Epilepsy is a condition that disrupts normal brain function and sometimes leads to seizures, unusual sensations, and temporary loss of awareness. Electroencephalograph (EEG) records are commonly used for diagnosing epilepsy, but traditional analysis is subjective and prone to misclassification. Previous studies applied Deep Learning (DL) techniques to improve EEG classification, but their performance has been limited due to dynamic and non-stationary nature of EEG structure. In this paper, we propose a multi-channel EEG classification model called LConvNet, which combines Convolutional Neural Networks (CNN) for spatial feature extraction and Long Short-Term Memory (LSTM) for capturing temporal dependencies. The model is trained using open source secondary EEG data from Temple University Hospital (TUH) to distinguish between epileptic and healthy EEG signals. Our model achieved an impressive accuracy of 97%, surpassing existing EEG classification models used in similar tasks such as EEGNet, DeepConvNet and ShallowConvNet that had 86%, 96% and 78% respectively. Furthermore, our model demonstrated impressive performance in terms of trainability, scalability and parameter efficiency during additional evaluations.

Objective: The purpose of this study was to explore the influence of suicide-related mental imagery (SuiMI) and experiential avoidance (EA) on suicidality. It was hypothesised that greater frequency of SuiMI would be associated with greater EA. It was also hypothesised that greater SuiMI would be associated with greater suicidality, and that EA may mediate or moderate this relationship. Method: Hypotheses were tested by surveying 197 university students who completed self-report measures that assessed suicide-related mental imagery, experiential avoidance, and suicidality. Results: Frequency of SuiMI was positively correlated with tendency to engage in EA. SuiMI was a significant predictor of both suicidality and EA. Exploratory analysis found that spontaneous SuiMI explained greater variance in suicidality than intrusive SuiMI, and that SuiMI only predicted EA in low-risk participants and not for those at high risk of suicide. EA did not predict suicidality and did not show a mediating or moderating influence on the relationship between SuiMI and suicidality. Conclusion: There is evidence to suggest that suicide-related mental imagery may play an important role in suicide risk. Future research should explore the processes involved in this relationship and how these may differ according to type of SuiMI.

Early flowering is a survival strategy in wheat ( Triticum aestivum L.) that sacrifices grain yield under long photoperiod conditions, and this contradiction is greatly affected by floral growth and development. However, little is known about the regulatory mechanisms that remove the barrier between “early flowering” and “high yielding” during floret development. Here, we showed high-resolution analyses of the number and morphology of floret primordia and the transcriptomes of wheat spikes in three light regimens. The development of all floret primordia in a spike could be divided into four distinct stages: differentiation (Stage I), differentiation and morphology development concurrently (Stage II), morphology development (Stage III), and polarization (Stage IV). Compared to the controls, the long photoperiod supplemented with red light treatment shortened the time required to complete Stage I-II, then improved assimilates in the spike and promoted anther development, thereby increasing fertile floret primordia during Stage III, and maintained fertile floret primordia development during Stage IV until they became fertile florets (grains) via a dynamic gene network centered on ubiquitin, calcium signaling, aldehyde dehydrogenase, zinc finger proteins, and heat shock proteins. Our findings proposed a light regimen, critical stages, and candidate regulators that promoted early flowering and high yield in wheat.

Introduction & Objective: Recently, the utilization of herbals for the biosynthesis of nanoparticles has been noticed in their properties such as environmental compatibility, simplicity, and economics. Numerous medicinal plants possess the ability to synthesize nanoparticles that have applications in medicine, biosciences, and the pharmaceutical industry. The primary objective of this research is to propose an environmentally friendly approach for synthesizing silver nanoparticles (AgNPs) for use in drug delivery, medicine, industry. Methods: First, the polygonum aviculare L. extract was prepared by maceration and synthesized by 2 mM AgNO 3 solution using the green method. After changing the color of the extract, confirmation of the formation of nanoparticles by UV-Vis spectroscopy, and Morphological investigation by TEM, FE-SEM, XRD and FT-IR to examine functional groups in nanoparticles and investigation of antioxidant and antibacterial activities of nanoparticles by DPPH assay and Disk Diffusion method. Results: The emergence of an absorption peak between the wavelengths of 400-450 nm on the UV-Vis spectrophotometer indicates the synthesis of silver nanoparticles. The shape of spherical and rod particles, their average size is about 25-70 nm. The free radical scavenging activity was calculated as IC 50 = 15.63 mg/L. The synthesized silver nanoparticles had significant antimicrobial activity. Conclusion: polygonum aviculare L. extract can reduce Ag + ions to silver nanoparticles. In addition, synthesized silver nanoparticles have good antioxidant and antimicrobial properties.

