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Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
Getting a better understanding of the evolution and nucleosynthetic yields of the most metal-poor stars (Z ≲ 10−5) is critical because they are part of the big picture of the history of the primitive universe. Yet many of the remaining unknowns of stellar evolution lie in the birth, life, and death of these objects. We review stellar evolution of intermediate-mass Z ≤ 10−5 models existing in the literature, with a particular focus on the problem of their final fates. We emphasise the importance of the mixing episodes between the stellar envelope and the nuclearly processed core, which occur after stars exhaust their central He (second dredge-up and dredge-out episodes). The depth and efficiency of these episodes are critical to determine the mass limits for the formation of electron-capture SNe. Our knowledge of these phenomena is not complete because they are strongly affected by the choice of input physics. These uncertainties affect stars in all mass and metallicity ranges. However, difficulties in calibration pose additional challenges in the case of the most metal-poor stars. We also consider the alternative SN I1/2 channel to form SNe out of the most metal-poor intermediate-mass objects. In this case, it is critical to understand the thermally pulsing Asymptotic Giant Branch evolution until the late stages. Efficient second dredge-up and, later, third dredge-up episodes could be able to pollute stellar envelopes enough for the stars to undergo thermal pulses in a way very similar to that of higher initial Z objects. Inefficient second and/or third dredge-up may leave an almost pristine envelope, unable to sustain strong stellar winds. This may allow the H-exhausted core to grow to the Chandrasekhar mass before the envelope is completely lost, and thus let the star explode as an SN I1/2. After reviewing the information available on these two possible channels for the formation of SNe, we discuss existing nucleosynthetic yields of stars of metallicity Z ≤ 10−5 and present an example of nucleosynthetic calculations for a thermally pulsing Super-Asymptotic Giant Branch star of Z = 10−5. We compare theoretical predictions with observations of the lowest [Fe/H] objects detected. The review closes by discussing current open questions as well as possible fruitful avenues for future research.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
Introduction: Analyzing the charts of patients who have a return visit to an emergency department (ED) requiring hospital admission (termed ‘RV’) is an efficient way to identify adverse events (AEs). Investigating these AEs can inform efforts to improve the quality of care provided. The ED RV Quality Program (RVQP) is a new initiative supported by Ontario’s Ministry of Health and Long-Term Care and managed by Health Quality Ontario. It aims to promote a culture of continuous quality improvement through routine audit/investigation of RVs. Methods: The provincial program is mandatory for high-volume EDs and requires auditing of some 72-hour RVs and all 7-day RVs involving ‘sentinel diagnoses’ (subarachnoid hemorrhage [SAH], acute myocardial infarction [AMI], or pediatric sepsis [PS]). A standardized audit template is followed that includes assessment of the type/severity and underlying causes of AEs, and potential actions for improvement. Results: 73 high-volume EDs and 16 smaller EDs (collectively receiving 90% of all ED visits in Ontario) are participating in the program. Nine months’ data have been released to date, comprising 33,956 RVs (1.05% of 3,235,751 ED visits). Of these, 233 RVs (0.69%) were for a sentinel diagnosis (SAH=11, AMI=191, PS=31). The most common presenting complaint on the index visit was abdominal pain (18%). The most common discharge diagnosis following RV admission was acute appendicitis (3.8%). Conclusion: The ED RVQP aims to improve the quality of care provided in Ontario’s EDs by requiring hospitals to conduct audits of RVs and plan actions for improvement when quality gaps are identified. Participating hospitals have completed hundreds of audits to date.
Leptospirosis is a zoonotic disease that the pathogen can be transmitted to humans through the excretions of infected animals. In the Republic of Korea, the Livestock Manure Control Act was enforced in September 2007 to improve underground water hygiene. The objective of this study was to evaluate the impact of Livestock Manure Control Policy on the incidence and the trend of human leptospirosis. An interrupted time series analysis using the monthly incidence of leptospirosis was conducted based on data derived from the Korean National Surveillance System between January 1999 and January 2015. We used a Spearman correlation method to compare the level of leptospirosis incidence decrease between the metropolitan cities and rural provinces. The annual incidence of leptospirosis in South Korea decreased by 33% after policy enforcement of the policy. A significant change in the slope of human leptospirosis cases was observed after the policy enforcement (β = −0·09, P < 0·001). Moreover, we detected a clear association between the size of the rice paddy fields and the decrease in leptospirosis incidence in provinces (r = 0·817, P = 0·01). This study shows that the Livestock Manure Control Policy had significantly reduced human leptospirosis incidence in the Republic of Korea, in particular, in rural regions.
