Hand, foot and mouth disease: First vaccine.


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The first vaccine which protects children against hand, foot and mouth disease has been reported by scientists in China.

The infection causes a rash and painful blisters, but in some cases results in brain infections which can be fatal.

A trial involving 10,000 children, published in the Lancet, showed the vaccine was 90% effective against one virus which causes the disease.

It does not protect against other viruses that result in the disease.

Viruses can cause large outbreaks of hand, foot and mouth disease. In 2009, there was an outbreak in China involving 1.2 million people. Nearly 14,000 people had severe complications and 353 people died.

Groups of researchers in Jiangsu province and Beijing tested a vaccine made from a deactivated enterovirus 71 (EV71), which causes the disease.

Two jabs were given to children between six and 35 months old. They prevented 90% of cases of hand, foot and mouth disease caused by EV71.

“Infection with EV71 is of particular concern because it can cause severe disease and even death in children. The EV71 vaccine could help prevent hospital admissions and severe cases,” the researchers said.

Hand, foot and mouth disease is caused by many other viruses, such as Coxsackievirus A16 and even other strains of EV71, so this vaccine could not eliminate the disease.

The researchers themselves warn that: “The EV71 vaccine might have little part in reducing the overall incidence of HFMD, even by universal mass immunisation of children.”

Commenting on the research, Dr Nigel Crawford and Dr Steve Graham, both from the University of Melbourne, said the vaccine was tailored to the predominant strain in China.

“The major effect of this vaccine will be to reduce hospital admission, which is an important result of many vaccines.

“The next step is to assess the appropriateness of including an EV71 vaccine in China’s national immunisation programme.”

 

Source: BBC

Nuking Dangerous Asteroids Might Be the Best Protection, Expert Says.


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If a dangerous asteroid appears to be on a collision course for Earth, one option is to send a spacecraft to destroy it with a nuclear warhead. Such a mission, which would cost about $1 billion, could be developed from work NASA is already funding, a prominent asteroid defense expert says.

Bong Wie, director of the Asteroid Deflection Research Center at Iowa State University, described the system his team is developing to attendees at the International Space Development Conference in La Jolla, Calif., on May 23. The annual National Space Society gathering attracted hundreds from the space industry around the world.

An anti-asteroid spacecraft would deliver a nuclear warhead to destroy an incoming threat before it could reach Earth, Wie said. The two-section spacecraft would consist of a kinetic energy impactor that would separate before arrival and blast a crater in the asteroid. The other half of the spacecraft would carry the nuclear weapon, which would then explode inside the crater after the vehicle impacted.

The goal would be to fragment the asteroid into many pieces, which would then disperse along separate trajectories. Wie believes that up to 99 percent or more of the asteroid pieces could end up missing the Earth, greatly limiting the impact on the planet. Of those that do reach our world, many would burn up in the atmosphere and pose no threat.

Wie’s study has focused on providing the capability to respond to a threatening asteroid on short notices of a year or so. The plan would be to have two spacecraft on standby — one primary, the other backup — that could be launched on Delta 4 rockets. If the first spacecraft failed on launch or didn’t fragment the asteroid, the second would be sent aloft to finish the job.

 

 

Bong Wie, director of the Asteroid Deflection Research Center at Iowa State University, described the system his team is developing to attendees at the International Space Development Conference in La Jolla, Calif., on May 23. The annual National Space Society gathering attracted hundreds from the space industry around the world.

An anti-asteroid spacecraft would deliver a nuclear warhead to destroy an incoming threat before it could reach Earth, Wie said. The two-section spacecraft would consist of a kinetic energy impactor that would separate before arrival and blast a crater in the asteroid. The other half of the spacecraft would carry the nuclear weapon, which would then explode inside the crater after the vehicle impacted. [Gallery: Potentially Dangerous Asteroids]

The goal would be to fragment the asteroid into many pieces, which would then disperse along separate trajectories. Wie believes that up to 99 percent or more of the asteroid pieces could end up missing the Earth, greatly limiting the impact on the planet. Of those that do reach our world, many would burn up in the atmosphere and pose no threat.

Wie’s study has focused on providing the capability to respond to a threatening asteroid on short notices of a year or so. The plan would be to have two spacecraft on standby — one primary, the other backup — that could be launched on Delta 4 rockets. If the first spacecraft failed on launch or didn’t fragment the asteroid, the second would be sent aloft to finish the job.

