Chapter 8 HPV vaccines

Vaccines to prevent infection with high-risk human papillomaviruses (HPV) will help protect women against cervical cancer, and some are likely to be available within the next year. One vaccine, a quadrivalent vaccine against HPV types 6, 11, 16 and 18 and known as Garadsil ©(Merck &Co., Inc), was approved by the Federal Drug Administration (FDA) for the prevention of cervical cancer, cervical cancer precursors and vulval and vaginal cancer precursors associated with HPV 16 and 18 in June 2006. In addition, the vaccine has been approved for the prevention of genital warts and low grade cervical lesions e.g. cervical intraepithelial neoplasia1. The main vaccines components are recombinant viral capsid proteins assembled into virus-like particles and alum-based adjuvants. If given before HPV infection, the vaccines, which induce HPV type-specific, virus-neutralizing antibodies, have proven safe and highly effective at preventing HPV infection and its clinical consequences, including high-grade cervical lesions. Their use should not immediately alter existing screening programs for cervical cancer, however. Because they incorporate only the 2 HPV types most commonly associated with cervical cancer (HPV-16 and HPV-18), they can only prevent about 70% of cervical cancers. Vaccines to treat existing HPV infection are under development but are unlikely to become clinically available in the near future.

Choosing to study pharmacy: measuring influences and motivations

This paper reports part of a national study of career motivations and expectations of United Kingdom MPharm students. The aim was to describe the students’ influences and motivations in making their choice to study pharmacy. A self-completion questionnaire was administered to year one and year four students in thirteen pharmacy schools during 2005. The reasons considered most important were objective ones that related to self-interest, both in terms of the nature of the degree course and the advantages conferred by the degree. However, there was evidence that for female students, future patterns of working that are not central to career progression were considered more important than for males. At a time of expanding demand by students for pharmacy education and a parallel demand for qualified pharmacists, this study adds to earlier knowledge on the motivations and influences on students when making their early career choices.

Choosing to study pharmacy: measuring influences and motivations

This paper reports part of a national study of career motivations and expectations of United Kingdom MPharm students. The aim was to describe the students’ influences and motivations in making their choice to study pharmacy. A self-completion questionnaire was administered to year one and year four students in thirteen pharmacy schools during 2005. The reasons considered most important were objective ones that related to self-interest, both in terms of the nature of the degree course and the advantages conferred by the degree. However, there was evidence that for female students, future patterns of working that are not central to career progression were considered more important than for males. At a time of expanding demand by students for pharmacy education and a parallel demand for qualified pharmacists, this study adds to earlier knowledge on the motivations and influences on students when making their early career choices.

Dynamic Life Cycle Assessment Modeling Approaches for Transboundary Energy Feedstocks

The rise of the twenty-first century has seen the further increase in the industrialization of Earth’s resources, as society aims to meet the needs of a growing population while still protecting our environmental and natural resources. The advent of the industrial bioeconomy – which encompasses the production of renewable biological resources and their conversion into food, feed, and bio-based products – is seen as an important step in transition towards sustainable development and away from fossil fuels. One sector of the industrial bioeconomy which is rapidly being expanded is the use of biobased feedstocks in electricity production as an alternative to coal, especially in the European Union.

As bioeconomy policies and objectives increasingly appear on political agendas, there is a growing need to quantify the impacts of transitioning from fossil fuel-based feedstocks to renewable biological feedstocks. Specifically, there is a growing need to conduct a systems analysis and potential risks of increasing the industrial bioeconomy, given that the flows within it are inextricably linked. Furthermore, greater analysis is needed into the consequences of shifting from fossil fuels to renewable feedstocks, in part through the use of life cycle assessment modeling to analyze impacts along the entire value chain.

To assess the emerging nature of the industrial bioeconomy, three objectives are addressed: (1) quantify the global industrial bioeconomy, linking the use of primary resources with the ultimate end product; (2) quantify the impacts of the expaning wood pellet energy export market of the Southeastern United States; (3) conduct a comparative life cycle assessment, incorporating the use of dynamic life cycle assessment, of replacing coal-fired electricity generation in the United Kingdom with wood pellets that are produced in the Southeastern United States.

