Use of intranet and other interventions to increase influenza vaccination among health care workers

Influenza (the flu) is a serious respiratory illness that can cause severe complications, often leading to hospitalization and even death. Influenza epidemics occur in most countries every year, usually during the winter months. Despite recommendations from the Centers for Disease Control and Prevention (CDC) and efforts by health care institutions across the United States, influenza vaccination rates among health care workers in the United States remain low. How to increase the number of vaccinated health care workers is an important public health question and is examined in two journal articles included here. ^ The first journal article evaluates the effectiveness of an Intranet intervention in increasing the proportion of health care workers (HCWs) who received influenza vaccination. Hospital employees were required go to the hospital's Intranet and select "vaccine received," "contraindicated," or "declined" from the online questionnaire. Declining employees automatically received an online pop-up window with education about vaccination; managers were provided feedback on employees' participation rates via e-mail messages. Employees were reminded of the Intranet requirement in articles in the employee newsletter and on the hospital's Intranet. Reminders about the Intranet questionnaire were provided through managers and newsletters to the HCWs. Fewer than half the employees (43.7%) completed the online questionnaire. Yet the hospital witnessed a statistically significant increase in the percentage of employees who received the flu vaccine at the hospital – 48.5% in the 2008-09 season as compared to 36.5%, 38.5% and 29.8% in the previous three years (P < 0.05). ^ The second article assesses current interventions employed by hospitals, health systems and nursing homes to determine which policies have been the most effective in boosting vaccination rates among American health care workers. A systematic review of research published between January 1994 and March 2010 suggests that education is necessary but not usually sufficient to increase vaccine uptake. Education about the flu and flu vaccines is most effective when complemented with easy access and making the vaccine free, although this combination may not be sufficient to achieve the desired vaccination levels among HCWs. The findings point toward adding incentives for HCWs to get vaccinated and requiring them to record their vaccination status on a declination/consent form – either written or electronic. ^ Based on these findings, American health care organizations, such as hospitals, nursing homes, and long-term care facilities, should consider using online declination forms as a method for increasing influenza vaccination rates among their employees. These online forms should be used in conjunction with other policies, including free vaccine, mobile distribution and incentives. ^ To further spur health care organizations to adopt policies and practices that will raise influenza vaccination rates among employees, The Joint Commission – an independent, not-for- profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States – should consider altering its standards. Currently, The Joint Commission does not require signed declination forms from employees who eschew vaccination; it only echoes the CDC's recommendations: "Health care facilities should require personnel who refuse vaccination to complete a declination form." Because participation in Joint Commission accreditation is required for Medicare reimbursement, action taken by the Joint Commission to require interventions such as mandatory declination/consent forms might result in immediate action by health care organizations to follow these new standards and lead to higher vaccination rates among HCWs.^ 1“Frequently Asked Questions for H1N1 and Seasonal Influenza.” The Joint Commission - Infection Control: http://www.jointcommission.org/PatientSafety/InfectionControl/h1n1_faq.htm. ^

Elemental contents, non-carbonate, fatty acids and alcohols analysis from different Holes of IODP Expedition 310

During IODP Expedition 310 (Tahiti Sea Level), drowned Pleistocene-Holocene barrier-reef terraces were drilled on the slope of the volcanic island. The deglacial reef succession typically consists of a coral framework encrusted by coralline algae and later by microbialites; the latter make up < 80% of the rock volume. Lipid biomarkers were analyzed in order to identify organisms involved in reef-microbialite formation at Tahiti, as the genesis of deglacial microbialites and the conditions favoring their formation are not fully understood. Sterols plus saturated and monounsaturated short-chain fatty acids predominantly derived from both marine primary producers (algae) and bacteria comprise 44 wt% of all lipids on average, whereas long-chain fatty acids and long-chain alcohols derived from higher land plants represent an average of only 24 wt%. Bacterially derived mono-O-alkyl glycerol ethers (MAGEs) and branched fatty acids (10-Me-C16:0; iso- and anteiso-C15:0 and -C17:0) are exceptionally abundant in the microbial carbonates (average, 19 wt%) and represent biomarkers of intermediate-to-high specificity for sulfate-reducing bacteria. Both are relatively enriched in 13C compared to eukaryotic lipids. No lipid biomarkers indicative of cyanobacteria were preserved in the microbialites. The abundances of Al, Si, Fe, Mn, Ba, pyroxene, plagioclase, and magnetite reflect strong terrigenous influx with Tahitian basalt as the major source. Chemical weathering of the basalt most likely elevated nutrient levels in the reefs and this fertilization led to an increase in primary production and organic matter formation, boosting heterotrophic sulfate reduction. Based on the observed biomarker patterns, sulfate-reducing bacteria were apparently involved in the formation of microbialites in the coral reefs off Tahiti during the last deglaciation.