Political fallout

Wie admitted that sending nuclear weapons into space would be politically controversial. However, he said there are a number of safety features that could be built into the spacecraft to prevent the nuclear warhead from detonating in the event of a launch failure.

A nuclear weapon is the only thing that would work against an asteroid on short notice, Wie added. Other systems designed to divert an asteroid such as tugboats, gravity tractors, solar sails and mass drivers would require 10 or 20 years of advance notice.

Much of the technology for the mission has already been successfully demonstrated in flight, Wie said. NASA’s Deep Impact spacecraft sent a kinetic impactor to collide with Comet Tempel 1 on July 4, 2005. Four years later, the space agency sent a Centaur upper stage crashing into the moon during theLCROSS mission (Lunar Crater Observation and Sensing Satellite), followed by a sub-satellite that photographed the impact before crashing into the surface itself.

Funding the mission

Wie’s work has been funded under the NASA Innovative Advanced Concepts (NIAC) program. He received a $100,000 Phase I grant for 2011-2012 and then a Phase II grant worth $500,000 for 2012-2014.

NIAC doesn’t provide any additional funding after Phase II, so Wie will have to convince some agency — whether it be NASA or the Department of Defense — to fund the program through completion. This could be a difficult issue because there is no one agency in charge of planetary defense, he said.

The first step would be a $500 million flight validation mission that would target an asteroid approximately 50 meters in size. A nuclear weapon probably would not be required to destroy a body of that size, Wie said.

The point would be to demonstrate the capability to accurately target an asteroid that small, something that neither Deep Impact nor LCROSS accomplished. Accurately hitting a larger, more threatening asteroid would be easier.

Source: SPACE.com

 

Getting Better All The Time.


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New Delhi, India

Halfway through the first day of my India trip, TV personality Prannoy Roy told a story I think really highlights the progress of India’s long journey to better health.

We were filming a question-and-answer segment in front of a studio audience for his show on New Delhi Television, one of India’s largest news networks. Prannoy was asking me and Bollywood star Aamir Khan about philanthropy, health, and India’s development when he recounted a discussion he had about 20 years ago. A former prime minister asked him and a group of other people what India could do to be a better country.  Prannoy said his answer – provide better toilets for women – was met with nothing but laughter.

Things have really changed. Just before seeing Prannoy, I had spent several hours in meetings with Indian parliamentarians and ministers. Our wide-ranging conversations about health and vaccines almost always returned to how to stop the spread of diseases through better sanitation and, specifically, toilets.

I was glad: the toilet is one of my favorite topics. At each meeting I got to talk about how flush toilets (ones that use water to clear the waste away through plumbing) won’t make it anytime soon to much of the world, including rural India where infrastructure is poor and water is scarce. Instead, we need to invent a better toilet, one that doesn’t use water yet eliminates harmful microbes and gets rid of any smell. Last year our foundation sponsored a “re-invent the toilet” fair where 14 universities submitted innovative answers to that problem. None were perfect but they all were a step in the right direction.

After several meetings it was clear there was strong interest in holding a similar “re-inventing the toilet” event in India early next year. We set some follow-up meetings to start figuring out how to make it happen. We agreed that applying India’s many creative minds to the sanitation problem could speed the path to a breakthrough.

In my post, “Why I’m Going to India,” I wrote that the country is an ideal place for understanding both the problems and the solutions in areas that our foundation focuses on. In my meetings yesterday, the sanitation discussions were just one example of the great optimism I felt from government leaders and health experts for overcoming the problems. I also heard about several new solutions.

A group of polio experts updated me on how India’s focus on ridding itself of that disease is paying dividends to broader health efforts. After a lot of hard work, India has been polio free since January 2011. India will be certified polio-free if there isn’t another case by next January. I’m confident we can get there. Yesterday the experts walked me through how they are using satellite mapping to not only see where they need to provide the polio vaccine but also to expand the country’s system of routine vaccinations (the vaccines children get in their early years). With satellites and cellphones we are getting far more detailed health data on hard-to-reach places. I’m convinced those tools, pioneered with polio, will be a game changer for expanding routine vaccination.

