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Corey L, Nabel GJ, Dieffenbach C, Gilbert P, Haynes BF, Johnston M, Kublin J, Lane HC, Pantaleo G, Picker LJ, Fauci AS. HIV-1 vaccines and adaptive trial designs. Sci Transl Med 2011; 3:79ps13. [PMID: 21508308 DOI: 10.1126/scitranslmed.3001863] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Developing a vaccine against the human immunodeficiency virus (HIV) poses an exceptional challenge. There are no documented cases of immune-mediated clearance of HIV from an infected individual, and no known correlates of immune protection. Although nonhuman primate models of lentivirus infection have provided valuable data about HIV pathogenesis, such models do not predict HIV vaccine efficacy in humans. The combined lack of a predictive animal model and undefined biomarkers of immune protection against HIV necessitate that vaccines to this pathogen be tested directly in clinical trials. Adaptive clinical trial designs can accelerate vaccine development by rapidly screening out poor vaccines while extending the evaluation of efficacious ones, improving the characterization of promising vaccine candidates and the identification of correlates of immune protection.
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Sira M, Gilbert P, Sneddon K, Akinwunmi J, Malhotra R. Recognising phenytoin therapy as a cause of thickening of the eyelids and paranasal region. J Plast Reconstr Aesthet Surg 2011; 64:1720-1. [PMID: 21768008 DOI: 10.1016/j.bjps.2011.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 06/12/2011] [Accepted: 06/16/2011] [Indexed: 11/25/2022]
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78
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Fitzgerald DW, Janes H, Robertson M, Coombs R, Frank I, Gilbert P, Loufty M, Mehrotra D, Duerr A. An Ad5-vectored HIV-1 vaccine elicits cell-mediated immunity but does not affect disease progression in HIV-1-infected male subjects: results from a randomized placebo-controlled trial (the Step study). J Infect Dis 2011; 203:765-72. [PMID: 21343146 DOI: 10.1093/infdis/jiq114] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Step study was a randomized trial to determine whether an adenovirus type 5 (Ad5) vector vaccine, which elicits T cell immunity, can lead to control of human immunodeficiency virus (HIV) replication in participants who became HIV-infected after vaccination. METHODS We evaluated the effect of the vaccine on trends in HIV viral load, CD4+ T cell counts, time to initiation of antiretroviral therapy (ART), and AIDS-free survival in 87 male participants who became infected with HIV during the Step study and who had a median of 24 months of post-infection follow-up. RESULTS There was no overall effect of vaccine on mean log(10) viral load (estimated difference between groups, -0.11; P = .47). In a subset of subjects with protective HLA types (B27, B57, B58), mean HIV-1 RNA level over time was lower among vaccine recipients. There was no significant difference in CD4+ T cell counts, time to ART initiation, or in AIDS-free survival between HIV-1-infected subjects who received vaccine versus those who received placebo. CONCLUSIONS HIV RNA levels, CD4+ T cell counts, time to initiation of ART, and AIDS-free survival were similar in vaccine and placebo recipients. There may have been a favorable effect of vaccine on HIV-1 RNA levels in participants with HLA types associated with better control of HIV-1.
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Gilbert P, Al-Hiti MM, Smith PM. Evaluation of a New Disinfectant-Cleanser Developed for use in Fibreoptic Endoscopy. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1981.tb11729.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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80
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Daoud NN, Crooks PA, Gilbert P. Identification of Component Alkyl Chains Within Commercial Samples of Benzalkonium Chloride Mixtures by Chemical Ionisation Mass Spectrometry. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1981.tb11667.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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81
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Gilbert P, Al-Hiti MM, Beveridge EG. Rational Approach Towards Improving the Reproducibility and Predictive Effectiveness of ‘Official’ Antimicrobial Preservative Challenge Tests. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1980.tb10817.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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82
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Gilbert P, Beveridge EG. The Action of 2-Phenyoxyethanol Upon Polymer Biosynthesis in Escherichia Coli NCTC 5933. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1980.tb10819.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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83
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Wright NE, Gilbert P. Sensitivity of Escherichia Coli Towards Chlorhexidine Diacetate and Polymixin B Associated with Growth-Rate-Mediated Changes in Envelope Phospholipid and Protein Composition. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1985.tb14163.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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84
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Plumpton EJ, Fell JT, Gilbert P. Survival of Microorganisms During Compaction of Various Direct Compression Mixes. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1981.tb11770.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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85
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Shepherd JA, Woodcock PM, Gilbert P. Interaction of 2-Bromo-2-Nitropropan-1,3-Diol with Some Respiration and Dehydrogenase Enzyme Systems in Escherichia Coli. J Pharm Pharmacol 2011. [DOI: 10.1111/j.2042-7158.1985.tb14167.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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86
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Wolfson J, Gilbert P. Statistical identifiability and the surrogate endpoint problem, with application to vaccine trials. Biometrics 2011; 66:1153-61. [PMID: 20105158 DOI: 10.1111/j.1541-0420.2009.01380.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Given a randomized treatment Z, a clinical outcome Y, and a biomarker S measured some fixed time after Z is administered, we may be interested in addressing the surrogate endpoint problem by evaluating whether S can be used to reliably predict the effect of Z on Y. Several recent proposals for the statistical evaluation of surrogate value have been based on the framework of principal stratification. In this article, we consider two principal stratification estimands: joint risks and marginal risks. Joint risks measure causal associations (CAs) of treatment effects on S and Y, providing insight into the surrogate value of the biomarker, but are not statistically identifiable from vaccine trial data. Although marginal risks do not measure CAs of treatment effects, they nevertheless provide guidance for future research, and we describe a data collection scheme and assumptions under which the marginal risks are statistically identifiable. We show how different sets of assumptions affect the identifiability of these estimands; in particular, we depart from previous work by considering the consequences of relaxing the assumption of no individual treatment effects on Y before S is measured. Based on algebraic relationships between joint and marginal risks, we propose a sensitivity analysis approach for assessment of surrogate value, and show that in many cases the surrogate value of a biomarker may be hard to establish, even when the sample size is large.