Transcriptional response to cardiac injury in the zebrafish: systematic identification of genes with highly concordant activity across in vivo models

BACKGROUND Zebrafish is a clinically-relevant model of heart regeneration. Unlike mammals, it has a remarkable heart repair capacity after injury, and promises novel translational applications. Amputation and cryoinjury models are key research tools for understanding injury response and regeneration in vivo. An understanding of the transcriptional responses following injury is needed to identify key players of heart tissue repair, as well as potential targets for boosting this property in humans. RESULTS We investigated amputation and cryoinjury in vivo models of heart damage in the zebrafish through unbiased, integrative analyses of independent molecular datasets. To detect genes with potential biological roles, we derived computational prediction models with microarray data from heart amputation experiments. We focused on a top-ranked set of genes highly activated in the early post-injury stage, whose activity was further verified in independent microarray datasets. Next, we performed independent validations of expression responses with qPCR in a cryoinjury model. Across in vivo models, the top candidates showed highly concordant responses at 1 and 3 days post-injury, which highlights the predictive power of our analysis strategies and the possible biological relevance of these genes. Top candidates are significantly involved in cell fate specification and differentiation, and include heart failure markers such as periostin, as well as potential new targets for heart regeneration. For example, ptgis and ca2 were overexpressed, while usp2a, a regulator of the p53 pathway, was down-regulated in our in vivo models. Interestingly, a high activity of ptgis and ca2 has been previously observed in failing hearts from rats and humans. CONCLUSIONS We identified genes with potential critical roles in the response to cardiac damage in the zebrafish. Their transcriptional activities are reproducible in different in vivo models of cardiac injury.

Outward FDI from developing countries : a case of Chinese firms in South Africa

Outward foreign direct investment (FDI) from developing countries is increasing. In the research on FDI, it has been considered that only competitive and productive firms can invest in foreign countries. However, since the differences in competitiveness and productivity between multinational enterprises (MNEs) from developed and developing countries have not been explicitly investigated, we cannot say whether MNEs from developing countries can or cannot survive in competition with MNEs from developed countries as well as against competitive and productive indigenous firms in host countries. To examine the activities of MNEs from developing countries, this study investigates Chinese firms in South Africa. It reveals that in order to compensate for the weak brand recognition of Chinese products and to expand sales, Chinese firms have mainly been making products that are sold under the brand names of indigenous South African firms. Chinese firms have expanded their business in South Africa relying on the business resources of indigenous firms in the host country. This indicates that business with indigenous firms is significant for MNEs from developing countries in boosting competitiveness.

Agglomeration and firm-level productivity : a Bayesian spatial approach

This paper estimates the impact of industrial agglomeration on firm-level productivity in Chinese manufacturing sectors. To account for spatial autocorrelation across regions, we formulate a hierarchical spatial model at the firm level and develop a Bayesian estimation algorithm. A Bayesian instrumental-variables approach is used to address endogeneity bias of agglomeration. Robust to these potential biases, we find that agglomeration of the same industry (i.e. localization) has a productivity-boosting effect, but agglomeration of urban population (i.e. urbanization) has no such effects. Additionally, the localization effects increase with educational levels of employees and the share of intermediate inputs in gross output. These results may suggest that agglomeration externalities occur through knowledge spillovers and input sharing among firms producing similar manufactures.

