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Background: When measuring young Duchenne Muscular Dystrophy (DMD) patients’ health-related quality of life (HRQoL), parent-proxy reports are heavily relied on. Therefore, it is imperative that the relationship between parent-proxy and child self-report HRQoL is understood. This study examined the level of agreement between children and their parent-proxy rating of the child’s HRQoL. Methods: We used FOR-DMD clinical trial baseline data. HRQoL, measured using the PedsQL inventory, was reported by 178 parent and child (ages 4 to 7 years) dyads. Intracorrelation coefficients (ICC) measured absolute agreement while paired t-tests determined differences in the average HRQoL ratings between groups. Results: The level of agreement between child and parent-proxy ratings of HRQoL was poor for the generic PedsQL scale (ICC: 0.29) and its subscales; and, similarly low for the neuromuscular disease module (ICC:0.16). On average, parents rated their child’s HRQoL as poorer than the children rated themselves in all scales except for psychosocial and school functioning. Conclusions: Child and parent-proxy HRQoL ratings are discordant in this study sample, as occurs in other chronic pediatric diseases. This should be taken into account when interpreting clinical and research HRQoL findings in this population. Future studies should examine reasons for parents’ perception of poorer HRQoL than that reported by their children.
The prediction of solar flares, eruptions, and high energy particle storms is of great societal importance. The data mining approach to forecasting has been shown to be very promising. Benchmark datasets are a key element in the further development of data-driven forecasting. With one or more benchmark data sets established, judicious use of both the data themselves and the selection of prediction algorithms is key to developing a high quality and robust method for the prediction of geo-effective solar activity. We review here briefly the process of generating benchmark datasets and developing prediction algorithms.
The management of Bell's palsy has been the subject of much debate, with corticosteroids being the preferred medication. However, evidence also supports the use of antiviral drugs for severe cases and even decompression surgery in patients who, despite medical treatment, are not recovering.
A literature review was conducted on the management of Bell's palsy.
This paper describes the background, statistical evidence, study results and pathophysiological theories that support more aggressive treatment for patients with severe palsy and those who have inadequate recovery.
Combination therapy including antiviral medication significantly improves outcomes in patients with severe Bell's palsy. Decompression should be considered in patients who have not recovered with drug treatment.
We investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2–22·0] and 5·5 (95% CI 2·1–14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control.
Individual symptoms of post-myocardial infarction (MI) depression may be differentially associated with cardiac prognosis, in which somatic/affective symptoms appear to be associated with a worse cardiovascular prognosis than cognitive/affective symptoms. These findings hold important implications for treatment but need to be replicated before conclusions regarding treatment can be drawn. We therefore examined the relationship between depressive symptom dimensions following MI and both disease severity and prospective cardiac prognosis.
Patients (n=473) were assessed on demographic and clinical variables and completed the Beck Depression Inventory (BDI) within the first week of hospital admission for acute MI. Depressive symptom dimensions were associated with baseline left ventricular ejection fraction (LVEF) and prospective cardiac death and/or recurrent MI. The average follow-up period was 2.8 years.
Factor analysis revealed two symptom dimensions – somatic/affective and cognitive/affective – in the underlying structure of the BDI, identical to previous results. There were 49 events attributable to cardiac death (n=23) or recurrent MI (n=26). Somatic/affective (p=0.010) but not cognitive/affective (p=0.153) symptoms were associated with LVEF and cardiac death/recurrent MI. When controlling for the effects of previous MI and LVEF, somatic/affective symptoms remained significantly predictive of cardiac death/recurrent MI (hazard ratio 1.31, 95% confidence interval 1.02–1.69, p=0.038). Previous MI was also an independent predictor of cardiac death/recurrent MI.
We confirmed that somatic/affective, rather than cognitive/affective, symptoms of depression are associated with MI severity and cardiovascular prognosis. Interventions to improve cardiovascular prognosis by treating depression should be targeted at somatic aspects of depression.
High mobility channel materials and new device structures will be needed to meet the power and performance specifications in future technology nodes. Therefore, the use of Ge and III/V materials and novel devices such as heterojunction TunnelFET’s is investigated for future CMOS applications. High-performance CMOS can be obtained by combining Ge pMOS devices with nMOS devices made on III/V compounds such as InGaAs. In all cases the key challenge is the electrical passivation of the interface between the high-k dielectric and the alternative channel materials.
Recent studies have demonstrated good electrical properties of the GeO2/Ge interface. Since the GeO2 layer is very hygroscopic, full in-situ processing of GeO2 formation and high-k deposition must be performed or other methods must be employed to stabilize the GeO2 layer. One of the most successful passivation techniques for Ge MOS gate stacks is a thin, epitaxial layer of Si. A lot of attention went into better understanding of this passivation and the effects of its optimization on various device characteristics. It was found that mobility and Vt trends in both pMOS and nMOS transistors can be explained based on defects located at the Si/SiO2 interface.
