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The SARS-CoV-2 virus responsible for the COVID-19 global pandemic has exhibited a striking capacity for viral evolution that drives continued evasion from vaccine and infection-induced immune responses. Mutations in the receptor binding domain of the S1 subunit of the spike glycoprotein have led to considerable escape from antibody responses, reducing the efficacy of vaccines and monoclonal antibody (mAb) therapies. Therefore, there is a need to interrogate more constrained regions of spike, such as the S2 subdomain. Here, we present a collection of S2 mAbs from two SARS-CoV-2 convalescent individuals that target multiple regions in S2, including regions outside of those commonly reported. One of the S2 mAbs, C20.119, which bound to a highly conserved epitope in the fusion peptide, was able to broadly neutralize across SARS-CoV-2 variants, SARS-CoV-1, and closely related zoonotic sarbecoviruses. The majority of the mAbs were non-neutralizing; however, many of them could mediate antibody-dependent cellular cytotoxicity (ADCC) at levels similar to the S1-targeting mAb S309 that was previously authorized for treatment of SARS-CoV-2 infections. Several of the mAbs with ADCC function also bound to spike trimers from other human coronaviruses (HCoVs), such as MERS-CoV and HCoV-HKU1. Our findings suggest S2 mAbs can target diverse epitopes in S2, including functional mAbs with HCoV and sarbecovirus breadth that likely target functionally constrained regions of spike. These mAbs could be developed for potential future pandemics, while also providing insight into ideal epitopes for eliciting a broad HCoV response.

Background: Studies have investigated a possible association between family history of HZ and the occurrence of HZ. However, the results were inconclusive and susceptible to bias. We evaluated this association in an elderly population. Methods: The matched case-control study conducted at Kaiser Permanente Southern California in 2012-2015 included 656 incident HZ patients ≥60 whose skin lesion tested positive for varicella zoster virus by polymerase chain reaction. Half of the HZ patients were vaccinated with zoster vaccine as achieved by stratified sampling. The controls were randomly selected and 1:1 matched to the cases on sex, age (±1 year), and zoster vaccination (±3 months of the case’s vaccination date). Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Results: Having any blood relative with a history of HZ was associated with a slightly increased risk of HZ (adjusted OR = 1.37, 95% CI 1.05–1.79). The adjusted OR associated with having one and two categories of first-degree blood relatives with a history of HZ was 1.30 (95% CI: 0.97–1.73) and 2.53 (95% CI: 1.17–5.44), respectively. Conclusions: Our results suggested a weak association between the development of HZ and a positive family history of HZ among the elderly population.

Background The focus on P. falciparum diagnosis has led to an underestimation of the global burden of malaria resulting from neglected Plasmodium species. However, there is still scarce data on the prevalence of P. ovale species (spp) globally. To address this knowledge gap, data collected from cross-sectional studies in Kilifi county were used to: 1) determine the prevalence of P. ovale spp infections; and 2) determine the sensitivity of different diagnostic assays in detecting P. ovale spp infections. Methods A total of 531 individuals were sampled across three study sites in Kilifi County, Kenya between 2009 and 2020. Blood smears were prepared from peripheral blood and screened for Plasmodium parasite stages using light microscopy. Molecular screening involved DNA extraction of dried blood spots and blood in ethylenediaminetetraacetic acid, polymerase chain reaction (PCR) using primers targeting the 18 small ribosomal subunit and sequencing. Results Microscopy screening revealed that the most prevalent species was P. falciparum (32.0%) followed by P. malariae (9.0%) and then P. ovale spp( 1.5%). PCR screening identified additional P. ovale spp positives cases. Overall PCR results indicate that43 (8.1%) out of the 531 individuals harbored P. ovale spp infection with the highest prevalence reported in the tertiary health facility, (14.6%, 95% CI 8-23.6%), followed by the primary health facility (8.3%, 95% CI 5.4-11.9%), and the community from a cross-sectional blood survey, (3.6%, 95% CI 1.2-8.2%). Microscopy screening for P. ovale spp had a low sensitivity of 7% (95% CI 1-19-30%) and a high specificity of 99% (95% CI 98-100%). Sequencing results confirmed the presence of P.ovale curtisi. Conclusions This study provides baseline data for P.ovale spp surveillance in Kilifi County, primarily using PCR to improve diagnosis. These results suggest that malaria elimination and eradication efforts should not only concentrate on P. falciparum but should embrace a holistic approach towards elimination of all Plasmodium spp.