To quantify the emergent industrial bioeconomy, an empirical analysis was undertaken. Existing databases from multiple domestic and international agencies was aggregated and analyzed in Microsoft Excel to produce a harmonized dataset of the bioeconomy. First-person interviews, existing academic literature, and industry reports were then utilized to delineate the various intermediate and end use flows within the bioeconomy. The results indicate that within a decade, the industrial use of agriculture has risen ten percent, given increases in the production of bioenergy and bioproducts. The underlying resources supporting the emergent bioeconomy (i.e., land, water, and fertilizer use) were also quantified and included in the database.

Following the quantification of the existing bioeconomy, an in-depth analysis of the bioenergy sector was conducted. Specifically, the focus was on quantifying the impacts of the emergent wood pellet export sector that has rapidly developed in recent years in the Southeastern United States. A cradle-to-gate life cycle assessment was conducted in order to quantify supply chain impacts from two wood pellet production scenarios: roundwood and sawmill residues. For reach of the nine impact categories assessed, wood pellet production from sawmill residues resulted in higher values, ranging from 10-31% higher.

The analysis of the wood pellet sector was then expanded to include the full life cycle (i.e., cradle-to-grave). In doing to, the combustion of biogenic carbon and the subsequent timing of emissions were assessed by incorporating dynamic life cycle assessment modeling. Assuming immediate carbon neutrality of the biomass, the results indicated an 86% reduction in global warming potential when utilizing wood pellets as compared to coal for electricity production in the United Kingdom. When incorporating the timing of emissions, wood pellets equated to a 75% or 96% reduction in carbon dioxide emissions, depending upon whether the forestry feedstock was considered to be harvested or planted in year one, respectively.

Finally, a policy analysis of renewable energy in the United States was conducted. Existing coal-fired power plants in the Southeastern United States were assessed in terms of incorporating the co-firing of wood pellets. Co-firing wood pellets with coal in existing Southeastern United States power stations would result in a nine percent reduction in global warming potential.

The Hidden benefits of “poster presentation assessment”: Skill acquirement and learning; evaluated from the nursing students perspective

Introduction
This paper reports to an exercise in evaluating poster group work and poster presentation and the extra learning and skill acquisition that this can provide to nursing students, through a creative and stimulating assessment method. Much had been written about the benefits of using posters as an assessment method, yet there appears to be a lack of research that captures the student experience.
Aim
This evaluative study sought to evaluate the student experience by using a triangulation approach to evaluation:
Methodology
All students from the February 2015 nursing intake, were eligible to take part (80 students) of which 71 participated (n=71). The poster group presentations took place at the end of their first phase of year one teaching and the evaluation took place at the end of their first year as undergraduate. Evaluation involved;
1. Quantitative data by questionnaires
2. Qualitative data from focus group discussions
Results
A number of key themes emerged from analysis of the data which captured the “added value” of learning from the process of poster assessment including:
 Professionalism: developing time keeping skills, presenting skills.
 Academic skills: developing literature search, critic and reporting
 Team building and collaboration
Overall 88% agreed that the process furnished them with additional skills and benefits above the actual production of the poster, with 97% agreeing that these additional skills are important skills for a nurse.
Conclusion
These results would suggest that the process of poster development and presentation furnish student nurses with many additional skills that they may not acquire through other types of assessment and are therefore beneficial. The structure of the assessment encourages a self-directed approach so students take control of the goals and purposes of learning. The sequential organization of the assessment guides students in the transition from dependent to self-directed learners.

