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Coen, Pietro G. "Mathematical models of Haemophilus influenzae type b and Neisseria meningitidis." Thesis, University of Oxford, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298260.
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Barbour, Marina Louise. "Conjugate vaccine and carriage of Haemophilus influenzae type b." Thesis, University of Oxford, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.358581.
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Dinan, Leonie Rita. "Antibody responses after Hib immunisation in premature and term infants /." Title page, table of contents and abstract only, 1998. http://web4.library.adelaide.edu.au/theses/09MPM/09mpmd583.pdf.
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Ladhani, Shamez N. "Investigations into the long-term impact of Haemophilus influenzae serptype b (Hib) immunisation on invasive H. influenzae disease, with particular emphasis on children with Hib vaccine failure." Thesis, Queen Mary, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.542039.
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Chen, Hsiang Yin. "The regulation of brown adipose tissue gene expression in HIB-1B cells." Thesis, University of Nottingham, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.575158.
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The main objective of this thesis is to contribute to our understanding of the regulation of brown adipose gene expression by examining the transcriptional regulation of the two key brown adipogenic genes, UCPl and PGCla during the initial stage of differentiation in a model brown adipocyte cell line. The principal findings were that UCP land PGC 1 a expression was induced by both forskolin and rosiglitazone, and that combination of these drugs produced a synergistic increase which required the full length promoters. These effects on UCPl and PGCla expression were partially suppressed by PKA and PPARy antagonists and results suggested that there is a cross-talk between PKA and PPARy signalling pathways. C~anges in brown adipogenic gene expression similarly provided evidence of cross-talk between PKA and PPARy signalling pathways which may explain the mechanism responsible for the synergistic effects offorskolin and rosiglitazone on UCPl expression. PPARy and CIEBPP, but not PGC 1 a overexpression, increased basal and stimulated UCP 1 mRNA. Similar results were observed with the 3.lkb UCPl-Luc reporter and co-overexpression ofPPARy with PGC 1 a markedly upregulated UCP 1 transcription in response to either forskolin or rosiglitazone. PGCla mRNA was increased in response to C/EBPP, but not PPARy overexpression and these results were confirmed using the 2.6kb PGCla-Luc reporter. PGC 1 a transcription was further up-regulated by co-overexpression of C/EBPP with PPARy in response to either forskolin or rosiglitazone. RIPl40 overexpression inhibited the effect of PG Cl a on rosiglitazone stimulated 3.lkb UCPl-Luc promoter activity. The results suggests that there are differences in transcriptional regulation between UCP 1 and PGCla promoters which indicate that the synergistic effect of cAMP and PPARy ligand stimulation on UCPl expression is a direct results of control of the PPRE and CRE on the UCPl promoter rather than indirect control though the PGCla promoter. vi
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Hadida, M. "Epidemiology of acute respiratory infections, transplacental transfer of antibodies and immunogenicity of a hib conjugate vaccine in Libyan infants." Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243199.
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Bago, Barbara Christina Barbosa. "Validação do processo de limpeza de tanque multiuso utilizado para formulação de vacinas." Universidade do Estado do Rio de Janeiro, 2010. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=2716.
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A validação de limpeza de equipamentos é requisito regulatório para assegurar que os procedimentos de limpeza removem os resíduos de produto e agente de limpeza existentes até um nível de aceitação pré-determinado, garantindo que não haja contaminação cruzada. A metodologia analítica escolhida para monitorar a ocorrência de contaminação cruzada foi a determinação de carbono orgânico total (TOC) por ser uma técnica não específica permitindo assim quantificar os resíduos antes e após o procedimento de limpeza. Para execução desta validação foi selecionado o pior caso em relação ao contaminante. A vacina Hib foi escolhida como pior caso, pois possui maior aderência ao aço inox 316L, apresentando uma menor percentagem de recuperação, quando comparada à vacina Meningite A e C, sendo respectivamente de 93,0% e 98,4% para o tempo de extração de 30 segundos e 67,8% e 72,6% para o tempo de extração de 10 segundos. O resíduo aceitável de produto em água de rinsagem foi de 0,0007 g/mL de polissacarídeo (0,49 g/mL de TOC) e em swab foi de 0,006 g/mL de polissacarídeo (3,49 g/mL de TOC). As amostras retiradas para determinação de resíduo de produto foram analisadas e corrigidas pelo fator de recuperação deste resíduo para amostras de água de rinsagem que é de 98,5% e para amostras em swab que é de 98,4%. Já o resíduo aceitável para agente de limpeza (NaOH) foi de 3,5 g/mL que fornece um pH de 9,94, porém não existem evidências que a concentração calculada de resíduo de NaOH não interferirá quimicamente ao entrar em contato com a vacina. Assim o critério adotado foi o mesmo da água para injetáveis, segundo USP que é pH entre 5 e 7. As amostras retiradas para determinação de resíduo de agente de limpeza não foram corrigidas pelo fator de recuperação uma vez que o critério utilizado é muito mais crítico que o calculado.
Todas as análises realizadas apresentaram resultados dentro dos parâmetros aceitáveis permitindo a conclusão de que o procedimento de limpeza para tanque de aço inox 316L é eficiente removendo os resíduos até níveis aceitáveis, evitando assim uma contaminação cruzadaThe cleaning validation of equipments is a regulatory requirement to ensure that the procedure to remove residues of the product and the cleaning agent to a level of acceptance, ensuring no cross contamination. The analytical methodology chose to monitor the occurrence of cross-contamination was the determination of total organic carbon (TOC) as it is a non-specific technique allowing to quantify the residues before and after the cleaning procedure. For the execution of the validation it was selected the worst case regarding contaminant. The Hib vaccine was chosen as the worst case because it has greater adherence to stainless steel 316L, with a lower percentage of recovery when compared to vaccine meningitis A and C, being respectively 93.0% and 98.4% for the extraction time of 30 seconds and 67.8% and 72.6% for the extraction time of 10 seconds. The considered acceptable product residue in the rinsing water was 0.0007 mg/mL of polysaccharide (0.48 mg/mL of TOC) and in swab it was 0.006 mg/mL of polysaccharide (3.49 mg/mL of TOC). Samples took for determination of residual product has been analyzed and corrected by the recovery factor for this waste water samples by rinsing which is 98.5% and for samples in swab that is 98.4%. The acceptable residue for the cleaning agent (NaOH) was 3.512 mg/mL which provides a pH of 9.94, but there is no evidence that the concentration of residual NaOH does not chemically interfere in contact with the vaccine. Thus, the criterion used was the same as for water for injection, according to USP, that is between pH 5 and 7. Samples took for the determination of residual cleaning agent were not corrected by the recovery factor because the criterion used is much more critical than that calculated. All the analysis results were within the acceptable parameters allowing to conclude that the cleaning procedure for 316L stainless steel tank was effective, removing the waste to acceptable levels, thus, preventing from cross-contamination
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Martins, Fernanda Otaviano. "Avaliação da resposta imunológica humoral, em animais de experimentação, induzida pela combinação da vacina DTP-Hib com as vacinas meningocócicas B e C conjugada, desenvolvidas em Bio-Manguinhos." Instituto de Tecnologia em Imunobiológicos, 2011. https://www.arca.fiocruz.br/handle/icict/5918.
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Fundação Oswaldo Cruz. Instituto de Tecnologia em Imunobiológicos. Rio de Janeiro, RJ, Brasil.
A combinação de vacinas é uma estratégia de grande relevância para o Programa Nacional de Imunizações. Através dela, é possível aumentar a proteção a múltiplas doenças em uma única vacina, bem como diminuir as constantes visitas ao posto de saúde. Contudo, uma das desvantagens em relação a esse tipo de estratégia é a possibilidade de ocorrer interferência antigênica entre os seus componentes,o que pode resultar na diminuição da resposta imunológica. Devido a este fato, foi realizada uma combinação com vacinas já presentes no calendário brasileiro de imunizações (DTP-Hib) a vacinas experimentais em desenvolvimento em Bio-Manguinhos (meningocócica B e meningocócica C conjugada), com a finalidade de apresentar uma nova perspectivade produto a esta unidade bem como estabelecer a correlação antigênica entre esses componentes, comparando metodologias já padronizadas para este fim à metodologia alternativa (ELISA), além de avaliar a pirogenicidade e a interferência entre os componentes vacinais utilizados na combinação. A resposta imunológica aos componentes vacinais foiavaliada em camundongos suíços, NIH e cobaias Short-Hair pelo ELISA (VME, polissacarídeo C, PRRP, Bordetella pertussis) e os testes de soroneutralização in vivo(componentes tetânico e diftérico). Todos os componentes vacinais avaliados pelo ELISA induziram soroconversão nos animais 30 dias após a última imunização. Quando comparadas à vacina combinada completa, somente a resposta imunológica ao polissacarídeo C sofreu interferência de algum componente vacinal. Após novas combinações davacina meningocócica C conjugada às outras vacinas, pode-se concluir que avacinas DTP e Hib interagem positivamente na resposta daquela vacina. Em relação à soroneutralização in vivo, houve uma diminuição da potência dos componentes tetânicoe diftérico quando cobaias Short-Hair foram imunizadas com a vacina DTP-Hib combinada às vacinas meningocócicas B e C conjugada. Em contrapartida, na quantificação de IgG total em camundongos suíços imunizados com as duas combinações (DTP-Hib e DTP-Hib/B/C), não ocorreu diferença significativa entre os dois grupos. O teste de pirogenicidade realizado em coelhos comprovou que, quando combinadas entre si, às vacinas são capazes de aumentar a temperatura destes animais, provavelmente, devido àpresença de Bordetella pertussise VME de Neisseria meningitidisgrupo B. Apesar de não ter sido possível à comparação com ostestes padronizados, o ELISA mostrou-se muito satisfatório na pesquisa da resposta imunológica em camundongos. Embora preliminares, os resultados são muito importantes, pois introduzem novas perspectivas para a realização de outras combinações que atendam as demandas requisitadas pelo Programa Nacional de Imunizações.