I also sat down with some of India’s top scientists, public health experts and pediatricians. This group was celebrating amazing progress of the phase 3 trial of Rotavac, India’s first home-grown vaccine for rotavirus, the world’s main cause of diarrheal disease—which, after pneumonia, is the second leading killer of children under age five. I touched on rotavirus in yesterday’s post but it’s worth emphasizing again. The work the group did to create the vaccine, and run a very high quality trial is nothing short of phenomenal. Rotavac is a rare global collaboration among the Indian government, vaccine manufacturer Bharat Biotech, and others including PATH, the U.S. Centers for Disease Control and Prevention and the National Institutes of Health. Our foundation provided grants to support the work.The next milestone is to get the vaccine licensed by Indian authorities.

Dr. M.K. “Raj” Bhan, former secretary of India’s Department of Biotechnology and a pediatrician who shepherded the vaccine’s creation, told me that he expects the vaccine to clear India’s regulators by the end of the year, an estimate the country’s minister of health echoed later in the day. That means that India could start introducing the vaccine next year and start saving tens of thousands of kids’ lives a year.

In answering the prime minister two decades ago, Prannoy, our TV interviewer, pointed to a health problem that India still hasn’t fixed. Yet things are absolutely getting better. Since that time, India’s child mortality has dropped 45%, better than 35% for the world as a whole. With every visit to the country I see how India will drop that further as it gradually solves its health issues. An official I met at India’s Planning Commission yesterday described how India is “slow and deliberate” and ultimately successful in working through challenges. “That’s what this country is all about: finding a way,” she told me.

Today I’ll see another example of how India is finding a way when I visit a research center using old and new technologies to help boost agriculture productivity and fight malnutrition.

Source: http://www.thegatesnotes.com

Natural History of Combined Aortic Stenosis and Aortic Regurgitation.


In a prospective case series, event rates were high and unrelated to baseline severity of disease, but aortic jet velocity was a reliable predictor of outcome.

Lacking evidence-based management strategies in patients with both aortic stenosis (AS) and aortic regurgitation (AR), clinicians often follow guideline recommendations for the more-severe disorder. However, this approach has not been validated. To find out more, investigators prospectively studied disease progression and outcomes in 71 consecutive asymptomatic patients (mean age, 52; 30% women) with mixed AS and AR of at least moderate severity.

About half of the patients had bicuspid valves. At baseline, mean peak aortic jet velocity (AV-Vel) was 4.31 m/sec, and mean aortic valve area was 0.98 cm2. During long-term follow-up (mean, 8.9 years), 50 patients (71%) developed indications for aortic-valve replacement, including symptoms, progression of AS, and aortic aneurysm. Event-free survival was 82% at 1 year, 33% at 4 years, and 19% at 6 years. AV-Vel was an independent predictor of event-free survival; patients with an AV-Vel between 3.0 and 3.9 m/sec had a low event rate, but progression to a higher-velocity group (associated with a higher event rate) was common. In the 43 patients who underwent surgery, only one perioperative death and no postoperative deaths occurred.

Comment: This is among the first studies to examine the natural history of combined stenotic and regurgitant aortic valve disease. The findings suggest that asymptomatic patients can be safely followed until surgical criteria for aortic stenosis, aortic regurgitation, or aortic lesions are met; and that aortic jet velocity can be used for risk stratification. Nonetheless, as the editorialists point out, most of these patients were relatively young, the proportion of bicuspid disease was high, and the prognosis even with a low AV-Vel (3.0–3.9 m/sec) was worse than in patients with moderate AS alone. This condition warrants very close surveillance.

  Source: Journal Watch Cardiology

China: The electronic wastebasket of the world.