Projeto raia de fogo: aspectos populacionais da raia de fogo (Dasyatis marianae Gomes, Rosa & Gadig, 2000) e pesca de elasmobrânquios no complexo recifal do Parracho de Maracajaú

The species Dasyatis marianae inhabits coastal areas associated with coral reefs, considered endemic to the northeast of Brazil, occurring from the State of Maranhão to the south of Bahia. Specimens of this species are commonly sighted by divers and fishermen in the area of Maracajaú reefs, a complex reef that is part of the Environmental Protection Area of Coral Reefs (EPACR), which was developed in this study about the ecology and biology of the D. marianae, in order to characterize aspects of population structure in the area of the reef complex of Parracho de Maracajaú. We analyzed 120 specimens caught by artisanal fishing site of the size, weight, sex, stage of maturity and stomach contents. Most subjects were adult males (1.7:1) and was more abundant for rays with lengths between 25 and 29cm of LD, where females reach larger sizes, a feature common to other rays. The largest specimens were captured in the area of seagrass, which is preferred for the species. The distribution of species in the area showed an ontogenetic and sexual segregation, where the youthful occur near the beach, which is a likely area for nursery and growth of the adult females prevail in the seagrass, which apparently has a high prey availability, and Adult males are more distant, a higher proportion occurring in outlying areas, suggesting a habit more exploratory than the females. The evaluation of the reproductive system indicated 3 reproductive cycles per year, one young per pregnancy, and showed that the mature males were smaller than females. The cubs of D. marianae size at birth 12 to 15cm LD. As for diet, the species was characterized as carnivorous crustacean specialist. The performance of visual censuses in different localities allowed to evaluate the density of D. marianae in different environments of the complex. The species occurs in greater numbers in seagrass, environment very important for the conservation of the species. 100 individuals of D. marianae marked in reef complex area enrolled in a recapture rate of 3%. Some behavioral aspects were evaluated, as diurnal pattern of activity, interaction with cleaning and fish Pomacanthus paru followers as Lutjanus analis and Carangoides bartholomaei. Overall, much of the information obtained should be used for management of the species

Características químicas do solo e desempenho de culturas após quatro anos de aplicações de cama de aviário em diferentes épocas e níveis

Due to the high supply and its attractive cost, the poultry litter has been used in the southwestern region of Parana to the improvement of soil fertility seeking greater production of grains and pastures. However, the use without technical knowledge can minimize the benefits of poultry litter or even cause undesirable effects on soil, environmental pollution and also productivity losses in the used crops. The objective of this study was to evaluate the influence of different times of poultry litter application, predating the winter crop, associated with increasing levels, about soil chemical properties, release of nutrients and crop performances in four consecutive years (2011-2014). In the first three years the experimental design was randomized blocks with a split plot system and four replications. In the main plots were tested four poultry litter application times preceding the wheat production: 0, 15, 30 and 45 days before sowing (DAS); in the subplots were applied four poultry litter levels (wet basis): 0, 4, 8 and 12 Mg ha-1. Last year one more subdivision of plots was done, evaluating the use or not of nitrogen in coverage in wheat, at a dose of 100 kg N ha-1. The wheat cultivar used in the four years was the BRS 220. In three years it was evaluated the residual effect on soybean production (cultivar - BMX Turbo RR) and in one year on the beans. The chemical soil attributes were evaluated at four depths 0-2,5cm, 2,5-5cm, 5-10cm and 10-20cm, and also the rate of decomposition and nutrient release of poultry litter and the crop productivity. The different times of application concerning the poultry litter had little influence on the studied variables, demonstrating that the producer does not need to have a specific date (before planting) to the application of poultry litter. Potassium was fully released 60 days after the allocation of litter bags into the field; for nitrogen and phosphorus the release was slower. The use of increasing levels of poultry litter increased the levels of various soil elements, highlighting the potassium which reached 20 cm deep in the second year of evaluation. The increase in pH and in the base saturation occurred only in the upper layers, while the phosphorus reached 10 cm deep in the third year of the study. It was observed increased pH and base saturation. The use of increasing doses of poultry litter contributed to the wheat plant nutrition, significantly increasing the weight of a thousand grains, and the grain yield of wheat in all the evaluated years; the nitrogen fertilization in coverage also had significant effect for the fourth evaluated year. Also there was a significant response from the residual effect of poultry litter for crops planted in summer for both soybeans and beans.