Background: Leishmanization using non-pathogenic to human Leishmania spp. is considered a reliable approach to immunize subjects against Leishmania infection. Objectives: Here, we evaluated the long-term immune responses (14 weeks) after immunization with either live- or killed-Iranian Lizard Leishmania (ILL) mixed with chitin microparticles (CMPs) against L. major infection in BALB/c mice. Methods: In total, nine groups of mice were included in the study. To evaluate short-term immunity, mice were immunized with live-ILL and three weeks later were challenged with L. majorEGFP. To evaluate the long-term immunity, mice were immunized with either live- or killed-ILL, and 14 weeks after immunization were challenged with L. majorEGFP. A group of healthy mice who received no injection was also included in the study. Eight weeks after the challenge with L. majorEGFP all subjects were sacrificed and the parasite burden (quantitative real-time PCR), cytokines levels (IFN-γ, IL-4, and IL-10), Leishmania-specific antibody concentration, and total levels of IgG1 and IgG2a were measured. In addition, nitric oxide concentration, and arginase activity were evaluated. Results: In mice that were immunized using live-ILL+CMP, the induced proactive immune response lasted at least 14 weeks since, when they were challenged with L. major EGFP at the 14 th-week post-immunization, no open lesion was formed during 8 weeks follow-up, and the footpad swelling was significantly lower than controls. As well, they showed a significant reduction in the parasite burden in splenocytes, in comparison to the control groups including the group that received killed-ILL+CMP. The observed protection was associated with a higher IFN-γ and a lower IL-10 production by splenocytes. Additionally, the results demonstrated that arginase activity was decreased in the ILL+CpG group compared to other groups. Conclusion: The long-term response against L. major infection induced by Live-ILL+CMP was more competent than the response elicited by killed-ILL+CMP to protect mice against infection with L. major EGFP.

Between 60 and 90 % of ERP implementation projects fail. One of the reasons is the non-ERP readiness of the organizations. However, actual ERP readiness management (ERM) methods tend to be context specific, making them inefficient in other contexts. With a focus on the African context, existing contextual and functional gaps are identified by assessing actual ERM methods. The purpose of this work is to build a metamethod capable to be specified based on the context of the organization. The solution is built using Method Engineering as Design Science methodology. The main idea is to introduce situational properties in ERM method design using the Situational Method Engineering approach based on chunks. The solution is demonstrated using experimentations and within a case study. The findings of this work provide greater insights into situational ERM design and thus are helpful for organisations to build suitable ERM methods: (1) There is no one size fits all method in IS implementation like in software development; (2) Well-formed and suitable ERM methods can be designed using the framework proposed using an easier to understand process and artefacts from this article. (3) The results open perspectives of situational ERP implementation life-cycle for ERP implementation success. In ERP implementation research, must of the contributions come from field studies. This potentially limits the scope of the results, with biases. This article comes to contribute to fill this gap in introducing SME in ERP implementation for context-aware methods as a solution to the failure issue.

Sghaier Jihed1, Afef Slim2 and Habib Hamdi3Department of Medicine and Oral Surgery, University Dental Clinic, Monastir, TunisiaAbstractCervical lymphadenopathy, an intricately multifactorial condition, is one of the foremost prevalent presentations dental clinics encounter. Consequently, oral surgeons should possess extensive knowledge regarding the etiology of cervical lymphadenopathy. The present article describes a case of a 60-year-old female who reported to the Department of oral medicine and oral surgery at the University Dental Clinic of Monastir- Tunisia with a complaint of painless swelling of 5 days duration on the right side of her neck, specifically in the jugular-carotid region. The oral examination revealed an infected right maxillary third molar, confirmed on the radiograph. Considering the possibility of neck swelling caused by reactive lymphadenitis secondary to an infected molar, removing the third molar on the right side was performed under antibiotic coverage, which was uneventful. The ultrasound examination, as well as the opinion of the otorhinolaryngologist, confirms the inflammatory origin and absence of signs of malignancy. The patient remained free of the presenting symptoms 28 days later. As well as complete regression of the swelling. The article aims to spotlight the oral physician’s crucial position withinside the early identity of neck swellings, which could bring about well-timed care.