IntroductionWhitefly (Bemisia tabaci) is a pest of cassava (Manihot esculenta Crantz) and the vector for two of the crop’s major viral diseases – cassava mosaic disease (CMD) and cassava brown streak disease (CBSD), causing severe economic losses for farmers. In this context, we conducted an on-farm experiment to study the efficiency of a seed treatment technology containing thiamethoxam, fludioxonil, and metalaxyl for rapid multiplication of superior cassava genotypes and early protection of the crop against whitefly at Salima and Nkhotakota, central Malawi in the 2019/2020 and 2020/2021 cropping seasons, respectively.MethodsThe trials were conducted using a randomized complete block design with four replicates. The effect of the application of the seed treatment on stake germination, whitefly population, CMD and CBSD incidences, and stem and storage root yields of three cassava varieties (Kalawe, Mbundumali, and Sauti) at three stake sizes (8 cm, 16 cm, and 25 cm) was compared with control – a 25 cm stake size of each of the cassava variety without seed treatment. A benefit-cost analysis was conducted to determine the profitability of the seed treatment technology for each stake size under certified and non-certified stem scenarios.Results and discussionRegardless of stake size and variety, plant germination was highest (96% by 16%) and mean whitefly population lowest (adult 0.4 vs. 3.0 plant-1; nymph 1.0 vs. 3.3 plant-1) with seed treatment application than without. Disease incidence measurements showed no significant effect of seed treatment on CBSD control (p = 0.31), but it reduced CMD incidence by 17% vs. 20% in the untreated. Stem and storage root yields across stake size and cassava variety were highest with seed treatment; 489 bundles ha-1 and 10 (DM) Mg ha-1, respectively. Using the 8 cm stake regardless of variety resulted in the highest average benefit-cost ratio for certified (18.3 USD USD-1) and non-certified (7.8 USD USD-1) cassava stem scenarios.ConclusionWe conclude that the application of the seed treatment tested in this study would offer protection to planted stakes, increase their germination, reduce whitefly population, increase stem and storage root yields in areas experiencing whitefly pressure, and result in high economic profits.

The COVID-19 pandemic caused a severe economic shock to which governments responded by announcing large-scale recovery packages with magnitudes unseen before. While some of these policies have been expected to have positive environmental outcomes (“green” policies), most of them have not been designed to address those challenges (“colourless”). Focusing on the economic recovery program announced in South Africa, a country still heavily reliant on fossil-fuels, this paper shows how colourless recovery policy can increase environmental harm, whereas green elements in recovery packages can enhance the decarbonisation effects of energy policy and promote positive economic outcomes. The analysis uses the energy-environment-economy model E3ME to simulate effects of different kinds of recovery policies and quantify the combined impact of a package of measures.

Abstract Previously, we developed and applied a glasshouse screen for potato tuber yield under heat stress and identified a candidate gene (HSc70) for heat tolerance by genetic analysis of a diploid potato population. Specific allelic variants were expressed at high levels on exposure to moderately elevated temperature due to variations in gene promoter sequence. In this study, we aimed to confirm the results from the glasshouse screen in field trials conducted over several seasons and locations including those in Kenya, Malawi and the UK. We extend our understanding of the HSc70 gene and demonstrate that expression level of HSc70 correlates with tolerance to heat stress in a wide range of wild potato relatives. The physiological basis of the protective effect of HSc70 was explored and we show that genotypes carrying the highly expressed HSc70 A2 allele are protected against photooxidative damage to PSII induced by abiotic stresses. Overall, we show the potential of HSc70 alleles for breeding resilient potato genotypes for multiple environments.

The versatility of Polyethylene terephthalate (PET) as a material with numerous applications in the food industry and its recalcitrance to chemical and microbial degradation has recently made it an environmental nuisance. In this study, we applied computational methods to ascertain the dependence of PET nanoplastic (NP) degradation on the chain length of the oligomer. The binding affinities of the NPs on the novel enzyme Polyester Hydrolase Leipzig 7 (PHL7) were used to relate their ease of degradation at the enzyme active site. The results revealed that the binding affinity of PET NPs at the enzyme target decreased from -5.2 kcal/mol to -0.8 kcal/mol, with an increase in PET chain length from 2.18 nm to 5.45 nm (2-5 PET chains). The binding affinities became positive at chain lengths 6.54 nm (6 PET chains) and above. These findings indicated that PET NP degradation at this enzyme’s active site is most efficient as chain length decreases from 5-2 units and is not likely to occur at longer PET chains. A feedforward Artificial Neutral Network (ANN) analysis predicted that the energy of the PET NPs is a very important factor in its degradation.