Olfactory dysfunction in young smokers J.

To establish the prevalence of olfactory dysfunction in smoking and non-smoking students of our Faculty who attend the Department of Otolaryngology (ENT) of our Hospital. Materials and method: Students (smokers and non-smokers) that do and do not suffer from olfactory dysfunction. We applied a questionnaire and a pocket smell test for screening all of the students. Results: We evaluated 207 students, between 18 and 30 years old; 50.7% (n=105) were women and 49.3% (n=102) were men. The smokers among them smoked up to 6 packs per year. One hundred twenty three students were non-smokers and 84 students were smokers. Of the 84 students who were smokers, 67 (79.7%) answered the Pocket Smell Test correctly (3/3) and 17 (20.2%) students had one or more errors. We had 123 non-smoker students and 103 (83.7%) students answered the Pocket Smell Test correctly and 20 (16.2%) answered with one or more errors. The prevalence of olfactory dysfunction in young smokers with a 95% conidence interval would be 32.8%. Conclusions: This study informed us about olfactory dysfunctions in our student population and their smoking habits. We corroborate that the Pocket Smell Test is reliable with the questionnaire; nevertheless it is a screening test. We have a population of young people who smoke one cigarette per day and who didn’t have a signiicant alteration in their ability of smell at the time of the study. This is consistent with medical literature. More studies should be conducted in order to expand this information.

Projeto raia de fogo: aspectos populacionais da raia de fogo (Dasyatis marianae Gomes, Rosa & Gadig, 2000) e pesca de elasmobrânquios no complexo recifal do Parracho de Maracajaú

The species Dasyatis marianae inhabits coastal areas associated with coral reefs, considered endemic to the northeast of Brazil, occurring from the State of Maranhão to the south of Bahia. Specimens of this species are commonly sighted by divers and fishermen in the area of Maracajaú reefs, a complex reef that is part of the Environmental Protection Area of Coral Reefs (EPACR), which was developed in this study about the ecology and biology of the D. marianae, in order to characterize aspects of population structure in the area of the reef complex of Parracho de Maracajaú. We analyzed 120 specimens caught by artisanal fishing site of the size, weight, sex, stage of maturity and stomach contents. Most subjects were adult males (1.7:1) and was more abundant for rays with lengths between 25 and 29cm of LD, where females reach larger sizes, a feature common to other rays. The largest specimens were captured in the area of seagrass, which is preferred for the species. The distribution of species in the area showed an ontogenetic and sexual segregation, where the youthful occur near the beach, which is a likely area for nursery and growth of the adult females prevail in the seagrass, which apparently has a high prey availability, and Adult males are more distant, a higher proportion occurring in outlying areas, suggesting a habit more exploratory than the females. The evaluation of the reproductive system indicated 3 reproductive cycles per year, one young per pregnancy, and showed that the mature males were smaller than females. The cubs of D. marianae size at birth 12 to 15cm LD. As for diet, the species was characterized as carnivorous crustacean specialist. The performance of visual censuses in different localities allowed to evaluate the density of D. marianae in different environments of the complex. The species occurs in greater numbers in seagrass, environment very important for the conservation of the species. 100 individuals of D. marianae marked in reef complex area enrolled in a recapture rate of 3%. Some behavioral aspects were evaluated, as diurnal pattern of activity, interaction with cleaning and fish Pomacanthus paru followers as Lutjanus analis and Carangoides bartholomaei. Overall, much of the information obtained should be used for management of the species

Early Literacy in Library Storytimes: A Study of Measures of Effectiveness

Across the nation, librarians work with caregivers and children to encourage engagement in their early literacy programs. However, these early literacy programs that libraries provide have been left mostly undocumented by research, especially through quantitative methods. Valuable Initiatives in Early Learning that Work Successfully (VIEWS2) was designed to test new ways to measure the effectiveness of these early literacy programs for young children (birth to kindergarten), leveraging a mixed methods, quasi-experimental design. Using two innovative tools, researchers collected data at 120 public library storytimes in the first year of research, observing approximately 1,440 children ranging from birth to 60 months of age. Analysis of year-one data showed a correlation between the early literacy content of the storytime program and children’s outcomes in terms of early literacy behaviors. These findings demonstrate that young children who attend public library storytimes are responding to the early literacy content in the storytime programs.