Desarrollo de estructuras nanofotonicas de campo cercano para intensificacion localizada de luz en celulas solares de banda intermedia - Near-field nanophotonic structures for localized light enhancement in intermediate band solar cells

This doctoral thesis explores some of the possibilities that near-field optics can bring to photovoltaics, and in particular to quantum-dot intermediate band solar cells (QD-IBSCs). Our main focus is the analytical optimization of the electric field distribution produced in the vicinity of single scattering particles, in order to produce the highest possible absorption enhancement in the photovoltaic medium in their surroundings. Near-field scattering structures have also been fabricated in laboratory, allowing the application of the previously studied theoretical concepts to real devices. We start by looking into the electrostatic scattering regime, which is only applicable to sub-wavelength sized particles. In this regime it was found that metallic nano-spheroids can produce absorption enhancements of about two orders of magnitude on the material in their vicinity, due to their strong plasmonic resonance. The frequency of such resonance can be tuned with the shape of the particles, allowing us to match it with the optimal transition energies of the intermediate band material. Since these metallic nanoparticles (MNPs) are to be inserted inside the cell photovoltaic medium, they should be coated by a thin insulating layer to prevent electron-hole recombination at their surface. This analysis is then generalized, using an analytical separation-of-variables method implemented in Mathematica7.0, to compute scattering by spheroids of any size and material. This code allowed the study of the scattering properties of wavelengthsized particles (mesoscopic regime), and it was verified that in this regime dielectric spheroids perform better than metallic. The light intensity scattered from such dielectric spheroids can have more than two orders of magnitude than the incident intensity, and the focal region in front of the particle can be shaped in several ways by changing the particle geometry and/or material. Experimental work was also performed in this PhD to implement in practice the concepts studied in the analysis of sub-wavelength MNPs. A wet-coating method was developed to self-assemble regular arrays of colloidal MNPs on the surface of several materials, such as silicon wafers, amorphous silicon films, gallium arsenide and glass. A series of thermal and chemical tests have been performed showing what treatments the nanoparticles can withstand for their embedment in a photovoltaic medium. MNPs arrays are then inserted in an amorphous silicon medium to study the effect of their plasmonic near-field enhancement on the absorption spectrum of the material. The self-assembled arrays of MNPs constructed in these experiments inspired a new strategy for fabricating IBSCs using colloidal quantum dots (CQDs). Such CQDs can be deposited in self-assembled monolayers, using procedures similar to those developed for the patterning of colloidal MNPs. The use of CQDs to form the intermediate band presents several important practical and physical advantages relative to the conventional dots epitaxially grown by the Stranski-Krastanov method. Besides, this provides a fast and inexpensive method for patterning binary arrays of QDs and MNPs, envisioned in the theoretical part of this thesis, in which the MNPs act as antennas focusing the light in the QDs and therefore boosting their absorption

The introduction of teaching innovations into the traditional teaching of construction and building materials

The traditional teaching methods used for training civil engineers are currently being called into question as a result of the new knowledge and skills now required by the labor market. In addition, the European Higher Education Area is requesting that students be given a greater say in their learning. In the subject called Construction and Building Materials at the Civil Engineering School of the Universidad Politécnica de Madrid, a path was set three academic years ago to lead to an improvement in traditional teaching by introducing active methodologies. The innovations are based on cooperative learning, new technologies, and continuous assessment. The writers’ proposal is to offer their experience as a contribution to the debate on how students can be encouraged to acquire the skills currently demanded from a civil engineer, though not overlooking solid, top-quality training. From the outcomes obtained, it can be concluded that using new teaching techniques to supplement a traditional approach provides more opportunities for students to learn while boosting their motivation. In our case, the introduction of these changes has resulted in an increased pass rate of 29% on average, when such a figure is considered in the light of the mean value of passes during the last decade.

