of globalism enable the disembodied extension of power across territory, to the extent that one model, universally applicable for all societies, is positioned as supreme. The only possible challenge to globalism perhaps, is through a similarly disembedded counter-movement, that mirrors the global reach and power of mainstream globalism. The praxis of counter-globalist movements suggests a different tendency, one that centres on the assertion of particularity against universality. Expressed in the legitimacy of ‘many worlds’ against ‘one world’ globalism, such resistance centres on exposing the material effects and foregrounding concrete and material experiences of globalism. Movements mobilise against the disembodied logic of globalism on the basis of co-presence and inter-subjectivity, and are embedded in relational concepts of selfhood. They are often intensely embodied and are radically emplaced through militant localism and trans-local dialogue. Counter-globalism thus does not seek to defeat geography; rather it embraces it, as the starting-point of mobilisation. The starting point of this article is thus to analyse globalism as a spatial strategy, a strategy of displacement grounded in material power. Globalism thus signifies the capacity to exploit and dominate at distance, from the sanctity of corporate boardrooms, military briefings and media cutting rooms. The claim is to universal market, military and normative power, but the impact is of extended and deepened division. Centres of power appear more as islands, or enclaves, defined against the backwash effects of counter-globalism, and the logic of offensive defence. Counter movements gain traction as paradigmatic challengers, grounded in the aspiration to alternative ways of being.

Globalism is a contested concept, but perhaps best understood as a spatial strategy, which disempowers those unable to transcend the fixity of place and social context. Under globalism fluidity becomes a key source of power, enabling the powerful to liquefy assets, to disembed, and thereby displace, political, social or ecological impacts. The infrastructures of globalism enable the disembodied extension of power across territory, to the extent that one model, universally applicable for all societies, is positioned as supreme. The only possible challenge to globalism perhaps, is through a similarly disembedded counter-movement, that mirrors the global reach and power of mainstream globalism. The praxis of counter-globalist movements suggests a different tendency, one that centres on the assertion of particularity against universality. Expressed in the legitimacy of ‘many worlds’ against ‘one world’ globalism, such resistance centres on exposing the material effects and foregrounding concrete and material experiences of globalism. Movements mobilise against the disembodied logic of globalism on the basis of co-presence and inter-subjectivity, and are embedded in relational concepts of selfhood. They are often intensely embodied and are radically emplaced through militant localism and trans-local dialogue. Counter-globalism thus does not seek to defeat geography; rather it embraces it, as the starting-point of mobilisation. The starting point of this article is thus to analyse globalism as a spatial strategy, a strategy of displacement grounded in material power. Globalism thus signifies the capacity to exploit and dominate at distance, from the sanctity of corporate boardrooms, military briefings and media cutting rooms. The claim is to universal market, military and normative power, but the impact is of extended and deepened division. Centres of power appear more as islands, or enclaves, defined against the backwash effects of counter-globalism, and the logic of offensive defence. Counter movements gain traction as paradigmatic challengers, grounded in the aspiration to alternative ways of being.

After Hurricane Jeanne in September 2004, surveillance for mosquitoborne diseases in Gonaïves, Haiti, identified 3 patients with malaria, 2 with acute dengue infections, and 2 with acute West Nile virus infections among 116 febrile patients. These are the first reported human West Nile virus infections on the island of Hispaniola.