The combination of vaccines is a great relevance strategy to the National Immunization Program. It enables increase protection to multiple diseases in a single injection, as well as reduces constant visits to health care. However, a disadvantage of this strategy is antigenic interference among vaccine components, resulting in immune response decreased. Due to this fact, a combination between vaccines of Brazilian immunization calendar (DTP-Hib) and experimental vaccines developed in Bio-Manguinhos (meningococcal B and meningococcal C conjugate) wasperformed, in order to present a new perspective of product to this unit and establish the antigenic correlation of these components, comparing standardized methodologies with alternative methodology (ELISA), besides evaluating pyrogenicity and interference ofcombined vaccine components. The immune response to vaccine components was evaluated in Swiss and NIH mice and Short-Hair guinea pigs by ELISA (OMV, polysaccharide C, PRP, Bordetella pertussis) and in vivoneutralization test (tetanus and diphtheria components). All vaccine components assessed by ELISA induced seroconversion rates 30 days after the last immunization in animals. The complete combined vaccine, interfered in the immune response to polysaccharide C. After new combinations of meningococcal C conjugate vaccine to other vaccines, we concluded that DTP and Hib vaccines induce a positive interaction in immune response to that vaccine. Regarding in vivoneutralization, there was a decrease of tetanus and diphtheria components potency when Short-Hair guinea pigs were immunized with DTP-Hib combined to B and C meningococcal conjugate vaccines. In contrast, when total IgG in Swiss mice immunizedwith the two combinations (DTP-Hib and DTP-Hib/B/C) was quantified, no significant difference was observed. Pirogenicity test in rabbits proved that complete combined vaccine increase the temperature of these animals, probably due to the presence of Bordetella pertussisand Neisseria meningitidisgroup B outer membrane vesicle. Although it was not possible comparision with standardized test, ELISA was a satisfactory test in studing immune response in mice. Although preliminary, the results are important because introduce new perspectives for other combinations could be done to atempt the required demands of National Immunization Program.
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Weissmueller, Nikolas T. "Needle-free vaccination : formulation and dermal delivery of diphtheria toxin CRM197 mutant." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:be74f39b-1f36-451c-8200-4f14b701bcee.
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The unsafe use of needles propagates cross infections with bloodborne pathogens and reduces the positive impact of vaccinations on global health. While a plethora of needle-free injection devices exist, the reformulation of protein-based vaccines is largely empirical and costly, which presents a barrier to their widespread clinical application. This thesis contributes to the identification of approaches that facilitate rapid vaccine reformulation and enhance the immunogenicity of needle-free dry-powder vaccines with the help of novel antigen delivery platforms. We hypothesised that the thermodynamic stabilisation of diphtheria toxin mutant 197 (CRM197), a glycoconjugate vaccine carrier protein, may enhance its structural preservation during spray-freeze-drying (SFD), and that its formulation in either soluble, surface-adsorbed, or nanoparticle form impacts the elicited immune response. Differential scanning fluorimetry was used to study the effect of excipients on the thermal stability of CRM197. Dry-powder formulation of CRM197 used i) encapsulation into a thermodynamically stabilising excipient matrix by SFD, ii) surface-immobilisation via physisorption onto a novel potassium-doped hydroxyapatite (kHA) carrier microparticle formed by molten salt synthesis, and iii) chemical conjugation and surface presentation on amphiphilic block copolymer nanoparticles that were incorporated into SFD-powders (SFD-NP). The structural integrity of CRM197 was assessed by size separation in addition to various spectral and thermal analysis methods. The immunogenicity of dry-powder CRM197 formulations was subsequently tested in vivo. The results suggest that the thermodynamic stability of CRM197 in solution does not ensure its structural stability during SFD. While needle-free dermal vaccination with kHA-adsorbed CRM197 induced comparable antibody titres to conventional IM injection of alum-adjuvanted CRM197, needle-free SFD and SFD-NP powders were less immunogenic. The highest mean IgG titre and most balanced Th1/Th2 response was achieved with nanoparticle-conjugated CRM197 by IM, which outperformed the current clinical standard. Therefore, future vaccine design should combine thermodynamic and kinetic stability screening, and place special emphasis on the delivery and structural presentation of the antigen to the immune system.
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Anwar, Kanar Shwan. "Adverse prevents in premature infants born before 28 + 0 weeks of gestation after vaccation with Synflorix (PhiD-CV) and Infanrix hexa (DTPaHBV-IPV/Hib)." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-52512.
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Le, hir Jerome. "Compréhension du métabolisme cellulaire et de la synthèse du polyoside capsulaire chez Haemophilus influenzae de type b." Thesis, Toulouse, INSA, 2012. http://www.theses.fr/2012ISAT0013.
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Réalisé au sein du LISBP (Laboratoire d’Ingénierie des Systèmes Biologiques et des Procédés, INSA Toulouse), ce travail porte sur l’étude du germe pathogène Haemophilus influenzae de type b (Hib). L’objectif du travail est l’amélioration de la compréhension du métabolisme cellulaire et de la synthèse du polyoside capsulaire chez Hib, utilisé pour la fabrication du vaccin. Ainsi, une étude bibliographique associée à une analyse in silico et à une démarche expérimentale rationnelle a permis de développer un milieu chimiquement défini répondant aux critères de robustesse du procédé et de qualité du produit. Par ce travail, il a pu être défini les facteurs nutritionnels et environnementaux influents sur la production de biomasse et de PRP. Plus généralement, ce travail a permis une meilleure compréhension de la physiologie cellulaire. Une étude Bioinformatique et Transcriptomique a permis l’établissement de cartes métaboliques spécifiques de la souche Hib de notre étude, et de mieux comprendre l’influence du milieu de culture sur la production de polyoside capsulaire. En complément, une étude Fluxomique a permis de développer les connaissances sur le métabolisme général de la souche et plus particulièrement sur la voie de synthèse du polyoside.Sur un plan plus appliqué, une corrélation directe entre la consommation de glucose et la production de polyoside a pu être établie, et ce, dans un environnement maîtrisé de culture en fermenteur. La combinaison du travail développé tant sur le procédé que sur le milieu de culture chimiquement défini ou la sélection de souche, a permis, à l’échelle laboratoire, une multiplication par 6,2 de la production de polyoside capsulaire (7,8 en spécifique) par rapport à la condition initiale de l’étude en milieu complexe. Ce résultat a alors pu être validé chez Sanofi-pasteur à l’échelle pré-industrielle (1000L), tout en conservant une qualité du produit conforme aux critères de production pharmaceutiqueThis work, undertaken at LISBP (Laboratoire d’Ingénierie des Systèmes Biologiques et des Procédés, INSA Toulouse), concerns the study of the pathogen Haemophilus influenzae type b (Hib). The objective was to improve the understanding of cellular metabolism and the synthesis of the capsular polysaccharide in Hib, used for vaccine production. A literature review coupled with a rational experimental approach has enabled a chemically defined medium that meets the criteria of process robustness and product quality to be developed. This work has defined the key nutritional and environmental factors affecting biomass and PRP production. Bioinformatics and Transcriptomic studies have allowed the specific metabolic characteristics of the Hib strain to be mapped and enabled a better understanding of the influence of culture medium on capsular polysaccharide production to be obtained. A Fluxomics study points to specific organization of the central pathways and more specifically the interaction between the pentose phosphate pathway and the pathway of polysaccharide biosynthesis. On a more applied aspect, direct correlation between glucose consumption and production of polysaccharide was established in a batch culture. The combined knowledge obtained in this study enabled a 6.2-fold increase in production of capsular polysaccharide (7.8 in specific production) to be obtained in laboratory scale installations as compared to the initial fermentation process using complex media. This result was then validated at Sanofi-pasteur at the pilot-plant level (1000L), and shown to maintain product quality as defined by pharmaceutical production criteria
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Rodrigues, Elô de Oliveira. "Elaboração de material de referência in house para vacina contra Hib e produtos intermediários: uma proposta para normalização de testes físico-químicos do controle de qualidade." Instituto de Tecnologia em Imunobiológicos, 2009. https://www.arca.fiocruz.br/handle/icict/5860.
