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We report two cases of respiratory toxigenic Corynebacterium diphtheriae infection in fully vaccinated UK born adults following travel to Tunisia in October 2019. Both patients were successfully treated with antibiotics and neither received diphtheria antitoxin. Contact tracing was performed following a risk assessment but no additional cases were identified. This report highlights the importance of maintaining a high index of suspicion for re-emerging infections in patients with a history of travel to high-risk areas outside Europe.
In a RCT of family psychoeducation, 47 carers of 34 patients were allocated to one of three groups; Multifamily Group Psychoeducation, Solution Focussed Group Therapy or Treatment as Usual. Carers in both the MFGP intervention and the SFGP arm demonstrated greater knowledge and reduction in burden than those in the TAU arm.
Internet gaming disorder appears to be associated with self-concept deficits and increased identification with one's avatar. For increased social network use, the few existing studies suggest striatal-related positive social feedback as an underlying factor. Furthermore, few study findings indicate that internet addicts generally have problems in emotional inhibitory control processing.
Pathological and addicted internet gamers as well as social network users were compared with healthy controls regarding psychometric and neurobiological measures of self-concept-related characteristics, avatar identification and emotional inhibitory control processing.
Results and conclusion
Psychometric results indicated that both subgroups showed higher self-concept deficits compared to healthy controls. Neurobiologically, different brain activation patterns were observed in the subgroups during self-knowledge retrieval and inhibition of emotional stimuli. Furthermore, addicted internet gamers showed a higher identification with the own avatar, mirrored in an increased left angular gyrus activation, a region functionally associated with identification processing and feelings of empathy.
These findings provide a starting point for the deduction of specific psychotherapeutic treatment approaches for addicted internet gamers and social network users.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Schmidt-hammer exposure-age dating (SHD) of boulders on cryoplanation terrace treads and associated bedrock cliff faces revealed Holocene ages ranging from 0 ± 825 to 8890 ± 1185 yr. The cliffs were significantly younger than the inner treads, which tended to be younger than the outer treads. Radiocarbon dates from the regolith of 3854 to 4821 cal yr BP (2σ range) indicated maximum rates of cliff recession of ~0.1 mm/yr, which suggests the onset of terrace formation before the last glacial maximum. Age, angularity, and size of clasts, together with planation across bedrock structures and the seepage of groundwater from the cliff foot, all support a process-based conceptual model of cryoplanation terrace development in which frost weathering leads to parallel cliff recession and, hence, terrace extension. The availability of groundwater during autumn freezeback is viewed as critical for frost wedging and/or the growth of segregation ice during prolonged winter frost penetration. Permafrost promotes cryoplanation by providing an impermeable frost table beneath the active layer, focusing groundwater flow, and supplying water for sediment transport by solifluction across the tread. Snow beds are considered an effect rather than a cause of cryoplanation terraces, and cryoplanation is seen as distinct from nivation.
Analysis of human remains and a copper band found in the center of a Late Archaic (ca. 5000–3000 cal BP) shell ring demonstrate an exchange network between the Great Lakes and the coastal southeast United States. Similarities in mortuary practices suggest that the movement of objects between these two regions was more direct and unmediated than archaeologists previously assumed based on “down-the-line” models of exchange. These findings challenge prevalent notions that view preagricultural Native American communities as relatively isolated from one another and suggest instead that wide social networks spanned much of North America thousands of years before the advent of domestication.
Implementation of a novel experimental approach using a bright source of narrowband x-ray emission has enabled the production of a photoionized argon plasma of relevance to astrophysical modelling codes such as Cloudy. We present results showing that the photoionization parameter ζ = 4πF/ne generated using the VULCAN laser was ≈ 50 erg cm s−1, higher than those obtained previously with more powerful facilities. Comparison of our argon emission-line spectra in the 4.15 - 4.25 Å range at varying initial gas pressures with predictions from the Cloudy code and a simple time-dependent code are also presented. Finally we briefly discuss how this proof-of-principle experiment may be scaled to larger facilities such as ORION to produce the closest laboratory analogue to a photoionized plasma.
The pore structure of vapour deposited ASW is poorly understood, despite its importance to fundamental processes such as grain chemistry, cooling of star forming regions, and planet formation. We studied structural changes of vapour deposited D2O on intra-molecular to 30 nm length scales at temperatures ranging from 18 to 180 K and observed enhanced mobility from 100 to 150 K. An Arrhenius type model describes the loss of surface area and porosity with a common set of kinetic parameters. The low activation energy (428 K) is commensurate with van der Waals forces between nm-scale substructures in the ice. Our findings imply that water porosity will always change with time, even at low temperatures.
