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Seasonal influenza virus epidemics have a major impact on healthcare systems. Data on population susceptibility to emerging influenza virus strains during the interepidemic period can guide planning for resource allocation of an upcoming influenza season. This study sought to assess the population susceptibility to representative emerging influenza virus strains collected during the interepidemic period. The microneutralisation antibody titers (MN titers) of a human serum panel against representative emerging influenza strains collected during the interepidemic period before the 2018/2019 winter influenza season (H1N1-inter and H3N2-inter) were compared with those against influenza strains representative of previous epidemics (H1N1-pre and H3N2-pre). A multifaceted approach, incorporating both genetic and antigenic data, was used in selecting these representative influenza virus strains for the MN assay. A significantly higher proportion of individuals had a ⩾four-fold reduction in MN titers between H1N1-inter and H1N1-pre than that between H3N2-inter and H3N2-pre (28.5% (127/445) vs. 4.9% (22/445), P < 0.001). The geometric mean titer (GMT) of H1N1-inter was significantly lower than that of H1N1-pre (381 (95% CI 339–428) vs. 713 (95% CI 641–792), P < 0.001), while there was no significant difference in the GMT between H3N2-inter and H3N2-pre. Since A(H1N1) predominated the 2018–2019 winter influenza epidemic, our results corroborated the epidemic subtype.
In this study, the pull-in phenomenon of a Nano-actuator is investigated employing a nonlocal Bernoulli-Euler beam model with clamped-clamped conditions. The model accounts for viscous damping, residual stresses, the van der Waals (vdW) force and electrostatic forces with nonlocal effects. The hybrid differential transformation/finite difference method (HDTFDM) is used to analyze the nonlocal effects on a graphene sheet nanobeam, which is electrostatically actuated under the influence of the coupling effect, the von Kármán nonlinear strains and the fringing field effect. The pull-in voltage as calculated by the presented model deviates by no more than 0.29% from previous literature, verifying the validity of the HDTFDM. Furthermore, the nonlocal nonlinear behavior of the electrostatically actuated nanobeam is investigated, and the effects of viscous damping, residual stresses, and length-gap ratio are examined in detail. Overall, the results reveal that small scale effects significantly influence the characteristics of the graphene sheet nanobeam actuator.
Background: Hereditary transthyretin-mediated (hATTR) amyloidosis a hereditary, multi-systemic and life-threatening disease resulting in neuropathy and cardiomyopathy. In the APOLLO study, patisiran, an investigational RNAi therapeutic targeting hepatic TTR production resulted in significant improvement in neuropathy and QoL compared to placebo and was generally well tolerated. Methods: APOLLO, a Phase 3 study of patisiran vs. placebo (NCT01960348) prespecified a cardiac subpopulation (n=126 of 225 total) that included patients with baseline left ventricular (LV) wall thickness ≥ 13mm and no medical history of aortic valve disease or hypertension. Cardiac measures included structure and function by electrocardiography, changes in NT-proBNP and 10-MWT gait speed. Results: At 18 months, patisiran treatment resulted in a mean reduction in LV wall thickness of 1 mm (p=0.017) compared to baseline, which was associated with significant improvements relative to placebo in LV end diastolic volume (+8.31 mL, p=0.036), global longitudinal strain (-1.37%, p=0.015) and NT-proBNP (55% reduction, p=7.7 x 10-8) (Figure 1). Gait speed was also improved relative to placebo (+0.35 m/sec, p=7.4 x 10-9). Rate of death or hospitalization was lower with patisiran. mNIS+7 results in the cardiac subpopulation will also be presented. Conclusions: These data suggest patisiran has the potential to halt or reverse cardiac manifestations of hATTR amyloidosis.
Background: Hereditary transthyretin-mediated (hATTR) amyloidosis is a multi-systemic, heterogenous, life-threatening disease. Patisiran resulted in significant improvement in neuropathy and QoL at 18-months compared to placebo, and was generally well-tolerated in the Phase 3 APOLLO study. Methods: Multi-center, OLE study to evaluate the efficacy and safety of long-term patisiran dosing for ≤ 5 years in hATTR amyloidosis patients with polyneuropathy who have completed the APOLLO study (NCT02510261). Endpoints include safety, tolerability and long-term efficacy of patisiran. Measures of clinical benefit are the same endpoints used in APOLLO including changes in mNIS+7 composite neuropathy impairment score and QoL (Norfolk QoL-DN) Results: As of December 2017, 184 of 186 (99%) patients who completed APOLLO and 25 patients from the Ph 2 OLE study enrolled in the Global OLE study. Baseline data for 211(APOLLO/placebo, n=49; APOLLO/patisiran, n=137 and patisiran Ph 2 OLE, n=25) patients included: median age 61 years (26-84); 74% males; 46% V30M. Interim safety data and 12-month efficacy results will be presented. Conclusions: The global OLE study includes a diverse population of hATTR amyloidosis patients. Interim data will include the long-term safety and maintenance of effect in patients continuing on patisiran, as well as the impact of treatment with patisiran on patients previously treated with placebo.
