https://link.springer.com/content/pdf/10.1057%2Fap.2012.9.pdf

The quality of government: Corruption, social trust and inequality in international perspective

In vaccine design, antigens are often arrayed in a multivalent nanoparticle form, but in vivo mechanisms underlying the enhanced immunity elicited by such vaccines remain poorly understood. We compared the fates of two different heavily glycosylated HIV antigens, a gp120-derived mini-protein and a large, stabilized envelope trimer, in protein nanoparticle or "free" forms after primary immunization. Unlike monomeric antigens, nanoparticles were rapidly shuttled to the follicular dendritic cell (FDC) network and then concentrated in germinal centers in a complement-, mannose-binding lectin (MBL)-, and immunogen glycan-dependent manner. Loss of FDC localization in MBL-deficient mice or via immunogen deglycosylation significantly affected antibody responses. These findings identify an innate immune-mediated recognition pathway promoting antibody responses to particulate antigens, with broad implications for humoral immunity and vaccine design.

/pdf/innate-immune-recognition-of-glycans-targets-hiv-3y1gel3dkr.pdf

Innate immune recognition of glycans targets HIV nanoparticle immunogens to germinal centers

The debate between the 'Will Theory' and the 'Interest Theory' of rights is actually a debate over stipulative definitions. I argue how this could have happened, and suggest how we might proceed building a theory of rights.

The Nature of Rights

Background Notwithstanding the need to produce evidence-based knowledge on medications for pregnant women, they remain underrepresented in clinical research. Sometimes they are excluded because of their supposed vulnerability, but there are no universally accepted criteria for considering pregnant women as vulnerable. Our aim was to explore whether and if so to what extent pregnant women are vulnerable as research subjects. Method We performed a conceptual and empirical analysis of vulnerability applied to pregnant women. Analysis A conceptual analysis supports Hurst9s definition of vulnerability. Consequently, we argue that pregnant women are vulnerable if they encounter an identifiably increased likelihood of incurring additional or greater wrong. According to the literature, this increased likelihood could exist of four alleged features for pregnant women9s vulnerability: (i) informed consent, (ii) susceptibility to coercion, (iii) higher exposure to risk due to lack of knowledge, (iv) vulnerability of the fetus. Discussion Testing the features against Hurst9s definition demonstrates that they all concern the same issue: pregnant women are only vulnerable because a higher exposure to risk due to lack of scientific knowledge comprises an increased wrong. Research Ethics Committees have a responsibility to protect the vulnerable, but a higher exposure to risk due to lack of scientific knowledge is a much broader issue and also needs to be addressed by other stakeholders. Conclusions The only reason why pregnant women are potentially vulnerable is to the extent that they are increasingly exposed to higher risks due to a lack of scientific knowledge. Accordingly, the discussion can advance to the development of practical strategies to promote fair inclusion of pregnant women in clinical research.

https://jme.bmj.com/content/medethics/43/10/657.full.pdf

Vulnerability of pregnant women in clinical research

For much of the 20th century, vulnerability to deprivations of health has often been defined by geographical and economic factors. Those in wealthy, usually ‘Northern’ and ‘Western’, parts of the world have benefited from infrastructures, and accidents of geography and climate, which insulate them from many serious threats to health. Conversely, poorer people are typically exposed to more threats to health, and have lesser access to the infrastructures needed to safeguard them against the worst consequences of such exposure. However, in recent years the increasingly globalized nature of the world’s economy, society and culture, combined with anthropogenic climate change and the evolution of antibiotic resistance, has begun to shift the boundaries that previously defined the categories of person threatened by many exogenous threats to health. In doing so, these factors expose both new and forgotten similarities between persons, and highlight the need for global cooperative responses to the existential threats posed by climate change and the evolution of antimicrobial resistance. In this article, we argue that these emerging health threats, in demonstrating the similarities that exist between even distant persons, provides a catalyst for global solidarity, which justifies, and provides motivation for, the establishment of solidaristic, cooperative global health infrastructures.

/pdf/global-health-solidarity-47lvohgk98.pdf

Global Health Solidarity.

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged - that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care - thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to (i) physical integrity, (ii) autonomy, (iii) freedom, (iv) social provision, (v) impartial quality of government, (vi) social bases of self-respect or (vii) communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice.

Fleshing out vulnerability.

Fair resource allocation in humanitarian medicine is gaining in importance and complexity, but remains insufficiently explored. It raises specific issues regarding non-ideal fairness, global solidarity, legitimacy in non-governmental institutions and conflicts of interest. All would benefit from further exploration. We propose that some headway could be made by adapting existing frameworks of procedural fairness for use in humanitarian organizations. Despite the difficulties in applying it to humanitarian medicine, it is possible to partly adapt Daniels and Sabin's ‘Accountability for reasonableness' to this context. This would require: (1) inclusion of internally explicit decisions and rationales; (2) publicity to donors, local staff, community leaders and governments, as well as frank answers to any beneficiary—or potential beneficiary—who asked for clarification of decisions and their rationale; (3) a consistent reasoning strategy to weigh conflicting views of equity in specific situations; (4) advocacy within the organization as a mechanism for revision and appeals; and (5) internal regulation according to publicly accessible mechanisms. Organizations could generate a common corpus of allocation decisions from which to draw in future similar cases. Importantly, the complexity of these challenges should encourage, rather than hinder, broader discussion on ethical aspects of resource allocation in humanitarian medicine.

Allocating Resources in Humanitarian Medicine

High immunogenicity of delayed third dose of hepatitis B vaccine in travellers.

Voyager enceinte est possible. On recommandera de : voyager au deuxieme trimestre, eviter les regions a forte endemicite de paludisme, favoriser les destinations ou il existe des services medicaux de qualite, prevoir un voyage de type confortable, sans grands trajets en voiture ou en avion, avoir une bonne couverture d'assurance, s'abstenir en cas de grossesse a risque. Les risques et benefices des vaccinations et des medicaments prescrits doivent etre peses, en se rappelant qu'une femme enceinte est plus vulnerable et a plus haut risque de complications.

[Travelling when pregnant? possible, but...].

Le Strongyloides stercoralis est un parasite qui peut s'acquerir dans les regions tropicales et subtropicales, mais aussi dans certains pays d'Europe. Cette helminthiase, souvent a- ou paucisymptomatique, peut persister en phase latente durant plusieurs decennies. A l'occasion d'une immunosuppression, elle peut se reactiver et etre responsable de complications severes, parfois fatales, dues a un syndrome d'hyperinfestation. Nous presentons deux cas de reactivation d'une strongyloidiase chez des patients connus pour lymphomes et traites par chimiotherapie. Chez les patients ayant sejourne en zone d'endemie, un depistage de ce parasite devrait etre propose avant toute prescription de corticotherapie ou autre traitement immunosuppresseur, ainsi qu'en presence de certaines pathologies compromettant l'immunite.

Nathalie Marie-Françoise Mezger

Papers

Fleshing out vulnerability.

Allocating Resources in Humanitarian Medicine

High immunogenicity of delayed third dose of hepatitis B vaccine in travellers.

[Travelling when pregnant? possible, but...].

[Lymphoma and pruritus: search for parasites].