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Fundação Oswaldo Cruz. Instituto de Tecnologia em Imunobiológicos. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
O Instituto de Tecnologia em Imunobiológicos, Biomanguinhos, é uma unidade da FIOCRUZ produtora de vacinas, biofármacos e reativos. O Departamento de Controle de Qualidade, pertencente a unidade de Biomanguinhos, é responsável pelos diversos ensaios físico-químicos, microbiológicos e biológicos para liberação dos produtos finais, produtos intermediários e matérias-primas. Devido à necessidade de normalizar seus ensaios referentes a produtos finais e intermediários, várias medidas têm sido tomadas como: calibração e qualificação de equipamentos, validação de métodos analíticos, aquisição de padrões, entre outras atividades de melhoria. Uma das dificuldades encontradas pelos laboratórios de controle de qualidade é a aquisição de padrões que tenham características semelhantes aos produtos produzidos em Biomanguinhos. A disponibilidade de materiais de referência/padrões que atendam às necessidades do laboratório e a dificuldade em obtê-los, além dos custos elevados, os tornam impeditivos para uso nos ensaios rotineiros. Esta dissertação tem como objetivo estabelecer a prática da produção de material de referência in housepara os métodos que são utilizados para o controle de qualidade de produtos obtidos em Biomanguinhos. O planejamento eelaboração do material de referência de trabalho serão realizados considerando-se todas as condições necessárias para que a substância candidata atenda às normas vigentes relacionadas à normalização de métodos de controle de qualidade. A implantação da metodologiae dos requisitos necessários para obtenção do material serão descritos neste trabalho. O material “candidato” a material de referência é opolirribosil-ribitol fosfato, o PRRP, que após conjugação com a proteína monomérica tetânica, torna-se o princípio ativo da vacina contra Haemophilus influenzae, a vacina Hib. A avaliação do material de referência candidato é baseada nos estudos de caracterização, homogeneidade e estabilidade, utilizando-se ferramentas estatísticas adequadas, visando à atribuição do seu valor com uma incerteza de medição associada, atendendo aos propósitos desejados e agregando maior confiabilidade aos produtos analisados pelo laboratório. Além do uso interno, há a intenção de produzir este material de referência emitindo certificado de acordo com as normas vigentes, e assim fornecê-lo também para o INCQS, órgão da FIOCRUZ responsável pelo controle de qualidade nacional de vacinas e medicamentos.
The Institute of Technology in Immunobiologicals, Biomanguinhos, is a vaccine, biopharmaceuticals, and diagnostic kits production unit that belongs to Fiocruz. The Quality Control Department is responsible for the many physical-chemical, microbiological, and biological assays performed to release the final and intermediate products and the raw materials. Due to the need of standardization of the assays, some measures have been being taken, such as equipments’ calibration and qualification, validation of analytical methods, and standards purchase. One of the challenges faced by the quality control laboratories is the acquisition of standards that have the same characteristics as the Biomanguinhos products. The low availability of standards and reference materials that attend the laboratories’ needs and the difficulties in obtaining these products, besides the high costs, make their use in the laboratories routine almost impossible. This thesis intends to establish the production practice for the in-house reference materials used in Biomanguinhos’ quality control assays. The planning and elaboration of the reference materials will be made according to the current legislation that concerns the standardization of quality control methods. The deployment of the methodology and of the requirements for the material obtainment will be discussed in this work. The ‘candidate’ to be a reference material is the polyrribosil ribitol phosphate (PRRP) that, after conjugation with the tetanical monomeric protein, becomes the active substance of the Haemophilus influenzaevaccine (Hib). The evaluation of the candidate material is based in characterization, homogeneity and stability studies, using suitable statistical tools, in order to assign its value with an associated measurement uncertainty. It aggregates reliability to the products analyzed in the laboratories. Besides the internal use, the purpose of this work is to certify the reference material in accordance with the current regulations, so that itcan be more trustable and therefore be used by INCQS, Fiocruz unit responsible for the nationalquality control of vaccines and other pharmaceutical products.
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Petschaelis-Hofer, Kati [Verfasser]. "Die Antikörperantwort frühgeborener Kinder unterhalb der 36. Schwangerschaftswoche auf die Einzelkomponenten (DTaP-HBV-IPV/Hib) von hexavalenten Impfstoffen im Rahmen der Grundimmunisierung nach den STIKO-Empfehlungen / Kati Petschaelis-Hofer." Greifswald : Universitätsbibliothek Greifswald, 2012. http://d-nb.info/1019346795/34.
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Carvalhanas, Telma Regina Marques Pinto. "Avaliação do impacto do programa de vacinação contra o Haemophilus influenzae tipo b (Hib) no Estado de São Paulo e município de São Paulo, após dez anos de introdução da vacina." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-20022014-132149/.
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Objetivos: Avaliar o impacto global, direto, indireto e a tendência da duração de proteção da vacinação contra o Haemophilus influenzae tipo b (Hib), no estado de São Paulo (ESP) e no município de São Paulo (MSP), na população de 0 - 59 meses, comparando os períodos pré-vacinal (1996 - 1998) e pós-vacinal (2001 - 2009). Métodos: estudo com componente descritivo e de cunho analítico, retrospectivo. A população de estudo incluiu os menores de cinco anos residentes no ESP e no MSP. Adotou-se como definição de caso confirmado o menor de cinco anos identificado como positivo para o Hib em cultura e/ou contraimunoeletroforese e/ou látex e/ou RT-PCR, em amostra de LCR e sangue, e/ou vínculo epidemiológico. Os dados foram obtidos a partir do SINAN, SIGH-Web Instituto Adolfo Lutz e Fundação IBGE. As variáveis de estudo incluíram as demográficas, clínicas e relativas ao agente, apresentadas em séries temporais e períodos estabelecidos para parametrização e comparabilidade. O parâmetro das avaliações de impacto foi a magnitude da variação da incidência de meningite causada pelo Hib. Para cada estimativa de impacto construiu-se um Intervalo de Confiança (IC) de 95 por cento a partir do cálculo de Risco Relativo (RR). As estimativas do risco relativo (RR) e os respectivos intervalos de 95 por cento de confiança foram analisados utilizando-se o software R. Resultados: nos períodos considerados, foram descritos 1.561 casos confirmados de meningites por Hib no ESP, sendo 27,16 por cento (424/1.561) no MSP, e 80,78 por cento (1.261/1.561) dos casos foram registrados em menores de cinco anos. A maioria dos casos foi confirmada por cultura, com percentual médio de 65 por cento no ESP e 66 por cento no MSP. As taxas médias de incidência de meningites por Hib mais significativas no período pré-vacinal verificaram-se nos menores de um ano (30,56/105- ESP; 32,06/105 - MSP), considerada a faixa etária de maior risco de adoecimento. Após a introdução da vacina contra o Hib em 1999 (menores de dois anos), as taxas de incidência de meningites por Hib declinaram de forma sustentável nos períodos subsequentes analisados. A incidência de meningite por Hib durante o período pós-vacinal variou de 4,02/105- 1,68/105 nos menores de um ano, no ESP e MSP respectivamente e, de forma similar, de 1,43/105 1,01/105 nos menores de cinco anos. Nos menores de 7 - 23 meses (impacto direto), o percentual de redução foi de 95,11 por cento [66,43 - 99,29] no ESP e 95,91 por cento [70,63 - 99,43] no MSP. O impacto global observado nos menores de cinco anos foi 88,19 por cento [26,58 - 98,10] no ESP e 91,06 por cento [33,99 - 98,79] no MSP. Os dados de vigilância mostram que os casos de meningites por Hib continuam ocorrendo, porém em níveis baixos, ao longo de 10 anos após a introdução do esquema de três doses primárias da vacina conjugada específica. Conclusão: a partir deste racional pode-se inferir a utilidade prática e econômica a favor desta modalidade programática adotada no território paulista, com a evidência de redução relativa de meningites por Hib.Objectives: To evaluate global impact, direct and indirect, as well as the tendency of the duration of vaccine protection against Haemophilus influenzae type b (Hib) in the state of São Paulo (ESP) and in the city of São Paulo (MSP), amongst the population between 0-59 months of age during the periods pre-vaccine (1996-1998) and post vaccine (2001-2009). Methods: a retrospective study with a descriptive component and with analytic venue. Studied population included children under five years old, dwelling in ESP and MSP. Criteria adopted as definition of confirmed case was child under five years of age identified as positive for Hib in culture and/or counterimmunelectroforesis and/or latex and/or RT/PCR, in LCR sample and blood. and/or epidemiologic link. Data were obtained from the SINAN, SIGH-Web Instituto Adolfo Lutz and IBGE Foundation. Variables under study included socio-demographic and clinical ones, and those related to the agent; they were presented in temporal series and periods established in order to allow parametric and comparison. Impact evaluation was established upon the variation of incidence magnitude of meningitis caused by Hib. For each impact estimate a Confidence Interval (IC) of 95 per cent from the calculus of Relative Risk (RR). Estimates of relative risk (RR) and the respective intervals of 95 per cent confidence were analyzed employing the R software. Results: During the analyzed periods 1561 confirmed cases of meningitis caused by Hib were described in the state of São Paulo, 27.16 per cent of which (424/1561) in MSP; 80.78 per cent (1261/1561) of the registered cases occurred in children under five years of age. The majority of the cases were confirmed by culture, with an average percentage of 65 per cent in ESP and 66 per cent in MSP. More significant average rates of meningitis per Hib during the pre-vaccine period were registered in children under one year of age (30.56/105- ESP; 32.06/105 - MSP), considered the bracket under higher risk of disease. After the introduction of the vaccine against Hib, in 1999 (for children under two years of age), the rates of meningitis incidence per Hib decreased in sustainable fashion for the subsequent periods analyzed. The incidence of meningitis per Hib during the post vaccine period varied from 4.02/105 - 1.68/105 for children under one year old, in ESP and MSP, respectively and, in similar way, from 1.43/105 to 1.01/105 for those under five years old. For children between 7-23 months old (direct impact), the percentage of reduction was of 95.11 per cent [66.43 - 99.29] in ESP and 95.91 per cent [70.63 - 99.43] in MSP, whereas the global impact observed in children under five years old was 88.19 per cent [26.58 - 98.10] in ESP and 91.06 per cent [33.99 98.79] in MSP. Surveillance data show that cases of meningitis by Hib continue to occur but in low levels along 10 years after the introduction of the three doses primary scheme of administration of the specific conjugated vaccine. Conclusion: from this rationale, it is possible to infer the practical and economic utility favoring this programmatic modality adopted in São Paulo, with the evidence of the relative reduction of meningitis caused by Hib.