Aim: Behçet’s disease (BD) is a chronic, inflammatory disease effecting multiple organs. Vascular involvement is a major cause of morbidity and mortality in BD patients. Though clinically well-defined, there is limited information related to disease pathogenesis and vascular incidences in this patient group. The aim of the current study is to investigate the unique metabolic signatures of BD patients with vascular involvement (VBD). Methods: Metabolomic profiling was performed on serum samples of 48 BD patients (18 with vascular involvement) and 40 healthy controls using gas chromatography-mass spectrometry (GC-MS) based untargeted metabolomics analysis. Multivariate and univariate statistical analyses were performed to find altered metabolites and pathways. Results: Untargeted metabolomics results showed that a total of 168 metabolites were identified. The comparison between the groups of BD, vascular involvement in BD and the healthy control group showed that altered amino acid and oxidative stress pathways, especially with glutathione synthesis could be an important stage for developing BD. Conclusion: In the present work, the untargeted metabolomics approach provided new molecular insights for a better understanding of BD pathogenesis and also developing vascular involvement in BD at the metabolite level. The results showed that vascular involvement in BD could be highly linked with amino acid metabolism and also the antioxidant system and these disease-related pathways could be evaluated with further experiments for diagnosis and prognosis of BD and also for vascular involvement in BD.

With their high volumetric capacity and electronic conductivity, sodium-selenium (Na-Se) batteries have attracted attention for advanced battery systems. However, the irreversible deposition of sodium selenide (Na2Se) results in rapid capacity degradation and poor Coulombic efficiency. To address these issues, cubic α-Mn2O3 is introduced herein as an electrocatalyst to effectively catalyze Na2Se conversion and improve the utilization of active materials. The results show that the addition of 10 wt% Mn2O3 in the Se/KB composite enhances the conversion from Na2Se to Se by lowering activation energy barrier and leads to fast sodium-ion kinetics and low internal resistance. Consequently, the Mn2O3-based composite delivers a high specific capacity of 635 mAh·g-1 at 675 mA·g-1 after 250 cycles as well as excellent cycling stability for 800 cycles with a high specific capacity of 317 mAh·g-1 even at the high current density of 3375 mA·g-1. Due to the cubic Mn2O3 electrocatalyst, the performance of the composites is mostly superior to existing state-of-the-art Na-Se batteries reported in the literature.

Improving performance by combining polyoxometalates (POM) clusters with metal-organic frameworks (MOFs) containing different transition metals presents a challenge. Here, a solvothermal method was first used to synthesized a POM-based metal-organic frameworks (POMOFs) Zn[N(C4H9)4][MnMo6O18{(OCH2)3CNH2}2]@Zn3(C9H3O6)2·6C3H7NO (HRBNU-5, which Zn[N(C4H9)4][MnMo6O18{(OCH2)3CNH2}2]·3C3H7NO ({Zn[MnMo6]}), Zn3(C9H3O6)2·3C3H7NO (Zn-BTC)) . Structural characterization revealed that the compound is host-guest structure with Zn-BTC encapsulation {Zn[MnMo6]}. In the three-electrode system, its specific capacitance is 851.3 F g-1 at a current density of 1 A g-1, and it remains highly stable (97.2%) after 5000 cycles. In the symmetrical supercapacitor (SSC) system, HRBNU-5 still performs well with energy density and power density of 11.02 Wh kg-1 and 605.7 W kg-1 at 1 A g-1, respectively. Besides, it shows good catalytic performance in 1 M KOH, with overpotentials and Tafel slopes for hydrogen and oxygen evolution reactions of 177 mV (η10 HER), 126.9 mV dec-1 and 370 mV (η50 OER), 36.3 mV dec-1, respectively, outperforming its precursors and most reported literature. The good activity is ascribed to host-guest structure, high conductivity of HRBNU-5 for electron-transfer, and porous structure that facilitates mass transport. This provides new inspiration for the design of Anderson-type POMOFs electrode materials with multiple active sites and a clear structure.

A document by zahra saadatian. Click on the document to view its contents.