Introduction Little is known about the clinical course of COVID-19 following mild symptoms, and how the disease affects the survivors over time. Moreover, information on the severity of the long-term health effects as well as the associated risk factors is scant. This study aims to determine the short, intermediate and long-term health effects of COVID-19 on the survivors and the associated risk factors.Methods and analysis We propose conducting a 24-month prospective quantitative study in 10 health facilities (2 specialist, 3 regional, 2 mission and 3 subdistrict hospitals) from Lusaka and Southern Province of Zambia. Health facilities will be those which served as COVID-19 treatment centres during the third wave (June–August 2021). Study participants will comprise a randomly selected cohort of 450 COVID-19 survivors who had mild or no symptoms (80%) and severe cases (20%). Using a questionnaire, respondent demographic, clinical and laboratory data will be collected at baseline and at a 3-month interval for 18 months using a questionnaire. Respondents’ medical records will be reviewed and data collected using a checklist. Descriptive statistics will be computed to summarise respondents’ characteristics and clinical outcomes. Bivariate analysis (Χ2 and t-test) will be conducted to test the association between respondent characteristics and clinical outcomes. Multivariate logistic regression analysis will be run to determine the risk factors for short, intermediate and long-term health effects; adjusted ORs will be computed to test the strength of the association (p

Solanum aethiopicum cultivation is highly constrained by Fusarium wilt. A trial was conducted to control soil-borne and seed-borne F. oxysporum f.sp. melongenae using botanicals (ginger and garlic extracts). Seeds of Bello variety of eggplant were used for the trial. The trial was set up using completely randomized design with nine treatments and each treatment replicated thrice. Data were collected on percentage germination, shoot height, number of leaves, plant vigour, shoot weight, disease incidence and disease severity. The results shows that treatment T9 has the lowest percentage germination (18.3%) at 7 DAS which is lower than T1 (44.2%) or mean (48.1%). T7 permits 72.5% germination which is at par with T6 (83.3%) at 15 DAS. Based on germination, T8, T5, T6 and T7 tops the chart (≥ 72.3% germination) compared to T9 (50.8%) at 15 DAS. The incidence of wilt is highest (33.4%) in T9 compared to all treated plots. T4, and T2 are the best treatments (0.0% incidence) at 45 DAS. Percentage severity of wilt follows the same trend as incidence. Based on shoot weight, T8 (8.3 g) and T7 (7.0 g) are the best treatments. The highest vigour index (45 DAS) is from T3 (823) followed by T2 (769), T5 (692), T7 (658) then T1 (604) in descending order of vigour index and mean vigour index is 582. It is concluded that the infection of eggplant by Fusarium sp. affects germination of seeds and subsequent growth in the absence of control measures. However, control of Fusarium sp. is possible with the use of botanicals.

Introduction ACOSOG-Z0011(Z11) trial showed that axillary node clearance (ANC) may be omitted in women with ≤2 positive nodes undergoing breast conserving surgery (BCS) and whole breast radiotherapy (RT). A confirmatory study is needed to clarify the role of axillary treatment in women with ≤2 macrometastases undergoing BCS and groups that were not included in Z11 for example, mastectomy and those with microscopic extranodal invasion. The primary objective of POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus Clearance or axillary radiotherapy (POSNOC) is to evaluate whether for women with breast cancer and 1 or 2 macrometastases, adjuvant therapy alone is non-inferior to adjuvant therapy plus axillary treatment, in terms of 5-year axillary recurrence.Methods and analysis POSNOC is a pragmatic, multicentre, non-inferiority, international trial with participants randomised in a 1:1 ratio. Women are eligible if they have T1/T2, unifocal or multifocal invasive breast cancer, and 1 or 2 macrometastases at sentinel node biopsy, with or without extranodal extension. In the intervention group women receive adjuvant therapy alone, in the standard care group they receive ANC or axillary RT. In both groups women receive adjuvant therapy, according to local guidelines. This includes systemic therapy and, if indicated, RT to breast or chest wall. The UK Radiotherapy Trials Quality Assurance Group manages the in-built radiotherapy quality assurance programme. Primary endpoint is 5-year axillary recurrence. Secondary outcomes are arm morbidity assessed by Lymphoedema and Breast Cancer Questionnaire and QuickDASH questionnaires; quality of life and anxiety as assessed with FACT B+4 and State/Trait Anxiety Inventory questionnaires, respectively; other oncological outcomes; economic evaluation using EQ-5D-5L. Target sample size is 1900. Primary analysis is per protocol. Recruitment started on 1 August 2014 and as of 9 June 2021, 1866 participants have been randomised.Ethics and dissemination Protocol was approved by the National Research Ethics Service Committee East Midlands—Nottingham 2 (REC reference: 13/EM/0459). Results will be submitted for publication in peer-reviewed journals.Trial registration number ISRCTN54765244; NCT0240168Cite Now