A new feature extraction method for signal classification applied to cat spinal cord signals

In the spinal cord of the anesthetized cat, spontaneous cord dorsum potentials (CDPs) appear synchronously along the lumbo-sacral segments. These CDPs have different shapes and magnitudes. Previous work has indicated that some CDPs appear to be specially associated with the activation of spinal pathways that lead to primary afferent depolarization and presynaptic inhibition. Visual detection and classification of these CDPs provides relevant information on the functional organization of the neural networks involved in the control of sensory information and allows the characterization of the changes produced by acute nerve and spinal lesions. We now present a novel feature extraction approach for signal classification, applied to CDP detection. The method is based on an intuitive procedure. We first remove by convolution the noise from the CDPs recorded in each given spinal segment. Then, we assign a coefficient for each main local maximum of the signal using its amplitude and distance to the most important maximum of the signal. These coefficients will be the input for the subsequent classification algorithm. In particular, we employ gradient boosting classification trees. This combination of approaches allows a faster and more accurate discrimination of CDPs than is obtained by other methods.

Short tethers for electrodynamic thrust

The operational advantages of electrodynamic tethers of moderate length are becoming evident from studies of collision avoidance. Although long tethers (of order of 10 kilometers) provide high efficiency and good adaptability to varying plasma conditions, boosting tethers of moderate length (- 1 kilometer) and suitable design might still operate at acceptable efficiencies and adequate adaptability to a changing environment. In this paper we carry out a parametric analysis of the performance of 1-km long boosting tethers, to maximize their efficiency. We also discuss the possible use of multiple, parallel such tethers for keeping thrust high when length is decreased. We then estimate the survivability of short tethers to micrometeoroids and orbital debris. Finally, a few considerations are made on the dynamic stability of electrodynamic tether systems versus length.

Electrodynamic tether applications and constraints

Propulsion and power generation by bare electrodynamic tethers are revisited in a unified way and issues and constraints are addressed. In comparing electrodynamic tethers, which do not use propellant, with other propellantconsuming systems, mission duration is a discriminator that defines crossover points for systems with equal initial masses. Bare tethers operating in low Earth orbit can be more competitive than optimum ion thrusters in missions exceeding two-three days for orbital deboost and three weeks for boosting operations. If the tether produces useful onboard power during deboost, the crossover point reaches to about 10 days. Power generation by means of a bare electrodynamic tether in combination with chemical propulsion to maintain orbital altitude of the system is more efficient than use of the same chemicals (liquid hydrogen and liquid oxygen) in a fuel cell to produce power for missions longer than one week. Issues associated with tether temperature, bowing, deployment, and arcing are also discussed. Heating/cooling rates reach about 4 K/s for a 0.05-mm-thick tape and a fraction of Kelvin/second for the ProSEDS (0.6-mm-radius) wire; under dominant ohmic effects, temperatures areover200K (night) and 380 K (day) for the tape and 320 and 415 K for that wire. Tether applications other than propulsion and power are briefly discussed.

Road fright transport decoupling: A comparative analysis between the United Kingdom and Spain

Economic growth has traditionally been linked to road freight transport demand, leading to a steady rise in social and environmental impacts. Concern about this problem has caused the EU to promote a decoupling strategy aimed at boosting sustainable development in European countries by improving the efficiency of transport systems without curbing economic growth. Over the last few years empirical evidence in some countries such as the United Kingdom has shown an increase in GDP while the volume of road freight traffic has remained stable or even decreased. This paper compares recent decoupling trends by analyzing the evolution of road tonne-kms/GDP relationship in the United Kingdom and Spain from 1999 to 2007. This comparison seeks to identify the main differences and key drivers of decoupling in both countries. We first provide an overview of the divergences between both economic structures and levels of road transport intensity. Then we conduct a decomposition analysis in order to identify the variables that explain the evolution of truck traffic per unit of GDP in each country. The results show that the increasing share of services in GDP has substantially contributed to decreasing road transport demand in both cases. Changes in road transport intensity due to improvements in logistic and supply chain management have been more successful in the UK than in Spain.

