However, the lower responses were still within the 2-fold GMC cri

However, the lower responses were still within the 2-fold GMC criterion for noninferiority for all pneumococcal serotypes, with the exception of 19F, which

was just below the noninferiority margin. The lower immune response Capmatinib observed by concomitant administration of these vaccine antigens is not easily understood. Such interactions are thought to be caused by complex, multi-factorial interactions, including antigen competition, and the effects of other vaccine components on the immune response [23]. A possible mechanism could be that vaccine antigens interfere with the MHC class I and II antigen processing and presentation pathways, leading to a uniformly reduced response to PCV13 serotypes [24]. Further research is required to better understand this phenomenon. Local reactions at the PCV13 injection site were comparable. Although systemic events were more common after PCV13 + TIV relative to TIV or PCV13 alone, this is probably because of the additive effects of both TIV and PCV13 systemic events. Overall, fever rates were low, and there were no Baf-A1 chemical structure vaccine-related SAEs during the study. Although immune responses to vaccine antigens were

observed after receipt of both vaccines, the lack of knowledge about the threshold level of antibodies needed to protect against pneumococcal disease in adults is a limitation of the study. The results from the efficacy study of PCV13 being conducted in adults aged ≥65 years in The Netherlands are awaited to help establish an effective antibody level against pneumococcal disease in adults [12].

Overall, the why concomitant administration of PCV13 and TIV was demonstrated to be immunogenic and safe. If PCV13 is determined to add value in a comprehensive immunization strategy against pneumococcal disease, the ability to coadminister PCV13 and TIV would facilitate the immunization of older adults. Financial support. This study was funded by Pfizer Inc. Pfizer was involved in the study design, data collection, data analysis, data interpretation, writing of the manuscript, and the decision to submit the paper for publication. Nancy Price at Excerpta Medica provided assistance in preparing and editing the manuscript, which was funded by Pfizer Inc. All authors had full access to all data. Potential conflicts of interest. T.F.S. has received honoraria from Pfizer, GlaxoSmithKline, and Novartis for conducting clinical trials and lecturing, and has participated as a member of advisory boards. J.F., H.C.R., and J.P. have no conflicts to report. C.J., A.W., D.J., P.G., E.A.E., W.C.G., and B.S-T are current or former employees of Pfizer Inc. Author contributions: C.J., E.A.E, W.C.G., and B.S-T participated in the conception and design, acquisition of data, analysis, and interpretation of the study; the writing of the report; and critically revising it for important intellectual content, and approved the final version to be submitted. T.F.S., J.F., H.C.R., and J.

All animals in this study were 4 months old at the time of inocul

All animals in this study were 4 months old at the time of inoculation. Sheep

(Suffolk cross, Rideau Arcott cross, Ile-de-France cross with Rideau Arcott) and goats (Alpine-Boer cross) were obtained from breeders in Manitoba. All animal manipulations were approved by the Animal Care Committee of the Canadian Science Centre for Human and Animal Health in compliance with the Canadian Council on Animal Care guidelines (Animal Use Documents #C-08-007, #C-09-004, #C-10-001, #C-11-011). The work with infected animals was performed under containment level 3 conditions (zoonotic BSL-3 Ag). Animals were acclimatized for two weeks prior to inoculation and inoculated subcutaneously this website (SC) with 1 ml of RVFV (ZH501) into the right side of the neck, and if applicable re-inoculated SC or intravenously (IV) depending on the inoculation group. Two doses were compared: “low” dose of 105 PFU per animal and “high” dose of 107 PFU per animal. Rectal temperatures were taken for three days following arrival of the animal to the facility

and for minimum of five days prior to inoculation, Protein Tyrosine Kinase inhibitor and daily during the first week post inoculation. Except for the first group (sheep group A; see below), blood was collected daily for up to 6 or 7 days post inoculation (dpi). At this time point animals were either euthanized to determine virus presence in liver and spleen, or were kept up to 35 dpi for serum production, and bled weekly to follow antibody development (not reported in this manuscript). Overview of the inoculation groups is provided in Table 1. Where it was possible to group animals to compare two experimental