With the onset of the coronavirus-19 (COVID-19) pandemic, we transformed an in-person art museum-based course for medical students into an online format. This brought new challenges but offered unexpected advantages. The course included daily close-looking of artworks using the Visual Thinking Strategies method, group arts-based activities, reflective writing, and independent creating assignments. The virtual format allowed us to incorporate important features that were unavailable in our in-person elective: multi-media activities, access to nearly unlimited international works of art, and personal reflection from one’s private space. As instructors, the experience enlightened us on the value of online arts-based teaching.

Gender representativity in political and managerial positions in local government in general and women empowerment in particular remain contentious issues. Although an extensive statutory and regulatory framework for gender equality was established and despite the fact that specific equity targets are set, it is evident that much more needs to be done to facilitate women empowerment in the local government sector. The purpose of this article is to reflect on findings of an empirical survey conducted amongst female politicians, managers, and experts in the local government sector with the aim to design the parameters of a competency framework for women empowerment. The results support the fact that a women empowerment competency framework should incorporate various dimensions and elements, notably sector-specific job requirements, registered gender-based formal programs in the tertiary education sector, as well as content of women empowerment initiatives taken by non-governmental organizations.

Objective Neovascular age-related macular degeneration (nAMD) causes damage to the macula and severe vision loss. Bevacizumab is the most cost-effective nAMD treatment. The TANDEM trial was designed to determine whether, in patients with nAMD, low-dose bevacizumab is non-inferior to the standard dose in terms of visual deterioration and whether a bimonthly regimen is non-inferior to monthly, treatment as required, regimens.Methods This was a multicentre, 2×2 factorial, double-masked, non-inferiority randomised trial with patients considered eligible if they met the National Institute for Health and Care Excellence criteria for nAMD treatment with ranibizumab. Participants were randomly assigned to standard (1.25 mg) or low (0.625 mg) dose bevacizumab and either monthly or bimonthly review regimen. The primary outcome was time to vision deterioration, defined as reduction of ≥15 letters (three lines) during the loading phase (visual acuity scores at visits B and C compared with the initial visit A), or ≥6 letters (one line) during the maintenance phase (visual acuity scores at subsequent visits compared with mean vision at visits A–C).Results In total 812 participants (918 eyes) were randomised into the trial. The low dose showed some evidence of being non-inferior to standard dose (HR 1.07; 95% CI 0.80 to 1.42), however, there was no strong evidence of bimonthly review being non-inferior to monthly review (HR 1.45; 95% CI 1.09 to 1.94). There was no difference in visual acuity when assessed at 9 months and no major differences in the frequency of serious adverse events or reactions between the groups.Conclusion The standard dose of bevacizumab can be halved without compromising efficacy. Bimonthly review cannot be considered to be no worse than monthly review.

With the onset of the coronavirus-19 (COVID-19) pandemic, we transformed an in-person art museum-based course for medical students into an online format. This brought new challenges but offered unexpected advantages. The course included daily close-looking of artworks using the Visual Thinking Strategies method, group arts-based activities, reflective writing, and independent creating assignments. The virtual format allowed us to incorporate important features that were unavailable in our in-person elective: multi-media activities, access to nearly unlimited international works of art, and personal reflection from one's private space. As instructors, the experience enlightened us on the value of online arts-based teaching.