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Olowokure, Babatunde. "The impact of Hib conjugate vaccine on the epidemiology of invasive Haemophilus influenzae disease in the West Midlands and the effect of deprivation and other environmental risk factors : an ecological study, 1990-1994." Thesis, University of Warwick, 1999. http://wrap.warwick.ac.uk/38287/.
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Objective: To describe the epidemiology of invasive Haemophilus influenzae (HI) disease, and to explore the relationship between socioeconomic disadvantage and invasive HI disease in the two years immediately before (October 1990 to September 1992), and following (October 1992 to September 1994) the introduction of HI type b (Hib) conjugate vaccine. Design: Multiple sources of case ascertainment were used to identify children with invasive HI disease in the West Midlands Health Region (WMHR) and compile a case register. An ecological study examined socioeconomic disadvantage using selected socioeconomic census data for enumeration districts, and the Townsend index of material deprivation. Setting: WMHR, England from October 1990 to September 1994. Subjects: Children under 5 years of age with invasive HI present on the West Midlands invasive HI case register (HICARE). Results : The incidence of invasive HI disease in the WMHR fell from 28.3/105 (95% CI=24.5 to 32.6) children <5 years of age in the pre-conjugate vaccine period to 5.4/105 (3.8 to 7.4) after the vaccine had been introduced. Nine vaccine failures were identified. Those aged 6-11 months were most at risk in the pre-conjugate vaccine period (OR=2.69,95% CI=1.14 to 6.55). In the post-conjugate vaccine period those aged 24-35 months were at most risk (OR=2.64,1.16 to 5.94). More cases of meningitis were identified in girls than boys but the difference was not statistically significant. Significantly more cases of invasive HI seen in children of South Asian origin aged less than 12 months than in non-South Asian children (OR=2.88,1.07 to 7.86). Children from affluent areas were at significantly reduced risk of disease compared to children from the more deprived areas (OR=0.73,0.54 to 0.99). In the second period of the study a number of significant risk factors were identified. Children living in areas containing predominantly rented accommodation (p=0.0025), mobile populations (p=0.013) and a low density of children aged <5 years per km2 (p=0.039) were at increased risk of invasive HI disease. Following meningitis, children from deprived areas were more likely to suffer sensorineural hearing loss (p=0.035). Case fatality was higher in the second period of the study, although not significantly so (OR=3.64,0.88 to 15.05). Conclusion: This four year study provides the first detailed account of the relationship between deprivation, , socioeconomic risk factors, ethnic group, and invasive HI disease in Britain. The incidence of the disease fell dramatically in the post-conjugate vaccine period. A number of socioeconomic risk factors were identified in the second period of the study. The data suggest that although Hib conjugate vaccine has greatly reduced the incidence of disease, children from deprived areas remain at greater risk than children in more affluent areas. They also indicate that the disease is still responsible for considerable sequelae and mortality.
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Jesus, Alice Aurora Batalha. "Estudo de cepas de haemophilus influenzae isoladas no período pré e pós-vacinal com a vacina contra o Hib: caracterização de marcadores de resistência a antibióticos e possíveis mudanças geneticas na região capsular do Hi." reponame:Repositório Institucional da FIOCRUZ, 2010. https://www.arca.fiocruz.br/handle/icict/4015.
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Previous issue date: 2010Fundação Oswaldo Cruz. Instituto Nacional de Controle de Qualidade em Saúde
A bactéria Haemophilus da espécie influenzae, pode causar no homem diversas infecções, invasivas ou não. O H. influenzae do tipo b (Hib), antes da introdução da vacina conjugada contra Hib, associava-se a infecções como epiglotite, artrite séptica, bacteriemia, pneumonia septicemia e meningite, principalmente em crianças. As outras espécies tipáveis (a,c,d,e,f) e não tipáveis estavam associadas a infecções do trato respiratório adquiridas na comunidade. Após a introdução dessa vacina, houve redução expressiva das doenças causadas pelo Hib em diversas partes do mundo, inclusive no Brasil. Atualmente, outros tipos da espécie H. influenzae (Hi) que não o Hib estão sendo isoladas não somente em crianças, causando infecções graves. O ressurgimento de casos por Hib, em crianças vacinadas, tem sido reportado como possível falha vacinal. Esses fatos preocupam a Saúde Pública no mundo, demonstrando que mudanças epidemiológicas podem estar ocorrendo devido à seleção de cepas após a introdução da vacina. Neste estudo, mudanças genéticas na região capsular do Hi foram encontradas em cepas isoladas nos períodos pré e pós-vacinal de três estados brasileiros. Através do estudo de susceptibilidade foram encontradas cepas produtoras de β-lactamase (BLA+) e não produtoras resistentes a ampicilina (BLNAR). A análise de redução da susceptibilidade às quinolonas foi avaliada utilizando-se o ácido nalidíxico como marcador, confrontando-se a resistência deste antibiótico com os marcadores moleculares das regiões determinantes de resistência a quinolonas (QRDRs) através do sequenciamento dos genes gyrA e parC que codificam a síntese das proteínas GyrA e ParC. Os resultados obtidos demonstraram que o ácido nalidíxico é o antibiótico mais indicado desse grupo para detectar a redução da sensibilidade.
The bacteria specie Haemophilus influenzae can cause several infections on men, either invasive or not. Before the introduction of conjugated vaccine against type b H. influenzae (Hib), it was associated to infections like epiglottitis, septic arthritis, bacteremia, pneumonia, septicemia and meningitis, occurring mostly in children. The other typeable species (a,c,d,e,f) and not typeable (NT) were associated to infections of respiratory trait acquired in the community. After introducing this vaccine, expressive reduction of diseases caused by Hib has been observed worldwide, including Brazil. Recently, different types of H. influenzae species other than Hib have been isolated in children and adults, causing severe infections. The reemergence of Hib cases in vaccinated children has been reported as a possible vaccine failure. These facts are a concern to public health departments around the world showing that epidemiologic changes may happen due to the selection of strains after vaccine introduction. In this study, genetic changes in the capsular region of Hi were found in isolated strains in the pre and post vaccinal periods in three Brazilian states. Through susceptibility studies, β-lactamase producer strains were found as well as non producer resistant to ampicilin (BLNAR). Analysis of susceptibility reduction to quilonones was evaluated by using nalidixic acid as a marker, and comparing the resistance to this antibiotic to molecular markers of the determining regions of resistance to quilonones (QRDRs) through sequencing of gyrA and parC genes that codify the synthesis of GyrA and ParC proteins. The results show that nalidixic acid is the most suitable antibiotic of this group able to detect sensibility reduction to quinolones. This study shows that there is a need for routine and research laboratories to evaluate and develop simple and quick methods to indicate possible capsule changes and emergence of resistant strains, to help epidemiological and sanitary surveillance.
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Santos, Eliane Matos dos. "Análise da temperatura axilar e da febre verificadas em um ensaio clínico com vacinas." reponame:Repositório Institucional da FIOCRUZ, 2009. https://www.arca.fiocruz.br/handle/icict/2312.
