Draft Genome Sequence Analyses of Two Novel Marinobacter suadae sp. nov. and Wenyingzhuangia gilva sp. nov. Isolated from the Root of Suaeda japonica Makino.

Gram-negative, rod-shaped, and aerobic bacteria designated chi1T and chi5T were isolated from the root of Suaeda japonica Makino. Phylogenetics utilizing 16S rRNA and whole-genome sequences of the two novel strains chi1T and chi5T confirmed that they were related to the genera Marinobacter and Wenyingzhuangia, respectively. For the novel strains chi1T and chi5T, the digital DNA-DNA hybridization values (19-20% and 22.1-36.6%, respectively) and average nucleotide identity values (74.4-76.5% and 79.1-88.9%, respectively) fell within the range for the genera Marinobacter and Wenyingzhuangia, respectively. Pangenome analyses of the novel strains chi1T and chi5T revealed 357 and 368 singletons genes, respectively. The genomic DNA G + C contents of the strains chi1T and chi5T were 57.2% and 31.5%, respectively. The major fatty acids of strain chi1T were C12:0, C16:0, and summed feature 3 (C16:1ω6c and/or C16:1ω7c), while those of the strain chi5T were iso-C15:0 3OH, iso-C17:0 3OH, and iso-C15:0. Data from the phylogenetic, phylogenomic, pangenome, genomic, physiological, and biochemical analyses indicated that the novel strains were distinct. Therefore, we propose the names Marinobacter suadae (type strain chi1T = KACC 23259T = TBRC 17652T) and Wenyingzhangia gilva (type strain chi5T = KACC 23262T = TBRC 17900T) for the studied bacterial strains.

COVID-19 vaccine perspectives and uptake among university students three years into the pandemic.

BACKGROUND: University students have been uniquely impacted by the COVID-19 pandemic for the past three years (2020-2023). Understanding their COVID-19 perspectives, beliefs, and vaccine uptake may help to improve future vaccine initiatives and education. METHODS: A cross sectional, confidential, online survey was conducted at four universities in Pennsylvania in spring 2023 to assess undergraduate, graduate, and professional students' perspectives regarding their knowledge of COVID-19 vaccines, importance of COVID-19 vaccines and mandates, number of doses of COVID-19 vaccine received including the recent BA.4/BA.5 bivalent booster, where they were vaccinated, receipt of influenza vaccine, and sources of information used to make decisions about COVID-19 vaccine. RESULTS: Vaccination for COVID-19 was considered important by 75 % of 2223 students surveyed; 68 % agreed with mandating COVID-19 vaccine. Over 89 % were fully COVID-19 vaccinated (≥2 doses), 65 % were up-to-date (≥3 doses), but only 35 % had received the BA.4/BA.5 booster. Students who considered COVID-19 vaccine important were generally older, female, and non-business majors. Higher rates of up-to-date COVID-19 vaccination were found in those who received influenza vaccine in 2022-2023, females, Asians, doctoral or professional students, those attending larger universities, non-US residents, and those interested in learning more about COVID-19 vaccines. Most trusted sources of information on COVID-19 vaccines were the Centers for Disease Control and Prevention, healthcare providers, and parents; the least trusted sources were social media, television, and the internet. CONCLUSIONS: The majority of university students agreed that COVID-19 vaccination is important and supported COVID-19 mandates. While the rate of fully vaccinated and up-to-date students was similar to the US adult population, the latter rate needs improvement. Receipt of the BA.4/BA.5 booster was particularly low. Further education is needed to improve vaccine knowledge, especially as we move to periodic boosters. Business majors, males, and younger students may benefit from increased on-campus vaccine education initiatives.

Effect of a brief training program on the knowledge of Filipino primary care providers in a rural and a remote setting: A before and after study

Background and Objective@#Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge.@*Methods@#A series of training workshops were conducted among 184 remote- and 210 rural-based primary care providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05.@*Results@#The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14). @*Conclusions@#Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.