This study was carried out to analyze the concentrations of some atmospheric pollutants in some parts of Imo State, southeastern Nigeria using statistical techniques. In the present study, PM10, NO2, SO2, CO, VOC and H2S in some parts of Imo State Southeastern Nigeria were analyzed to determine their presence, concentrations and possible sources of emission. This study also tried to establish possible relationship between pollutants spatial variation and dispersion with industrial and anthropogenic activities within the study area. The study area includes Egbema, Orlu, Okigwe and Orlu areas of Imo State, Nigeria. Air quality data was collected three times a day (morning, afternoon and evening) using the Gasman Air Monitors which was specifically used for SO2, NO2 and CO measurements, the Haze-dust Particulate Monitor 10 µm was used for PM10 data acquisition. Similarly, the Aeroqual Gas Monitor Model 300 was used for H2S measurement while the Ibrid MX6 Gas Monitor was used for VOC measurement. Results of the study revealed that the mean PM10 and CO levels in the locations exceeded the 24 h limit of 150 µg/m3 and 35 ppm of the United States National Ambient Air Quality Standards (US NAAQS) respectively. In addition, the mean concentrations of NO2 was above the annual limit of 0.053 ppm as prescribed by US NAAAQS, while the mean values of SO2 were within the annual and 1–hour limits of 0.5 ppm and 0.075 ppm respectively as stipulated by the US NAAQS. Whereas significant concentrations of H2S were not detected in the various locations, elevated concentration of VOC were recorded within Egbema area indicating possible influence from gas flaring and other crude oil related activities. The ANOVA and Box and Whisker plots revealed remarkable variations of the air pollutant concentrations in the study area. In addition, while the Hierarchical Cluster Analysis (HCA) grouped the pollutants into one major group, Principal Component Analysis (PCA) further grouped them into one coherent component indicating similar source of emission. The findings of this study therefore showed the need for regular air quality monitoring of the area to forestall adverse environmental problems. Keywords: Statistical analyses, Atmospheric pollution, Wind rose, Particulate matter, Imo State

The purpose of this article is to reflect on the findings of a local government sector-wide technical skills audit. A mixed-method research design was followed in both a positivist and interpretivist scientific paradigm to conduct the survey in local, district and metropolitan municipalities. Quantitative and qualitative data were processed and thematic analyses were done per respondent and participant category to obtain rich descriptions of current technical skills challenges and skills development priorities in local government. From the empirical survey it is evident that significant technical skills shortages exist, especially in rural district and local municipalities. This severely compromises the delivery of the four basic technical services, namely water provisioning, waste management, sanitation and sewerage, and electricity.

Public infrastructure investment is believed to be one of the key factors in addressing South Africa

Interference from spoken language can hinder adult learners’ reading, so it is helpful for tutors to be aware of differences between spoken and written syntax. Study of the incidence of ellipsis in two adult learners’ conversational language demonstrates the absence of most forms of coordination and subordination ellipsis typical of writing, and the frequent omission of subordinators, including the total absence of that relatives from one informant’s corpus. Examples of typically spoken situational ellipsis draw attention to the different locus of reference (situational or textual) in spoken and written ellipsis, and therefore the different strategy of interpretation required in reading. It is also shown that the use and non-use of ellipsis often have communicative functions in the dialogues that reflect linguistic skills rather than sloppiness or incompetence. Implications for tuition are suggested.

Clinical excellence is the goal in healthcare delivery, at both the provider and system level. At Johns Hopkins University School of Medicine, The Miller Coulson Academy of Clinical Excellence (MCACE) was established to celebrate and promote clinical excellence in hopes of optimizing the care experienced by patients. The MCACE describes clinical excellence as achieving a level of mastery in several areas including, but not limited to, communication and interpersonal skills, professionalism and humanism, diagnostic acumen, and negotiation of the healthcare system. The Academy's definition also puts an emphasis on teaching others to serve our patients and being a role model for clinical excellence. To have a positive influence on those beyond their immediate reach at Hopkins, the MCACE team launched CLOSLER, a free and open access medical education website (closler.org). With the goal of sharing thoughtful clinical stories and perspectives to stimulate reflection about providing exceptional care to every patient, CLOSLER takes its name from William Osler, the founder of academic medicine in the United States and an early champion of patient-centered care worldwide. CLOSLER offers articles written by healthcare professionals relaying pearls and lessons from practice for all, organized into four sections: Connecting with Patients, Clinical Reasoning, Passion in the Medical Profession, and Lifelong Learning in Clinical Excellence. CLOSLER has ushered in a new era of education that can help to move us closer to Osler and clinical excellence; it pushes the perspectives of outstanding role models to all who are interested in developing in this realm.

