Durability and cross-reactivity of SARS-CoV-2 mRNA vaccine in adolescent children

Importance: Emergent SARS-CoV-2 variants and waning humoral immunity in vaccinated individuals are causing increased infections and hospitalizations. Children are not spared from infection nor complications of COVID-19, and the recent recommendation for boosters in individuals ages 12 years or older calls for broader understanding of the adolescent immune profile after mRNA vaccination. Objective: We sought to test the durability and cross-reactivity of anti-SARS-CoV-2 serologic responses over a six-month time course in vaccinated adolescents against the wildtype and Omicron antigens. Design, Setting and Participants: Adolescents who received a full (two-dose) series of the Pfizer-BioNTech mRNA vaccination participated in this longitudinal cohort study from May 2021 to January 2022. Blood samples were collected in clinical settings from thirty-one adolescents, nineteen of whom provided samples at four timepoints (prior to vaccination, two to three weeks after first dose, two to four weeks after second dose and six months after complete series). Sera were analyzed for antibody responses against wildtype and Omicron variant SARS-CoV-2-specific proteins. Main Outcomes and Measures: The main outcome was to analyze vaccine-induced immune responses over time by ELISA, as well as their cross-reactivity between antibody responses against wildtype SARS-CoV-2 and the Omicron variant of concern. Results: Thirty-one adolescents provided a blood sample for at least one timepoint. The median age of the cohort was 13.9 years. Half of the cohort was male, and one quarter of the population was Hispanic. Anti-Spike and anti-RBD antibodies waned after six months, nearing pre-vaccination levels. After the second dose of the vaccine, adolescent children displayed equal sensitivity for the Omicron-RBD and wildtype SARS-CoV-2-RBD, as well as an upward trend of Omicron-reactive antibodies six months after vaccination. Waning mRNA vaccine-induced immunity in adolescents highlights a vulnerability in pediatric protection against SARS-CoV-2 infection. Conclusions and Relevance: Vaccine-induced immunity wanes in adolescents over time to near pre-vaccinated levels. Cross-reactivity of antibodies generated by adolescents display efficacy against Omicron. These findings highlight the need for SARS-CoV-2 boosters to protect adolescents from highly infectious variants, illness and post-COVID-19 complications.

Corporate Capacity

This chapter examines the ultra vires doctrine, under which the capacity of companies used to be limited by the objects stated in their memorandum. This doctrine could be justified through a concession style argument as well as through contractual analysis. The doctrine, however, proved unsuitable for the operation of commercial organizations. These organizations need flexibility, and the law adapted to the requirements of organizational action and now mandates that all non-charitable companies have unlimited capacity. The chapter then analyses the recent recommendation for companies to set themselves a purpose discouraging them form making the generation of financial return their primary objective. It argues that the programmatic statement of a corporate purpose is likely to bring about only cosmetic changes. If there is a desire for wider aims to be integrated into corporate decisions these would have to be institutionalized. This can be achieved, for example, by identifying a board member to represent these interests on the board.

Examining Diagnostic Options and Classification Systems Available for Endometriosis

Introduction: Endometriosis is characterised by the presence of endometrium-like tissue outside the uterus, and is often associated with chronic pelvic pain, infertility, and compromised quality of life. Development of reliable methods of early diagnosis, staging, and classification of endometriosis would allow for restriction of disease progression by its early detection and strategising towards its early treatment and management. Diagnostic options: Typically, diagnosis and staging of endometriosis include a history and physical examination followed by clinical, imaging, and laparoscopic findings. Surgical inspection of lesions at laparoscopy with histological confirmation remains the most reliable procedure towards the detection of endometriosis and its classification. Although there are many putative peripheral biomarkers having potential diagnostic values for endometriosis, further studies are necessary for their validation. Classification systems: Based on anatomical, clinical, imaging, and several pathophysiological findings, various classifications and staging systems of endometriosis, e.g., revised American Society for Reproductive Medicine (rASRM), ENZIAN, Endometriosis Fertility Index (EFI) and Foci–Ovarian endometrioma–Adhesion–Tubal endometriosis–Inflammation (FOATI) scoring systems, have so far been postulated. However, there is no fool-proof diagnostic and classification approach available for the disease due to the general failure of current systems to reflect reproducible correlation with the major symptoms of endometriosis. Conclusion: A ‘toolbox approach’, using all the available diagnostic and classification systems maximising the information available to healthcare providers and females, is a recent recommendation. Development of collaborative research networks for the harmonisation of patient information, biological sample collection, and its storage, and that of methodological and analytical tools in a wider patient base is necessary to discover reliable leads for future diagnostic options and a classification system for endometriosis.