approaches, Student’s t-test was performed. A P value <0.05 was considered statistically significant. Sheep: Group S-A: eight animals (Suffolk cross) were inoculated with 105 PFU of RVFV prepared in Vero E6 cells. In this pilot trial, blood was collected at 3, 5 and 7 dpi. Group S-B: four animals (Rideau Arcott cross) were inoculated with 105 PFU of RVFV Vero E6 stock. Group S-C: four animals (Rideau Arcott cross) were inoculated with 105 PFU of RVFV C6/36-stock. Group S-D: four animals (Rideau Arcott crotamiton cross) were inoculated with 107 PFU of Vero E6 stock. Group S-E: eight animals (Rideau Arcott cross) were inoculated with 107 PFU of C6/36-stock in two separate trials. Group S-F: four animals (Rideau Arcott cross) were inoculated with 107 PFU of C6/36 stock and re-inoculated at 1 dpi SC with the same dose. Group S-G: 4 animals (Rideau cross with Arcott or Ile de France) were inoculated with 107 PFU of the C6/36 derived virus stock, followed by IV inoculation with the same dose at 1 dpi. Most of the sheep were euthanized at 6–7 dpi, except for few animals kept for antibody production for 28 dpi. Some of the animals kept for production of antiserum were boosted at 14 dpi. Goats: All animals were Boer cross in groups of four. Group G-A was inoculated with 105 PFU of Vero E6 derived RVFV stock. Group B G-B was inoculated with 105 PFU of C6/36 derived RVFV stock.

5311–0 7111 with all the matrix tablets indicating non-Fickian (a

5311–0.7111 with all the matrix tablets indicating non-Fickian (anomalous) diffusion as the release mechanism from all the matrix tablets formulated with starch acetate. Plots of percent released versus square

root of time were found to be linear with (R2 > 0.9225) all the matrix tablets formulated indicating that the drug release from these tablets was diffusion controlled. As the starch acetate proportion (%) in the matrix tablets was increased, release rate was decreased, a good linear relationship was observed between percent polymer (starch acetate) and release rate (K0) ( Fig. 1). Glipizide release from the matrix tablets could be controlled by varying the proportion of drug:polymer in selleck compound the matrix. Short term accelerated stability testing was performed. The matrix tablets were packed in screw capped HDPE bottles and were stored at 40 °C ± 2 °C and 75% RH ± 5% RH for 6 months. No visible changes were observed in starch acetate matrix tablets after storage. Drug content and drug release from the matrix tablets were evaluated before and after storage. Drug content of the matrix tablets

before and after storage for 6 months. No significant difference (P > 0.05) was observed in the percent drug content before and after storage for 6 months. The drug release characteristics of all the matrix tablets tested remained unaltered during the storage period. Matrix tablets Fulvestrant supplier of glipizide (10 mg) prepared employing starch acetate as matrix former in different proportions gave slow and controlled release over more than 24 h. Drug release was diffusion

controlled and dependent on mafosfamide strength (%) of starch acetate and type of diluent in the tablets. Non-Fickian diffusion was the release mechanism from these tablets. Good linear relationship was observed between percent of polymer (starch acetate) and release rate (K0) of the matrix tablets. Release rate of the matrix tablets was stable and unaltered during short time accelerated stability study. Starch acetate was found suitable as matrix former for controlled release and the matrix tablets of glipizide formulated employing starch acetate gave controlled release of glipizide over 24 h. All authors have none to declare. The authors thank Sri Ramachandra University, Chennai for providing the necessary facilities to carry out this research work. “
“In current years, combination of different drugs in antihypertension therapy in the form of single-dose is significant alternative that combines effectiveness of blood pressure reduction and a low side effect profile with convenient once-daily dosing to enhance patient compliance.1 Also, because of the lower dose of each antihypertensive drug in a combination, metabolic and clinical adverse effects are decreased.