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Previous issue date: 2009Objetivos: Analisar a temperatura axilar no estudo da vacina contra difteria, tétano, o componente pertussis e hemófilo (DTP/Hib), a frequência de febre e a associação dos eventos adversos. Analisar a metodologia para verificação da temperatura corpórea e febre utilizada em diferentes estudos clínicos com a vacina DTP/Hib. Materiais e métodos: Este trabalho é baseado em dados obtidos do Estudo de imunogenicidade e reatogenicidade de vacina combinada contra difteria, tétano, pertussis e hemófilo tipo b: validação clínica de produto produzido totalmente no Brasil, com 1000 lactentes, realizado no município do Rio de Janeiro, no ano de 2006. Foi analisada a temperatura axilar nos tempos 3, 6, 12, 24, 48 e 72 horas após a vacinação. Foram analisadas as associações entre os eventos adversos locais e eventos adversos sistêmicos. Resultados: A freqüência de febre foi de 53,4 por cento após a primeira dose, 39,9 por cento após a segunda dose e 31,5 por cento após a terceira dose nas 24 horas após a vacinação. A freqüência de febre foi diminuindo com a aplicação das doses. Não houve padrão de associação entre os eventos adversos locais e sistêmicos. A mediana da distribuição da temperatura axilar foi maior nostempos 6 e 12 horas após a vacinação. Conclusões: A definição de febre e as metodologias utilizadas nos estudos clínicos para verificar a temperatura corpórea ainda são heterogêneas, o que dificulta a comparabilidade entre eles.
Objectives: To analyze the axillary temperature in the study of the vaccine DTP/Hib (Martins et al., 2008), the frequency of fever and the association of the adverse events. To analyze the methodology for checking of the corporal temperature and fever used in different clinical trial with the vaccine DTP/Hib. Materials and methods: This work is based on obtained data of the “Study of immunogenicity and reactogenicity of vaccine combined against diphtheria, tetanus, pertussis and haemophylus type b: clinical validation of product produced totally in Brazil ”, with 1000 infants,carried out in the local authority of the Rio of January, in the year of 2006. The axillary temperature was analyzed in the times 3, 6, 12, 24, 48 and 72 hours after the vaccination. The associations were analyzed between the adverse local events and adverse systemic events. Results: The frequency of fever was 53.4 % after the first dose, 39.9 % after the second dose and 31.5 % after the third dose in 24 hours after the vaccination. The frequency of fever was lessening with the application of the doses. There was no standard of association between the adverse local events and systemic adverse events. The medium one of the distribution of the axillary temperature was bigger in the times 6 and 12 hours after the vaccination. Conclusions: The definition of fever and the methodologies used in the clinical studies to check the corporal temperature they are still heterogeneous what makes difficult the comparability between them.
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Noronha, Tatiana Guimarães de. "Episódio Hipotônico-hiporresponsivo associado à vacina combinada contradifteria, tétano, pertussis e Haemophilus influenzae tipo b: análise da definição de caso para vigilância." reponame:Repositório Institucional da FIOCRUZ, 2010. https://www.arca.fiocruz.br/handle/icict/2419.
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Previous issue date: 2010Analisar as vantagens e limitações da definição de caso de episódio hipotônico-hiporresponsivo (EHH) baseada na revisão da literatura, e as implicações para o Sistema de Informação de Eventos Adversos Pós-Vacinação do Programa Nacional de Imunizações. Materias e métodos: Este trabalho é baseado em dados obtidos por um estudo de vigilância ativade eventos adversos pós-imunização com a vacina combinada contra difteria, tétano, coqueluche e Haemophilus influenzae tipo b (DTP/Hib), realizado no município do Rio de Janeiro, no ano de 2004 (VIGAT), cujo objetivo primário era determinar em crianças com menos de 1 ano de idade a incidência do episódio hipotônico-hiporresponsivo (EHH) que se inicia nas primeiras 48 horas após a aplicação da vacina DTP/Hib utilizada pelo Programa Nacional de Imunização. Foram analisados o desempenho das perguntas de triagem para potenciais casos de EHH aplicadas no VIGAT, a reprodutibilidade da sua definição de caso de EHH quando aplicada em diferentes níveis de avaliação, o seu valor preditivo positivo, assim como, o seu desempenho em relação a outras definições de caso presentes na literatura, considerando-se o grau em que esse desempenho afeta a vigilância de eventos adversos associados à vacina DTP/Hib. Foi realizada também uma análise demográfica e dos antecedentes pessoais dos casos de EHH, e da sua possível associação com fatores relacionados à vacina, sua aplicação e outros eventos adversos pós-vacinais (EAPV). Resultados: A freqüência de EHH encontrado no VIGAT foi de 8,1 por 10.000 vacinados (IC95 por cento 4,7 - 13,0 por 10.000). Não houve significância estatística para a associação entre o EHH e o sexo do lactente, baixo peso de nascimento, índice de Apgar abaixo do normal, dose da vacina aplicada e lotes dos componentes vacinais. A febre maior ou igual a 39°C foi considerada como fator de risco para a ocorrência de EHH, encontrando-se associação entre eles com risco relativo de 8,2 (IC 95 por cento = 2,6; 25,7). O valor preditivo positivo da definição de caso do EHH adotada no VIGAT (2004) para o diagnóstico de EHH, quando utilizada pelo coordenador local do estudo foi 0,68 (17/25). Houve 100 por cento de concordância no diagnóstico de EHH entre o Grupo de Revisão de Diagnóstico (GRD) e o Comitê de Monitoramento Externo (CME). O Valor Preditivo Positivo (VPP) das duas perguntas de triagem combinadas foi de 17/47 (36,2 por cento). A concordância entre a definição de caso de EHH do VIGAT e a de Braun et al (1998) foi de 0,84 (kappa = 0,68); de 0,8 (kappa = 0,61) em relação a Brighton (2004); de 0,84 (kappa = 0,66) para Vermeer et al (2006); e de 0,92 (kappa = 0,82) para Brighton (2007). Conclusões: A definição de caso de EHH do VIGAT, norteada por perguntas de triagem de elevada sensibilidade e aplicada por uma equipe capacitada, apresentou bom desempenho na vigilância ativa desse EAPV. Entretanto, observou-se uma dificuldade no processo de diagnóstico de EHH, em função das características inerentes a esse evento, chamando atenção para a necessidade de criterios a avaliação dos dados obtidos por vigilância passiva, principalmente, na comparabilidade entre eles.
Objectives: To analyze the advantages and limitations of the case definition for hypotonichyporesponsive episode (HHE) based on the literature review, and the implications for the Postvaccination Adverse Events (VAE) Information System of the National Immunizations Program. Materials and methods: This work is based on data obtained by an active surveillance study of post-vaccination adverse events with the combined diphtheria-tetanus-whole cell pertussis- Haemophilus influenzae type b vaccine performed in the Rio de Janeiro municipality in 2004 (VIGAT), whose primary objective was to determine the incidence of hypotonic-hyporesponsive episode (HHE) that began in the first 48 hours after the application of the DTP/Hib vaccine used by the National Immunization Program in children under the age of 1 year. The performance of the screening questions for potentials HHE cases performed in VIGAT were analyzed, the reproducibility of its definition for HHE cases when performed in different evaluation levels, its positive predictive value, as well as its performance in relation to other case definitions present in the literature, considering in what degree this performance affects adverse events surveillance associated to the DTP/Hib vaccine. A demographic analysis and of the personal antecedents of HHE cases was also accomplished, and of its possible association with vaccine-related factors, its application and other vaccine adverse events (VAE). Results: The frequency of HHE found in VIGAT was 8.1 for 10,000 vaccinated subjects (CI 95% 4.7 –13.0 for 10,000). There was no statistical significance for the association between HHE and the sex of the infant, low birth weight, below normal Apgar index, dosage of vaccine and lots of vaccinal components. Fever equal to or higher than 39°C was considered as risk factor for the occurrence of HHE, having found an association among them with the relative risk of 8.2 (CI 95% = 2.6; 25.7). The predictive positive value for the HHE case definition adopted in VIGAT (2004) for the HHE diagnosis, when used by the local study coordinator was 0.68 (17/25). There was a 100% agreement in the HHE diagnosis between the Diagnosis Review Group (DRG) and the External Monitoring Committee (EMC). The Predictive Positive Value (PPV) of the two combined screening questions was 17/47 (36.2%). The agreement between the HHE case definition of VIGAT and of Braun et al (1998) was of 0.84 (kappa = 0.68); 0,8 (kappa = 0.61) in relation to Brighton (2004); 0.84 (kappa = 0.66) for Vermeer et al (2006); and 0.92 (kappa = 0.82) for Brighton (2007). Conclusions: The case definition for HHE of VIGAT, orientated by screening questions of high sensibility and applied by a qualified team, presented good performance in the active surveillance of that VAE. However, a difficulty was observed in the HHE diagnosis process, due to the inherent characteristics to that event, highlighting the need for a criterial data evaluation obtained by passive surveillance, mainly, in the comparability among them.