Living evidence and adaptive policy: perfect partners?

BACKGROUND: While there has been widespread global acceptance of the importance of evidence-informed policy, many opportunities to inform health policy with research are missed, often because of a mismatch between when and where reliable evidence is needed, and when and where it is available. 'Living evidence' is an approach where systematic evidence syntheses (e.g. living reviews, living guidelines, living policy briefs, etc.) are continually updated to incorporate new relevant evidence as it becomes available. Living evidence approaches have the potential to overcome a major barrier to evidence-informed policy, making up-to-date systematic summaries of policy-relevant research available at any time that policy-makers need them. These approaches are likely to be particularly beneficial given increasing calls for policy that is responsive, and rapidly adaptive to changes in the policy context. We describe the opportunities presented by living evidence for evidence-informed policy-making and highlight areas for further exploration. DISCUSSION: There are several elements of living approaches to evidence synthesis that might support increased and improved use of evidence to inform policy. Reviews are explicitly prioritised to be 'living' by partnerships between policy-makers and researchers based on relevance to decision-making, as well as uncertainty of existing evidence, and likelihood that new evidence will arise. The ongoing nature of the work means evidence synthesis teams can be dynamic and engage with policy-makers in a variety of ways over time; and synthesis topics, questions and methods can be adapted as policy interests or contextual factors shift. Policy-makers can sign-up to be notified when relevant new evidence is found, and can be confident that living syntheses are up-to-date and contain all research whenever they access them. The always up-to-date nature of living evidence syntheses means producers can rapidly demonstrate availability of relevant, reliable evidence when it is needed, addressing a frequently cited barrier to evidence-informed policymaking. CONCLUSIONS: While there are challenges to be overcome, living evidence provides opportunities to enable policy-makers to access up-to-date evidence whenever they need it and also enable researchers to respond to the issues of the day with up-to-date research; and update policy-makers on changes in the evidence base as they arise. It also provides an opportunity to build flexible partnerships between researchers and policy-makers to ensure that evidence syntheses reflect the changing needs of policy-makers.

How Do Orthopedic Surgeons Stay Up-to-Date With the Literature? A Survey.

Background: With the rise of social media and other web-based platforms, there has been a shift in how medical research findings are disseminated. Questions/Purposes: We sought to investigate how often orthopedic surgeons use different knowledge-seeking methods and how confident they were in their ability to stay up-to-date. Methods: We distributed a 23-question survey to 120 orthopedic surgeons employed at a single tertiary-care metropolitan orthopedic hospital. The survey collected the surgeons' use of reference managers, RSS feeds, and preferred methods of staying up-to-date. Respondents were asked to report the number of hours they spent staying up-to-date per week and their success with keeping up with orthopedic specialty literature. Results: A total of 85 physicians responded (median age, 52 years); 83% of respondents who spent 3 or more hours a week in keeping up-to-date with the literature said they felt successful in doing so, while 40% of participants who spent less than 1 hour a week said they felt successful. Fifty-five percent of surgeons under the median age used social media, while only 29% of surgeons over the median age used social media. Conclusions: This survey suggests that spending only 1 to 2 hours per week was enough to make the orthopedic surgeons we surveyed feel confident that they were keeping up with the literature in their specialty. These findings also suggest that it may be more important for surgeons to choose a convenient method of literature review that will enable them to maximize time spent reading, rather than attempting to use any one source.

Update on Hypertension Research in 2021.

In 2021, 217 excellent manuscripts were published in Hypertension Research. Editorial teams greatly appreciate the authors' contribution to hypertension research progress. Here, our editorial members have summarized twelve topics from published work and discussed current topics in depth. We hope you enjoy our special feature, "Update on Hypertension Research in 2021".

Renewing and improving the environmental risk assessment of chemicals.