The World Health Organization recently reported that maternal mental health is a major public health concern. As many as one in four women suffer from psychiatric disorders at some point during pregnancy or the first postpartum year. Furthermore, self-injurious thoughts and behaviors (SITBs) represent one of the leading causes of death among women during this time. Thus, efforts to identify women at risk for serious forms of psychopathology and especially for SITBs are of utmost importance. Despite this urgency, current single-diagnostic approaches fail to recognize a significant subset of women who are vulnerable to perinatal stress and distress. The current study was among the first to investigate emotion dysregulation—a multilevel, transdiagnostic risk factor for psychopathology—and its associations with stress, distress, and SITBs in a sample of pregnant women (26–40 weeks gestation) recruited to reflect a range of emotion dysregulation. Both self-reported emotion dysregulation and respiratory sinus arrhythmia, a biomarker of emotion dysregulation, demonstrated expected associations with measures of mental health, including depression, anxiety, borderline personality pathology, and SITBs. In addition, self-reported emotion dysregulation was associated with blunted respiratory sinus arrhythmia responsivity to an ecologically valid infant cry task. Findings add to the literature considering transdiagnostic risk during pregnancy using a multiple-levels-of-analysis approach.
Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) have been considered prevalent pathogens in foot infections. However, whether empiric therapy directed against these organisms is necessary, and in whom to consider treatment, is rather unclear. The aim of this study was to develop predictive algorithms for forecasting the probability of isolating these organisms in the infected wounds of patients in a population where the prevalence of resistant pathogens is low. This was a retrospective study of regression model-based risk factor analysis that included 140 patients who presented with infected, culture positive foot ulcers to two urban hospitals. A total of 307 bacteria were identified, most frequently MRSA (11.1%). P. aeruginosa prevalence was 6.5%. In the multivariable analysis, amputation (odds ratio (OR) 5.75, 95% confidence interval (CI) 1.48–27.63), renal disease (OR 5.46, 95% CI 1.43–25.16) and gangrene (OR 2.78, 95% CI 0.82–9.59) were identified as risk factors associated with higher while diabetes (OR 0.07, 95% CI 0.01–0.34) and Infectious Diseases Society of America infection severity >3 (OR 0.18, 95% CI 0.03–0.65) were associated with lower odds of P. aeruginosa isolation (C statistic 0.81). Similar analysis for MRSA showed that amputation was associated with significantly lower (OR 0.29, 95% CI 0.09–0.79) risk, while history of MRSA infection (OR 5.63, 95% CI 1.56–20.63) and osteomyelitis (OR 2.523, 95% CI 1.00–6.79) was associated with higher odds of isolation (C statistic 0.69). We developed two predictive nomograms with reasonable to strong ability to discriminate between patients who were likely of being infected with P. aeruginosa or MRSA and those who were not. These analyses confirm the association of some, but also question the significance of other frequently described risk factors in predicting the isolation of these organisms.
Hemostasis, a process which causes bleeding to stop, can be enhanced using chitosan; but the detailed mechanism is unclear. Red blood cells (RBCs) adhere to chitosan because of their opposite charges, but the adhesion force is small, 3.83 pN as measured here using an optical tweezer, such that the direct adhesion cannot be the sole cause for hemostasis. However, it was observed in this study that layer structures of aggregated RBCs were formed next to chitosan objects in both static and flowing environments, but not formed next to cotton and rayon yarns. The layer structure is the clue for the initiation of hemostatsis. Through the supporting measurements of zeta potentials of RBCs and pH's using blood-chitosan mixtures, it is proposed here that the formation of the RBC layer structure next to chitosan objects is due to the reduction of repulsive electric double layer force between RBCs, because of the association of H+ deprotonated from chitosan with COO− on RBC membrane, under the DLVO (Derjaguin-Landau-Verwey-Overbeek) theory. The results are beneficial for designing effective chitosan-based wound dressings, and also for general biomedical applications.
A range of endophenotypes characterise psychosis, however there has been limited work understanding if and how they are inter-related.