Unfortunately, III-V/oxide interfaces are not quite as robust and most interfaces present rather high densities of interface states. Although, considerable improvements have been realized in the reduction of the interface state density, further developments are required to obtain high performance MOS devices. To this purpose various passivation methods were critically evaluated. Simulations using Density Functional Theory reveal the possibility of using a thin amorphous layer made of GeOX to obtain an electrically unpinned gap. The major challenge resides in the control of the c-Ge thickness and the oxidation of this layer to avoid the diffusion of oxygen atoms at the Ge/GaAs(001) interface. Promising results are obtained by optimizing the surface preparation, high-k deposition and annealing cycle on In0.53Ga0.47As-Al2O3 interfaces. Self-aligned inversion channel n-MOSFETs fabricated on p-type In0.53Ga0.47As demonstrate inversion-mode operation with high drive current and a peak electron mobility of 3000 cm2/Vs.
Since ultimately the major showstopper on the scaling roadmap is not device speed, but rather power density, the introduction of these advanced materials will have to go together with the introduction of new device concepts. Novel structures such as heterojunction TunnelFET’s can fully exploit the properties of these new materials and provide superior performance at lower power consumption by virtue of their improved subthreshold behaviour. Vertical surround gate devices produced from nanowires allow the introduction of a wide range of materials on Si. This illustrates the possibilities that are created by the combination of new materials and devices to allow scaling of nanoelectronics beyond the Si roadmap.
Implementation of full thermodynamic models in performance assessment (PA) calculations (large domain and very large timescales) is practically unfeasible due to excessive computational times. The complex competitive sorption processes of radionuclides are often simplified.
In this paper, such simple sorption models (i.e. linear Kd and Langmuir isotherms) were compared with more complex thermodynamic models for a reduced geometry and relatively short timescales (compared to traditional PA calculations).
Within the context of a safety case the value of this study is twofold. Primarily, it provides support information on how to choose adequate parameter values in a consistent simplified analysis for compliance with safety criteria. For the cases studied in this paper it became clear that a linear model is sufficient to represent sorption, but a proper choice of the Kd values is critical. Secondly, the comparison of results from these compliance calculations with more realistic analyses demonstrates quantitatively the safety margin implicitly present in PA calculations through model abstraction.
Nanoporous organosilicate films have been recently prepared using tetraalkylammonium cations in acid and basic media, outperforming other materials. Resulting films using basic medium were called zeolite-inspired low-k dielectrics. Here we study the dependence of the properties of these films on the used silica sources: methyltrimethoxy silane (MTMS) and tetraethyl orthosilicate (TEOS). A set of experiments varying the MTMS:TEOS ratio were prepared in acid medium and characterized. A textural, physico-chemical, mechanical, and electrical characterization of this series of experiments is presented.
Reduced heart rate variability (HRV) is a prognostic factor for cardiac mortality. Both depression and anxiety have been associated with increased risk for mortality in cardiac patients. Low HRV may act as an intermediary in this association. The present study examined to what extent depression and anxiety differently predict 24-h HRV indices recorded post-myocardial infarction (MI).
Ninety-three patients were recruited during hospitalization for MI and assessed on self-reported symptoms of depression and anxiety. Two months post-MI, patients were assessed on clinical diagnoses of lifetime depressive and anxiety disorder. Adequate 24-h ambulatory electrocardiography data were obtained from 82 patients on average 78 days post-MI.
In unadjusted analyses, lifetime diagnoses of major depressive disorder was predictive of lower SDNN [standard deviation of all normal-to-normal (NN) intervals; β=−0.26, p=0.022] and SDANN (standard deviation of all 5-min mean NN intervals; β=0.25, p=0.023), and lifetime anxiety disorder of lower RMSSD (root mean square of successive differences; β=−0.23, p=0.039). Depression and anxiety symptoms did not significantly predict HRV. After adjustment for age, sex, cardiac history and multi-vessel disease, lifetime depressive disorder was no longer predictive of HRV. Lifetime anxiety disorder predicted reduced high-frequency spectral power (β=−0.22, p=0.039) and RMSSD (β=−0.25, p=0.019), even after additional adjustment of anxiety symptoms.
Clinical anxiety, but not depression, negatively influenced parasympathetic modulation of heart rate in post-MI patients. These findings elucidate the physiological mechanisms underlying anxiety as a risk factor for adverse outcomes, but also raise questions about the potential role of HRV as an intermediary between depression and post-MI prognosis.
Although many studies have focused on post-myocardial infarction (MI) depression, there is limited information about the evolution and determinants of depressive symptoms in the first year post-MI. Therefore we examined (1) the course of depressive symptoms during the first year post-MI and (2) the predictors of these symptom trajectories.