The processes underpinning the environmental risk assessment (ERA) of chemicals have not changed appreciably in the last 30 years. It is unclear how successful these processes are in protecting the environment from any adverse effects of chemicals. To ascertain if the current methodology can be improved, and if so, how, we invited experts to suggest how the current ERA process could be improved. They were not asked to select from a list of suggestions. The 36 experts made 109 suggestions for improvement, which could be grouped into 33 categories. The category that received the most support, from 12 experts, was to utilise a broader range of scientific information, including all up-to-date information, in ERAs. The second most popular category, supported by 10 experts, was the suggestion to regulate mixtures of chemicals; the current regulatory process involves chemical-by-chemical assessment. Two quite radical proposals were suggested. One was to replace the regulator with artificial intelligence. The other was to establish a new competent authority that would appoint groups of experts, each including representatives of the range of stakeholders, to decide which studies were required, commission those studies, then conduct the ERA based on the results of those studies. These two radical proposals, which the authors support strongly, are not necessarily mutually exclusive. We conclude that the present ERA process could be improved to better protect the environment from the myriad of chemicals in use.

Evaluating vaccination coverage and timeliness in American Indian/Alaska Native and non-Hispanic White children using state immunization information system data, 2015-2017.

Comprehensive estimates of vaccination coverage and timeliness of vaccine receipt among American Indian/Alaska Native (AI/AN) children in the United States are lacking. This study's objectives were to quantify vaccination coverage and timeliness, as well as the proportion of children with specific undervaccination patterns, among AI/AN and non-Hispanic White (NHW) children ages 0-24 months in Montana, a large and primarily rural U.S. state. Data from Montana's immunization information system (IIS) for children born 2015-2017 were used to calculate days undervaccinated for all doses of seven recommended vaccine series. After stratifying by race/ethnicity, up-to-date coverage at key milestone ages and the proportion of children demonstrating specific patterns of undervaccination were reported. Among n = 3,630 AI/AN children, only 23.1% received all recommended vaccine doses on-time (i.e., zero days undervaccinated), compared to 40.4% of n = 18,022 NHW children (chi-square p < 0.001). A greater proportion of AI/AN children were delayed at each milestone age, resulting in lower overall combined 7-vaccine series completion, by age 24 months (AI/AN: 56.6%, NHW: 64.3%, chi-square p < 0.001). As compared with NHW children, a higher proportion of AI/AN children had undervaccination patterns suggestive of structural barriers to accessing immunization services and delayed starts to vaccination. More than three out of four AI/AN children experienced delays in vaccination or were missing doses needed to complete recommended vaccine series. Interventions to ensure on-time initiation of vaccine series at age 2 months, as well initiatives to encourage completion of multi-dose vaccine series, are needed to reduce immunization disparities and increase vaccination coverage among AI/AN children in Montana.

Echinicola arenosa sp. nov., isolated from marine sand.

A novel bacterium, designated CAU 1574T, was isolated from marine sand. Cells were Gram stain negative, aerobic, gliding and rod shaped. Growth was observed at 20-37 °C (optimum, 30 °C), a pH of 5.5-10.0 (optimum, 8.0), and 0-3.0% (w/v) NaCl concentrations (optimum, 1%). Based on the results of 16S rRNA gene sequence analyses, strain CAU 1574T belonged to the genus Echinicola, and showed the highest similarity to Echinicola shivajiensis JCM 17847T (97.5%). Phylogenomic analysis based on consisting of 92 core genes extracted from the genome sequences showed that strain CAU 1574T was affiliated with species in the genus Echinicola. The average nucleotide identity (ANI), average amino acid identity (AAI), and digital DNA-DNA hybridization (dDDH) values between strain CAU 1574T and the closely related species were below the cut-off values of 95-96, 90, and 70%, respectively used for species demarcation. The chemotaxonomic data of CAU 1574T were as follows: major isoprenoid quinone, MK-7; predominant polar lipids, phosphatidylethanolamine, two unidentified aminophospholipids and two unidentified lipids; major fatty acids, iso-C15:0, summed feature 3 (C16:1 ω6c/C16:1 ω7c). The 5.4 Mb genome included 20 contigs and 4237 protein-coding genes with a 39.8 mol% G + C content. Based on the phylogenetic, phenotypic, and physiological result, strain CAU 1574T represents a novel species of this genus Echinicola, for which the name Echinicola arenosa sp. nov. is proposed. The type strain is CAU 1574T (= KCTC 82410T = MCCC 1K05669T).

