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The aim of this retrospective review was to assess the overall burden and trend in spinal tuberculosis (TB) at tertiary hospitals in the Western Cape Province of South Africa. All spinal TB cases seen at the province's three tertiary hospitals between 2012 and 2015 were identified and clinical records of each case assessed. Cases were subsequently classified as bacteriologically confirmed or clinically diagnosed and reported with accompanying clinical and demographic information. Odds ratios (OR) for severe spinal disease and corrective surgery in child vs. adult cases were calculated. A total of 393 cases were identified (319 adults, 74 children), of which 283 (72%) were bacteriologically confirmed. Adult cases decreased year-on-year (P = 0.04), however there was no clear trend in child cases. Kyphosis was present in 60/74 (81%) children and 243/315 (77%) adults with available imaging. Corrective spinal surgery was performed in 35/74 (47%) children and 80/319 (25%) adults (OR 2.7, 95% confidence interval 1.6–4.5, P = 0.0003). These findings suggest that Western Cape tertiary hospitals have experienced a substantial burden of spinal TB cases in recent years with a high proportion of severe presentation, particularly among children. Spinal TB remains a public health concern with increased vigilance required for earlier diagnosis, especially of child cases.
To understand increasing rates of hepatitis C virus (HCV) infection in Tennessee, we conducted testing, risk factor analysis and a nested case–control study among persons who use drugs. During June–October 2016, HCV testing with risk factor assessment was conducted in sexually transmitted disease clinics, family planning clinics and an addiction treatment facility in eastern Tennessee; data were analysed by using multivariable logistic regression. A nested case–control study was conducted to assess drug-using risks and behaviours among persons who reported intranasal or injection drug use (IDU). Of 4753 persons tested, 397 (8.4%) were HCV-antibody positive. HCV infection was significantly associated with a history of both intranasal and IDU (adjusted odds ratio (aOR) 35.4, 95% confidence interval (CI) 24.1–51.9), IDU alone (aOR 52.7, CI 25.3–109.9), intranasal drug use alone (aOR 2.6, CI 1.8–3.9) and incarceration (aOR 2.7, CI 2.0–3.8). By 4 October 2016, 574 persons with a reported history of drug use; 63 (11%) were interviewed further. Of 31 persons who used both intranasal and injection drugs, 26 (84%) reported previous intranasal drug use, occurring 1–18 years (median 5.5 years) before their first IDU. Our findings provide evidence that reported IDU, intranasal drug use and incarceration are independent indicators of risk for past or present HCV infection in the study population.
To investigate an outbreak of Burkholderia cepacia complex and describe the measures that revealed the source.
A 629-bed, tertiary-care, pediatric hospital in Houston, Texas.
Pediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units.
We investigated an outbreak of B. cepacia complex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory.
Overall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2–148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within the B. cepacia complex. Product cultures of liquid docusate were positive with an identical strain of B. cepacia complex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation.
Our investigation revealed an outbreak of a unique strain of B. cepacia complex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer.
Down through the years the Constitution has not always included all Americans — especially Blacks and women. No such charges have been leveled against the Religious Liberty clauses, though there have been occasions when their protections have been overridden or imperfectly applied. To remind us — as the Framers knew well — that “nothing human can be perfect,” we hear remarks from a distinguished Baptist pastor, an accomplished lawyer, and an eminent civil rights leader, Dr. Benjamin Hooks.
Persecutory delusions are a key psychotic experience. A reasoning style known as ‘jumping to conclusions’ (JTC) – limited information gathering before reaching certainty in decision making – has been identified as a contributory factor in the occurrence of delusions. The cognitive processes that underpin JTC need to be determined in order to develop effective interventions for delusions. In the current study two alternative perspectives were tested: that JTC partially results from impairment in information-processing capabilities and that JTC is a motivated strategy to avoid uncertainty.
A group of 123 patients with persistent persecutory delusions completed assessments of JTC (the 60:40 beads task), IQ, working memory, intolerance of uncertainty, and psychiatric symptoms. Patients showing JTC were compared with patients not showing JTC.