The decline in the world economy that followed the 2008-2009 global economic crisis had detrimental effects on most economies. Not enough attention has been paid to the process through which crisis-related pressures affected regional economies and sub-national governments. A regional computable general equilibrium model was developed to analyse impacts of the crisis on the regional economy of the Free State province in South Africa. Key results included a general fall in prices in the province, a fall in demand in sectors that are more vulnerable to global conditions, falling wages and declining incomes for agents and provincial government.

Introduction: The authors conducted a review of the literature to identify curricula that incorporate the visual arts into undergraduate, graduate, and continuing medical education to facilitate the teaching of clinical excellence. Methods: The authors searched the PubMed and ERIC electronic databases in May 2017, using search terms such as "paintings," "visual arts," and "medical education," along with terms corresponding to previously defined domains of clinical excellence. Search results were reviewed to select articles published in the highest impact general medicine and medical education journals describing the use of visual arts to teach clinical excellence to all levels of medical trainees and practicing physicians. Results: Fifteen articles met inclusion criteria. Each article addressed at least one of the following clinical excellence domains: communication and interpersonal skills, humanism and professionalism, diagnostic acumen, and knowledge. No articles described the use of the visual arts to teach the skillful negotiation of the health care system, a scholarly approach to clinical practice, or a passion for patient care. Conclusions: This review supports the use of visual arts in medical education to facilitate the teaching of clinical excellence. However, research designed specifically to evaluate the impact of the visual arts on clinical excellence outcomes is needed.

The prevalence of burnout among physicians in the United States now exceeds 50%, with many physicians feeling isolated and lacking in a sense of community. Book clubs among colleagues may be one way to foster community and restore joy to medicine. The authors introduced two book clubs at the annual meetings of the Society for General Internal Medicine (SGIM) and the Association for Academic Psychiatry (AAP). Response rates for completed surveys for the SGIM and AAP book clubs were 71% and 86%, respectively. About half of the book club participants were already members of a book club, and had read an average of 10 non-medical books in the past year. Eighty-one percent reported the discussions had "a lot" or "tremendous" impact on their learning, and that they would be "likely" or "very likely" to look for a non-medical book in the future as a resource to assist in their professional growth. Sixty-seven percent said they would be "likely" or "very likely" to organize their own book club. Participants listed the "most enjoyable and/or impactful non-medical book read in past year." Survey responses speak to the impact of book club participation on attendees' professional growth, learning, and recognition of overall value of reading non-medical books. These findings support the role of the humanities in professional development to encourage physicians to challenge assumptions, tolerate ambiguity, appreciate cultural influences, and honor the unique perspectives of our patients. In the increasingly complex and challenging work environment of academic health centers, faculty must find mechanisms to maintain workplace meaning and prevent burnout. Reading a book prior to attending one's annual professional society meeting and participating in thoughtful discussions was enjoyable and useful. When facilitators are thoughtfully prepared to guide conversations, professional growth can result in useful insights related to academic practices and pursuits.