A mixed inflammatory cell infiltrate, granulation-like tissue, fo

A mixed inflammatory cell infiltrate, granulation-like tissue, focal calcification, ossification, and myxoid

change might be present. Electron microscopy shows a mixture of cell types in a dense collagenous matrix, with no glandular or mesothelial differentiation.1 Morphology, histology, and immunohistochemical analyses are necessary for equivocal cases. In this reported case, the fibrous pseudotumor was located on the penile shaft, and complete excision is curative, as these lesions behave in a benign fashion once excised.1 When testicles are involved, local excision of these lesions with sparing of testicles is standard. In equivocal cases, frozen section biopsy has been reported in aiding management and avoiding radical surgery. However, radical orchiectomy is often necessary for fibromatous periorchitis, when tunics are too diffusely involved

for preservation of testicular tissues.3 Clinical MAPK Inhibitor Library price recurrence has been hypothesized in incomplete excisions of these lesions; however, there have been no reports of recurrence, and certainly there have been no cases demonstrating metastatic potential. A penile lump with a history of previous trauma should prompt the physician to consider the differential of fibrous pseudotumor. In the setting of operative repair of penile fracture, if dissection is difficult and a fibrous mass is identified, one should consider the diagnosis of fibrous pseudotumor. Excision of the lesion and repair of fracture should provide definitive treatment. “
“Penile abscesses are an uncommon urologic condition and have been described in association with penile trauma, in the presentation this website of disseminated infection, or in association with underlying disease such as poorly controlled diabetes mellitus. The most commonly implicated organisms in penile abscess include Staphylococcus aureus, Streptococci, Fusibacteria, and Bacteroides. 1 Penile abscesses may be Non-specific serine/threonine protein kinase diagnosed with various imaging modalities,

including magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound. Such modalities may be used to concurrently treat penile abscesses; however, surgical evacuation and antibiotic therapy remain first line. We present a unique case of penile abscess in a 45-year-old male patient occurring after injection of amphetamine into the penis. We report a case of penile abscess in a 45-year-old man who presented 1 week after self-injection of amphetamine into the dorsal aspect of his penis. The penis was chosen as an injection site in the absence of suitable peripheral veins; a used syringe needle was utilized for drug injection. On presentation to the emergency department, the patient had a fluctuant necrotic area, approximately 2 × 3 cm at the base of the dorsal aspect of his penis associated with moderate penile shaft oedema (Fig. 1). This patient had a history of intravenous (IV) drug use in the absence of a significant medical history or sexually transmitted disease.

The HPV vaccination programme represents an ideal opportunity to

The HPV vaccination programme represents an ideal opportunity to convey the benefit of prevention programmes and reinforcement of this message is needed. Uptake of HPV vaccination was positively correlated with uptake of cervical screening, and cytology results indicate that vaccination has a protective effect against an abnormal result. Women from more socially deprived areas engage less with cervical cancer prevention healthcare services.

New strategies to enhance uptake of screening services need to be directed at young women with a focus on areas classified as socially deprived. SP and SH conceived of the study. HB, SB and MAR collected the data for the study. HB, SH and check details SP contributed to the analyses of the study and all authors contributed to the interpretation

of results and the writing of this paper and have approved the final draft. All authors declare no conflicts of interest that could have influenced this work. This study was funded by Cancer Research UK and sponsored by Cardiff University. The research was also supported by The Centre for the Improvement of Population Health through E-records Research (CIPHER). CIPHER is one of four UK e-health Informatics Research Centres funded by a joint investment from: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (Grant reference: MR/K006525/1). “
“Foot-and-mouth disease (FMD) vaccines are used on an enormous scale across the globe, with over 2 billion doses thought to be used every

year [1]. Despite this, little is done to assess their performance in the field. Vaccine effectiveness, defined as the reduction in risk in vaccinated individuals compared to similarly exposed unvaccinated individuals under field conditions [2], provides a direct measure of vaccine protection within a vaccination programme. FMD in Anatolian Turkey (Fig. 1) poses a threat to the EU which mafosfamide is disease free [3]. During 2009–11 (inclusive) approximately twenty-million doses of polyvalent FMD vaccine were used a year for biannual mass vaccination of Turkey’s cattle population [4]. In Turkey, inactivated, oil adjuvanted FMD vaccines with a specified protective effect of >3PD50 (PD50 = 50% protective dose) are administered intra-muscularly. In 2011 Turkey experienced an incursion of the FMD Asia-1 serotype. Although serotypes A and O are endemic this serotype had not been present since 2002 [5]. Vaccine matching tests suggested that the vaccine used at the time (Asia-1 Shamir) would not protect against the new field strain (FMD Asia-1 Sindh-08) [6].

