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As the novel coronavirus disease 2019 changed patient presentation, this study aimed to prospectively identify these changes in a single ENT centre.
A seven-week prospective case series was conducted of urgently referred patients from primary care and accident and emergency department.
There was a total of 133 referrals. Referral rates fell by 93 per cent over seven weeks, from a mean of 5.4 to 0.4 per day. Reductions were seen in referrals from both primary care (89 per cent) and the accident and emergency department (93 per cent). Presentations of otitis externa and epistaxis fell by 83 per cent, and presentations of glandular fever, tonsillitis and peritonsillar abscess fell by 67 per cent.
Coronavirus disease 2019 has greatly reduced the number of referrals into secondary care ENT. The cause for this reduction is likely to be due to patients’ increased perceived risk of the virus presence in a medical setting. The impact of this reduction is yet to be ascertained, but will likely result in a substantial increase in emergency pressures once the lockdown is lifted and the general public's perception of the coronavirus disease 2019 risk reduces.
When open-cut mines are eventually abandoned, they leave a large hole with sloping sides. The hole fills with rain water, and there is also contaminated run-off from surrounding land, that moves through the rock and eventually through the sloping sides of the abandoned mine. This paper considers a two-dimensional unsteady model motivated by this leaching flow through the rock and into the rain-water reservoir. The stability of the interface between the two fluids is analysed in the inviscid limit. A viscous Boussinesq model is also presented, and a closed-form solution is presented to this problem, after it has been linearized in a manner consistent with Boussinesq theory. That solution suggests that the interfacial zone is effectively neutrally stable as it evolves in time. However, an asymptotic theory in the interfacial region shows the interface to be unstable. In addition, the nonlinear Boussinesq model is solved using a spectral method. Interfacial travelling waves and roll-up are observed and discussed, and compared against the predictions of asymptotic Boussinesq theory.
Twelve evidence-based profiles of roles across the translational workforce and two patients were made available through clinical and translational science (CTS) Personas, a project of the Clinical and Translational Science Awards (CTSA) Program National Center for Data to Health (CD2H). The persona profiles were designed and researched to demonstrate the key responsibilities, motivators, goals, software use, pain points, and professional development needs of those working across the spectrum of translation, from basic science to clinical research to public health. The project’s goal was to provide reliable documents that could be used to inform CTSA software development projects, educational resources, and communication initiatives. This paper presents the initiative to create personas for the translational workforce, including the methodology, engagement strategy, and lessons learned. Challenges faced and successes achieved by the project may serve as a roadmap for others searching for best practices in the creation of Persona profiles.
The withdrawal of water with a free surface through a line sink from a two-dimensional, vertical sand column is considered using the hodograph method and a novel spectral method. Hodograph solutions are presented for slow flow and for critical, limiting steady flows, and these are compared with spectral solutions to the steady problem. The spectral method is then extended to obtain unsteady solutions and hence the evolution of the phreatic surface to the steady solutions when they exist. It is found that for each height of the interface there is a unique critical coning value of flow rate, but also that the value obtained is dependent on the flow history.
Background: SMA is a neurodegenerative disease caused by biallelic deletion/mutation of SMN1. Copies of a similar gene (SMN2) modify disease severity. In a phase 1 study, SMN GRT onasemnogene abeparvovec (AVXS-101) improved outcomes of symptomatic SMA patients with two SMN2 copies (2xSMN2) dosed ≤6 months. Because motor neuron loss can be insidious and disease progression is rapid, early intervention is critical. This study evaluates AVXS-101 in presymptomatic SMA newborns. Methods: SPR1NT is a multicenter, open-label, phase 3 study enrolling ≥27 SMA patients with 2–3xSMN2. Asymptomatic infants ≤6 weeks receive a one-time intravenous AVXS-101 infusion (1.1x1014 vg/kg). Safety and efficacy are assessed through study end (18 [2xSMN2] or 24 months [3xSMN2]). Primary outcomes: independent sitting for ≥30 seconds (18 months [2xSMN2]) or assisted standing (24 months [3xSMN2]). Results: From April–September 2018, 7 infants received AVXS-101 (4 female; 6 with 2xSMN2) at ages 8–37 days. Mean baseline CHOP-INTEND score was 41.7 (n=6), which increased by 6.8, 11.0, 18.0, and 22.5 points at day 14 (n=4), month 1 (n=3), 2 (n=3), and 3 (n=2). Updated data available at the time of the congress will be presented. Conclusions: Preliminary data from SPR1NT show rapid motor function improvements in presymptomatic SMA patients.
