Effect of Tetanus Toxoid Vaccine on Neonatal Tetanus

Effect of Tetanus Toxoid Vaccine on Neonatal Tetanus Evaluation of the effect of Tetanus Toxoid vaccine on neonatal tetanus Clinical scenario Tetanus is a vaccine preventable disease caused by a ubiquitous spore-forming bacteria called Clostridium tetani (reference need). Due to its ubiquity, the disease cannot be eradicated (Roper et al. 2007). Tetanus that occurs in neonates between 3-28 days of life is termed neonatal tetanus (CDC, 1997) and the most common nidus of infection in neonates is through the freshly cut umbilical cord (Bennett et al. 1996; Roper et al. 2007). Substantial progress has been made towards the elimination of maternal and neonatal tetanus (MNT) by the WHO initiative, although it still remains a major problem in more than 30 developing countries (figure 1) (WHO, 2015). Figure 1. The global map sowing the advancement towards the elimination of maternal and neonatal tetanus. Source: WHO. (2015). [Online]. http://www.who.int/immunization/diseases/MNTE_initiative/en/index4.html Developed countries such as the United States of America, England and Denmark, have long ago eliminated tetanus linked neonatal deaths compared to developing countries (Pascual et al. 2003; Simonsen et al. 1987; Rushdy et al. 2003). Haws et al. (2007) mentioned that in areas where the prevalence of neonatal tetanus is common, vaccinating women against tetanus during pregnancy is likely to prevent the disease. Neonatal tetanus still remains one of the leading causes of infant mortality in many developing countries despite the fact that tetanus vaccine has been available for years (Stanfield et al. 1984). Hence, the aim of this critical appraisal is to evaluate the effect of tetanus toxoid vaccine given to pregnant women to provide effective protection and reduce deaths from neonatal tetanus in comparison to no vaccine. Focused Clinical Question Table 1: Search Strategy Inclusion and Exclusion Criteria Table 2: search and screening results Total number of studies = 3 (Blencowe et al., 2010; Maral et al., 2001 and Demicheli et al., 2013). Table 3: CASP screening tool for the appraisal of two Systematic Reviews and one Cross-sectional Study *A cross-sectional appraisal tool does not exist, therefore Maral et al., 2001 was appraised using the systematic review appraisal tool. Exclusions Summary of best evidence Blencowe et al., 2010 Systematic review Aim/Objective of the Systematic review: To evaluate the effect of Tetanus Toxoid vaccination of pregnant women or women of child bearing age on neonatal tetanus mortality. Study Design Search Strategy A range of appropriate databases were used such as PubMed, EMASE, Cochrane Libraries and World Health Organisation Regional Databases. Suitable search terms were used such as ‘Neonatal Tetanus, Tetanus Toxoid, Neonatal Mortality and Women’. Publications in any language were also included. Selection Criteria for inclusion of studies The PICO format (Patient, Intervention, Comparison and Outcome) was used in this review to identify the studies to be included as follows: Population – Neonates Intervention – At least two Tetanus Toxoid vaccine doses Comparison – Neonates born without Tetanus Toxoid vaccination Outcome – Mortality from Neonatal Tetanus Randomised trails and observational studies meeting the above criteria’s were considered in this review. Methods A systematic review of various databases was carried out to identify suitable studies meeting inclusion criteria Standardised abstraction forms were used for each outcome of interest for studies meeting the inclusion criteria Studies not meeting the inclusion criteria, studies which only reported serological outcomes and duplicate reports of studies or trails were all excluded Quality of individual studies and evidence were evaluated according to the CHERG version of the GRADE method to generate an approximate calculation of the effects in reducing neonatal mortality A meta-analysis was carried out using STATA version 10.0 statistic software and stated the mantel-haenszel pooled relative risk and corresponding 95% confidence intervals (CI) Findings Two studies which had no heterogeneity between them (p=0.16) i.e. a high-quality randomised controlled trial and a well-designed cohort study with adjustment for publication bias in its analysis, were joined into one meta-analysis to give an estimate of relative risk (RR)= 0.06 (95% CI 0.02-0.2) (Fig. 1). While, three case-control studies each with adjustment for publication bias showed a protective effect of two tetanus toxoid injections during pregnancy (odd ratio (OR) = 0.05 (0.005-0.4); OR=0.1 (0.03_0.4); OR=0.2 (0.03-0.7). Overall result A 94% reduction in neonatal tetanus mortality (95% CI 80-98%). The confidence interval of 95% for these results appear to be accurate.