Using pMOS Pass-Gates to Boost SRAM Performance by Exploiting Strain Effects in Sub-20-nm FinFET Technologies

Strained fin is one of the techniques used to improve the devices as their size keeps reducing in new nanoscale nodes. In this paper, we use a predictive technology of 14 nm where pMOS mobility is significantly improved when those devices are built on top of long, uncut fins, while nMOS devices present the opposite behavior due to the combination of strains. We explore the possibility of boosting circuit performance in repetitive structures where long uncut fins can be exploited to increase fin strain impact. In particular, pMOS pass-gates are used in 6T complementary SRAM cells (CSRAM) with reinforced pull-ups. Those cells are simulated under process variability and compared to the regular SRAM. We show that when layout dependent effects are considered the CSRAM design provides 10% to 40% faster access time while keeping the same area, power, and stability than a regular 6T SRAM cell. The conclusions also apply to 8T SRAM cells. The CSRAM cell also presents increased reliability in technologies whose nMOS devices have more mismatch than pMOS transistors.

Design and Simulation of Deep Nanometer SRAM Cells under Energy, Mismatch, and Radiation Constraints

La fiabilidad está pasando a ser el principal problema de los circuitos integrados según la tecnología desciende por debajo de los 22nm. Pequeñas imperfecciones en la fabricación de los dispositivos dan lugar ahora a importantes diferencias aleatorias en sus características eléctricas, que han de ser tenidas en cuenta durante la fase de diseño. Los nuevos procesos y materiales requeridos para la fabricación de dispositivos de dimensiones tan reducidas están dando lugar a diferentes efectos que resultan finalmente en un incremento del consumo estático, o una mayor vulnerabilidad frente a radiación. Las memorias SRAM son ya la parte más vulnerable de un sistema electrónico, no solo por representar más de la mitad del área de los SoCs y microprocesadores actuales, sino también porque las variaciones de proceso les afectan de forma crítica, donde el fallo de una única célula afecta a la memoria entera. Esta tesis aborda los diferentes retos que presenta el diseño de memorias SRAM en las tecnologías más pequeñas. En un escenario de aumento de la variabilidad, se consideran problemas como el consumo de energía, el diseño teniendo en cuenta efectos de la tecnología a bajo nivel o el endurecimiento frente a radiación. En primer lugar, dado el aumento de la variabilidad de los dispositivos pertenecientes a los nodos tecnológicos más pequeños, así como a la aparición de nuevas fuentes de variabilidad por la inclusión de nuevos dispositivos y la reducción de sus dimensiones, la precisión del modelado de dicha variabilidad es crucial. Se propone en la tesis extender el método de inyectores, que modela la variabilidad a nivel de circuito, abstrayendo sus causas físicas, añadiendo dos nuevas fuentes para modelar la pendiente sub-umbral y el DIBL, de creciente importancia en la tecnología FinFET. Los dos nuevos inyectores propuestos incrementan la exactitud de figuras de mérito a diferentes niveles de abstracción del diseño electrónico: a nivel de transistor, de puerta y de circuito. El error cuadrático medio al simular métricas de estabilidad y prestaciones de células SRAM se reduce un mínimo de 1,5 veces y hasta un máximo de 7,5 a la vez que la estimación de la probabilidad de fallo se mejora en varios ordenes de magnitud. El diseño para bajo consumo es una de las principales aplicaciones actuales dada la creciente importancia de los dispositivos móviles dependientes de baterías. Es igualmente necesario debido a las importantes densidades de potencia en los sistemas actuales, con el fin de reducir su disipación térmica y sus consecuencias en cuanto al envejecimiento. El método tradicional de reducir la tensión de alimentación para reducir el consumo es problemático en el caso de las memorias SRAM dado el creciente impacto de la variabilidad a bajas tensiones. Se propone el diseño de una célula que usa valores negativos en la bit-line para reducir los fallos de escritura según se reduce la tensión de alimentación principal. A pesar de usar una segunda fuente de alimentación para la tensión negativa en la bit-line, el diseño propuesto consigue reducir el consumo hasta en un 20 % comparado con una célula convencional. Una nueva métrica, el hold trip point se ha propuesto para prevenir nuevos tipos de fallo debidos al uso de tensiones negativas, así como un método alternativo para estimar la velocidad de lectura, reduciendo el número de simulaciones necesarias. Según continúa la reducción del tamaño de los dispositivos electrónicos, se incluyen nuevos mecanismos que permiten facilitar el proceso de fabricación, o alcanzar las prestaciones requeridas para cada nueva generación tecnológica. Se puede citar como ejemplo el estrés compresivo o extensivo aplicado a los fins en tecnologías FinFET, que altera la movilidad de los transistores fabricados a partir de dichos fins. Los efectos de estos mecanismos dependen mucho del layout, la posición de unos transistores afecta a los transistores colindantes y pudiendo ser el efecto diferente en diferentes tipos de transistores. Se propone el uso de una célula SRAM complementaria que utiliza dispositivos pMOS en los transistores de paso, así reduciendo la longitud de los fins de los transistores nMOS y alargando los de los pMOS, extendiéndolos a las células vecinas y hasta los límites de la matriz de células. Considerando los efectos del STI y estresores de SiGe, el diseño propuesto mejora los dos tipos de transistores, mejorando las