TSARM-UDP: An Efficient Time Series Association Rules Mining Algorithm Based on Up-to-Date Patterns.

In many industrial domains, there is a significant interest in obtaining temporal relationships among multiple variables in time-series data, given that such relationships play an auxiliary role in decision making. However, when transactions occur frequently only for a period of time, it is difficult for a traditional time-series association rules mining algorithm (TSARM) to identify this kind of relationship. In this paper, we propose a new TSARM framework and a novel algorithm named TSARM-UDP. A TSARM mining framework is used to mine time-series association rules (TSARs) and an up-to-date pattern (UDP) is applied to discover rare patterns that only appear in a period of time. Based on the up-to-date pattern mining, the proposed TSAR-UDP method could extract temporal relationship rules with better generality. The rules can be widely used in the process industry, the stock market, etc. Experiments are then performed on the public stock data and real blast furnace data to verify the effectiveness of the proposed algorithm. We compare our algorithm with three state-of-the-art algorithms, and the experimental results show that our algorithm can provide greater efficiency and interpretability in TSARs and that it has good prospects.

Polymeric Nanoparticles for Antimicrobial Therapies: An Up-To-Date Overview.

Despite the many advancements in the pharmaceutical and medical fields and the development of numerous antimicrobial drugs aimed to suppress and destroy pathogenic microorganisms, infectious diseases still represent a major health threat affecting millions of lives daily. In addition to the limitations of antimicrobial drugs associated with low transportation rate, water solubility, oral bioavailability and stability, inefficient drug targeting, considerable toxicity, and limited patient compliance, the major cause for their inefficiency is the antimicrobial resistance of microorganisms. In this context, the risk of a pre-antibiotic era is a real possibility. For this reason, the research focus has shifted toward the discovery and development of novel and alternative antimicrobial agents that could overcome the challenges associated with conventional drugs. Nanotechnology is a possible alternative, as there is significant evidence of the broad-spectrum antimicrobial activity of nanomaterials and nanoparticles in particular. Moreover, owing to their considerable advantages regarding their efficient cargo dissolving, entrapment, encapsulation, or surface attachment, the possibility of forming antimicrobial groups for specific targeting and destruction, biocompatibility and biodegradability, low toxicity, and synergistic therapy, polymeric nanoparticles have received considerable attention as potential antimicrobial drug delivery agents. In this context, the aim of this paper is to provide an up-to-date overview of the most recent studies investigating polymeric nanoparticles designed for antimicrobial therapies, describing both their targeting strategies and their effects.

Temporal recalibration for improving prognostic model development and risk predictions in settings where survival is improving over time.

BACKGROUND: Prognostic models are typically developed in studies covering long time periods. However, if more recent years have seen improvements in survival, then using the full dataset may lead to out-of-date survival predictions. Period analysis addresses this by developing the model in a subset of the data from a recent time window, but results in a reduction of sample size. METHODS: We propose a new approach, called temporal recalibration, to combine the advantages of period analysis and full cohort analysis. This approach develops a model in the entire dataset and then recalibrates the baseline survival using a period analysis sample. The approaches are demonstrated utilizing a prognostic model in colon cancer built using both Cox proportional hazards and flexible parametric survival models with data from 1996-2005 from the Surveillance, Epidemiology, and End Results (SEER) Program database. Comparison of model predictions with observed survival estimates were made for new patients subsequently diagnosed in 2006 and followed-up until 2015. RESULTS: Period analysis and temporal recalibration provided more up-to-date survival predictions that more closely matched observed survival in subsequent data than the standard full cohort models. In addition, temporal recalibration provided more precise estimates of predictor effects. CONCLUSION: Prognostic models are typically developed using a full cohort analysis that can result in out-of-date long-term survival estimates when survival has improved in recent years. Temporal recalibration is a simple method to address this, which can be used when developing and updating prognostic models to ensure survival predictions are more closely calibrated with the observed survival of individuals diagnosed subsequently.