A total of 30 (24%) patients with delusions showed JTC. There were no differences between patients who did and did not jump to conclusions in overall psychopathology. Patients who jumped to conclusions had poorer working memory performance, lower IQ, lower intolerance of uncertainty and lower levels of worry. Working memory and worry independently predicted the presence of JTC.
Hasty decision making in patients with delusions may partly arise from difficulties in keeping information in mind. Interventions for JTC are likely to benefit from addressing working memory performance, while in vivo techniques for patients with delusions will benefit from limiting the demands on working memory. The study provides little evidence for a contribution to JTC from top-down motivational beliefs about uncertainty.
Schistosomiasis is the generic name given to diseases caused by parasitic blood flukes of the genus Schistosoma. An older name, still widely used in Africa, is bilharzia. Of the three major species that commonly infect humans, two occur predominantly in Africa:
S. mansoni, a cause of intestinal schistosomiasis, also found in Brazil and the Caribbean; and
S. haematobium, the cause of urinary schistosomiasis, also found in the Middle East.
The third major species, S. japonicum, causes another form of intestinal schistosomiasis but is found only in the Far East. A minor species, S. intercalatum, causes infection but insignificant disease in small areas of Central Africa.
Schistosomiasis is typically a chronic infection. Adult worms slowly accumulate from early childhood over a period of 10 to 20 years, and the deposition of eggs in the tissues leads to fibrosis in the intestines and liver (S. mansoni) or the urinary tract (S. haematobium). Mild or moderate symptoms occur in most infected children: severe disease develops in later life in only a minority of these individuals. For detailed reviews of different aspects, the reader is referred to books edited by Jordan et al. (1993) and Mahmoud (2001).
EMU is a wide-field radio continuum survey planned for the new Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The primary goal of EMU is to make a deep (rms ∼ 10 μJy/beam) radio continuum survey of the entire Southern sky at 1.3 GHz, extending as far North as +30° declination, with a resolution of 10 arcsec. EMU is expected to detect and catalogue about 70 million galaxies, including typical star-forming galaxies up to z ∼ 1, powerful starbursts to even greater redshifts, and active galactic nuclei to the edge of the visible Universe. It will undoubtedly discover new classes of object. This paper defines the science goals and parameters of the survey, and describes the development of techniques necessary to maximise the science return from EMU.
Diffraction-contrast TEM, focused probe electron diffraction, and high-resolution X-ray diffraction were used to characterize the dislocation arrangements in a 16[.proportional]m thick coalesced GaN film grown by MOVPE LEO. As is commonly observed, the threading dislocations that are duplicated from the template above the window bend toward (0001). At the coalescence plane they bend back to lie along  and thread to the surface. In addition, three other sets of dislocations were observed. The first set consists of a wall of parallel dislocations lying in the coalescence plane and nearly parallel to the substrate, with Burgers vector (b) in the (0001) plane. The second set is comprised of rectangular loops with b = 1/3 [11 20] (perpendicular to the coalescence boundary) which originate in the coalescence boundary and extend laterally into the film on the (1 100). The third set of dislocations threads laterally through the film along the [1 100] bar axis with 1/3<11 20>-type Burgers vectors These sets result in a dislocation density of ∼109 cm−2. High resolution X-ray reciprocal space maps indicate wing tilt of ∼0.5°.
The Herschel-ATLAS (H-ATLAS) will provide an unrivalled sample of galaxies, probing the normal star-forming submillimetre population of galaxies for the first time. Here, we exploit the Science Demonstration Phase (SDP) data to model the evolution of the interstellar content of galaxies in recent history. The most massive H-ATLAS galaxies show a large increase in the dust content five billion years ago compared to the present epoch. These observations are difficult to explain using standard dust models, one possibility could be contributions from a non-stellar source of dust e.g. grain growth in dense clouds; this would imply that less than 10% of dust would be condensed in stellar atmospheres. Alternatively, an initial mass function which becomes top heavy at high star formation rate densities could also explain this discrepancy.