The rotation rate of a planet is a fundamental parameter, no less than its mass or composition, and planetary investigators require this rate to assess various other phenomena such as planetary wind speeds, internal and atmospheric models, ring dynamics and so forth. Saturn presents a conundrum, however, because none of its various planetary periods indicates the “true” rotation of the planet. Thus, although the planet displays an abundance of periodicities near 10.7 hours, the exact rotation period of Saturn is unknown. In the magnetosphere, “planetary-period oscillations” (PPOs) appear in charged particles, magnetic fields, energetic neutral atoms, radio emissions and motions of the plasma sheet and magnetopause. In Saturn’s rings, the spoke phenomenon can exhibit periodicities near 10.7 hours, and ring phenomena themselves may be related to the interior rotation of the planet. In the high-latitude ionosphere, modulations near this period appear in auroral motions and intensities. In the upper atmosphere, some cloud features rotate near this period, although wind speeds are generally faster, and the well-known polar hexagon rotates with a period close to 10.7 hours. Some of the magnetospheric/ionospheric oscillations differ in the northern and southern hemispheres and their periods do not remain constant, sometimes varying on long time scales of a year or longer and sometimes on much shorter time scales. These variations in the period argue against a cause related to changes interior to Saturn, and because the magnetic and spin axes of Saturn are reported to be axisymmetric (unlike those of any other known planet), Saturn’s periodicities cannot be explained as “wobble” caused by a geometric tilt or by a nondipolar magnetic anomaly. Several models have been proposed to account for the observed periodicities, including rotating atmospheric vortices, periodic plasma releases and a flapping magnetodisk, but none can satisfactorily explain all of Saturn’s periodicities nor their common origin, and none can determine the exact rotation rate of the planet. This chapter reviews Saturn’s periodicities, theories thereof, and how they might be used to determine the elusive rotation rate of the planet.
The objective of this study was to investigate the impact of the most commonly cited factors that may have influenced infants’ gut microbiota profiles at one year of age: mode of delivery, breastfeeding duration and antibiotic exposure. Barcoded V3/V4 amplicons of bacterial 16S-rRNA gene were prepared from the stool samples of 52 healthy 1-year-old Australian children and sequenced using the Illumina MiSeq platform. Following the quality checks, the data were processed using the Quantitative Insights Into Microbial Ecology pipeline and analysed using the Calypso package for microbiome data analysis. The stool microbiota profiles of children still breastfed were significantly different from that of children weaned earlier (P<0.05), independent of the age of solid food introduction. Among children still breastfed, Veillonella spp. abundance was higher. Children no longer breastfed possessed a more ‘mature’ microbiota, with notable increases of Firmicutes. The microbiota profiles of the children could not be differentiated by delivery mode or antibiotic exposure. Further analysis based on children’s feeding patterns found children who were breastfed alongside solid food had significantly different microbiota profiles compared to that of children who were receiving both breastmilk and formula milk alongside solid food. This study provided evidence that breastfeeding continues to influence gut microbial community even at late infancy when these children are also consuming table foods. At this age, any impacts from mode of delivery or antibiotic exposure did not appear to be discernible imprints on the microbial community profiles of these healthy children.
The Philippines has long been viewed as the “East Asian exception”. Although suffering massive wartime destruction, in the 1950s and 1960s its economic prospects were considered to be favourable. While very poor, its per capita income was somewhat higher than most of its neighbours. In the post-colonial era it neither closed off from the global economy — as China, Indonesia and Myanmar did — nor was it overwhelmed by the conflict that engulfed Indochina. Its civil society and polity appeared to be among the most robust in developing East Asia. And it retained close commercial and political ties with the undisputed global super power of that era, the United States. As a vote of confidence, Manila was selected to be the headquarters of the Asia Pacific's premier development finance institution, the Asian Development Bank, in 1966.
However, these early high expectations were not realized. From the late 1960s the Philippines increasingly parted company with its neighbours, as first the four Asian NIEs, then the ASEAN four (i.e., Indonesia, Malaysia, Thailand, together with Singapore) and, most important of all, China began to register exceptionally high rates of economic growth. By contrast, Philippine economic growth began to falter, especially from the late 1970s, and particularly during the country's deep economic and political crisis in the mid-1980s. The collapse of the two-decade Marcos rule in early 1986 was accompanied by the sharpest economic contraction in the country's economic history as an independent nation state. The economy was in free fall, with GDP declining by about 15 per cent in the years 1984'86 and poverty incidence rising sharply. Thereafter, a fragile political system was gradually constructed, punctuated by periodic political instability and extended debt negotiations. This was the country's lost decade, as most of East Asia boomed, fuelled by a newly dynamic China and the relocation of labour-intensive manufacturing from Northeast to Southeast Asia. At the turn of the century, Philippine per capita income (PCI) had not progressed beyond that achieved in 1980.