Survival among juvenile ungulates is an important demographic trait affecting population dynamics. In many systems, juvenile ungulates experience mortality from large carnivores, hunter harvest and climate-related factors. These mortality sources often shift in importance both in space and time. While wolves (Canis lupus) predate on moose (Alces alces) throughout all seasons, brown bear (Ursus arctos) predation and human harvest happen primarily during early summer and fall, respectively. Hence, understanding how the mortality of juvenile moose is affected by predation, harvest and climate is crucial to adaptively managing populations and deciding sustainable harvest rates. We used data from 39 female moose in south-central Scandinavia to investigate the mortality of 77 calves in summer/fall and winter/spring, in relation to carnivore presence (defined as wolf presence and bear density), summer productivity, secondary road density, winter severity and migratory strategy (migratory versus resident) using logistic regressions. Summer mortality varied significantly between years but was not correlated to any of our covariates. In winter, calf mortality was higher with deeper snow in areas with wolves compared to areas without and increased more strongly with an increasing proportion of clearcuts/young forests in the presence of wolves compared to when wolves were absent. Lastly, increasing hunting risk was associated with higher calf mortality, and migratory females had higher calf mortality compared to stationary ones. Our study provides useful insight into mortality rates of moose calves coexisting with two large carnivores and with an intensive harvest pressure. Increasing our understanding of the mechanisms driving calf mortality both in summer and winter will become increasingly important if the populations of wolves and bears continue to expand and the moose population declines, and both summers and winters become warmer.

Urban environments represent a theatre for life history evolution. Species able to survive in cities can adapt to the local and often divergent environmental conditions compared to rural or natural environments. Dispersal determines establishment, gene flow, and thus the potential for local adaptation. Since habitats in urban environments are highly fragmented, and showing substantial turnover, contrasting adaptive effects on dispersal are expected. Fragmentation selects against dispersal while patch turn-over is expected to promote the evolution of dispersal. We here show both processes to act in concert when different scales are considered. Dispersal behaviour of juvenile, lab-reared garden spiders from two mid-sized European cities were tested under standardized conditions. While long-distance dispersal showed to be overall rare, short-distance dispersal strategies increased with urbanization at small scales, but declined when urbanization was quantified at large scales. We discuss the putative drivers behind these differences in natal dispersal and highlight its importance for urban evolution and ecology.

Background. Discharge against medical advice (DAMA) is used in healthcare facilities in a situation where patients refuse care or decide to leave the hospital before the treating physician recommends discharge. Previous studies have found DAMA to be prevalent among patients with various chronic conditions. The study had four objectives. The study aimed to investigate: 1) the prevalence of DAMA during COVID-19 (2020-2021) among Jordanian patients with chronic diseases, 2) the association between DAMA and sociodemographic and clinical characteristics of patients with chronic diseases, 3) the predictors of DAMA, and 4) the reasons behind DAMA at the patient, hospital, and environmental levels. Methods. A descriptive cross-sectional correlational design was used in the study. A convenience sampling approach was used to collect data from 1576 patients with chronic diseases from 3 private hospitals. Results. The study found that the prevalence rate of DAMA was 33.3%. There was a significant association between the sociodemographic and clinical characteristics of patients with chronic diseases and DAMA. Health insurance found to be the strongest predictor of DAMA. Finally, the study found that patient, hospital, and environmental- related factors had a low impact on DAMA. Conclusions: DAMA is prevalent among patients with chronic diseases in Jordan during COVID-19 pandemic. The current study’s findings can serve as an empirical basis for planning and implementing DAMA prevention programs and/or establishing or revising policies for the target population.

Zebrafish is widely used in bone research, but there is a lack of methods to assess its bone development in vivo. The objective of this study was to monitor skull growth of zebrafish and investigate whether a correlation exists between the bone thickness and body length and age. The skull of zebrafish with different body lengths or ages were evaluated using optical coherence tomography (OCT) and histology. There was a significant normal linear correlation between these two methods (r=0.9988, P<0.05). Both OCT and histology showed that the skull thicknesses of older zebrafish were markedly higher than younger zebrafish (P<0.05), but no significant difference was found between zebrafish with the same age but different body lengths (P>0.05). This study demonstrated the age of zebrafish, not their body length can represent their developmental stages.OCT providing a powerful tool for noninvasive and nondestructive procedures in analyzing bone growth processes in long-time studies.