Association between ALDH2 Gene Polymorphism and Late-onset Alzheimer Disease: An Up-to-date Meta-analysis.

OBJECTIVES: Previous case-control studies have focused on the relationship between ALDH2 gene polymorphism and late-onset Alzheimer's Disease (LOAD), but no definite unified conclusion has been reached. Therefore, the correlation between ALDH2 Glu504Lys polymorphism and LOAD remains controversial. To analyze the correlation between ALDH2 polymorphism and the risk of LOAD, we implemented this up-to-date meta-analysis to assess the probable association. METHODS: Studies were searched through China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals, China Biology Medicine, PubMed, Cochrane Library, Clinical- Trials.gov, Embase, and MEDLINE from January 1, 1994 to December 31, 2018, without any restrictions on language and ethnicity. RESULTS: Five studies of 1057 LOAD patients and 1136 healthy controls met our criteria for the analysis. Statistically, the ALDH2 GA/AA genotype was not linked with raising LOAD risk (odds ratio (OR) = 1.48, 95% confidence interval (CI) = 0.96-2.28, p = 0.07). In subgroup analysis, the phenomenon that men with ALDH2*2 had higher risk for LOAD (OR = 1.72, 95%CI = 1.10-2.67, p = 0.02) was observed. CONCLUSION: This study comprehends only five existing case-control studies and the result is negative. The positive trend might appear when the sample size is enlarged. In the future, more large-scale casecontrol or cohort studies should be done to enhance the association between ALDH2 polymorphism and AD or other neurodegenerative diseases.

Devosia indica sp. nov., isolated from surface seawater in the Indian Ocean.

A Gram-stain-negative bacterium, designated IO390501T, was isolated from a sea water sample from the Indian Ocean and taxonomically characterized using a polyphasic approach. The strain is phylogenetically close to 'Devosia lucknowensis' L15 and Devosia chinhatensis IPL18T, with 16S rRNA gene sequence similarity of 97.7 and 97.4 %, respectively. The genome of IO390501T has a DNA G+C content of 61.9 mol% for the 3.9 Mb chromosome. Genome-based phylogenetic trees indicated that IO390501T clusters as an independent lineage with 'D. lucknowensis' L15. Genomic relatedness of in silico DNA-DNA hybridization between IO390501T and phylogenetic neighbours ranged from 18.8 to 21.5 %, below the cutoff of 70 %, and corresponding average nucleotide identity values were between 71.4 and 79.0 %, lower than the 95.0 % threshold. The predominant cellular fatty acids of IO390501T are summed feature 8 (C18 : 1ω7c/C18  : 1ω6c) and C16  :  0. IO390501T contains ubiquinone-10 as the sole respiratory quinone, and phosphatidylglycerol and glycolipids as the major polar lipids. On the basis of the results of phenotypic, chemotaxonomic and genetic analyses, strain IO390501T represents a novel species of the genus Devosia for which the name Devosia indica sp. nov. is proposed. The type strain is IO390501T.

Surveillance of adverse drug reactions and drug-drug interactions with pediatric oncology patients in a south Indian tertiary care hospital.