ASSESSMENT OF ENERGY CONSUMPTION IN GREENHOUSE PRODUCTION IN THE WEST REGION OF PORTUGAL

Greenhouse production is a very important activity in the West region of Portugal, with an area of approximately 800 ha where the regular production consists in two crops per year, one in winter-spring and the other in summer-autumn. Many growers are now prepared to better exploit market opportunities, since they know that the big export window opportunity is from June to September, when the production is difficult in other regions of south due to high temperatures. Grower’s use new and more productive varieties, either in soil or hydroponic systems, mostly in unheated greenhouses, naturally ventilated, and equipped with modern fertigation systems. Greenhouse production causes some environmental impacts due to the high use of inputs. Several improvements in technologies and crop practices may contribute to increase the use efficiency of resources, decreasing the negative environmental impacts. Greenhouse vegetable production in Northern EU countries is based on the supply of heating and differs significantly from the production system in the Southern EU countries. In the Northern countries, direct energy inputs, mostly for heating, are predominant while in the South the indirect energy input is also important, mainly associated with fertilizers, plastic cover materials and other auxiliary materials. The main objective of this work was to characterise the greenhouse production systems in the West region of Portugal, in order to evaluate the energetic consumptions (direct and indirect), the GHH emissions, the production costs and the farmer’s income. With this work the mostly important inputs were identified, allowing proposing alternative measures to improve efficiency and sustainability. All the data was obtained by surveys performed directly with growers, previously selected to be representative of the crop practices and greenhouse type of the region. However, more research should be performed in order to develop and to test technologies capable to improve resources use efficiency in greenhouse production.

One year follow-up of cannabis dependence among long-term users in Sydney, Australia

Eighty one percent of a sample of long-term cannabis users was followed up at 1 year (162/200). Half (51%) were daily smokers, while 20% had substantially decreased or ceased use. More than half received a dependence diagnosis on each of three measures in the last year, with 44% dependent on all three. Remission was much more common than incidence of dependence. Nevertheless, use and dependence patterns were strongly related over time. Longitudinal analyses revealed that quantity of use and severity of dependence at baseline were the primary predictors of those same variables at follow-up. These data suggest that cannabis use and dependence are fairly stable among long-term users. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.

Combined Laser and Intravitreal Triamcinolone for Proliferative Diabetic Retinopathy and Macular Edema: One-year Results of a Randomized Clinical Trial

PURPOSE: To evaluate laser combined with intravitreal triamcinolone acetonide (IVTA) for the management of patients with proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). DESIGN: Randomized clinical trial. METHODS: SETTINGS: Single center. STUDY POPULATION: Twenty-two patients with bilateral treatment,naive moderate PDR and CSME. INTERVENTION: Laser (panretinal and macular) photocoagulation was performed in each eye, followed by IVTA in one randomly assigned eye. Best,corrected visual acuity (BCVA), fundus photography, and optical coherence tomography were performed at baseline and at months 1, 3, 6, 9, and 12. MAIN OUTCOME MEASURES:. Changes in BCVA, central macular thickness (CMT), and total macular volume (TMV). RESULTS: The mean logarithm of the minimal angle of resolution (logMAR) BCVA improved significantly, and mean CMT and TMV were significantly reduced in the IVTA group compared with the laser,only group (controls) at all study follow-up visits (P < .001). The mean logMAR BCVA (Snellen equivalent) was 0.44 (20/50(-2)) for the IVTA group and 0.38 (20/50(+1)) for the controls at baseline, and 0.12 (20/25(-1)) for the IVTA group and 0.32 (20/40(-1)) for the controls at 12 months (P < .001.). The mean CMT and TMV were, respectively, 360 mu m and 8.59 mm(3) for the IVTA group and 331 mu m and 8.44 mm(3) for the controls at baseline, and 236 mu m and 7.32 mm(3) for the IVTA group and 266 mu m and 7.78 mm(3) for the controls at 12 months (P < .001). CONCLUSIONS: The combination of laser photocoagulation with IVTA was associated with improved BCVA and decreased CMT and TMV when compared with laser photocoagulation alone for the treatment of moderate PDR with CSME. (Am J Ophthalmol 2009;147:291-297. (C) 2009 by Elsevier Inc. All rights reserved.)

