Irish Travellers are a Roman Catholic endogamous minority group believed to originate from the 12th century whose ethnicity was finally recognised by the Irish Government in March 2017. Latest estimates put their numbers at 40 129 on the island of Ireland, 15 000 in the United Kingdom, 6000 on Mainland Europe and 7000 in America. Nomadism and family are core features of their identity. Early and arranged marraige, frequent child bearing and consanguinity are cultural norms. Our aim was to collate current data on morbidity and mortality of Traveller children with a view to planning of services and provision of healthcare for this population in our region.
Methods
A Literature and database(s) search was conducted and relevant clinicians contacted in an effort to compile data on the complexity and heterogeneity of the moden Irish Traveller Community to inform appropriate action in the area of Traveller Child Health.
Results
Almost 50% of the Irish Traveller population are children under 15 years of age. Between 650 and 850 Traveller babies are born on the island of Ireland every year. The infant mortality rate is 3.5 times that of the general population. 10% of Traveller children are dead before their second birthday. Main causes of mortality are accidents, congenital malformations and inherited metabolic disorders. To date 93 different genetic disorders are reported, 82 of which the genetic basis is known. There are 60 founder mutations. The commonest disorders are Galactosemia, Hurler Syndome and I-Cell disease, the carrier frequency for which is 1/11,1/11 and 1/15 respectively. Our study highlights the huge disease burden imposed on these children by the combination of curcumstances of poverty, increased frequency of genetic disorders in consanguineous communities, peripatetic lifestyle,nomadic mindset, superstition, stigma and distrust and provides useful epidemiological information with particular reference to the healthcare needs of minority groups marginalised in our society.
Abstract Background Universal immunisation is the cornerstone of preventive medicine for children, The World Health Organisation (WHO) recommends diphtheria-tetanus-pertussis (DTP) vaccine administered at 6, 10 and 14 weeks of age as part of routine immunisation. However, globally, more than 17 unique DTP-containing vaccine schedules are in use. New vaccines for other diseases continue to be introduced into the infant immunisation schedule, resulting in an increasingly crowded schedule. The OptImms trial will assess whether antibody titres against pertussis and other antigens in childhood can be maintained whilst adjusting the current Expanded Programme on Immunisation (EPI) schedule to provide space for the introduction of new vaccines. Methods The OptImms studies are two randomised, five-arm, non-inferiority clinical trials in Nepal and Uganda. Infants aged 6 weeks will be randomised to one of five primary vaccination schedules based on age at first DTwP-vaccination (6 versus 8 weeks of age), number of doses in the DTwP priming series (two versus three), and spacing of priming series vaccinations (4 versus 8 weeks). Additionally, participants will be randomised to receive their DTwP booster at 9 or 12 months of age. A further sub-study will compare the co-administration of typhoid vaccine with other routine vaccines at one year of age. The primary outcome is anti-pertussis toxin IgG antibodies measured at the time of the booster dose. Secondary outcomes include antibodies against other vaccine antigens in the primary schedule and their safety. Discussion These data will provide key data to inform policy decisions on streamlining vaccination schedules in childhood. Trial registrations ISRCTN12240140 (Nepa1, 7 th January 2021) and ISRCTN6036654 (Uganda, 17 th February 2021).
In 1999, Kenya, Tanzania and Uganda signed the ‘Treaty for the Establishment of the East African Community’ (EAC), which set out a comprehensive and highly ambitious regional governance agenda. In comparison with the rest of the continent, where commitments to regional integration are often made in principle but less often operationalised in practice, the EAC can be regarded as something a ‘success’ story of regionalism in Africa. Since its (re)establishment, several key integration milestones have been met, and membership has expanded to include Rwanda, Burundi and South Sudan. In recent years, however, the relative success of the EAC has confronted a series of challenges, due to tensions and divergences between the partner-states regarding the region’s vision for comprehensive economic and political integration. In this thesis, I aim to explain: (a) why East Africa’s policy elite were motivated to (re)establish regional governance in 1999; and (b) why, in recent years, tensions and divergences have come to characterise the EAC’s regional regime. Here, I depart from dominant understandings of African regionalism, which typically appeal to concepts of clientelism and regime boosting. Instead, I situate my study of the EAC within a wider IPE literature that emphasises the broader systemic context in which regions are imagined, institutionalised and even contested. Forwarding an agent-centred constructivist framework, I argue that the EAC’s social purpose was initially tied to a particular (neoliberal) conception of globalisation as a non-negotiable economic constraint. For East Africa’s political elite, therefore, the EAC predominantly came to be imagined and institutionalised as a space to respond to the (perceived) economic and policy imperatives of globalisation through a process of market-led integration. Yet, towards the end of the 2000s, these intersubjective conceptions of globalisation weakened among the EAC’s policy community, reflecting broader systemic shifts in the global economic order. Within this context, I highlight that discursive space has emerged within the region for the espousal of more nationalist (as opposed to regional) development agendas. This, however, has resulted in tensions arising between an emerging agenda for national development planning and the EAC’s principal ambition for deep regional economic and political integration.