Suboptimal Selective Service: An Analysis of the Obstacles to Selective Service Reform in American Political Institutions

Expanding mandatory selective service registration in the United States to include women would seem to be good public policy that increases national security and reduces gender bias. Despite the recent recommendation of a congressionally-mandated commission, recent efforts to implement this important reform have repeatedly stalled. Why? In this article, we explain the failure of selective service reform through the lens of American political institutions. Neither the composition of the Supreme Court, nor the institutional incentives facing legislators, are conducive to movement on this issue. Building on the legislative entrepreneurship literature, we argue that recent trends in congressional representation and the adoption of new issue framings are the most likely factors that will increase the probability of selective service reform. The absence of selective service reform in the United States reveals important facts about agenda-setting in defense policy and how political institutions shape the relationship between the public and the military.

Metabolic syndrome in individuals suffering from multiple sclerosis: Why we should not blame the patients

Multiple sclerosis (MS) is a progressive inflammatory disease of the central nervous system that normally leads to impairment and persistent disability at a rather early age. The observation that physical stress can lead to the onset of reversible neurological symptoms has in the past led to patients being discouraged from doing sports. We investigated the current status of research and conclude that this advice may be as incorrect for a majority of MS patients as recent recommendation which encourage individuals with MS to engage in all kinds of physical activity.

Microbiome differential abundance methods produce disturbingly different results across 38 datasets

Identifying differentially abundant microbes is a common goal of microbiome studies. Multiple methods have been applied for this purpose, which are largely used interchangeably in the literature. Although it has been observed that these tools can produce different results, there have been very few large-scale comparisons to describe the scale and significance of these differences. In addition, it is challenging for microbiome researchers to know which differential abundance tools are appropriate for their study and how these tools compare to one another. Here, we have investigated these questions by analyzing 38 16S rRNA gene datasets with two sample groups for differential abundance testing. We tested for differences in amplicon sequence variants and operational taxonomic units (referred to as ASVs for simplicity) between these groups with 14 commonly used differential abundance tools. Our findings confirmed that these tools identified drastically different numbers and sets of significant ASVs, however, for many tools the number of features identified correlated with aspects of the tested study data, such as sample size, sequencing depth, and effect size of community differences. We also found that the ASVs identified by each method were dependent on whether the abundance tables were prevalence-filtered before testing. ALDEx2 and ANCOM produced the most consistent results across studies and agreed best with the intersect of results from different approaches. In contrast, several methods, such as LEfSe, limma voom, and edgeR, produced inconsistent results and in some cases were unable to control the false discovery rate. In addition to these observations, we were unable to find supporting evidence for a recent recommendation that limma voom, corncob, and DESeq2 are more reliable overall compared with other methods. Although ALDEx2 and ANCOM are two promising conservative methods, we argue that those researchers requiring more sensitive methods should use a consensus approach based on multiple differential abundance methods to help ensure robust biological interpretations.