prestaciones de la célula SRAM complementaria en más de un 10% para una misma probabilidad de fallo y un mismo consumo estático, sin que se requiera aumentar el área. Finalmente, la radiación ha sido un problema recurrente en la electrónica para aplicaciones espaciales, pero la reducción de las corrientes y tensiones de los dispositivos actuales los está volviendo vulnerables al ruido generado por radiación, incluso a nivel de suelo. Pese a que tecnologías como SOI o FinFET reducen la cantidad de energía colectada por el circuito durante el impacto de una partícula, las importantes variaciones de proceso en los nodos más pequeños va a afectar su inmunidad frente a la radiación. Se demuestra que los errores inducidos por radiación pueden aumentar hasta en un 40 % en el nodo de 7nm cuando se consideran las variaciones de proceso, comparado con el caso nominal. Este incremento es de una magnitud mayor que la mejora obtenida mediante el diseño de células de memoria específicamente endurecidas frente a radiación, sugiriendo que la reducción de la variabilidad representaría una mayor mejora. ABSTRACT Reliability is becoming the main concern on integrated circuit as the technology goes beyond 22nm. Small imperfections in the device manufacturing result now in important random differences of the devices at electrical level which must be dealt with during the design. New processes and materials, required to allow the fabrication of the extremely short devices, are making new effects appear resulting ultimately on increased static power consumption, or higher vulnerability to radiation SRAMs have become the most vulnerable part of electronic systems, not only they account for more than half of the chip area of nowadays SoCs and microprocessors, but they are critical as soon as different variation sources are regarded, with failures in a single cell making the whole memory fail. This thesis addresses the different challenges that SRAM design has in the smallest technologies. In a common scenario of increasing variability, issues like energy consumption, design aware of the technology and radiation hardening are considered. First, given the increasing magnitude of device variability in the smallest nodes, as well as new sources of variability appearing as a consequence of new devices and shortened lengths, an accurate modeling of the variability is crucial. We propose to extend the injectors method that models variability at circuit level, abstracting its physical sources, to better model sub-threshold slope and drain induced barrier lowering that are gaining importance in FinFET technology. The two new proposed injectors bring an increased accuracy of figures of merit at different abstraction levels of electronic design, at transistor, gate and circuit levels. The mean square error estimating performance and stability metrics of SRAM cells is reduced by at least 1.5 and up to 7.5 while the yield estimation is improved by orders of magnitude. Low power design is a major constraint given the high-growing market of mobile devices that run on battery. It is also relevant because of the increased power densities of nowadays systems, in order to reduce the thermal dissipation and its impact on aging. The traditional approach of reducing the voltage to lower the energy consumption if challenging in the case of SRAMs given the increased impact of process variations at low voltage supplies. We propose a cell design that makes use of negative bit-line write-assist to overcome write failures as the main supply voltage is lowered. Despite using a second power source for the negative bit-line, the design achieves an energy reduction up to 20% compared to a conventional cell. A new metric, the hold trip point has been introduced to deal with new sources of failures to cells using a negative bit-line voltage, as well as an alternative method to estimate cell speed, requiring less simulations. With the continuous reduction of device sizes, new mechanisms need to be included to ease the fabrication process and to meet the performance targets of the successive nodes. As example we can consider the compressive or tensile strains included in FinFET technology, that alter the mobility of the transistors made out of the concerned fins. The effects of these mechanisms are very dependent on the layout, with transistor being affected by their neighbors, and different types of transistors being affected in a different way. We propose to use complementary SRAM cells with pMOS pass-gates in order to reduce the fin length of nMOS devices and achieve long uncut fins for the pMOS devices when the cell is included in its corresponding array. Once Shallow Trench isolation and SiGe stressors are considered the proposed design improves both kinds of transistor, boosting the performance of complementary SRAM cells by more than 10% for a same failure probability and static power consumption, with no area overhead. While radiation has been a traditional concern in space electronics, the small currents and voltages used in the latest nodes are making them more vulnerable to radiation-induced transient noise, even at ground level. Even if SOI or FinFET technologies reduce the amount of energy transferred from the striking particle to the circuit, the important process variation that the smallest nodes will present will affect their radiation hardening capabilities. We demonstrate that process variations can increase the radiation-induced error rate by up to 40% in the 7nm node compared to the nominal case. This increase is higher than the improvement achieved by radiation-hardened cells suggesting that the reduction of process variations would bring a higher improvement.