Advances in theoretical and computable general equilibrium modeling brought their conceptual foundations more in line with standard microeconomic constructs. This reduced the theoretical gap between welfare measurements using a partial or a general equilibrium approach. However, the separation of the partial and general equilibrium literatures lingers in many applications that this manuscript seeks to bridge. The now shared conceptual foundations, the importance of functional specification, the role of common price movements and closure rules are discussed. The continuing stricture in U.S. Government guidelines against including secondary effects in welfare measures is questioned.
The human retina is supplied by two vascular systems: the highly vascular choroidal, situated behind the retina; and the retinal, which is dependent on the restriction that the light path must be minimally disrupted. Between these two circulations, the avascular retinal layers depend on diffusion of metabolites through the tissue. Oxygen supply to these layers may be threatened by diseases affecting microvasculature, for example diabetes and hypertension, which may ultimately cause loss of sight.
An accurate model of retinal blood flow will therefore facilitate the study of retinal oxygen supply and, hence, the complications caused by systemic vascular disease. Here, two simple models of the blood flow and exchange of hydrogen with the retina are presented and compared qualitatively with data obtained from experimental measurements. The models capture some interesting features of the exchange and highlight effects that will need to be considered in a more sophisticated model and in the interpretation of experimental results.
The success of scaling out depends on a clear understanding of the factors that affect adoption of grain legumes and account for the dynamism of those factors across heterogeneous contexts of sub-Saharan Africa. We reviewed literature on adoption of grain legumes and other technologies in sub-Saharan Africa and other developing countries. Our review enabled us to define broad factors affecting different components of the scaling out programme of N2Africa and the scales at which those factors were important. We identified three strategies for managing those factors in the N2Africa scaling out programme: (i) testing different technologies and practices; (ii) evaluating the performance of different technologies in different contexts; and (iii) monitoring factors that are difficult to predict. We incorporated the review lessons in a design to appropriately target and evaluate technologies in multiple contexts across scales from that of the farm to whole countries. Our implementation of this design has only been partially successful because of competing reasons for selecting activity sites. Nevertheless, we observe that grain legume species have been successfully targeted for multiple biophysical environments across sub-Saharan Africa, and to social and economic contexts within countries. Rhizobium inoculant and legume specific fertiliser blends have also been targeted to specific contexts, although not in all countries. Relatively fewer input and output marketing models have been tested due to public–private partnerships, which are a key mechanism for dissemination in the N2Africa project.
The estimated impacts, benefits, and costs of legalizing slot machines in Maryland are analyzed building on and contrasting with results from an impact analysis. The analysis provides estimates of the components and the total net benefits to the state and its citizens; the role of uncertainty, distributional impacts, and a basic tax alternative. The results forecast mostly positive net benefits for Maryland both in comparison to doing nothing and in comparison to raising an equivalent amount in taxes. However, if slot revenue raised from the lower income population is given more weight, then doing nothing or raising taxes appears to be preferred.
We use a WISE-2MASS-Pan-STARRS1 galaxy catalog to search for a supervoid in the direction of the Cosmic Microwave Background Cold Spot. We obtain photometric redshifts using our multicolor data set to create a tomographic map of the galaxy distribution. The radial density profile centred on the Cold Spot shows a large low density region, extending over 10's of degrees. Motivated by previous Cosmic Microwave Background results, we test for underdensities within two angular radii, 5°, and 15°. Our data, combined with an earlier measurement by Granett et al. 2010, are consistent with a large Rvoid=(192 ± 15)h−1 Mpc (2σ) supervoid with δ ≃ −0.13 ± 0.03 centered at z=0.22 ± 0.01. Such a supervoid, constituting a ∼3.5 σ fluctuation in the ΛCDM model, is a plausible cause for the Cold Spot.