Objective To assess whether narrow band imaging (NBI) detects fields of cancerisation around suspicious lesions in the upper aerodigestive tract, which were undetected by white light imaging (WLI). Method In 96 patients with laryngeal and pharyngeal lesions suspicious for malignancy, 206 biopsies were taken during laryngoscopy: 96 biopsies of suspicious lesions detected by both WLI and NBI (WLI+/NBI+), 60 biopsies adjacent mucosa only suspicious with NBI (WLI-/NBI+), and 46 biopsies of NBI and WLI unsuspicious mucosa (WLI-/NBI-) as negative controls. Optical diagnosis according to the Ni-classification was compared with histopathology. Results Signs of (pre)-malignancy were found in 88% of WLI+/NBI+ biopsies, 32% of WLI-/NBI+ biopsies, and 0% in WLI-/NBI- (p <.001). In 58% of the WLI-/NBI+ mucosa any form of dysplasia or carcinoma was detected. Conclusion The use of additional NBI led to the detection of (pre)-malignancy in 32% of the cases, that would have otherwise remained undetected with WLI alone. This highlights the potential of NBI as a valuable adjunct to WLI in the identification of suspicious lesions in the upper aerodigestive tract.

This paper aims to propose a novel method for designing an SRAM cell using an Etched Drain based Cyl. GAA TFET with a hetero-substrate material and an elevated density strip. The aim is to reduce power dissipation and improve stability, as demonstrated through analysis utilizing SNM as well as N-Curve methods. With respect to the 16nm MOSFET based SRAM cell, the proposed device-based SRAM cell shows significant improvements with a 68.305% reduction in leakage power, a 15.58% increase in SVNM, an 8.623% increase in SINM, an 8.152% increase in WTV, a 12.86% increase in WTI, a 27.62% increase in SPNM, and a 19.95% increase in WTP. The design is implemented and analyzed using Cadence Virtuoso software, and a novel approach of look up tables and Verilog A is utilized for the device to circuit application. These results indicate promising advancements in the design of SRAM cells, which could have significant implications for the development of advanced computer systems.

‘Yali’ pear (Pyrus bretschneideri) is one of the most seriously varieties of pears affected by saline-alkali in China. The research aimed to study the fruit quality changes of pear under saline-alkali stress. It was found that the functional gene KEGG pathways and particular miRNAs’ target gene KEGG pathways were consistent in specific metabolites under saline-alkali stress. Combined with the correlation analysis of metabolites, three gradations were combined to form one closed loop, which perfectly resolved the effect of saline-alkali stress in fruit quality of ‘Yali’ pear from different levels. Callus induced from ‘Yali’ fruits 45 days after flowering was firstly introduced for mechanism research. The effects of saline-alkali factors on key differential metabolites, genes, miRNAs in ‘Yali’ pear fruit were investigated and researched respectively in callus.

Background: In Angola, COVID-19 cases have been reported in all provinces, resulting in >105,000 cases and >1,900 deaths. However, no detailed genomic surveillance into the introduction and spread of the SARS-CoV-2 virus has been conducted in Angola. We aimed to investigate the emergence, and epidemic progression during the peak of the COVID-19 pandemic in Angola. Methods: We generated 1,210 whole-genome SARS-CoV-2 sequences, contributing West African data to the global context, that were phylogenetically compared against global strains. Viral movement events were inferred using ancestral state reconstruction. Results: The epidemic in Angola was marked by four distinct waves of infection, dominated by 12 viral lineages, including VOCs, VOIs, and the VUM C.16, which was unique to Southwestern Africa and circulated for an extended period within the region. Viral exchanges occurred between Angola and its neighboring countries, and strong links with Brazil and Portugal reflected the historical and cultural ties shared between these countries. The first case likely originated from southern Africa. Conclusion: A lack of a robust genome surveillance network and strong dependence on out-of-country sequencing limit real-time data generation to achieve timely disease outbreak responses, which remains of the utmost importance to mitigate future disease outbreaks in Angola.

A document by Kezhou Lu. Click on the document to view its contents.

An efficient Pd/Cu-catalyzed oxidative self-carbonylation of arylhydrazine with CO and molecular oxygen as an oxidant to afford symmetrical biaryl ketones via C-N bond activation has been developed. In this approach, arylhydrazine hydrochlorides are used as a green arylating agent which releases nitrogen and water as a byproduct. This developed protocol significantly restricts the for-mation of aryl iodide and homo-coupled azobenzene products even under favorable conditions. A library of symmetrical biaryl ke-tones with wide functionalities was synthesized in good yields under mild conditions.