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Cardoso, Elaine Cristina. "Avaliação da transferência materno-infantil de anticorpos séricos e secretores dirigidos ao polissacarídeo da cápsula de Haemophilus influenzae tipo B (HIB) em amostras pré e pós-vacinais de mães com PRP conjugado ao toxóide tetânico (PRP-T)." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/42/42133/tde-17092008-112422/.
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Introdução: O Haemophilus influenzae type b (Hib) é a primeira maior causa de meningites e pneumonias provocadas por bactérias encapsuladas. Trabalhos revelam que anticorpos maternos, séricos e secretores, podem proteger recém nascidos (RN) destes patógenos encapsulados e contribuem para a maturação do sistema imune do infante. Objetivo: O presente estudo teve como objetivo investigar a transferência materno-infantil de anticorpos anti-Hib em mães vacinadas e que não receberam a vacina anti-Hib. Materiais e Métodos: Nós avaliamos 29 mulheres saudáveis, das quais 13 foram vacinadas e 16 não receberam a vacina ActHib®. Destas mães foram obtidas amostras de sangue periférico e do cordão umbilical, colostro e leite, sendo determinadas as imunoglobulinas totais (lgG e IgA) e suas subclasses (IgG1 e 2) por Imunodifusão Radial Quantitativa (IDR) e nefelometria. A concentração de anticorpos IgG, as subclasses (lgG1 e 2) e IgA anti-Hib foram analisados por ensaio imunoenzimático (ELlSA), também utilizado para determinar a avidez dos anticorpos IgG e IgA anti-Hib. Avaliação qualitativa destes anticorpos foi realizada a partir de ensaios de immunoblotting (IB). Resultados: As amostras maternas de mães vacinadas não apresentaram diferenças quantitativas de imunoglobulinas secretoras (lgA), séricas (lgG) e suas subclasses (lgG1 e 2) totais, comparadas às amostras de mães que não receberam a vacina anti-Hib. O grupo vacinado mostrou maior concentração e avidez de anticorpos específicos para o Hib quando relacionados ao grupo de mães não vacinado. Os soros de cordões umbilicais de mães imunizadas apresentaram menor taxa de passagem transplacentária que os cordões de mães não vacinadas. Em ambos os grupos, as amostras de colostro apresentaram maior concentração de imunoglobulinas totais e específicas para o Hib que as amostras de leite. O 18 revelou o mesmo padrão de reconhecimento antigênico para o Hib entre as amostras maternas, nas duas populações. Conclusão: Os resultados revelaram que o perfil de resposta humoral de mães vacinadas pode proteger mais o infante que as mães não vacinadas, pois o primeiro grupo transferiu maior quantidade de anlicorpos com melhor avidez para a criança, conferindo proteção eficaz com relação às doenças causadas por Hib.Background: Haemophilus influenzae, type b (Hib) has been one of the major causes of bacterial meningitis and pneumonia. Recent works show that maternal, seric and secretory antibodies, may protect the newborn and contribute the maturation of the infant immune system. Objective: The present study has as aim to investigates the maternal-infantile transfer of anti-Hib antibodies in immunized and not immunized mothers\' with anti-Hib vaccine. Material and Methods: We evaluated 29 healthy women, from whitch 13 mothers were immunized and 16 not immunized mothers with the ActHib® vaccine. From these mothers it were obtained peripheric and cord serum, colostrum and milk samples, the total immunoglobulin (IgG and IgA) and its subclass (lgG1 and IgG2) was determined by Quantitative Radial Immunodiffusion (IDR) and nephelometry. The concentration of anti-Hib IgG, subclass (lgG1 IgG2) and IgA antibodies were analyzed by immunoenzymatic assay (ELlSA), it also were utilized to determine the antibodies avidities\'. Qualitative evaluation these antibodies were determined by Immunoblotting assays (IB). Results: The results didn\'t show difference between maternal samples of the immunized and not immunized mothers in the concentration of the total secretory and seric imunoglobulins as well as its total immunoglobulins subclasses. The immunized set showed higher avidity and anti-Hib antibody levels comparing to the non-immunized mother sets. The umbilical cord serums\' from immunized mothers revealed lower rate of placental transfer than the cord serum of not immunized mothers. In both sets, the colostrum sample showed higher antibody levels comparing to the milk samples. IB revealed the same recognition pattern of Hib antigens between mother and cord serum IgG and colostrum and milk IgA, in both populations. Conclusion: The results shows that the antibodies profile response of the immunized mother can protect more the infant than the not immunized mother, because the first set transported higher quantity of antibodies with better avidity for the children, these antibodies confere an efficient protection to infections provoked by Hib.
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Rafferty, Eileen N. "Jimmy Hit His First Home Run." VCU Scholars Compass, 2006. http://scholarscompass.vcu.edu/etd/958.
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This document begins with the end of a life and ends with the beginning of hope. It is a brief description of the artist's history, artistic and literary influences, and subsequent works produced during graduate school, specifically Dichotomy, Swan Dive, and Jimmy Hit His First Home Run. Topics discussed include Human Physiology, Transference, Buddhism, and Bubbles. This document was created in Microsoft Word 2004 for Mac, Version 11.2.
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Martins, Natália Alves. "Vacinação oportuna da série primária da vacina pentavalente no município de Goiânia, Goiás." Universidade Federal de Goiás, 2018. http://repositorio.bc.ufg.br/tede/handle/tede/8954.
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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
INTRODUCTION: Many countries have reported outbreaks of immunopreventable diseases, posing vaccination monitoring at a timely age as a strategic indicator for immunization programs to estimate actual protection. OBJECTIVE: To analyze the timely vaccination of the primary series of the pentavalent vaccine in children under 12 months of age, vaccinated in health units to the Unified Health System. METHODS: A population-based retrospective cohort study with children born in 2014 in the city of Goiânia, Goiás. Data from the Ambulatory Care Control System (SICAA) containing data from vaccines and the Live Birth Information System (SINASC) containing maternal and child data were used. The SICAA and SINASC databases were linked and re-structured through a deterministic linkage to identify the records of the same child. The follow-up time for each child was 365 days after the birth. Only doses and intervals between doses valid for analysis were used. The 10-valent pneumococcal vaccine (PCV10) was used as a vaccine to compare the receipt of the pentavalent vaccine. The timely endpoint vaccination of the three doses in the primary series was defined as the dose of vaccine given up to 30 days of the recommended age. Poisson regression was used to identify predictors of timely vaccination of the primary series of the pentavalent vaccine. RESULTS: Of the 13,523 children included, 77.0% (CI95% 76.3-77.7) and 79.1% (CI95% 78.4-79.8) received three valid doses of the primary series of the pentavalent vaccine and PCV10, respectively. Only 47.1% (95% CI 46.2-48.0) and 47.6% (CI 95% 46.8-48.4) received timely the three doses of pentavalent vaccine and PCV10, respectively. The predictive factors for timely vaccination of the pentavalent primary series and PCV10 were the same: married mother; 7 or more prenatal visits and the mother's age equal to or greater than 20 years. CONCLUSION: Almost 80% of children received valid three primary doses of pentavalent and PCV10 vaccines, but fewer than half of the birth cohort received them on time. New efforts are needed to improve timely vaccination and get the maximum benefit from vaccination.
INTRODUÇÃO: Muitos países têm relatado surtos de doenças imunopreveníveis, colocando o monitoramento da vacinação em idade oportuna como indicador estratégico para os programas de imunização estimarem a real proteção. OBJETIVO: Analisar a vacinação oportuna da série primária da vacina pentavalente em crianças menores de doze meses de idade, vacinadas em unidades de saúde ao Sistema Único de Saúde. METODOLOGIA: Estudo de coorte retrospectiva de base populacional com crianças nascidas em 2014 no município de Goiânia, Goiás. Foram utilizados dados do Sistema de Controle do Atendimento Ambulatorial (SICAA) que contém dados de vacinas e do Sistema de Informação de Nascidos Vivos (SINASC) que contém dados maternos e da criança. As bases de dados SICAA e SINASC foram vinculadas e reestruturadas por meio de linkage determinístico para identificação dos registros de mesma criança. O tempo de seguimento de cada criança foi de 365 dias. Foram utilizadas apenas doses e intervalos entre doses válidos para análise. A vacina pneumocócica 10-valente (PCV10) foi empregada como vacina de comparação do recebimento da vacina pentavalente. O desfecho vacinação oportuna das três doses da série primária foi definida como a dose de vacina administrada até 30 dias após a idade recomendada. Utilizou-se regressão de Poisson para identificar os fatores preditores da vacinação oportuna da série primária da vacina pentavalente. RESULTADOS: Das 13.523 crianças incluídas, 77,0% (IC95% 76,3-77,7) e 79,1% (IC95% 78,4-79,8) receberam três doses válidas da série primária da vacina pentavalente e da PCV10, respectivamente. Apenas 47,1% (IC95% 46,2-48,0) e 47,6% (IC95% 46,8-48,4) receberam oportunamente as três doses da vacina pentavalente e da PCV10, respectivamente. Os fatores preditores à vacinação oportuna da série primária da pentavalente e da PCV10 foram os mesmos: mãe casada; 7 ou mais consultas de pré-natal e idade da mãe maior ou igual a 20 anos. CONCLUSÃO: Quase 80% das crianças receberam três doses primárias válidas de vacinas pentavalente e PCV10, mas menos da metade da coorte de nascimento receberam oportunamente. Novos esforços são necessários para melhorar a vacinação oportuna e obter o máximo benefício da vacinação.