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87
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Gahide G, Hadjadj S, Therasse E, Kauffman C, Gilbert P, Oliva V, Soulez G. Abstract No. 341: C-arm CT value for evaluating femoropopliteal artery revascularization. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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88
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Lightfoot C, Ju Y, Dubois J, Giroux M, Gilbert P, Therasse E, Oliva V, Soulez G. Abstract No. 342: C-arm computed tomography: An additional guidance tool in the interventional management of vascular anomalies. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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89
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Kellett S, Gilbert P. Acne: A biopsychosocial and evolutionary perspective with a focus on shame. Br J Health Psychol 2010; 6:1-24. [PMID: 14596735 DOI: 10.1348/135910701169025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Hypotheses regarding the psychological factors implicated in the development and maintenance of acne first emerged in the middle of the eighteenth century. However, the psychodermatological literature from this date relating to acne has variously been described as confusing, overly prone to conjecture and, in particular, atheoretical. The current paper has two key objectives; first, to present a biopsychosocial model of acne development and maintenance and, secondly, to understand the psychosocial strain imposed by acne from an evolutionary perspective with a particular emphasis on body shame reactions. METHODS The psychodermatological literature relating to acne is reviewed with the data analysed for potential biopsychosocial interactions and shame eliciting responses. RESULTS The review indicates that acne can be reconceptualized as a biopsychosocial phenomena which, in turn, provides the field with innovative hypotheses for empirical inquiry and the potential for expanding and evaluating treatment options. The evolutionary analysis illustrates that acne provides the potential for distressing body shame reactions due to the skin disease's potential for damaging self-other evaluations of attractiveness. CONCLUSIONS Acne has tended to be viewed as a minor dermatological complaint which imposes minimal psychological distress upon sufferers. The paper concludes that acne has the ability to elicit in some sufferers significant mental health concerns due to a heightened sense of shame relating to appearance.
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90
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Gilbert P, Kaur N, Parkes M. Let's get spiritual. MENTAL HEALTH TODAY (BRIGHTON, ENGLAND) 2010:28-33. [PMID: 21275148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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91
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Gilbert P, Wang M, Wrin T, Petropoulos C, Gurwith M, Sinangil F, D'Souza P, Rodriguez-Chavez IR, DeCamp A, Giganti M, Berman PW, Self SG, Montefiori DC. Magnitude and breadth of a nonprotective neutralizing antibody response in an efficacy trial of a candidate HIV-1 gp120 vaccine. J Infect Dis 2010; 202:595-605. [PMID: 20608874 DOI: 10.1086/654816] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A candidate vaccine consisting of human immunodeficiency virus type 1 (HIV-1) subunit gp120 protein was found previously to be nonprotective in an efficacy trial (Vax004) despite strong antibody responses against the vaccine antigens. Here we assessed the magnitude and breadth of neutralizing antibody responses in Vax004. METHODS Neutralizing antibodies were measured against highly sensitive (tier 1) and moderately sensitive (tier 2) strains of HIV-1 subtype B in 2 independent assays. Vaccine recipients were stratified by sex, race, and high versus low behavioral risk of HIV-1 acquisition. RESULTS Most vaccine recipients mounted potent neutralizing antibody responses against HIV-1(MN) and other tier 1 viruses. Occasional weak neutralizing activity was detected against tier 2 viruses. The response against tier 1 and tier 2 viruses was significantly stronger in women than in men. Race and behavioral risk of HIV-1 acquisition had no significant effect on the response. Prior vaccination had little effect on the neutralizing antibody response that arose after infection. CONCLUSIONS Weak overall neutralizing antibody responses against tier 2 viruses is consistent with a lack of protection in this trial. The magnitude and breadth of neutralization reported here should be useful for identifying improved vaccines.