Histidine (His) is the most reactive amino acid at enzyme active sites. Multiple post-translational modifications (functions) are reported for His side chains. The high-throughput sequencing techniques produce a large number of protein sequences without functional annotations at the amino acid level. Experimental characterization of His functions in proteins is laborious and time-consuming. Computational characterization based on protein sequences may complement the need. There are only a handful of Histidine function prediction tools available and those annotate only a single function. Here we curated a dataset of active Histidine with known functions based on protein sequences obtained from UniProt database (sample size n=1584) and trained against four machine learning methods. The convolution neural network (CNN) model (“ Hist-i-fy”) performed the best with 75% overall accuracy. The external validation of Hist-i-fy on phosphorylated histidine data (sample size 34) showed 94.1% prediction accuracy. For the first time, we report multiple His function prediction, based on protein sequences using deep neural networks. The inputs to the model are i) protein sequence containing His, and ii) the His residue number. The model predicts one out of the eight histidine functions, namely, acetylation, ribosylation, glycosylation, hydroxylation, methylation, oxidation, phosphorylation, and protein splicing. The novelty of the work is, it predicts maximum number of histidine functions at a time with optimal performance. There is a scope of improvement in the model upon availability of a larger dataset. The model is available as a web application ([https://histify.streamlit.app/](https://histify.streamlit.app/)) and a stand-alone code [https://github.com/dibyansu24-maker/Histify](https://github.com/dibyansu24-maker/Histify)).

The canonical function of glutamyl-tRNA synthetase (GluRS) is to glutamylate tRNA Glu. Yet, not all bacterial GluRSs glutamylate tRNA Glu; many glutamylate both tRNA Glu and tRNA Gln, while some glutamylate only tRNA Gln and not the cognate substrate tRNA Glu. Understanding the basis of this unique tRNA Glx-specificity is important. Mutational studies have hinted at hotspot residues, both on tRNA Glx and GluRS, that play crucial roles in tRNA Glx-specificity. But the underlying structural basis remains unexplored. Majority of biochemical studies related to tRNA Glx-specificity have been performed on GluRS from Escherichia coli and other proteobacterial species. However, since the early crystal structures of GluRS and tRNA Glu-bound GluRS were from non-proteobacterial species ( Thermus thermophilus), the proteobacterial biochemical data have often been interpreted in the context of non-proteobacterial GluRS structures. Marked differences between proteo- and non-proteobacterial GluRSs have been demonstrated and therefore it is important that tRNA Glx-specificity be understood vis-a-vis proteobacterial GluRS structures. Towards this goal we have solved the crystal structure of GluRS from E. coli. Using the solved structure and several other currently available proteo- and non-proteobacterial GluRS crystal structures, we have probed the structural basis of tRNA Glx-specificity of bacterial GluRSs. Specifically, our analysis suggests a unique role played by a tRNA Glx D-helix contacting loop of GluRS in modulation of tRNA Gln-specificity. While earlier studies had identified functional hotspots on tRNA Glx that controlled tRNA Glx-specificity of GluRS, this is the first report of complementary signatures of tRNA Glx-specificity in GluRS.

Background. Despite an increase in immunisation coverage rates and number vaccines offered in Zambia over the past decade, the financial sustainability to maintain these gains is uncertain. This paper analyses availability of fiscal space to sustain the immunisation programme in Zambia in the short to medium term. Methods. We assessed fiscal space using a standard framework consisting of five pillars: economic growth, expenditure reprioritisation, grants and loans, earmarking of funds, and efficiency gains on existing outlays. To determine fiscal space from the five sources, we applied various analytical techniques including regression analysis on time series data from 1995-2018, Data Envelopment Analysis on cross section administrative data from a sample of 25 health districts, and benchmarking. Results. The evidence shows that fiscal space for immunisation in Zambia is negligible. Health spending is too weakly related to national income to generate fiscal space from economic growth. Reprioritisation of expenditure is difficult because of the huge burden from sovereign debt. Further, introducing new taxes barely three years after the introduction of a social health insurance tax is politically not feasible. Additionally, grants from donors are erratic and likely to diminish in the medium to long-run. However, fiscal space from efficiency gains is quite substantial. Conclusions. Prospects for increasing funding for immunisation from the five sources of fiscal space are minimal. However, efficiency gains in the immunisation programme can go a long way in freeing up resources. The challenge lies in identifying and resolving the sources of technical inefficiency.