23 (0 99, 1 50) and TT (aGMR 1 36 (1 04, 1 80) Both associations

No consistent associations were observed for other species. Maternal BCG scar was associated

with a markedly lower infant IL-5 and IL-13 responses to cCFP (aGMR 0.76 (0.61, 0.94) and 0.80 (0.64, 1.00)) and a somewhat lower IFN-γ response (aGMR 0.87 (0.70, 1.09)). An increasing number of doses of maternal tetanus immunisation during the pregnancy was associated with increased infant IFN-γ (aGMR 1.44 (1.16, 1.79)) and IL-13 (1.22 (1.01, 1.46)), and Galunisertib clinical trial a weak increase in IL-5 (aGMR 1.19 (0.97, 1.44)) responses to TT. Female infants had broadly lower responses for both cCFP and find more TT,

with aGMRs for each cytokine response ranging from 0.69 to 0.86 (Table 1, Table 2, Table 3 and Table 4). Associations for anthropometric variables were somewhat variable; after adjustment for confounding, associations remained for the IL-13 response for TT and IL-10 response to cCFP, which both showed increased responses for higher scores: IL-13 for TT, birth weight aGMR 1.43 (1.09, 1.89), weight-for-age z-score at one year, 1.13 (1.01, 1.28), height-for-age z-score at one year 1.13 (1.01, 1.26); IL-10 for CFP, height-for-age z-score at one year, 1.08 (1.00, 1.17). Current malaria parasitaemia was strongly associated with reduced IFN-γ, IL-5 and IL-13 responses for cCFP (aGMR 0.49 (0.28, 0.80), 0.41 (0.30, 0.60) and 0.46 (0.29, 0.75) respectively), and for TT (aGMR 0.47 (0.25, 0.85), 0.32 (0.21, 0.53) and 0.50 (0.26, 0.93) respectively), and with a reciprocal increase in IL-10 responses for TT (aGMR 2.38 (1.48, 3.80)).

Previous episodes of malaria during infancy showed weaker effects, but a high number of episodes was associated with a reduced IL-5 response to cCFP (aGMR 0.84 (0.76, 0.95)) and an increased IL-10 response to TT (aGMR 1.18 (1.03, 1.34)). Associations with infant HIV status differed for cCFP and TT. For cCFP, HIV-exposed-uninfected infants Linifanib (ABT-869) showed no difference in response compared to HIV-unexposed infants, but HIV-positive infants showed markedly lower IFN-γ, IL-5 and IL-13 responses (aGMR 0.06 (0.02, 0.23), 0.37 (0.25, 1.00) and 0.20 (0.09, 0.53) respectively), and higher IL-10 responses (aGMR 2.19 (1.56, 3.15)). For TT, both HIV-exposed-uninfected infants, and HIV-infected infants, showed impaired IFN-γ, IL-5 and IL-13 responses: HIV exposed-uninfected, aGMR 0.57 (0.35, 0.94), 0.51 (0.33, 0.82) and 0.61 (0.39, 0.95); HIV-infected, aGMR 0.35 (0.11, 1.13), 0.16 (0.10, 0.52) and 0.09 (0.04, 0.27); there was no effect on the IL-10 response. In this large birth cohort in Uganda, infant responses to BCG and tetanus immunisation were associated with pre-natal and early post-natal exposure to maternal M.

Three antigens (Neisserial adhesin A (NadA) allele 3, Neisseria H

Three antigens (Neisserial adhesin A (NadA) allele 3, Neisseria Heparin Binding Antigen (NHBA), factor H-binding protein (fHbp) variant 1 along with OMV of the epidemic strain (PorA P1.4) from New Zealand have been combined into a recently approved vaccine against MenB disease (4CMenB) [8] and [9].