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Wallace, Rick L., and Bruce Behringer. "Potential of Technology to Improve the Availability and Use of Health Information on Cancer Subjects for Clergy from Rural Communities." Digital Commons @ East Tennessee State University, 2020. https://doi.org/10.1111/hir.12275.
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Background: Cancer is a leading cause of death around the world and often is a chronic long term disease. This calls for an expanded workforce to include non-traditional health care providers.
Objective: To determine effectiveness of a cancer information training project with clergy from selected rural Appalachian areas to improve comfort and willingness to work as part of the cancer health care team.
Methods: Clergy were trained in the consumer health database of the National Library of Medicine MedlinePlus.gov. Exercises were required that were done using an iPad tablet with an online curriculum. They were also taught how to do a population health assessment of their particular area and develop a health ministry for their church.
Results: Three key elements were confirmed that would enable replication of the pilot: access to medlineplus, programmed learning modules using mobile technology such as iPads, and staff support including librarians and medical staff. With these key elements, the cancer project is potentially replicable with other groups beyond clergy.
Conclusion: about population health, built on new awareness and topical health knowledge, and using new skills to identify relevant information and library resources, could open minds and enhance community support for preventive and medical interventions.
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Wright, Ryan D. "Speaking like Her, Him, and Hir: The Search for a Transwoman’s Speech Community." University of Toledo / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1334748949.
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Kolbas, E. Dean. "Critical theory and the literary canon." Boulder, CO : Westview Press, 2001. http://hdl.handle.net/2027/heb.07706.
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Yeung, Wai Keung Steven. "Zhu Shunshui (1600-1682) – the influence of, on and via him during his lifetime." Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/62762.
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Of the many Chinese who sought refuge in Japan during the middle of the seventeenth century, Zhu Shunshui 朱舜水 (1600-1682) is perhaps one of the most talked about. He fled China in 1645. In 1659, giving up all hopes on the restoration of the fallen Ming dynasty 明朝 (1368-1644) after fifteen-year’s unfruitful efforts, Shunshui decided to sojourn in Japan and sworn not to return until the Manchu 滿族 regime is driven out of China. During his stay in Japan, the prominent Mito 水戶domain lord Tokugawa Mitsukuni 徳川光圀 (1628-1701) hired him as his teacher. Mitsukuni is the founding father of the Mitogaku 水戸学, one of the most important schools of thought in Edo period (1603-1867). This school aimed to reconstruct the historiography of Japan by Chinese Neo-Confucianism principles so as to promulgate indigenous Shinto beliefs and absolute loyalty to the emperor. The close relationship between Shunshui and Mitsukuni, and the involvement of Shunshui’s students in projects initiated by Mitsukuni, including the compilation of the Dai Nihon Shi 大日本史 (The History of the Great Japan, 1906), make some scholars believe that Shunshui has dominant influence on Japan’s Neo-Confucian thoughts, if not all Edo thoughts, as well as far-fetching inspiration on Meiji Ishin 明治維新 (the Meiji Restoration, 1868). But the flow of information among brains and its effect on recipient is too dynamic to be measured. Cultural influence over time is even more difficult to trace. By investigating Shunshui’s relationship with different people and his involvement in various events in Japan during his life time, this paper aims to clarify whether the general beliefs on his influence are plausible. In case when the findings are negative, the paper will look into the causes and suggest where Shunshui’s should be.Arts, Faculty of
Asian Studies, Department of
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Boterbloem, Kees. "Life and death under Stalin." Montreal : McGill-Queen's University Press, 1999. http://0-hdl.handle.net.biblio.eui.eu/2027/heb.05218.
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Poulin, René. ""Advise him of his happy state" : a study of Raphael's instruction of man in Milton's Eden." Thesis, McGill University, 1985. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=63386.
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Kozaczka, Edward Jonathan. ""I made him know his name should be Friday" naming and sexuality in Robinson Crusoe and Foe /." Diss., Online access via UMI:, 2009.
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Bell, Jacqueline Brooks. "Asperger's syndrome and metamemory how well can one child predict his knowledge of the world around him? /." Master's thesis, Mississippi State : Mississippi State University, 2007. http://library.msstate.edu/etd/show.asp?etd=etd-06292007-164551.
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Bell, Jacqueline Brooks. "ASPERGER?S SYNDROME AND METAMEMORY: HOW WELL CAN ONE CHILD PREDICT HIS KNOWLEDGE OF THE WORLD AROUND HIM?" MSSTATE, 2007. http://sun.library.msstate.edu/ETD-db/theses/available/etd-06292007-164551/.
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We investigated whether a child with Asperger?s Syndrome would demonstrate deficits in awareness of cognitive processing similar to those demonstrated for awareness of social interactions. The cognitive processes examined were memory and metamemory, or knowing about knowing. With regard to procedural metamemory, the child was unable to accurately predict his own memory, particularly which items he would not be able to recall. Declarative metamemory also was impaired. Tasks requiring imitation of the researcher or that were largely nonverbal resulted in particularly poor performance. The findings indicate that the child?s social deficits related to Asperger?s Syndrome extended to the cognitive domain. Overall, a deficit in cognitive awareness was observed.
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Amann, Freya. "„Hie Bayern, hie Preußen“?" Diss., Ludwig-Maximilians-Universität München, 2011. http://nbn-resolving.de/urn:nbn:de:bvb:19-155787.
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Escobar, Marina Sofia Martins. "HIP Ostearthritis - Total HIP Arthroplasty." Master's thesis, Instituto de Ciências Biomédicas Abel Salazar, 2009. http://hdl.handle.net/10216/53382.
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Escobar, Marina Sofia Martins. "HIP Ostearthritis - Total HIP Arthroplasty." Dissertação, Instituto de Ciências Biomédicas Abel Salazar, 2009. http://hdl.handle.net/10216/53382.
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Lindley, Arlette. "Robert Merle : his life, his work." Thesis, Lancaster University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309021.
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Hagen, Egil Ragnar. "Development of coffee production in Nepal : analysis of an appropriate supply chain and institutional support for production and export of specialty coffee from Nepal /." Agder : Faculty of Engineering and Science, Universitetet i Agder, 2008. http://brage.bibsys.no/hia/bitstream/URN:NBN:no-bibsys_brage_9008/1/Hagen.pdf.
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Galhena, Bandula Lanka. "Managerial career plateaue : determinants, consequences and coping strategies /." Agder : Department of Economics and Business Administration, Universitetet i Agder, 2008. http://brage.bibsys.no/hia/bitstream/URN:NBN:no-bibsys_brage_5932/1/master_okad_2008_galhena.pdf.
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Duvall, Melody Gayle. "HIV-specific cellular immune responses in HIV-1 and HIV-2 infection." Thesis, University of Oxford, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441307.
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Smith, Jeffrey. "James Losh : his ideas in relation to his circle and his time." Thesis, Northumbria University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.245210.
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De, Villiers Gezina Gertruida. "Understanding Gilgamesh his world and his story /." Pretoria : [S.n.], 2004. http://upetd.up.ac.za/thesis/available/etd-03072005-144957/.
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Ramalho, Elba Braga. "Luiz Gonzaga : his life and his music." Thesis, University of Liverpool, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.364181.
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Perez, Flora Olga Cristina. "Ernesto Lecuona: HIs Life and His Songs." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1373372039.
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De, Villiers Gerda. "Understanding Gilgamesh : his world and his story." Thesis, University of Pretoria, 2005. http://hdl.handle.net/2263/22989.