This multi-centre study includes 8754 participants: 2212 people with a psychotic disorder, 1487 unaffected relatives of probands, and 5055 healthy controls. We investigated cognition [digit span (N = 3127), block design (N = 5491), and the Rey Auditory Verbal Learning Test (N = 3543)], electrophysiology [P300 amplitude and latency (N = 1102)], and neuroanatomy [lateral ventricular volume (N = 1721)]. We used linear regression to assess the interrelationships between endophenotypes.
The P300 amplitude and latency were not associated (regression coef. −0.06, 95% CI −0.12 to 0.01, p = 0.060), and P300 amplitude was positively associated with block design (coef. 0.19, 95% CI 0.10–0.28, p < 0.001). There was no evidence of associations between lateral ventricular volume and the other measures (all p > 0.38). All the cognitive endophenotypes were associated with each other in the expected directions (all p < 0.001). Lastly, the relationships between pairs of endophenotypes were consistent in all three participant groups, differing for some of the cognitive pairings only in the strengths of the relationships.
The P300 amplitude and latency are independent endophenotypes; the former indexing spatial visualisation and working memory, and the latter is hypothesised to index basic processing speed. Individuals with psychotic illnesses, their unaffected relatives, and healthy controls all show similar patterns of associations between endophenotypes, endorsing the theory of a continuum of psychosis liability across the population.
To determine the impact of recurrent Clostridium difficile infection (RCDI) on patient behaviors following illness.
Using a computer algorithm, we searched the electronic medical records of 7 Chicago-area hospitals to identify patients with RCDI (2 episodes of CDI within 15 to 56 days of each other). RCDI was validated by medical record review. Patients were asked to complete a telephone survey. The survey included questions regarding general health, social isolation, symptom severity, emotional distress, and prevention behaviors.
In total, 119 patients completed the survey (32%). On average, respondents were 57.4 years old (standard deviation, 16.8); 57% were white, and ~50% reported hospitalization for CDI. At the time of their most recent illness, patients rated their diarrhea as high severity (58.5%) and their exhaustion as extreme (30.7%). Respondents indicated that they were very worried about getting sick again (41.5%) and about infecting others (31%). Almost 50% said that they have washed their hands more frequently (47%) and have increased their use of soap and water (45%) since their illness. Some of these patients (22%–32%) reported eating out less, avoiding certain medications and public areas, and increasing probiotic use. Most behavioral changes were unrelated to disease severity.
Having had RCDI appears to increase prevention-related behaviors in some patients. While some behaviors are appropriate (eg, handwashing), others are not supported by evidence of decreased risk and may negatively impact patient quality of life. Providers should discuss appropriate prevention behaviors with their patients and should clarify that other behaviors (eg, eating out less) will not affect their risk of future illness.
Self-report measurement instruments are commonly used to screen for mental health disorders in Low and Middle-Income Countries (LMIC). The Western origins of most depression instruments may constitute a bias when used globally. Western measures based on the DSM, do not fully capture the expression of depression globally. We developed a self-report scale design to address this limitation, the International Depression Symptom Scale-General version (IDSS-G), based on empirical evidence of the signs and symptoms of depression reported across cultures. This paper describes the rationale and process of its development and the results of an initial test among a non-Western population.
We evaluated internal consistency reliability, test–retest reliability and inter-rater reliability of the IDSS-G in a sample N = 147 male and female attendees of primary health clinics in Yangon, Myanmar. For criterion validity, IDSS-G scores were compared with diagnosis by local psychiatrists using the Structured Clinical Interview for DSM (SCID). Construct validity was evaluated by investigating associations between the IDSS-G and the Patient Health Questionnaire (PHQ), impaired function, and suicidal ideation.
The IDSS-G showed high internal consistency reliability (α = 0.92), test–retest reliability (r = 0.87), and inter-rater reliability (ICC = 0.90). Strong correlations between the IDSS-G and PHQ-9, functioning, and suicidal ideation supported construct validity. Criterion validity was supported for use of the IDSS-G to identify people with a SCID diagnosed depressive disorder (major depression/dysthymia). The IDSS-G also demonstrated incremental validity by predicting functional impairment beyond that predicted by the PHQ-9. Results suggest that the IDSS-G accurately assesses depression in this population. Future testing in other populations will follow.