The Tale of Genji by Murasaki Shikibu Essay -- The Heian Period, Japan

Being a student interested in the field of biology, one knows that studying life in the past plays an important role in the history of organisms that lived on this earth. Similarly, being Japanese, studying the past of how Japanese were plays an important role in Japanese history. Despite all the general aspects of life that have changed from the Heian period, the one idea that has definitely not changed is the romantic relationships between a man and woman. Though the general concept is the same, from reading The Tale of Genji, it is what was considered the ideal woman and ideal man that were both surprising and thus worth discussing. Written around 978 by Murasaki Shikibu, The Tale of Genji, regarded as the world’s first novel, is an excellent source describing the ideal woman and man during the Heian period. Life in the Heian period revolved around the court and the social hierarchy that came with it. Thus it is completely understandable that one of the most important characteristics of an ideal man or woman was the person’s ranking. For most women, especially those in the lower ranks, to be able to give birth to a son whose father was of high rank would up her own status. Note however, though that she did not need to marry the father, and this was indeed the case for many women. The main reason for this is because men, especially those with high ranks like Genji and Tà µ no Chujà µ had affairs with many women regardless to who they themselves were married. Genji and Tà µ no Chujà µ both knew that because of their high rank, they could for the most part, get any woman they wished. Yet, it is b ecause of this that in The Tale of Genji, they could actually seriously consider various characteristics that they feel represente... ...whereas the ideal man would be one of high rank, faithful and had a tenderness and eloquence. The main trait discussed that would still apply personally as an ideal man and woman though would be one who was faithful. Though appearance is still a factor, what is considered beautiful has changed and a social hierarchy in the United States does not exist today. All in all, a relationship between a man and woman is an important aspect of anyone’s life, regardless of the place in history, and studying these aspects from a great novel like The Tale of Genji, plays a vital role in understanding Japanese culture. Works Cited Shikibu, Murasaki. The Tale of Genji. NY, NY: Penguin Classics, 2001. 319. Print. Smits, Gregory. "The Heian Period Aristocrats." East Asian History. N.p., n.d. Web. 21 Feb 2011. .