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Duke-Novakovski T, Clark CR, Ambros B, Gilbert P, Steagall PVM. Plasma concentrations of buprenorphine after epidural administration in conscious cats. Res Vet Sci 2010; 90:480-3. [PMID: 20709341 DOI: 10.1016/j.rvsc.2010.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 04/13/2010] [Accepted: 07/12/2010] [Indexed: 11/24/2022]
Abstract
Buprenorphine plasma concentrations were measured after administering buprenorphine (20 μg/kg) into the lumbosacral epidural space of conscious cats chronically instrumented with an epidural catheter. Blood was collected from a jugular vein before injection and 15, 30, 45 and 60 min and 2, 3, 4, 5, 6, 8, 12 and 24 h after administration. Plasma buprenorphine concentrations were measured using ELISA. Background concentration (before injection) was 1.27 ± 0.27 ng/mL (mean ± SD). Including background concentration, the mean peak plasma concentration was obtained 15 min after injection (5.82 ± 3.75 ng/mL), and ranged from 3.79 to 2.20 ng/mL (30 min-3 h), remaining between 1.93 and 1.77 ng/mL (4-12 h), and declined to 1.40 ± 0.62 ng/mL at 24h. Elimination half-life was 58.8 ± 40.2 min and clearance 56.7 ± 21.5 mL/min. Results indicate early rapid systemic uptake of buprenorphine from epidural administration with plasma concentrations similar to using buccal or IM routes by 15 min postinjection.
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93
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Gilbert P, Clark M. Waking the sleeping giant: reflections on leadership and the National Institute for Mental Health in England (NIMHE) 2002‐2009. ACTA ACUST UNITED AC 2010. [DOI: 10.5042/ijlps.2010.0351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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94
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Bolam S, Carr S, Gilbert P. The Partnership Project: learning from experts by experience in mental health services; the Jersey Partnership perspective. ACTA ACUST UNITED AC 2010. [DOI: 10.5042/ijlps.2010.0354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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95
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Novitsky V, Wang R, Bussmann H, Lockman S, Baum M, Shapiro R, Thior I, Wester C, Wester CW, Ogwu A, Asmelash A, Musonda R, Campa A, Moyo S, van Widenfelt E, Mine M, Moffat C, Mmalane M, Makhema J, Marlink R, Gilbert P, Seage GR, DeGruttola V, Essex M. HIV-1 subtype C-infected individuals maintaining high viral load as potential targets for the "test-and-treat" approach to reduce HIV transmission. PLoS One 2010; 5:e10148. [PMID: 20405044 PMCID: PMC2853582 DOI: 10.1371/journal.pone.0010148] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 03/12/2010] [Indexed: 11/17/2022] Open
Abstract
The first aim of the study is to assess the distribution of HIV-1 RNA levels in subtype C infection. Among 4,348 drug-naïve HIV-positive individuals participating in clinical studies in Botswana, the median baseline plasma HIV-1 RNA levels differed between the general population cohorts (4.1–4.2 log10) and cART-initiating cohorts (5.1–5.3 log10) by about one log10. The proportion of individuals with high (≥50,000 (4.7 log10) copies/ml) HIV-1 RNA levels ranged from 24%–28% in the general HIV-positive population cohorts to 65%–83% in cART-initiating cohorts. The second aim is to estimate the proportion of individuals who maintain high HIV-1 RNA levels for an extended time and the duration of this period. For this analysis, we estimate the proportion of individuals who could be identified by repeated 6- vs. 12-month-interval HIV testing, as well as the potential reduction of HIV transmission time that can be achieved by testing and ARV treating. Longitudinal analysis of 42 seroconverters revealed that 33% (95% CI: 20%–50%) of individuals maintain high HIV-1 RNA levels for at least 180 days post seroconversion (p/s) and the median duration of high viral load period was 350 (269; 428) days p/s. We found that it would be possible to identify all HIV-infected individuals with viral load ≥50,000 (4.7 log10) copies/ml using repeated six-month-interval HIV testing. Assuming individuals with high viral load initiate cART after being identified, the period of high transmissibility due to high viral load can potentially be reduced by 77% (95% CI: 71%–82%). Therefore, if HIV-infected individuals maintaining high levels of plasma HIV-1 RNA for extended period of time contribute disproportionally to HIV transmission, a modified “test-and-treat” strategy targeting such individuals by repeated HIV testing (followed by initiation of cART) might be a useful public health strategy for mitigating the HIV epidemic in some communities.