Plant defence systems can be induced by biotic and abiotic stress. Experiments were undertaken to explore the feasibility of different fungal proteins for the reduction of vegetable diseases. Total proteins purified from three soil-borne and five foliar fungal pathogens had no fungistatic effects nor did they trigger hypersensitive reactions on test plants. The abilities to promote plant growth and to reduce disease severity varied among test proteins and plants. Depending on test proteins, experiments have demonstrated that exogenous application of fungal proteins could reduce Alternaria brassicicola-induced black spot severity on cabbage, Colletotrichum spp.-induced anthracnose on Chinese cabbage and cucumber, Rhizoctonia solani-induced damping-off on sweet pepper and Chinese cabbage, and powdery mildew on cucumber seedlings. An Alternariaprotein effector 1 (Ape1)-coding gene was cloned from two Alternaria spp. and expressed in Escherichia coli. The expressed Ape1 reduced anthracnose incidence on cucumber leaves, indicating that Ape1 was the primary activator in the crude protein extracts responsible for disease reduction. Application of Alternaria proteins onto Chinese cabbage seedlings caused an increase of phenylalanine ammonia lyase and peroxidase activities in treated seedlings, which may have played a role in host defence.
This paper investigates the rupture problem of a thin micropolar liquid film under a magnetic field on a horizontal plate, using long-wave perturbation to resolve nonlinear evolution equations with a free film interface. The governing equation is resolved using a finite difference method as part of an initial value problem for spatial periodic boundary conditions. The effect of a micropolar liquid under a magnetic field on the nonlinear rupture mechanism is studied in terms of the micropolar parameter, R, the Hartmann constant, m and the initial disturbance amplitude, H0. Modeling results indicate that the R, m and H0 parameters strongly affect the film flow. Enhancing the micropolar and magnetic effects is found to delay the rupture time. In addition, the results show that the film rupture time increases as the values of initial disturbance magnitude decrease. The micropolar and magnetic parameters indeed play a significant role in the film flow on a horizontal plate. Moreover, the optimum conditions can be found to alter stability of the film flow by controlling the applied magnetic field.
A general series solution to the problem of interacting circular inclusions in plane elastostatics is presented in this paper. The analysis is based on the use of the complex stress potentials of Muskhelishvili and the theorem of analytical continuation. The general forms of the complex potentials are derived explicitly for the circular inhomogeneities under arbitrary plane loading. Using the alternation technique, these general expressions were subsequently employed to treat the problem of an infinitely extended matrix containing two arbitrarily located inhomogeneities. The major contribution of the present proposed method is shown to be capable of yielding approximate closed-form solutions for multiple inclusions, thus providing the explicit dependence of the solution on the pertinent parameters. The result shows that the dislocation has a stable equilibrium position at a certain combination of material constants. The case of an inhomogeneity interacting with a circular hole under a remote uniform load is also investigated.
This paper investigates the weakly nonlinear stability of a thin axisymmetric viscoelastic fluid with hydromagnetic effects on coating flow. The governing equation is resolved using long-wave perturbation method as part of an initial value problem for spatial periodic surface waves with the Walter's liquid B type fluid. The most unstable linear mode of a film flow is determined by Ginzburg-Landau equation (GLE). The coefficients of the GLE are calculated numerically from the solution of the corresponding stability problem on coating flow. The effect of a viscoelastic fluid under an applied magnetic field on the nonlinear stability mechanism is studied in terms of the rotation number, Ro, viscoelastic parameter, k, and the Hartmann constant, m. Modeling results indicate that the Ro, k and m parameters strongly affect the film flow. Enhancing the magnetic effects is found to stabilize the film flow when the viscoelastic parameter destabilizes the one in a thin viscoelastic fluid.
Introduction: Use of diagnostic imaging in the emergency department (ED) has significantly increased over time. The decision to use a certain type of imaging, if any at all, is not always clear. Accordingly, concerns of appropriateness are justified. A starting point to assess imaging appropriateness is to measure variation in its use. It has been suggested that where large variation exists, there may be inappropriate use. Methods: We retrospectively studied consecutive ED visits at North York General Hospital between April 1, 2009 and March 31, 2013 (n = 316,251), and developed a two-level hierarchical logistic regression model to quantify inter-physician variation in imaging use (high-cost imaging: computed tomography (CT), magnetic resonance (MR), nuclear medicine; low-cost: plain radiography, ultrasound) in the ED after adjusting for patient-, visit- and physician-level factors. Results: Plain radiography or ultrasound examinations were performed during 36.3% of ED visits; CT, MR, or nuclear medicine examinations were performed during 10.6% of ED visits; 4.1% of ED visits had both high- and low-cost imaging. After adjusting for patient-, visit- and physician-specific factors, only 2.4% and 2.2% of the variation regarding whether or not an ED visit resulted in at least one high-cost and low-cost imaging test, respectively, was attributable to individual physician practice patterns. Physicians who had a tendency to obtain more low-cost imaging also obtained more high-cost imaging, and those who obtained less low-cost imaging also obtained less high-cost imaging. Conclusion: Only a small portion of the variation in imaging use was attributed to differences in ED physician ordering patterns, however, these findings may still help promote discussion among clinicians, and improve imaging utilization.