Solid phase physical and chemical characterization methods have been used in an ongoing study of residual wastes from several single-shell underground waste tanks at the U.S. Department of Energy's Hanford Site in southeastern Washington State. Because these wastes are highly-radioactive dispersible powders and are chemically-complex assemblages of crystalline and amorphous solids that contain contaminants as discrete phases and/or co-precipitated within oxide phases, their detailed characterization offers an extraordinary technical challenge. X-ray diffraction (XRD) and scanning electron microscopy/energy dispersive x-ray spectroscopy (SEM/EDS) are the two principal methods used, along with a limited series of analyses by synchrotron-based methods, to characterize solid phases and their contaminant associations in these wastes. Depending on the specific tank, numerous solids (e.g., èejkaite; Na2U2O7; clarkeite; gibbsite; böhmite; dawsonite; cancrinite; Fe oxides such as hematite, goethite, and maghemite; rhodochrosite; lindbergite; whewellite; nitratine; and several amorphous phases) have been identified in residual wastes studied to date. Because many contaminants of concern are heavy elements, SEM analysis using the backscattered electron (BSE) signal has proved invaluable in distinguishing phases containing elements, such as U and Hg, within the complex assemblage of particles that make up each waste. XRD, SEM/EDS, and synchrotron-based methods provide different, but complimentary characterization data about the morphologies, crystallinity, particle sizes, surface coatings, and compositions of phases in these wastes. The impact of these techniques is magnified when each is used in an iterative fashion to help interpret the results from the other analysis methods and identify additional, more focused analyses.
Amorphous diamond is a new material for surface-micromachined microelectromechanical systems (MEMS) that offers promise for reducing wear and stiction of MEMS components. The material is an amorphous mixture of 4-fold and 3-fold coordinated carbon with mechanical properties close to that of crystalline diamond. A unique form of structural relaxation permits the residual stress in the material to be reduced from an as-deposited value of 8 GPa compressive down to zero stress or even to slightly tensile values. Irreversible plastic deformation, achieved by heat treating elastically strained structures, is also possible in this material. Several types of amorphous diamond MEMS devices have been fabricated, including electrostatically-actuated comb drives, micro-tensile test structures, and cantilever beams. Measurements using these structures indicate the material has an elastic modulus close to 800 GPa, fracture toughness of 8 MPa.m½, an advancing H2O contact angle of 84° to 94°, and a surface roughness of 0.1 to 0.9 nm R.M.S. on Si and SiO2, respectively.
Hemoglobin (Hb) and myoglobin (Mb) were encapsulated in transparent silica glasses prepared by the sol-gel method. The preparation of the silica glasses was tailored so that when proteins were entrapped in the pores of the inorganic matrix, they retained their biochemical activity, i.e. they could bind ligands reversibly. Using optical spectroscopy to monitor ligand binding, we studied the binding of O2, CO, and NO with these two heme proteins encapsulated in silica glasses and compared them to heme proteins in aqueous buffer. Both Hb and Mb in the sol-gel glass bound O2, CO, and NO, producing the same spectroscopic properties as those in aqueous buffer. In addition, silica encapsulated Mb was used to evaluate the rate of ligand (O2) transport through the pores of the glass. When varying oxygen concentration and measuring the time required for full conversion of deoxyMb to MbO2 in the silica gel, the time vs. concentration data followed an exponential trend, as expected for diffusion controlled processes.
The sol-gel process is a solution synthesis technique which provides a low temperature chemical route for the preparation of rigid transparent matrices. A number of laser dyes have been incorporated in different sol-gel matrices and tunable laser action has been demonstrated with these materials. This paper extends the sol-gel laser field into two significant areas, infrared dyes and pyrromethenes. The work with the tricarbocyanine dyes shows the versatility of sol-gel chemistry as organic modifications produce a favorable environment for the dye molecules. The results with the pyrromethene system show a considerable increase in output energy and offer the promise of longer laser lifetimes.