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Abstract
Although death is the inevitable end of life, historical, sociological, and psychological analyses converge to demonstrate that human beings struggle to integrate it as a personal reality. In this article we attempt to bring to bear recent theoretical work on the linkage between our conceptions of death, and our difficulty adjusting to it as a species, by first surveying historical and philosophic perspectives on the meaning of death, and then sampling some of the broad field of psychological research on death attitudes in a variety of cultures and subcultures. Finally, we advance an argument that a fuller understanding of death as a phenomenon could mitigate the pervasive contemporary tendency toward its denial, and promote better adjustment to this ultimate reality, on both personal and societal levels.
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Steagall PVM, Millette V, Mantovani FB, Gilbert P, Luna SPL, Duke-Novakovski T. Antinociceptive effects of epidural buprenorphine or medetomidine, or the combination, in conscious cats. J Vet Pharmacol Ther 2009; 32:477-84. [PMID: 19754915 DOI: 10.1111/j.1365-2885.2009.01069.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to compare the antinociceptive effects of epidural buprenorphine (EB), epidural medetomidine (EM) or epidural buprenorphine-medetomidine (EBM). Eight cats were studied. Thermal thresholds (TT) were measured by increasing the temperature of a probe placed on the thorax. Mechanical thresholds (MT) were measured through inflation of a modified blood pressure bladder to the cat's forelimb. After baseline measurements, EB (0.02 mg/kg), EM (0.01 mg/kg) or half of the doses of each drug (EBM) were administered. Data were analysed using anova (P < 0.05) and 95% confidence interval (CI). TT increased from 30 min to 1 h after EB and at 45 min after EM. MT increased from 45 min to 2 h after EB, from 15 min to 1 h after EM and at 30, 45 min and at 2 h after EBM. MT were significantly lower after EB than EM at 30 min. TT were above the upper 95%CI from 15 min to 24 h after EB, from 15 min to 4 h after EM and from 15 min to 8 h after EBM. MT were above the upper 95%CI from 15 min to 5 h, and at 8, 12 and 24 h after EB, from 15 min to 6 h after EM and from 15 min to 6 h and at 12 and 24 h after EBM. All treatments had similar onset. Overall, EB presented longer period of action than EBM and EM. The same magnitude of analgesia was achieved, but with fewer side effects when EBM was compared with EM.
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Gilbert P, Ryu C, Sharifi V, Swithenbank J. Tar reduction in pyrolysis vapours from biomass over a hot char bed. BIORESOURCE TECHNOLOGY 2009; 100:6045-6051. [PMID: 19604685 DOI: 10.1016/j.biortech.2009.06.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 06/11/2009] [Accepted: 06/12/2009] [Indexed: 05/28/2023]
Abstract
The behaviour of pyrolysis vapours over char was investigated in order to maximise tar conversion for the development of a new fixed bed gasifier. Wood samples were decomposed at a typical pyrolysis temperature (500 degrees C) and the pyrolysis vapours were then passed directly through a tar cracking zone in a tubular reactor. The product yields and properties of the condensable phases and non-condensable gases were studied for different bed lengths of char (0-450 mm), temperatures (500-800 degrees C), particle sizes (10 and 15 mm) and nitrogen purge rates (1.84-14.70 mm/s). The carbon in the condensable phases showed about 66% reduction by a 300 mm long char section at 800 degrees C, compared to that for pyrolysis at 500 degrees C. The amount of heavy condensable phase decreased with increasing temperature from about 18.4 wt% of the biomass input at 500 degrees C to 8.0 wt% at 800 degrees C, forming CO, H(2) and other light molecules. The main mode of tar conversion was found to be in the vapour phase when compared to the results without the presence of char. The composition of the heavy condensable phase was simplified into much fewer secondary and tertiary tar components at 800 degrees C. Additional measures were required to maximise the heterogeneous effect of char for tar reduction.
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Todd CA, Yu X, Ozaki DA, Greene KM, Gao H, Wood B, Wang M, Gilbert P, Montefiori DC, Sarzotti-Kelsoe M. P15-04. Development and implementation of an international proficiency testing program for a neutralizing antibody assay for HIV-1 in TZM-bl cells. Retrovirology 2009. [PMCID: PMC2767699 DOI: 10.1186/1742-4690-6-s3-p205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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100
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Letvin N, Mascola J, Rao S, Buzby A, Roederer M, Hudgens M, Gilbert P, Seder R, Douek D, Koup R, Graham B, Nabel G. P19-57 LB. Gene-based vaccination protects against mucosal infection by a heterologous highly pathogenic SIV isolate in rhesus monkeys. Retrovirology 2009. [PMCID: PMC2767939 DOI: 10.1186/1742-4690-6-s3-p421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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