To assess depressive symptoms, 287 patients completed the Beck Depression Inventory during hospitalization for MI, and 2, and 12 months post-MI. Personality was assessed with the Type-D scale during hospitalization. We used latent class analysis to examine the evolution of depressive symptoms over a 1-year period and multinomial logit regression analyses to examine predictors of these symptom trajectories.
The course of depressive symptoms was stable during the first year post-MI. Four groups were identified and classified as non-depressed [40%, intercept (IC) 2.52], mildly depressed (42%, IC 6.91), moderately depressed (14%, IC 13.73) or severely depressed (4%, IC 24.54). In multivariate analysis, cardiac history (log ORsevere 2.93, p=0.02; log ORmoderate 1.81, p=0.02; log ORmild 1.46, p=0.01), history of depression (log ORsevere 4.40, p<0.001; log ORmoderate 1.97, p=0.03) and Type-D personality (log ORsevere 4.22, p<0.001; log ORmoderate=4.17, p<0.001; log ORmild 1.66, p=0.02) were the most prominent risk factors for persistence of depressive symptoms during the first year post-MI.
Symptoms of depression tend to persist during the first year post-MI. Cardiac history, prior depression and Type-D personality were identified as independent risk factors for persistence of depressive symptoms. The results of this study strongly argue for routine psychological screening during hospitalization for acute MI in order to identify patients who are at risk for chronicity of depressive symptoms and its deleterious effects on prognosis.
The prevalence of Cryptosporidium in calves younger than 10 weeks was estimated in a cross-sectional epidemiological study on 100 dairy (n=499) and 50 beef (n=333) farms in East Flanders (Belgium), using a previously evaluated immunofluorescence assay (Merifluor®). The calf prevalence was 37% (95% Probability Interval (PI): 7–70%) in dairy calves and 12% (95% PI: 1–30%) in beef calves. To elucidate the genetic diversity, the Cryptosporidium 18S ribosomal DNA and the 70 kDa heat shock protein gene were targeted. In the majority of the samples C. parvum was present, although C. bovis was also identified, all but one in calves older than 1 month. The porcine-specific C. suis was identified in 1 beef calf. Subtyping of C. parvum positive isolates by sequence analysis of the 60 kDa glycoprotein gene indicated the presence of 4 allele IIa subtypes, along with 1 subtype IIdA22G1. The subtype IIaA15G2R1 was most prevalent, next to subtype IIaA13G2R1 and IIaA16G2R1, and a new subtype IIaA14G2R1. The results of the present study indicate a high prevalence of Cryptosporidium infections in calves in Belgium and confirm that these calves should be considered as a potential zoonotic reservoir for human infections.
Global and Regional Characteristics and Impacts of ENSO Variability
Germán Poveda, Postgrado en Recursos Hidráulicos, Universidad National de Colombia, Facultadde Minas. Carrera 80 Calle 65, Bloque M2-300 Medellín, Colombia,
Nicholas E. Graham, Scripps Institution of Oceanography, University of California, San Diego, California, U.S.A.,
Paul R. Epstein, Center for Health and the Global Environment, Harvard Medical School, Boston, Massachusetts, U.S.A.,
William Rojas, Corporatión para Investigaciones Biológicas (CIB), Carrera 72 A No. 78 B 141, Medellím, Colombia,
Martha L. Quiñones,
Iván Darío Vélez, Programa de Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Calle 62 No. 52–19, Medellím, Colombia,
Willem J.M. Martens, International Centre for Integrative Studies, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
Climatic factors are associated with the incidence of diverse vector-borne diseases (VBDs). Colombia, located in tropical South America, witnesses high precipitation rates and temperatures, varying with elevation over the Andes. We show how temperatures are linked to malaria incidence throughout the country, and we compare those results with those obtained via simple mathematical expressions that represent indices associated with malaria transmission as a function of temperature. Interannual climatic variability in tropical South America is strongly associated with El Niño/Southern Oscillation (ENSO). Most of the region, including Colombia, experiences prolonged dry periods and above normal air temperatures during El Niño, and generally opposite conditions during La Niña. Through correlation analysis, we show that during El Niño events there are outbreaks of malaria and dengue fever in Colombia. These outbreaks could be explained in terms of a decrease in precipitation and an increase in air temperature, which favor the ecological, biological, and entomological components of these diseases.
We illustrate the ability to predict malaria cases in Colombia by using an epidemiological model based on the concept of vectorial capacity (see Martens et al. 1997). This transmission potential model is driven with surface air temperatures derived from an atmospheric general circulation model (ECHAM3 model, Max Planck Institute for Meteorology) with a spatial resolution of about 300 km. The malarial model produces peaks in Plasmodium vivax vectorial capacity during El Niño years and an upward trend with time, in agreement with the Colombian malarial historical record.