Cubic boron nitride (cBN) is a synthetic wide band gap material that has attracted attention due to its high thermal conductivity, optical transparency and optical emission. In this work, defects in cBN have been investigated using experimental and theoretical X-ray absorption near edge structure (XANES). Vacancy and O substitutional defects were considered, with O substituted at the N site (ON) to be the most energetically favorable. All defects produce unique signatures in either the B or N K-edges and can thus be identified using XANES. The calculations coupled with electron-irradiation / annealing experiments strongly suggest that ON is the dominant defect in irradiated cBN and remains after annealing. This defect is a likely source of optical emission in cBN.
Sensitive surveillance systems are crucial for effective control of infectious disease outbreaks, and regional surveillance could provide valuable data to supplement global systems, improve sensitivity and timeliness of reporting, or capture otherwise undetected outbreaks. In New Zealand (NZ), there are no endemic arboviral diseases in humans, and the majority of dengue cases are imported from neighbouring Pacific Islands where comprehensive surveillance systems are under development. From 1997 to 2009, 679 cases of dengue were reported in NZ (74·2% acquired from the Pacific Islands), and the patterns of reported incidence of dengue acquired from different islands closely reflected local reported incidence in those areas. NZ is therefore in a unique position to provide early alerts on dengue outbreaks in the Pacific Islands. Such a strategy would reduce disease burden in both the Pacific Islands and NZ, and provide a model for transnational collaboration in disease surveillance with regional as well as global benefits.
The Genesis 12–19 (G1219) Study is an ongoing longitudinal study of a sample of UK twin pairs, non-twin sibling pairs, and their parents. G1219 was initially designed to examine the role of gene–environment interplay in adolescent depression. However, since then data have continued to be collected from both parents and their offspring into young adulthood. This has allowed for longitudinal analyses of depression and has enabled researchers to investigate multiple phenotypes and to ask questions about intermediate mechanisms. The study has primarily focused on emotional development, particularly depression and anxiety, which have been assessed at multiple levels of analysis (symptoms, cognitions, and relevant environmental experiences). G1219 has also included assessment of a broader range of psychological phenotypes ranging from antisocial behaviors and substance use to sleep difficulties, in addition to multiple aspects of the environment. DNA has also been collected. The first wave of data collection began in the year 1999 and the fifth wave of data collection will be complete before the end of 2012. In this article, we describe the sample, data collection, and measures used. We also summarize some of the key findings to date.
Thin interposing Ni or Co layers between Fe thin films and Si have been shown to be very effective in inducing the growth and improving the quality of epitaxial FeSi2 on silicon. The formation of a transition layer with graded concentration is conceived to facilitate the epitaxial growth of FeSi2 on silicon. The thin interposing layer scheme may be extended to promote the epitaxial growth of a number of refractory suicides on silicon.
Recent progresses in the epitaxial growth of refractory metal suicides, FeSi2 and manganese suicides on silicon are reviewed.
The formation and structures of epitaxial suicides are described. Factors affecting the suicide epitaxy are examined. The lattice match criteria for the growth of epitaxial suicides are assessed. The effects of anharmonicity in the interatomic force of overlayer on the heteroepitaxial growth and pseudomorphism are discussed. The properties and possible applications of epitaxial suicides are summarized. Prospects for the study of epitaxial suicides are addressed.