An interception trap to collect airborne arthropods under extreme weather conditions is described. The trap, constructed from durable materials, is operated by wind pressure. It consists of a funnel of fine brass gauze mounted inside a cylinder of stainless steel that rotates into the wind on a mast at 1.5 m from the ground. The gauze funnel terminates in a removable, propanol-filled, collecting bottle into which airborne material accumulates. The counterbalanced cylinder rotates around a central shaft on roller bearings and faces into the wind. Two traps were successfully operated continuously for four and five years, respectively, on sub-Antarctic Macquarie Island and have collected large numbers of airborne arthropods and other biological material over this period.
Although contingent valuation methods are now frequently used to assess the total value of even distant events, benefit-cost analysis could also be informed by observed behavior that links distant events and consumers. It is typically the news media which connect passive consumers to distant events about which they may or may not take action. The information and adaptation costs incurred by the news consumer are privately beneficial, but additionally are shown to be a lower bound to social welfare losses from a socially defined “bad” event under plausible circumstances. The recent Deepwater Horizon well blow-out in the U.S. Gulf of Mexico is a current example which we seek to inform by study of the oil spill from the Valdez, Alaska spill in 1989. We identify an incremental willingness to pay for news about the Exxon Valdez spill above a standard news broadcast and an increased probability of viewing a broadcast related to the spill. We develop and explain how this private value associated with media consumption can be interpreted as a partial measure of social costs for passive viewers who take no further action beyond news viewing and likely represent the majority of affected citizens (though not necessarily the majority of social costs). Though the per-person values of passive users may be modest in magnitude in the present application, some passive use values appear to be measurable, and that it may well be worth pursuing further the search for the faint but observable links between behavior and distant events through the news media.
A new framework for modelling the evolution of the thermal bar system in a lake is presented. The model assumes that the thermal bar is located between two regions: the deeper region, where spring warming leads to overturning of the entire water column, and the near shore shallower region, where a stable surface layer is established. In this model the thermal bar moves out slightly more quickly than predicted by a simple thermal balance. Also, the horizontal extent of the thermal bar region increases as it moves out from the shore.
Benefit-cost analysis (BCA) is frequently applied to decisions involving public safety which requires analyzing risk and assessing options to manage risks. Principles and standards may assist analysts, decision-makers, and the public in developing and interpreting such BCAs. Principles and standards at best represent commonly held views among a community of practice. Such views are continually evolving with advances in the field. This paper presents a modularized format towards principles and standards that may assist in focusing discussion and decisions about whether such proposals actually reflect principles and standards within the benefit-cost analysis community of practice. Among topics covered are welfare measures, benefit or cost transfer, and valuing uncertain outcomes.
We summarize procedures for assessing the benefits and costs of using labor inputs in public projects. Examples are provided to illustrate how information on labor inputs can be analyzed and presented such that, should the analyst choose, labor services generate elements of both benefit and cost in times of high unemployment; however, this is not generally correct in times of full employment. Our analysis is consistent with the overall goal of identifying those projects which are estimated to improve efficiency—those with social benefits in excess of social costs.
This paper seeks to establish the concept that the analysis of high temporal resolution meteorological data adds value to the investigation of the effect of climatic variability on the prevalence and severity of agricultural pests and diseases. Specifically we attempt to improve disease potential maps of root rots in common beans, based on a combination of inherent susceptibility and the risk of exposure to critical weather events. We achieve this using simulated datasets of daily rainfall to assess the probability of heavy rainfall events at particular times during the cropping season. We then validate these simulated events with observations from meteorological stations in East Africa. We also assess the utility of remotely sensed daily rainfall estimates in near real time for the purposes of updating the risks of these events over large areas and for providing warnings of potential disease outbreaks. We find that simulated rainfall data provide the means to assess risk over large areas, but there are too few datasets of observed rainfall to definitively validate the probabilities of heavy rainfall events generated using rainfall simulations such as those generated by MarkSim. We also find that selected satellite rainfall estimates are unable to predict observed rainfall events with any power, but data from a sufficiently dense network of rain gauges are not available in the region. Despite these problems we show that remotely sensed rainfall estimates may provide a more realistic assessment of rainfall over large areas where rainfall observations are not available, and alternative satellite estimates should be explored.