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Understanding Gilgamesh – brokenly – is to understand life brokenly. The Epic of Gilgamesh is the narrative of life. It records the full cycle of the nerve and aplomb of youth, of the doubt and crisis of midlife, of the acceptance and quiescience of maturity. Moreover, this understanding is a broken understanding. It starts with the clay tablets that are broken in a literal sense of the word. Further, the narrative is a narrative of broken-ness – the story ends in tears. A man has lost his last chance of obtaining life everlasting. Yet he manages to recuperate despite his failure. The first part of this thesis examined the world of Gilgamesh. Initially he was known as the Sumerian king Bilgames. He makes his appearance in the form of oral compositions that are recited or sung in the royal courts of kings during the Sumerian period: sheer entertainment, nothing really serious. At his side is his loyal servant Enkidu who supports his master in everything he does. Akkadian gradually ousts Sumerian as vernacular, yet the latter continues to dominate as the language of culture and court. Bilgames survives the reign of the Sargonic dynasty, and even revives during the glorious Ur III period of Shulgi and of Ur-Nammu. Sumerian Bilgames-poems are recorded in writing. However, by the time that Hammurapi draws up his legal codex, the Sumerian Bilgames is known as the vibrant Akkadian king Gilgamesh. His servant Enkidu is elevated to the status of friend. Together they defy men, gods, monsters. When Enkidu dies, Gilgamesh goes even further in search of life everlasting. He reaches Uta-napishtim the Distant in order to learn the secret of eternal life. The optimism of the Old Babylonian Kingdom is replaced by the reflection and introspection of the Middle period. Life is difficult. Life is complex. The Gilgamesh Epic is once again re-interpreted and supplemented by a prologue and an epilogue: both begin and end at the same place, at the walls of Uruk. Here Gilgamesh looks back and forward to his life and contemplates about the meaning of life in general. The second part of this thesis dealt more specifically with the story – the literary aspects of the Epic. Genette’s theory illuminated several interesting literary devices with regards to the rhythm and pace of the narrative. However, much of the reflective nature of the Epic was also revealed. There were moments of looking forward, and looking backward: after Gilgamesh broke down in tears at the end of the Epic, he suddely gained perspective on life. Somehow a broken narrative focused into a meaningful whole that may just make future sense. Jauss’s theory illuminated why Gilgamesh refuses to be forgotten, why he is once again alive and well in the twenty first century. Although he was buried in the ruins of Nineveh for a thousand plus years, he is suddenly back on the scene – and not for academic reasons only. Not only scholars of the Ancient Near East take an interest in the old Epic, but also people from all sectors of life. Somehow Gilgamesh seems to respond to questions that are asked even by those who understand nuclear physics – but who grapple with the paradox of living meaningfully. Understanding Gilgamesh – brokenly – understands life.Thesis (DLitt)--University of Pretoria, 2006.
Ancient Languages
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Corley, Brigitte. "Conrad von Soest : his altarpieces, his workshop and his place in European art." Thesis, Birkbeck (University of London), 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.369553.
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Mokitimi, Serialong. ""I found myself having slept with him" : vulnerability to HIV and the first sexual encounter as described by six young Basotho women." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/11296.
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Bibliography: leaves 82-89.This study is a qualitative exploration of the first sexual experiences of six young Basotho women between the ages of 16 and 24 and how these experiences leave them vulnerable to HIV/AIDS. The six young women were interviewed using a semistructured interview schedule focusing on first sexual experiences and knowledge of HIV/AIDS. The interviews were recorded, transcribed and translated from Sesotho into English. Transcripts were analysed using thematic analysis. The themes which emerged were elucidated by linking the findings to the current literature on the vulnerability of young women to HIV/AIDS infection in sub-Saharan Africa. The dominant themes which emerged were: young women are engaging in sexual activity in early adolescence when issues of identity are still being negotiated, they have had little if any opportunity to discuss sex, love and intimacy and to develop their own thoughts about these issues, almost no guidance is offered by parents, teachers or other adults in these matters, peers and siblings are the main source of information and influenced these young women's attitudes towards sex, there was a high level of pressure and coercion by the young women's partners to have sex, there was a disturbing lack of knowledge of reproductive health and misconceptions about the prevention and spread of sexually transmitted infections and HIV/AIDS.
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Ni, Na. "The function of HIV-1 A-loop on primer selection." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2007. https://www.mhsl.uab.edu/dt/2008r/ni.pdf.
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Pantelic, Marija. "HIV, blame and shame : internalised HIV stigma among South African adolescents living with HIV." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:ebc47dd0-df36-4b12-93b5-4e7d43603490.
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Background: This is the first epidemiological study of internalised stigma among adolescents living with the human immunodeficiency virus (HIV) in Sub-Saharan Africa. It aims to establish predictors of internalized HIV-stigma among people living with HIV in Sub-Saharan Africa (Paper 1), develop an HIV-stigma scale for use with adolescents (Paper 2) and build and test a model of risk pathways for internalised stigma (Paper 3). The data used for papers 2 and 3 is part of the world's largest social science study of adolescents living with HIV (n=1060). Paper One systematically reviews evidence on the prevalence and predictors of internalised HIV stigma amongst people living with HIV in Sub-Saharan Africa. PRISMA guidelines were followed. An adapted version of the Cambridge Quality Checklist was used to assess the quality of the findings. A total of 18 papers were included. The prevalence of internalised stigma among adults living with HIV was 27% - 66%. The longitudinal predictors for internalised HIV stigma were poor HIV-related health and psychological distress. The review identifies two critical limitations of the literature. First, no studies on adolescents were found. One of the reasons for this may be the lack of a scale for measuring internalised HIV stigma in this population. Second, only individual-level risk factors for internalised stigma were examined. Papers 2 and 3 aim to address these limitations. Paper Two develops an HIV stigma scale with and for adolescents living with HIV. First, a multidimensional stigma scale previously used with adolescents in the US was cross-culturally adapted using semi-structured cognitive interviews with nine South African adolescents living with HIV. These data were interpreted through thematic analysis, and items were adapted in consultation with interviewees. Second, the revised version of the scale was administered to 1060 adolescents living with HIV. Confirmatory factor analysis confirmed the predicted 3-factor structure, and associations with hypothesised correlates provided evidence of validity. Paper Three develops and tests a model of risk pathways to internalised HIV stigma among adolescents living with HIV. Drawing on findings from the systematic review (Paper 1) and using the scale developed in Paper 2, both inter and intrapersonal pathways of risk from HIV-related disability to internalised HIV stigma were hypothesized. Following from modified labelling theory, interpersonal mechanisms were hypothesized to occur through maltreatment within power-unequal relationships, i.e. enacted HIV stigma and violence victimization. Hypothesized intrapersonal risks were anticipated HIV stigma and depression. Structural equation modelling enabled the grouping of theoretically related constructs and assessment of multiple, simultaneous pathways of risk. Prevalence of any internalised HIV stigma among adolescents living with HIV was 26.5%. As hypothesized, significant associations between internalised stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, violence victimization, and enacted stigma were not directly associated with internalised stigma. Rather, indirect pathways via intrapersonal risks were observed. Conclusions: More than a quarter of adolescents living with HIV in this study reported experiencing some level of internalised stigma. Findings suggest a need to expand programmatic responses to internalised HIV stigma, from individualistic, clinic-based programmes to integrative, community-based approaches. Providing mental health support and reducing the maltreatment of adolescents living with HIV might interrupt pathways from HIV-related disability to internalised stigma. This highlights the potential for interventions that do not necessarily target HIV-positive adolescents but are sensitive to their needs. Such efforts must be coupled with rigorous process and outcome evaluations, and longitudinal data is urgently needed. It is hoped that the adolescent-friendly stigma scale developed within this DPhil will enable further research with this understudied population. Prior to this thesis, there were no known epidemiological studies of internalised HIV stigma among adolescents living with HIV. Moreover, the broader, adult-focused corpus of research has overlooked interpersonal risk factors. This thesis highlights the relevance of power inequalities and domination for the study of internalised HIV stigma.
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Yang, Wa. "The evolution of HIV-1 and HIV-2." Thesis, University College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.405605.
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Paudice, Aleida. "Elia Capsali : his world and his historical works." Thesis, University of Cambridge, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.615289.
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Kobayashi, Noriko. "Robert Schumann : his mental illness and his music /." Thesis, Connect to this title online; UW restricted, 1996. http://hdl.handle.net/1773/11352.
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Nankivell, Louise C. "'I want him to be a better person than his dad was' : how mothers experience their relationship with their son following domestic violence." Thesis, University of Essex, 2015. http://repository.essex.ac.uk/15512/.
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Introduction: Research has considered the impact of Domestic Violence (DV) on both women and children, but little research has considered the role of mothering in a context of DV. The research questions how mothers of young sons experience this mother-son relationship in a context of and following DV. Method: This study utilised eight semi-structured interviews with women recruited from a Children's Centre and voluntary women's service and were analysed using a Constructivist Grounded Theory methodology. Results: The analysis suggested that the women constructed violence as being a cycle and their relationship with their son was impacted by this in multiple ways; being preoccupied with the perpetrator, difficulty bonding, impact on maternal mental health, experiencing mothering as a burden and son(s) 'copying' the perpetrator. With the support of services the women have reflected on this cycle and have ended it to enable their son(s) to be 'better than their dad'. Out of the context of DV the women's relationship with their son was able to be stronger and they were able to teach him 'right from wrong'. Discussion: Although only 8 women were recruited the interviews provided rich material and it was hoped that an in depth analysis was completed. The research findings will have clinical implications about how services support women in their relationship with their son(s) in a context of and following DV.