The use of CVD W as a diffusion barrier between Al and Si is becoming widespread. The initial stage of the deposition involves the Si reduction of WF6 according to the following reaction:
The reaction is thought to be self-limiting, since once a sufficiently thick W film forms, WF6 and Si are no longer able to be in contact. We have studied the effects of implanted dopant and damage on the rate of this reaction and the thickness of the self-limiting W film. To study the mechanism of W film growth, Si wafers were implanted with As, P or Sb. These wafers were either left in the as-implanted state (amorphized surface layer) or were annealed to drive-in the implant and recrystallize the Si. The reactivity with WF6 of these wafers, as well as unimplanted Si wafers, was then studied as a function of temperature between 210° C and 700° C. Si-WF6 reactivity is shown to have a strong temperature dependence, with maximum reactivity occuring at 340 °C, at which temperature a 960A thick film of W can form. Enhanced diffusion of Si through the growing W film is thought to be the mechanism responsible for thick film growth. At higher temperatures, thinner films form, due to the cessation of enhanced diffusion. Lower temperature films are also thinner, probably due to a nucleation barrier, not a kinetic barrier, to growth. Implantation lowers the temperature of the onset of enhanced reactivity between Si and WF6, when the wafers are reacted in the as-implanted state.
Cosputtered W70Zr30 and W40Zr60 films are investigated as diffusion barriers between Al and Si. W-Zr alloys of both compositions were determined by x-ray diffraction to crystallize at 900°C on Al2O3 substrates. On <111>Si the W-Zr alloy reacts with the substrate above 700°C, forming a uniform, polycrystal line layer of W and Zr suicides. Despite the high crystallization temperatures, an Al overlayer interacts with W-Zr and the Si substrate at ∼500°C. MeV He backscattering spectrometry, SEM and EDAX indicate that this reaction is laterally nonuniform with the formation of deep pits penetrating into the Si substrate. We believe this to be a consequence of fractures in the W-Zr layer induced by reaction with Al. Electrical measurements on shallow junction diodes with <Si>/W-Zr/Al contacts show that the device junctions were thermally stable after a 30 min annealing at 450°C but were all shorted after heat treatments at 500°C or above.
Alloyed ohmic contacts (i.e. Au-Ge-Ni) to n-GaAs lead to non-planar interfaces which are unsuitable for devices with shallow junctions and small dimensions. In this study, the fabrication of non-alloyed ohmic contacts (via solid state reactions) is investigated. A layered structure involving the solid phase epitaxy of Ge using a transport medium (PdGe) is shown to produce low (1 — 5 × 10∼6Ω cm2) and reproducible values of contact resistivity. The resultant interface is shown to be abrupt by cross-sectional transmission electron microscopy.
Silver-glass die attach adhesives provide a cost effective means of producing high reliability parts which can withstand the environmental testing required of electronic components. One step processing of these adhesives provides the additional advantages of increased throughput and processing flexibility compared to eutectically bonded assemblies.
This paper describes the performance of a one step silver-glass die attach adhesive processed under various time and temperature conditions. The effect of peak firing temperature and dwell time on the ultimate tensile strength of the adhesive will be discussed. Tensile data from parts subjected to thermal shock, thermal cycle and high temperature aging will be presented as an indication of the material's long term reliability.
Single crystal NiSi2 films of type A and type B orientations with thicknesses ranging from 70–600Å have been grown on (111), n-type Si substrates. TEM and channeling measurements indicate that these films are of excellent epitaxial quality with uniform orientations over the entire range of observation. HRTEM studies show regular and atomically abrupt interfaces for both NiSi2 orientations with occasional localized planar defects. I-V and photoresponse measurements of the Schottky barrier heights(SBH) of the type A films yield consistent values of 0.62±.01eV. However, for type B films I-V measurements give a SBH of 0.69±.01eV while the photoresponse results give 0.77±.05eV. This discrepancy can be explained quantitatively by a phenomenological model in which a small percentage of low barrier height regions is incorporated into the type B films.
High resolution SIMS (secondary ion mass spectrometry) depth profiles of Ge/Pd and Si/Pd/Ge/Pd non-alloyed ohmic contacts on InP are obtained by sputter-etching from the back (semiconductor) side. The samples contain an InGaAs etch stop layer, to allow chemical thinning, and InGaAsP marker layers, which allow alignment and calibration of the depth profiles. Detailed comparisons are made to corresponding contacts on GaAs, processed and analyzed under similar conditions. The importance of interfacial alloy formation, semiconductor regrowth, and dopant incorporation are highlighted.
It is becoming increasingly evident that recombinant DNA technology, physical-chemistry and selected biological processes can be coupled leading to the development of new “synthetic” biomaterials. This summary and prospectus will highlight selected features related to dental enamel biomineralization towards the development of human dental enamel as a restorative biomaterial.