Abstract Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK 1 . Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.
Main Points
1. The WHO and CDC recommend that in
exceptional epidemiological
circumstances, countries may
consider extending the dosing
interval to a maximum of 42 days .
Currently, only limited data are
available on the efficacy of mRNA
COVID 19 vaccines administered
beyond the 42 day window.
2. Modelling studies suggest that
initially vaccinating a greater
number of people with a single dose
will prevent more deaths and
hospitalizations than vaccinating a
smaller number of people w ith 2
doses ; and that extending the
dosing interval shows progressive
benefit to population immunity
3. Data suggest that the second dose
should not be delayed in t hose >65
years of age or in immunosuppressed
individuals such as cancer
patients or transplant recipients
due to reduced vaccine
immunogenicity after the first
dose.
The ChAdOx1 nCoV-19 (AZD1222) vaccine has been approved for emergency use by the UK regulatory authority, Medicines and Healthcare products Regulatory Agency, with a regimen of two standard doses given with an interval of 4-12 weeks. The planned roll-out in the UK will involve vaccinating people in high-risk categories with their first dose immediately, and delivering the second dose 12 weeks later. Here, we provide both a further prespecified pooled analysis of trials of ChAdOx1 nCoV-19 and exploratory analyses of the impact on immunogenicity and efficacy of extending the interval between priming and booster doses. In addition, we show the immunogenicity and protection afforded by the first dose, before a booster dose has been offered.
To assess the quality and quantity of newly formed bone around rough-surfaced titanium subperiosteal implants stabilized with two different fixation techniques and to investigate nanoindentation as a method for measuring the elastic properties of the bone around these implants.Ten 6-month-old white rabbits were used in this study. One femur received a subperiosteal implant fixed to the bone with screws. The other femur received a subperiosteal implant stabilized with a trough (bed) in the bone area, plus fixation screws. After a 3-month healing period, the animals were sacrificed and each titanium plate was resected along with the surrounding bone. Histometric measurements of osseointegration were performed on 16 titanium plates, and 16 titanium plates were evaluated qualitatively (hardness and modulus of elasticity) with nanoindentation. A regression model was used to analyze the data.Subperiosteal implants placed into a trough performed significantly better than those placed on top of the cortical bone in terms of percentage of bone in direct contact with the titanium plate, length of new bone, and percentage of area of new bone. The mechanical properties (modulus of elasticity, hardness) of the newly formed bone above the plate measured at the microstructural level were significantly inferior to those of the mature cortical bone below the plate.Subperiosteal implants placed into a trough performed better than those placed on top of the cortical bone, but it seems that 3 months of healing is not enough to achieve optimal integration and bone maturation around them. Nanoindentation can offer valuable insight into the elastic properties of the microstructural component of the bone.
This research project aims to investigate fuel tankering practices in the aviation industry, exploring their relation to carbon emissions and evaluating the Brazilian fuel tankering scenario in comparison to global and national policies and regulations. The study recommends sustainable national measures and compares global practices for minimizing the higher emissions due to fuel tankering. The results of the study show that the Brazilian aviation industry can sustainably neutralize the carbon emissions from the fuel tankering practice. The study recommends that airlines allocate part of the savings generated to purchasing carbon credits to offset the carbon emitted. Future research should focus on all members of the aviation ecosystem and external factors, including the fuel tankering post-pandemic scenario, the development of biofuels, and the global, cross-country analysis of fuel tankering strategies and their managerial processes.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
 scale(5.56106)'%3e%3ccircle r='1'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cpath id='b' d='M.195-.98 0-1.39l-.195.408' transform='rotate(11.25)'/%3e%3cuse xlink:href='%23b' transform='rotate(22.5)'/%3e%3cuse xlink:href='%23b' transform='rotate(45)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(67.5)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='scale(-1 1)'/%3e%3c/g%3e%3cg transform='translate(0 58.787) scale(8.1434)'%3e%3ccircle r='1'/%3e%3cg id='g'%3e%3cg id='f'%3e%3cpath id='e' d='M.259.966 0 1.576l-.259-.61'/%3e%3cuse xlink:href='%23e' transform='rotate(180)'/%3e%3c/g%3e%3cuse xlink:href='%23f' transform='rotate(90)'/%3e%3c/g%3e%3cuse xlink:href='%23g' transform='rotate(30)'/%3e%3cuse xlink:href='%23g' transform='rotate(60)'/%3e%3c/g%3e%3c/g%3e%3c/svg%3e)