Two variants of fHbp have also been used to create an investigational bivalent MenB vaccine (rLP2086) [10]. To date, three OMV-based vaccines against invasive MenB disease have successfully contained clonal outbreaks in various countries [11], [12] and [13]. However, immunogenicity of these vaccines was primarily based on the PorA outer membrane protein contained in the OMV and did not provide protection against strains carrying different PorA subtypes [14]. Antigens included in the newer MenB vaccines have Vemurafenib the potential see more to provide broad cross-protection against MenB strains and potentially other serogroups. The predicted protection afforded by these newer vaccines is not known and will be highly dependent on both the quantity of vaccine antigens expressed by strains causing

disease in a given geographic area and on the extent of their immunologic cross reactivity with the corresponding antigen in the vaccine. To this end, the Meningococcal Antigen Typing System (MATS) was developed to predict which individual MenB strains are likely to be covered by the 4CMenB vaccine [15]. To understand the potential coverage, a detailed epidemiologic, tuclazepam microbiologic and genetic characterization of the antigens found in MenB disease isolates is required. In collaboration with the Canadian Immunization Monitoring Program Active (IMPACT) surveillance network, the National Microbiology Laboratory (NML), the UK Health Protection Agency (HPA) and Novartis Vaccines & Diagnostics, we tested the potential strain coverage of the 4CMenB vaccine against invasive MenB strains isolated in Canada from 2006 to 2009. During this

time the incidence rate of MenB infection was stable at 0.25 per 100,000, but a higher rate occurred in Québec as a result of the circulation of clonal complex (cc) 269, [2], [16] and [17] one of two hyper-endemic ccs in Canada. Active, metropolitan area population-based surveillance for adult and pediatric hospital admissions related to infection with Neisseria meningitidis was conducted by the 12 centers of the IMPACT, in collaboration with local public health officials. IMPACT is a national surveillance initiative with centers located in 8 provinces [18]. Each center defined a population area and captured all IMD cases in children and adults. IMPACT meningococcal surveillance includes over 17 million Canadians, just over 50% of the population. Inclusion as a case required the isolation of N.

7 Communication is considered to be a key determinant of effectiv

7 Communication is considered to be a key determinant of effective healthcare.8 and 9 There is no specific evidence about how well physiotherapists communicate with Indigenous clients and little has been written about good communication practice for physiotherapists working with Indigenous people. A book chapter by Ewen and Jones10 is, to the authors’ knowledge, the only article on communication in Indigenous healthcare that relates to physiotherapy. Communication between the health professional and client is integral to establishing trust and rapport with clients8 and 9 and physiotherapists have a responsibility

as health workers to communicate appropriately and effectively with people from all cultural backgrounds, which includes acknowledging individual needs and differences.11 The lack

of literature about communication in Indigenous healthcare INCB024360 in vivo in the physiotherapy LGK-974 ic50 domain is concerning. It also emphasises the need to extend the discourse on communication in Indigenous healthcare to the physiotherapy discipline and to build physiotherapy practitioner knowledge on good practice. The concern over the scarce evidence to inform communication with Indigenous Australians in the physiotherapy context is accentuated by reports of ineffective communication between Indigenous Australians and non-Indigenous health professionals oxyclozanide across other health disciplines,8 and 12 which in some cases goes unrecognised.12 and 13 According to reports in the literature, lack of understanding and respect towards Indigenous culture and beliefs by health professionals provides a major barrier to effective communication in Indigenous healthcare and has a profound impact on the clinical interaction and the quality of care provided to Indigenous Australians.14 and 15

Misinterpreting Indigenous people’s responses is likely to provide an inaccurate account of their symptoms, the challenges they face, and their needs and priorities.16 This may result in misdiagnosis and lead to culturally insensitive practices, mismanagement and inappropriate delays in treatment, thus providing a major obstacle to good care and support.15 Ineffective communication between the health professional and client may also be a key factor in reinforcing a culturally unsafe environment.17 Adopting a health professional-dominated approach, which involves interrogational questioning by health professionals, may reinforce the power imbalance between some Indigenous communities and mainstream society. This has been shown to create anxiety for some Indigenous people, and significantly compromising the overall healthcare experience for some Indigenous Australians.18 Assumptions cannot be made, but it is likely that similar communication issues as those described above exist in the physiotherapy profession.