Background: Bullous pemphigoid (BP) is an autoimmune blistering skin disorder with increased morbidity and mortality in the elderly. Objectives: To evaluate the effectiveness, safety and cost-effectiveness of a strategy of initiating BP treatment with oral doxycycline or oral prednisolone. We hypothesised that starting treatment with doxycycline gives acceptable short-term blister control while conferring long-term safety advantages over starting treatment with oral prednisolone. Design: Pragmatic multicentre two-armed parallel-group randomised controlled trial with an economic evaluation. Setting: A total of 54 dermatology secondary care centres in the UK and seven in Germany. Participants: Adults with BP [three or more blisters at two sites and positive direct and/or indirect immunofluorescence (immunoglobulin G and/or complement component 3 immunofluorescence at the dermal-epidermal junction)] and able to give informed consent. Interventions: Participants were allocated using online randomisation to initial doxycycline treatment (200 mg/day) or prednisolone (0.5 mg/kg/day). Up to 30 g/week of potent topical corticosteroids was permitted for weeks 1–3. After 6 weeks, clinicians could switch treatments or alter the prednisolone dose as per normal practice. Main outcome measures: Primary outcomes: (1) the proportion of participants with three or fewer blisters at 6 weeks (investigator blinded) and (2) the proportion with severe, life-threatening and fatal treatment-related events at 52 weeks. A regression model was used in the analysis adjusting for baseline disease severity, age and Karnofsky score, with missing data imputed. Secondary outcomes included the effectiveness of blister control after 6 weeks, relapses, related adverse events and quality of life. The economic evaluation involved bivariate regression of costs and quality-adjusted life-years (QALYs) from a NHS perspective. Results: In total, 132 patients were randomised to doxycycline and 121 to prednisolone. The mean patient age was 77.7 years and baseline severity was as follows: mild 31.6% (three to nine blisters), moderate 39.1% (10–30 blisters) and severe 29.3% (> 30 blisters). For those starting on doxycycline, 83 out of 112 (74.1%) had three or fewer blisters at 6 weeks, whereas for those starting on prednisolone 92 out of 101 (91.1%) had three or fewer blisters at 6 weeks, an adjusted difference of 18.6% in favour of prednisolone [90% confidence interval (CI) 11.1% to 26.1%], using a modified intention-to-treat (mITT) analysis. Per-protocol analysis showed similar results: 74.4% compared with 92.3%, an adjusted difference of 18.7% (90% CI 9.8% to 27.6%). The rate of related severe, life-threatening and fatal events at 52 weeks was 18.2% for those started on doxycycline and 36.6% for those started on prednisolone (mITT analysis), an adjusted difference of 19.0% (95% CI 7.9% to 30.1%; p = 0.001) in favour of doxycycline. Secondary outcomes showed consistent findings. There was no significant difference in costs or QALYs per patient at 1 year between doxycycline-initiated therapy and prednisolone-initiated therapy (incremental cost of doxycycline-initiated therapy £959, 95% CI –£24 to £1941; incremental QALYs of doxycycline-initiated therapy –0.024, 95% CI –0.088 to 0.041). Using a willingness-to-pay criterion of

To describe the differences between clients presenting after rape and clients who have consented to sex as a minor to an SGBV clinic in Harare, Zimbabwe, and how these differences affect their care requirements.Adolescents and adults presenting at the specialized Sexual and Gender Based Violence clinic in Harare are offered a standardised package of free medical and psychosocial care. Zimbabwe has an HIV prevalence of 14%, so prevention of HIV infection using PEP for those that present within 72 hours is a key part of the response. STI treatment, emergency contraceptive pills, referral for termination of pregnancy, psychological, social and legal support is also provided.This is a retrospective descriptive study of routine programmatic data collected at the Edith Opperman polyclinic in Mbare SGBV clinic from 2011 to 2014. Chi-square tests and logistic regression were used to describe the different experiences and the differences in uptake of care between clients presenting for rape compared to those who consented to sex as a minor.During the study period a total of 3617 clients presented to the clinic. 2242 (62%) sought care after rape, 602 (17%) for having consented to sex as a minor and 395 (11%) for suspected sexual abuse. 1615 (45%) of people presenting were 12-15 year olds. Minors who consented to sex compared to survivors of rape were less likely to report within 72 hours- 156 (26%) vs 894 (40%) p

Background and Objective. Evaluation of dental attrition is an easy and relatively accurate approach to estimating the age of an adult either ante- or postmortem for some specific population. Dental attrition represents a progressive physiological age change that can be measured using variety of indices to aid as an adjunct in forensic age estimation. Some of the previously proposed indices have their own practical limitations. This paper focuses on using modified Kim’s criteria to score dental attrition to estimate the age of Chinese Malaysian adults and validate it. Methodology. Tooth wear was evaluated on 190 dental models of Chinese Malaysian adults (age range: 20–60 years) using modified Kim’s index to custom-derive a population specific linear equation. The same equation was validated further on new 60 dental casts. Results and Conclusion. Regression analysis revealed good correlation between age and teeth wear and lower standard error of estimate. Test of regression on a test sample (n=30 pairs, age range: 20–60 years) showed insignificant difference between predicted versus the actual age with statistically acceptable mean absolute difference. These data suggest that modified Kim’s index can be used effectively in forensic age estimation.

Retrocaval ureter is a rare congenital anomaly which has a incidence of occurence of one in 1500 live births. It is known to occur 2.8 times more commonly in males than females. While carrying out a study on congenital anomalies in urinary system in a collection of still born fetuses, a case of retrocaval ureter was noticed in a still born male foetus. In Retrocaval ureter, ureter is S shaped on the right side and a part of inferior vena cava is anterior to the proximal part of the ureter. Here the development of ureter is normal. Whereas the development of inferior vena cava is abnormal.