OBJECTIVE: The present study was conducted to evaluate the pattern of occurrence of adverse drug reactions and drug-drug interaction in a pediatric oncology unit of a tertiary care hospital. METHODS: A prospective, observational study was conducted in the Department of Pediatric Oncology, Sri Ramachandra Medical College and Hospital, India. Patients were monitored actively for the occurrences of any adverse drug reaction during the study period. Patient's demographic details, clinical, and treatment data were collected for drug-drug interaction analysis. The detected adverse drug reaction was assessed for causality, severity, and preventability. Drug-drug interaction identified was rated based on their level of urgency and the nature of actions necessary to respond to an interaction. RESULTS: Of 176 patients, 118 were detected for the occurrence of various adverse drug reaction. The majority of the cases were suffering with acute lymphocytic leukemia (67.9%). Vincristine was noted for a maximum number of adverse drug reaction in cytotoxic drugs. Rash is the most frequently occurred reaction. Assessment of causality showed that the majority of cases are "probable" (60.16%). In evaluating the severity of adverse drug reactions, 57.6% reactions were moderately severe and 74.5% of the reactions were preventable. Upon assessing the drug-drug interaction, 38.13% of the prescription needs to be monitored and 10 drug-drug interactions were under the risk category of "X." The majority of the adverse drug reaction was moderately severe in nature and those were preventable. CONCLUSION: Since pediatrics are vulnerable population, they must have a thorough surveillance system for adverse drug reaction and drug-drug interaction; thereby, a positive impact on the medication-use system and improved patient care can be achieved.

An up-to-date evaluation of alogliptin benzoate for the treatment of type 2 diabetes.

Introduction: A growth in the market for anti-diabetic drugs, along with an ever-increasing population suffering from type 2 diabetes mellitus (T2DM), requires a critical re-evaluation of anti-diabetic drugs used for a long time, in order to provide up-to-date practical prescribing information for clinicians. Alogliptin benzoate was firstly approved in 2010 in Japan for T2DM, both as a monotherapy or in combination with other anti-diabetic drugs. Areas covered: This article provides a comprehensive review of the latest data on alogliptin benzoate, including hypoglycemic activity and safety. Expert opinion: The cumulative evidence for alogliptin benzoate is robust with regards to glycemic efficacy and safety. Low hypoglycemia risks and weight changes support its consideration as a first-line medication for T2DM, either as a monotherapy or in combination therapy with other anti-diabetic drugs such as metformin. Ongoing trials will look to better analyze and address its safety and efficacy in pediatric patients and expand our clinical knowledge of this medication.

Devosia naphthalenivorans sp. nov., isolated from East Pacific Ocean sediment.

A Gram-stain-negative bacterium, designated CM5-1T, was isolated from a sediment sample collected from the East Pacific Ocean. 16S rRNA gene sequence analysis revealed that strain CM5-1T belongs to the genus Devosia, with closely related type strains Devosia submarina KMM 9415T (98.6 %), Devosia psychrophilaCr7-05T (98.6 %) and Devosia psychrophilaE84T (98.2 %). Up-to-date bacterial core gene set analysis revealed that strain CM5-1T represents one independent lineage with D. submarina KMM 9415T. The average nucleotide identity values of CM5-1T with D. submarina KMM 9415T and D. psychrophila Cr7-05T are 80.1 and 77.9 %, respectively. In silico DNA-DNA hybridization values between strain CM5-1T and D. submarina KMM 9415T and D. psychrophila Cr7-05T are 23.8 and 21.9 %, respectively. Strain CM5-1T contains diphosphatidylglycerol, phosphatidylglycerol and glycolipid as major polar lipids. The sole isoprenoid quinone is ubiquinone-10, and C18 : 1ω7c and 11-methyl C18 : 1ω7c are the dominant cellular fatty acids. The G+C content of the genomic DNA is 61.4 mol%. Differential phylogenetic distinctiveness and chemotaxonomic differences, together with the phenotypic properties observed in this study, revealed that strain CM5-1T could be differentiated from closely related species. Therefore, we propose strain CM5-1T as a novel species of the genus Devosia, for which the name Devosia naphthalenivorans sp. nov. is suggested. The type strain is CM5-1T (=JCM32509T=CGMCC 1.13553T).