Ex Post Facto Laws Essay

Ex post facto laws refer to laws that apply to acts committed before the enactment of such laws and are, therefore, disadvantageous to the affected persons. The United States constitution in article I, section 10 prohibits the state from enacting such retroactive laws. This prohibition protects individuals from unjust legislative acts. However, the ban on ex post facto laws applies only with regard to criminal and not civil laws (Zollar, 2002). I believe that the US constitution is reasonable and consistent by containing provisions that limit the enactment of ex post facto laws since this help in safeguarding the rights of individuals under existing laws. If the constitution did not contain the ex post facto clause, individuals would be unfairly subjected to laws that act retrogressively and deny them justice. For instance, an adult should not be prosecuted for crimes he committed when he was a minor if such crimes could not be instituted against him at that time due to limitation on juvenile court jurisdiction. I concur with the authors of the ex post facto clause that laws should not be applied retroactively. However, where the rule cannot be reasonably applied, various exceptions should be incorporated to make the rule workable. Like every other rule, I believe that it is important for the ex post facto clause to have various exceptions that would ensure its enforceability. While I agree that laws should not be enacted retrogressively, I feel that the biggest challenge facing the ex post facto clause is the obscure differentiation of criminal laws from civil laws. The clause that prohibits ex post facto laws bans several acts. First, it prohibits the creation of criminal laws and making them retroactive. Such retroactive laws have the effect of criminalizing acts committed before their enactments. The clause also prohibits laws that are made in order to retroactively aggravate a crime, for instance, by retroactively changing a misdemeanor to a felony. Retroactively increasing the punishment for a crime is also prohibited under US laws. Furthermore, the Ex post facto clause also bans the creation of laws that alter the rules of evidence and instead allow conviction based on different or lesser evidence than what the law proscribed at the time of the crime’s commission (Gardner & Anderson, 2011). There are several exceptions to the limitation of retroactive laws in the ex post facto clause. The rule is limited to penal law and is not applicable to cases where the new laws favor the accused. Moreover, the rule is not applicable to customary laws and precedent laws that are retrospective with regard to previous cases. Another exception to the ex post facto rule is a retroactive law that provides for retribution for certain acts that were illegal but not criminal when they were committed. An example of such a law is the London Agreement, which is retroactive to the extent of acts that constituted violations of international laws when they were committed (Bassiouni, 2011) One of the most important current aspects of ex post facto laws is taxation. Prohibition of retroactive laws is limited to criminal acts. Therefore, there is no ex post facto law prohibition in taxation since it is a civil act. In the case of Fernandez vs. Fernandez, it was ruled that prohibition on ex post facto laws was limited to criminal laws and that tax laws were civic. In September 2012, the U.S Commerce Department imposed an ex post facto tax of $ 100 million as an anti-dumping measure (Foldvary, 2012). I feel that there is need to address the lack of prohibition of ex post facto laws in taxation. It would be unjust if entrepreneurs would lose property through confiscation by the government in an effort to recover retroactive taxes. References Bassiouni, M. C. (2011). Crimes against humanity: Historical and contemporary application. Cambridge: Cambridge University Press. Foldvary, F. E. (2012). The Progress Report: Ex post Facto Taxation. Retrieved October 27, 2012 from: http://www.progress.org/2012/fold784.htm Gardner, T. J. and Anderson, T. M. (2011). Criminal Law. Belomont, CA: Cengage Learning. Zollar, J. (2002). Prohibition against Ex Post Facto laws. House Research. Retrieved October 7, 2012 from: http://www.house.leg.state.mn.us/hrd/pubs/ss/clssexpost.pdf

Desert Places - 841 Words

Desert Places by Robert Frost Snow falling and night falling fast, oh, fast In a field I looked into going past, And the ground almost covered smooth in snow, But a few weeds and stubble showing last. The woods around it have it - it is theirs. All animals are smothered in their lairs. I am too absent-spirited to count; The loneliness includes me unawares. And lonely as it is, that loneliness Will be more lonely ere it will be less - A blanker whiteness of benighted snow With no expression, nothing to express. They cannot scare me with their empty spaces Between stars where no human race is. I have it in me so much nearer home To scare myself with my own desert places In the poem â€Å"Desert Places† by†¦show more content†¦In line twelve, the imagery of depression and absence of identity is furthermore supported when the speaker compares himself to the snow to say ‘With no expression, nothing to express’ (12) mentioning his lack of identity and him falling into loneliness. The fourth and last stanza is where the speaker is most confident. The word ‘scare’ is mentioned twice in this stanza and it denotes fear. In the first line of the fourth stanza the speaker says he worries no more of empty and lonely spaces. The word ‘star’ denotes space, but it also connotes to an example of loneliness ‘where no human race is.’ (14) The speaker does not coward anymore of lonely empty spaces, he does not need empty fields covered with formless snow and space filled with loneliness to scare him; it’s already inside of him. The last line of the poem ‘To scare myself with my own desert places,’ (16) contain an image which displays Frost’s thought that fear comes from within oneself rather than without. 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