Comparative surveys of Asian economic development have highlighted, and puzzled over, the country's divergent economic path. A leading contributor to the literature on growth empirics speculated that the country was “a democratic dud” (Pritchett 2003).
It gives me great pleasure and honour to provide the introductory message for this rather impressive volume on the Philippine economy. Authored by renowned Filipino scholars and serious observers of the Philippine economy, the volume is arguably the most comprehensive reference work on the economy since at least the global financial crisis in 2008–9 and will likely shape the thinking and practice of Philippine development policy in the years ahead.
This volume had its beginning, albeit accidental, during my stint as Socioeconomic Planning Secretary and, concurrently, Director- General of the National Economic and Development Authority under the administration of President Benigno S. Aquino III. At that time, in early 2014, I got hold of the ADB Report entitled Asia 2050: Realizing the Asian Century, and it caught my interest. The report talked about how Asia is in the middle of a historic transformation. To quote the report: “If it continues to follow its recent trajectory, by 2050 its per capita income could rise six-fold in purchasing power parity (PPP) terms to reach Europe's levels today. It would make some 3 billion additional Asians affluent by current standards. By nearly doubling its share of global gross domestic product (GDP) to 52 percent by 2050, Asia would regain the dominant economic position it held some 300 years ago, before the industrial revolution.”
It was an exciting prospect for Asia, except for the Philippines. In the Report, the Philippines was a slow- or modest-growth aspiring country, lumped in the same group as Afghanistan, Bangladesh, North Korea, Laos, Myanmar, Nepal, Pakistan, and many of the Pacific Island countries. Even the Report's epic video-production did not make any reference to or show any significant Philippine landmark. That was, of course, understandable, given the country's poor-growth record in the three decades before 2010, which was the report's database for its extrapolation of the future. In contrast, since at least 2010, the country's economic performance has been quite stellar, impressively even earning the title 'the rising tiger of Asia', among other accolades bestowed upon the Philippine economy by various global development observers, e.g., the World Bank and HSBC.
In this volume, a leading group of scholars pose the question, has the Philippine economy rejoined the dynamic East Asian mainstream and, if so, what set of policies and priorities are required to maintain the strong economic momentum of recent years? Successive chapters address issues related to growth and poverty, infrastructure and urbanization, education, health, the environment, energy, development finance, and governance and institutions. This volume has been written with a broad audience in mind. First and foremost it is for readers in, and interested in, this fascinating and important country with a population that now exceeds 100 million people. Second, it will appeal to those in the broader development community with an interest in the analytical and policy challenges that democratic, middle-income countries face as they struggle to lift their citizens out of poverty and to achieve broad-based and environmentally sustainable growth.
Despite evidence demonstrating the advantages of metered-dose inhalers with spacers (MDI-s), nebulization (NEB) remains the primary method of asthma treatment in some pediatric emergency departments (PEDs). There is a perception that delivering salbutamol by MDI-s is more costly than by NEB. This research evaluates the relative costs of MDI-s and NEB using local, hospital-specific, patient-level data.
Regression models estimated associations between the salbutamol inhalation method and costs, length of stay (LOS) in the PED and hospital, and the probability of admission. Our population was a random sample of 822 patients presenting with wheeze to the PED in 2008/2009. Control variables included age, sex, triage acuity, time of PED visit, other medications, and vitals. Costs were calculated using the prices and quantities of medical resources used per treatment. Probabilistic sensitivity analysis was used.
Treatment with MDI-s versus NEB was associated with an absolute decrease in hospitalization of 4.4% (p<0.05) and a 25-hour (p<0.001) reduction in average inpatient stay, after controlling for triage acuity and patient characteristics. This resulted in savings of $24/patient in the PED and $180/patient overall (p<0.001). Inpatient care accounted for more than 90% of total patient costs.
Our results suggest economic gains associated with MDI-s for salbutamol inhalation in PEDs. Sensitivity analyses show that this conclusion is not affected by changes in model parameters that may differ by jurisdiction. Since most facilities already collect the data used for this study, our methods could be adopted for a cross-jurisdictional account of the cost effectiveness of MDI-s.