Pemberian Dini Vasopresor pada Syok Sepsis

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection and become one of leading causes of death in Intensive Care Unit (ICU). The two components of treating sepsis shock are fluid resuscitation and administration of vasopressor. Early administration of vasopressor in conjunction with fluid administration can reduce mortality because it reduces the volume of resuscitation so as to prevent excess fluid in the patient. Recent recommendation from Surviving Sepsis Campaign (SSC) suggest fluid resuscitation and medication within the first 1 hour including vasopressor administration in concomitant life-threatening cases of hyptension or immediately after fluid resuscitation to maintain MAP level ≥ 65mmHg. Holistic treatment will reduce the mortality of patient with sepsis shock in the ICU

Mandatory universal use of cloth mask for prevention of coronavirus disease 2019 transmission

Since the outbreak in Wuhan City, China, in late December 2019, the Coronavirus Disease 2019 (COVID-19) has spread to nearly the whole world, so that it was declared a pandemic by the Word Health Organization. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative organism of COVID-19, is extremely infectious and can adhere to droplet nuclei of < 5 mm diameter and become airborne (aerosol). Since COVID-19 was declared a pandemic, there has been controversy on the use of cloth masks by the public, because of the still inconclusive evidence of the efficacy of cloth masks in protecting against COVID-19 transmission. Universal masking as a healthcare intervention in the community is currently made mandatory by local governments of most countries, since they follow the recent recommendation by the World Health Organization. The issuing of the WHO recommendation on the public use of masks was based on a study demonstrating that COVID-19 transmission does not occur only through droplets but also through aerosols. In addition, there was a study showing that COVID-19 transmission does not only occur from patients with clinical symptoms but also through asymptomatic and pre-symptomatic subjects, so that universal masking is of benefit in providing protection when used by healthy people and as source control to prevent cross-transmission to other people. This review article aims to discuss the mechanism of COVID-19 transmission, the evidence related to the efficacy of cloth masks, and the guidelines related to the selection and use of masks by the general population.

A STUDY OF ETIOLOGICAL AND CLINICAL PROFILE OF ACUTE SYMPTOMATIC SEIZURES IN ADULTS

The word seizure is derived from Latin word “Sacire” meaning ‘to take possession of’. Seizure disorders are found Epilepsy can be broadly divided into idiopathic and symptomatic disorders. Idiopathic epilepsies are not associated with brain lesions or neurological abnormalities. They tend to be self limited and often respond well to antiepileptic therapy.An acute symptomatic seizure was defined in a recent recommendation from the International League Against Epilepsy (ILAE ) as a clinical seizure occurring in close temporal relationship with an acute central nervous system insult which may be metabolic, toxic, infectious or inflammatory. Seizures are common disorders found all over the that may require urgent attention and treatment to reverse world and are encountered frequently during medical potentially damaging causes. Such seizures are practice in variety of settings. Annually approximately considered to be an acute manifestation of the insult and 150,000 adults will present with a first seizure in the may not recur when the underlying cause has been United State1. India is home to about 10 million people removed or the acute phase has elapsed. The knowledge with epilepsy (prevalence of about 1%). An epileptic of the etiologic risk factors of acute symptomatic seizures seizure is an episode of neurologic dysfunction in which in third-world countries will invariably contribute to the abnormal neuronal firing is manifest clinically by changes effort aimed at preventing and managing medical conditions frequently complicated by seizures. The differential diagnosis of a single seizure includes psychogenic non-epileptic events, cardiac and neurogenic syncope, transient ischemic attacks, sleep disorders, and panic attacks.

A Survey on Recent Recommendation Systems for the Tourism Industry

Data mining is an important field that derives insights from the data and recommendation systems. Recommendation systems have become common in recent years in the field of tourism. These are widely used as a tool that can input various selection criteria and user preferences and yields travel recommendations to tourists. User's style and preferences should be constructed accurately so as to supply most relevant suggestions. Researchers proposed various types of tourism recommendation systems (TRS) in order to improve the accuracy and user satisfaction. In this chapter, the authors studied the current state of tourism recommendation system models and discussed their preference criteria. As a part of that, the authors studied various important preference factors in TRS and categorized them based on their likeness. This chapter reports TRS model future directions and compiles a comprehensive reference list to assist researchers.