Guiyu, China

Did you ever wonder what happens to your old laptop or cellphone when you throw it away? Chances are some of your old electronic junk will end up in China. According to a recent United Nations report, “China now appears to be the largest e-waste dumping site in the world.” E-waste, or electronic waste, consists of everything from scrapped TVs, refrigerators and air conditioners to that old desktop computer that may be collecting dust in your closet. Many of these gadgets were initially manufactured in China. Through a strange twist of global economics, much of this electronic junk returns to China to die. “According to United Nations data, about 70% of electronic waste globally generated ended up in China,” said Ma Tianjie, a spokesman for the Beijing office of Greenpeace. “Much of [the e-waste] comes through illegal channels because under United Nations conventions, there is a specific ban on electronic waste being transferred from developed countries like the United States to countries like China and Vietnam.” For the past decade, the southeastern town of Guiyu, nestled in China’s main manufacturing zone, has been a major hub for the disposal of e-waste. Hundreds of thousands of people here have become experts at dismantling the world’s electronic junk. On seemingly every street, laborers sit on the pavement outside workshops ripping out the guts of household appliances with hammers and drills. The roads in Guiyu are lined with bundles of plastic, wires, cables and other garbage. Different components are separated based on their value and potential for re-sale. On one street sits a pile of green and gold circuit boards. On another, the metal cases of desktop computers. At times, it looks like workers are reaping some giant plastic harvest, especially when women stand on roadsides raking ankle-deep “fields” of plastic chips. In one workshop, men sliced open sacks of these plastic chips, which they then poured into large vats of fluid. They then used shovels and their bare hands to stir this synthetic stew. “We sell this plastic to Foxconn,” one of the workers said, referring to a Taiwanese company that manufactures products for many global electronics companies, including Apple, Dell and Hewlett-Packard. Dirty, dangerous work This may be one of the world’s largest informal recycling operations for electronic waste. In one family-run garage, workers seemed to specialize in sorting plastic from old televisions and cars into different baskets. “If this plastic cup has a hole in it, you throw it away,” said a man who ran the operation, pointing to a pink plastic mug. “We take it and re-sell it.” But recycling in Guiyu is dirty, dangerous work. “When recycling is done properly, it’s a good thing for the environment,” said Ma, the Greenpeace spokesman in Beijing. “But when recycling is done in primitive ways like we have seen in China with the electronic waste, it is hugely devastating for the local environment.”   According to the April 2013 U.N. report “E-Waste in China,” Guiyu suffered an “environmental calamity” as a result of the wide-scale e-waste disposal industry in the area. Much of the toxic pollution comes from burning circuit boards, plastic and copper wires, or washing them with hydrochloric acid to recover valuable metals like copper and steel. In doing so, workshops contaminate workers and the environment with toxic heavy metals like lead, beryllium and cadmium, while also releasing hydrocarbon ashes into the air, water and soil, the report said. For first-time visitors to Guiyu, the air leaves a burning sensation in the eyes and nostrils. Toxic tech Studies by the Shantou University Medical College revealed that many children tested in Guiyu had higher than average levels of lead in their blood, which can stunt the development of the brain and central nervous system. Piles of technological scrap had been dumped in a muddy field just outside of town. There, water buffalo grazed and soaked themselves in ponds surrounded by piles of electronic components with labels like Hewlett-Packard, IBM, Epson and Dell. The enormous animals casually stomped through mounds of sheet glass, which clearly had been removed from video monitors. Flat screen displays often use mercury, a highly toxic metal. “Releases of mercury can occur during the dismantling of equipment such as flat screen displays,” wrote Greenpeace, in a report titled “Toxic Tech.” “Incineration or landfilling can also result in releases of mercury to the environment…that can bioaccumulate and biomagnify to high levels in food chains, particularly in fish.” Most of the workers in Guiyu involved in the e-waste business are migrants from destitute regions of China and poorly educated. Many of them downplayed the potential damage the industry could cause to their health. They asked only to use their family names, to protect their identity. “Of course it isn’t healthy,” said Lu, a woman who was rapidly sorting plastic shards from devices like computer keyboards, remote controls and even computer mice. She and her colleagues burned plastic using lighters and blow-torches to identify different kinds of material. “But there are families that have lived here for generations … and there is little impact on their health,” she said. Several migrants said that while the work is tough, it allows them more freedom than working on factory lines where young children are not permitted to enter the premises and working hours are stringent. Used to be worse Despite the environmental degradation and toxic fumes permeating the air, many in Guiyu said that conditions have improved dramatically over the years. “I remember in 2007, when I first came here, there was a flood of trash,” said Wong, a 20-year-old man who ferried bundles of electronic waste around on a motorcycle with a trailer attached to it. “Before people were washing metals, burning things and it severely damaged people’s lungs,” Wong added. “But now, compared to before, the [authorities] have cracked down pretty hard.” But residents who did not work in the e-waste business offered a very different take on the pollution in Guiyu. A group of farmers who had migrated from neighboring Guangxi province to cultivate rice in Guiyu told CNN they did not dare drink the local well water. They claimed if they tried to wash clothes and linens with the water, it turned fabrics yellow. The head of the group, who identified himself as Zhou, had another shocking admission. “It may not sound nice, but we don’t dare eat the rice that we farm because it’s planted here with all the pollution,” Zhou said, pointing at water-logged rice paddy next to him. Asked who did eat the harvested rice, Zhou answered: “How should I know? A lot of it is sold off … they don’t dare label the rice from here as ‘grown in Guiyu.’ They’ll write that its rice from some other place.” Not that surprising considering that the latest food scandal to hit the country earlier this month is cadmium-laced rice. Officials in Guangzhou city, roughly 400 kilometers away from Guiyu, found high rates of cadmium in rice and rice products. According to the city’s Food and Drug Administration samples pulled from a local restaurant, food seller and two university canteens showed high levels of cadmium in rice and rice noodles. Officials did not specify how the contaminated rice entered the city’s food supply. CNN made several attempts to contact the Guiyu town government. Government officials refused to comment on the electronic waste issue and hung up the phone. However, it did appear that government efforts to restrict imports of foreign waste are reducing the flow of e-trash here. “Why are they stopping the garbage from reaching us?” asked one man who ran a plastic sorting workshop. “Of course it’s hurting our business,” he added. Domestic e-waste grows The Chinese government had some success regulating e-waste disposal with a “Home Appliance Old for New Rebate Program,” which was tested from 2009 to 2011. With the help of generous government subsidies, the program collected tens of millions of obsolete home appliances, according to the U.N. Even if Chinese authorities succeed in limiting smuggled supplies of foreign garbage, the U.N. warns that the country is rapidly generating its own supply of e-waste. “Domestic generation of e-waste has risen rapidly as a result of technological and economic development,” the U.N. reported. It cited statistics showing an exponential surge in sales of TV’s, refrigerators, washing machines, air conditioners and computers in China over a 16-year period. To avoid a vicious cycle of pollution, resulting from both the manufacture and disposal of appliances, Greenpeace has lobbied for manufacturers to use fewer toxic chemicals in their products. The organization also has a message for consumers who seem to swap their phones, tablets and other computer devices with increasing frequency. “Think about where your mobile phone or where your gadgets go,” said Ma, the Greenpeace activist. “When you think about changing [your phone], or buying a new product, always think about the footprint that you put on this planet.”   STORY HIGHLIGHTS