Pharmacovigilance (PhV) databases were screened from 1986 until 2

Pharmacovigilance (PhV) databases were screened from 1986 until 2013 without revealing signals – though as highlighted above there are doubts about as to the use of such a database in uncovering relationships between SCIT and e.g., neurodegenerative diseases having a latency period of many years. A perceived positive benefit–risk-ratio is reiterated in their statement. However, since the potential of accumulation of aluminium in the body is clearly significant in the course of SCIT, companies learn more themselves indicate in relevant sections of their SmPCs as follows: “During therapy with AVANZ®preparations, taking

aluminium-containing drugs (e.g. antacids) should be restricted.” [67]. Additionally, “This product contains aluminium (4 mg). The risk of aluminium accumulation in tissues (CNS, bones) must be taken into account, in particular in case of renal insufficiency. The effects on the immune system of long-term administration of aluminium are unknown. As this preparation contains a considerable amount of aluminium, it is recommended to avoid taking other aluminium-containing medications (e.g. antacids) concomitantly.” [68]. Furthermore, PD0332991 molecular weight “Patients with Alzheimer’s

disease, Down’s syndrome and renal insufficiency are theoretically at risk from aluminium intake, including alum precipitated allergenic extracts” [69]. While so far it has not yet been definitely clarified which form of aluminium acts as an antigen [70], immune reactions to antigenic aluminium as a consequence of SCIT is plausible. Such immune reactions would target aluminium deposits in the human body, which has the potential to contribute to the onset and progression of aluminium-induced

autoimmune diseases [59]. The amount of aluminium in SCIT is a significant addition to the lifelong exposure to the metal in children and adults. Taking this into account the toxicological considerations, it is not unreasonable to question the long-term impact this has on human health. Long-term aluminium adjuvant-based immunotherapy treatment unquestionably predisposes an individual to a likely set of circumstances that could lead to accumulation, Tryptophan synthase toxicity and disease. According to Good Pharmacovigilance Practices, assessment of a benefit–risk relation must take into account the severity of the treated disease (e.g. hay fever), the presence of therapy alternatives, and to the type of risk assessed. In Germany, licensed and comprehensively documented alternative products with other depot mediators are commercially available for example use of l-tyrosine, a non-essential amino acid physiologically generated from phenylalanine and fully metabolised with a half-time of 48 h, has been well-documented as a commercial alternative for over 40 years [71], [72] and [73].

Ct bacterial loads are highest in those with TI [19] The presenc

Ct bacterial loads are highest in those with TI [19]. The presence of TF and/or TI defines active trachoma. Ct can often be isolated from cases of active trachoma but, because follicles can persist for months or years after the infection has resolved, even the most sensitive nucleic

acid detection systems often fail to identify infection in subjects with active trachoma. Some, but not all cases of active trachoma develop conjunctival scarring, but this process usually takes several years. Ct cannot usually be isolated from subjects with scarring trachoma. In human volunteer studies, and in experimental infections in non-human primates, PF-06463922 order scarring sequelae were not seen following a single infection [20], [21], [22], [23] and [24]. In trachoma endemic communities, the prevalence of scarring increases with age. It is more common in women, who are more frequently in contact with young children (the main reservoir of infection). People with intense inflammatory trachoma and persistent or recurrent Ct infection are more likely to develop scarring [25] and [26]. SB431542 supplier As the scarring progresses and the scars contract, the lashes may turn inward and rub against the cornea

(trachomatous trichiasis, or TT), which is painful and causes corneal damage that may result in blindness. Experimental studies in humans and NHPs showed that re-challenge with the same strain of Ct results in an attenuated clinical response compared to primary infection, with a lower bacterial load [17], [20] and [21]. In trachoma over endemic communities the prevalence of ocular Ct infection decreases with age, and the highest bacterial loads are found in young children, suggesting that a degree of protective immunity develops following natural infection. A study in a trachoma endemic community in The Gambia, in which members

of affected households were examined and tested for ocular Ct infection every two weeks over a 6-month period in the absence of treatment, showed that the duration of episodes of disease and of infection was age dependent. The duration of untreated infection was estimated to be approximately 15 weeks in children aged 0–4 years, and 8 weeks in older children and adults [27] and [28]. The estimated incidence of infection was also lower in older individuals. The conclusion from this study is that protective immunity develops following natural infection, and is associated with both a reduced incidence and a reduced duration of infection. Experiments in baboons and in the Taiwanese monkey (Macaca cyclops) in the 1960s evaluated the protective efficacy of whole organism chlamydial vaccines, delivered parenterally, against ocular infection [21] and [29]. In both species it was shown that vaccines can provide short term, strain-specific protection against ocular Ct infection, which is of relatively short duration (less than 2 years).