Update on treatment of immunoglobulin A nephropathy.

Immunoglobulin A nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide and the most common cause of end-stage renal disease in young adults. However, there are still no specific therapies capable of targeting key pathways involved in disease pathogenesis. Recently, many large randomized controlled trials have been reported, such as Supportive Versus Immunosuppressive Therapy for the Treatment of Progressive IgA Nephropathy, Targeted-release Budesonide Versus Placebo in Patients with IgA Nephropathy and Therapeutic Evaluation of Steroids in IgA Nephropathy Global, which are considered to update the 2012 Kidney Disease: Improving Global Outcomes Guideline. More importantly, with a deeper understanding of the roles of mucosal immunity, B-cell activation and complement activation in IgAN, the studies of targeting pathogenic pathways are ongoing. In this review, by systemically searching the clinical trials in IgAN on ClinicalTrials.gov (https://clinicaltrials.gov/), we update the evidence for corticosteroids/immunosuppressive therapy in IgAN and explore the promising targeting pathogenic pathway therapeutic options. With better understanding of pathogenesis of IgAN, emerging therapies will soon become a reality in future.

Impact of the addition of new vaccines in the early childhood schedule on vaccine coverage by 24 months of age from 2006 to 2016 in Quebec, Canada.

CONTEXT: Between 2004 and 2016, in the province of Quebec (Canada), 4 new antigens were added in the early childhood vaccine schedule from birth to 18 months, increasing the number of injections or doses needed from 7 to 12. These additions may have decreased the proportion of children who had received all recommended vaccines. OBJECTIVES: To assess the impact of the introduction of new vaccines to the childhood schedule on the 24-month vaccine coverage from 2006 to 2016 and identify factors associated with incomplete vaccination status by 24 months of age. METHODS: We used the data from six cross-sectional vaccine coverage surveys conducted every two years which included a total of 3515 children aged 2 years old and randomly selected from the Quebec public health insurance database. Factors associated with an incomplete vaccine status by 24 months were identified with multivariable logistic regression. RESULTS: Despite the addition of 4 new vaccine antigens since 2004, the vaccine coverage remained high from 2006 (82.4%) through 2016 (88.3%) for vaccines present in the schedule since 2006. In 2016, vaccine coverage was 78.2% for all vaccines included in the schedule. The vaccine coverage of new vaccines increases rapidly within 2 years of their introduction. For both new and older vaccines, incomplete vaccine status by 24 months of age is associated with a delay of 30 days or more in receiving the vaccines scheduled at 2 and 12 months of age. CONCLUSIONS: Increasing to 12 the number of doses in the recommended schedule has slightly reduced the vaccine coverage by 24 months of age and the vaccine coverage of vaccines already in the schedule remained stable over the years. Future additions to the vaccine schedule may not be similarly accepted by the population and this will require continuing the monitoring of vaccine coverage.

Human papillomavirus vaccination coverage using two-dose or three-dose schedule criteria.

In October 2016, the Advisory Committee on Immunization Practices (ACIP) updated the human papillomavirus (HPV) vaccination recommendation to include a 2-dose schedule for U.S. adolescents initiating the vaccine series before their 15th birthday. We analyzed records for >4million persons aged 9-17years receiving any HPV vaccine by the end of each quarter during January 1, 2014-September 30, 2016 from six Immunization Information Systems Sentinel Sites, and reclassified HPV vaccination up-to-date coverage according to the updated recommendations. Compared with HPV vaccination up-to-date coverage by the 3-dose schedule only, including criteria for either a 2-dose or 3-dose schedule increased up-to-date coverage in 11-12, 13-14, and 15-17 year-olds by 4.5-8.5 percentage points. The difference between 3-dose up-to-date coverage and 2- or 3-dose up-to-date coverage was greatest in late 2016. These data provide baseline HPV vaccination coverage using current ACIP recommendations.