  • U.N. report: “China now appears to be the largest e-waste dumping site in the world”
  • Products originally produced in China are now finding their way back as electronic junk
  • The small town of Guiyu as been a major hub for the disposal of e-waste
  • “When recycling is done in primitive ways … it is hugely devastating for the local environment”

Source: CNN

Low C-reactive protein levels helped rule out pneumonia.


  Acute bronchitis is managed expectantly, and pneumonia is managed with antibiotics. However, accurately distinguishing these conditions, based on history and physical examination alone, is difficult. Although chest x-ray can distinguish acute bronchitis from pneumonia, it is expensive, exposes patients to radiation (often unnecessarily), and is unavailable in some settings. In this European study, investigators determined whether measuring blood C-reactive protein (CRP) and procalcitonin concentrations, in addition to history and physical examination, improved diagnostic accuracy. Among 2820 adults (mean age, 50) who presented with cough to primary care practices, chest x-ray confirmed pneumonia in 140 patients (5%). The optimum combination of history and examination findings for pneumonia was absence of runny nose and presence of breathlessness, crackles and diminished breath sounds on auscultation, tachycardia, and fever. Adding CRP level as a continuous variable resulted in significantly improved ability to predict pneumonia (multivariate odds ratio, 1.2 per 10 mg/L rise in CRP concentration). Adding CRP as a dichotomized variable (>30 mg/L as high-risk for pneumonia) yielded similar results. Of 665 patients with low probability (<2.5%) for pneumonia based on history and examination findings only, 11 (2%) actually had pneumonia. Adding CRP level reclassified 891 additional patients into the low-risk group (total, 1556); of these, 31 (2%) actually had pneumonia. Procalcitonin added no diagnostic information. Comment: In this study, adding blood CRP concentration to history and examination findings improved diagnostic accuracy for pneumonia — mainly by ruling out the infection. Of course, this approach depends on the availability of timely point-of-care CRP testing.   Source:  Journal Watch General Medicine