The present report is drastically shorter and, therefore, different in form from previous reports. While galactic research has increased considerably in recent years, the financial situation in the IAU made it necessary to reduce the size of the reports to half their previous size. This obliged us to adopt an almost telegraphic style in our report. However, an extended version of the report, including also the necessary references, will be published by the University of Thessaloniki and distributed to members of Commission 33. Any other interested astronomer may write to ask for a copy.
The report has been prepared by G. Contopoulos (Sections I, V, VI) and S. McCuskey (Sections II, III, IV). In our work we have been helped by Drs Kerr (radio astronomy) and Haradze (Russian contributions). Dr Elvius has written the Report of the Committee “Selected Areas”. We could cover the literature up to the fall of 1969, plus work in progress, reported by members of our commission.
A number of thin silicon films are prepared through ultra-high-vacuum evaporation on optical quality fused quartz substrates with different growth temperatures. Through an analysis of grazing incidence X-ray diffraction results, a phase transition, from amorphous-to-crystalline, is found corresponding to increases in the growth temperature. The corresponding Raman spectra are also observed to change their form as the films go through this phase transition. Using a Raman peak decomposition process, this phase transition is then quantitatively characterized through the determination of the amount of intermediate-range order and the crystalline volume fraction for the various growth temperatures considered in this analysis. The possible device consequences of these results are then commented upon.
Malaysia introduced graphic health warning labels (GHWLs) on all tobacco packages in 2009. We aimed to examine if implementing GHWLs led to stronger warning reactions (e.g., thinking about the health risks of smoking) and an increase in subsequent quitting activities; and to examine how reactions changed over time since the implementation of the GHWLs in Malaysia and Thailand where GHWL size increased from 50–55% in 2010. Data came from six waves (2005–2014) of the International Tobacco Control Southeast Asia Survey. Between 3,706 and 4,422 smokers were interviewed across these two countries at each survey wave. Measures included salience of warnings, cognitive responses (i.e., thinking about the health risks and being more likely to quit smoking), forgoing cigarettes, and avoiding warnings. The main outcome was subsequent quit attempts. Following the implementation of GHWLs in Malaysia, reactions increased, in some cases to levels similar to the larger Thai warnings, but declined over time. In Thailand, reactions increased following implementation, with no decline for several years, and no clear effect of the small increase in warning size. Reactions, mainly cognitive responses, were consistently predictive of quit attempts in Thailand, but this was only consistently so in Malaysia after the change to GHWLs. In conclusion, GHWLs are responded to more frequently, and generate more quit attempts, but warning wear-out is not consistent in these two countries, perhaps due to differences in other tobacco control efforts.
The influence of ambient fluid stratification on buoyant miscible jets and plumes is studied theoretically and experimentally. Given a fixed set of jet/plume parameters, and an ambient fluid stratification sandwiched between top and bottom homogeneous densities, a theoretical criterion is identified to show how step-like density profiles constitute the most effective mixers within a broad class of stable density transitions. This is assessed both analytically and experimentally, respectively by establishing rigorous a priori estimates on generalized Morton–Taylor–Turner (MTT) models (Morton et al., Proc. R. Soc. Lond. A, vol. 234, 1956, pp. 1–23; Fischer et al., Mixing in Inland and Coastal Waters. Academic, 1979), and by studying a critical phenomenon determined by the distance between the jet/plume release height with respect to the depth of the ambient density transition. For fluid released sufficiently close to the background density transition, the buoyant jet fluid escapes and rises indefinitely. For fluid released at locations lower than a critical depth, the buoyant fluid stops rising and is trapped indefinitely. A mathematical formulation providing rigorous estimates on MTT models is developed along with nonlinear jump conditions and an exact critical-depth formula that is in good quantitative agreement with the experiments. Our mathematical analysis provides rigorous justification for the critical trapping/escaping criteria, first presented in Caulfield & Woods (J. Fluid Mech., vol. 360, 1998, pp. 229–248), within a class of algebraic density decay rates. Further, the step-like background stratification is shown to be the most efficient mixing profile amongst a broad family of stably stratified profiles sharing the same density transition within a fixed distance. Finally, the analysis uncovers surprising differences between the Gaussian and top-hat profile closures concerning initial mixing of the jet and ambient fluid.