Potent, protective anti-HIV immune responses generated by bimodal HIV envelope DNA plus protein vaccination

It is generally thought that an effective vaccine to prevent HIV-1 infection should elicit both strong neutralizing antibody and cytotoxic T lymphocyte responses. We recently demonstrated that potent, boostable, long-lived HIV-1 envelope (Env)-specific cytotoxic T lymphocyte responses can be elicited in rhesus monkeys using plasmid-encoded HIV-1 env DNA as the immunogen. In the present study, we show that the addition of HIV-1 Env protein to this regimen as a boosting immunogen generates a high titer neutralizing antibody response in this nonhuman primate species. Moreover, we demonstrate in a pilot study that immunization with HIV-1 env DNA (multiple doses) followed by a final immunization with HIV-1 env DNA plus HIV-1 Env protein (env gene from HXBc2 clone of HIV IIIB; Env protein from parental HIV IIIB) completely protects monkeys from infection after i.v. challenge with a chimeric virus expressing HIV-1 env (HXBc2) on a simian immmunodeficiency virusmac backbone (SHIV-HXBc2). The potent immunity and protection seen in these pilot experiments suggest that a DNA prime/DNA plus protein boost regimen warrants active investigation as a vaccine strategy to prevent HIV-1 infection.

The role of antigen and IL-12 in sustaining Th1 memory cells in vivo: IL-12 is required to maintain memory/effector Th1 cells sufficient to mediate protection to an infectious parasite challenge

IL-12 plays a central role in both the induction and magnitude of a primary Th1 response. A critical question in designing vaccines for diseases requiring Th1 immunity such as Mycobacterium tuberculosis and Leishmania major is the requirements to sustain memory/effector Th1 cells in vivo. This report examines the role of IL-12 and antigen in sustaining Th1 responses sufficient for protective immunity to L. major after vaccination with LACK protein (LP) plus rIL-12 and LACK DNA. It shows that, after initial vaccination with LP plus rIL-12, supplemental boosting with either LP or rIL-12 is necessary but not sufficient to fully sustain long-term Th1 immunity. Moreover, endogenous IL-12 is also shown to be required for the induction, maintenance, and effector phase of the Th1 response after LACK DNA vaccination. Finally, IL-12 is required to sustain Th1 cells and control parasite growth in susceptible and resistant strains of mice during primary and secondary infection. Taken together, these data show that IL-12 is essential to sustain a sufficient number of memory/effector Th1 cells generated in vivo to mediate long-term protection to an intracellular pathogen.