Diagnosis of Mild Cognitive Impairment Revisited after One Year Preliminary Results of a Prospective Study

Background/Aims: The diagnostic stability of mild cognitive impairment (MCI) on short-term follow- up is a key issue in the characterization of this clinical syndrome. We aim to determine the cognitive outcome after 1 year of follow- up in a cohort of older adults. Methods: Baseline clinical and neuropsychological assessments were carried out in older subjects recruited at a tertiary memory clinic. The subjects were reassessed after 1 year of follow- up with the same clinical and neuropsychological protocol. Results: A total of 115 older adults, including MCI (n = 54) and controls (n = 61), underwent baseline and follow- up evaluation. Ten subjects classified as MCI at baseline (23%) resumed normal cognitive function and 13 controls (21%) progressed to MCI upon follow-up (chi(2) = 0.015, d.f. = 1, p = 0.90). The subjects diagnosed as having MCI on both assessments were older (p = 0.002) and had a worse global cognitive performance according to the Cambridge Cognitive Test (p = 0.014). Conclusion: The subjects who maintain the MCI status are older and have a worse baseline cognitive performance as well as multiple cognitive deficits. Copyright (C) 2009 S. Karger AG, Basel

Intravitreal Bevacizumab for Diabetic Macular Edema Associated With Severe Capillary Loss: One-Year Results of a Pilot Study

PURPOSE: To evaluate the effects of intravitreal bevacizumab in patients with diabetic macular edema (DME) associated with severe capillary loss. DESIGN: Multicenter, open-label, nonrandomized study. METHODS: SETTING: Two tertiary ophthalmic referral centers in Brazil. STUDY POPULATION: Ten consecutive patients with DME and ""severe"" capillary loss. OBSERVATION PROCEDURES: Intravitreal injection(s) of bevacizumab (1.5 mg). Standardized ophthalmic evaluation was performed at baseline and at weeks 8, 16, 24, and 54. MAIN OUTCOME MEASURES: Changes in best-corrected visual acuity (BCVA) and in optical coherence tomography variables (central macular thickness [CMT] and total macular volume [TMV]). RESULTS: Significant changes in BCVA and in CMT/TMV were noted throughout the study (P<.001, P=.009, and P<.001, respectively). The mean logarithm of the minimal angle of resolution Early Treatment Diabetic Retinopathy Study BCVA was 0.786 (similar to 20/125(+1)) at baseline, 0.646 (similar to 20/80(-2)) at week 8, 0.580 (20/80(+1)) at week 16, 0.574 (similar to 20/80(+1)) at week 24, and 0.558 (similar to 20/80(+2)) at week 54. Compared with baseline, a significant change in BCVA was noted at all follow-up visits (P <=.008). The mean CMT/TMV values were, respectively, 472.6/10.9 at baseline, 371.4/9.9 at week 8, 359.5/9.8 at week 16, 323.9/9-4 at week 24, and 274.6/8.7 at week 54. Compared with baseline, a significant change in both CMT and TMV was noted only at 24 and 54 weeks (P <=.007). At 54 weeks, fluorescein angiography demonstrated no change in the extent of macular capillary loss and reduced dye leakage as compared with baseline in all patients. CONCLUSIONS: Favorable changes in BCVA and in CMT/TMV observed throughout 1 year suggest that intra-vitreal bevacizumab may be a viable alternative treatment for the management of patients with DME and severe capillary loss. (Am J Ophthalmol 2009;147:1022-1030. (C) 2009 by Elsevier Inc. All rights reserved.)