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This study assessed variation in coverage of maternal pertussis vaccination, introduced in England in October 2012 in response to a national outbreak, and a new infant rotavirus vaccination programme, implemented in July 2013. Vaccine eligible patients were included from national vaccine coverage datasets and covered April 2014 to March 2015 for pertussis and January 2014 to June 2016 for rotavirus. Vaccine coverage (%) was calculated overall and by NHS England Local Team (LT), ethnicity and Index of Multiple Deprivation (IMD) quintile, and compared using binomial regression. Compared with white-British infants, the largest differences in rotavirus coverage were in ‘other’, white-Irish and black-Caribbean infants (−13·9%, −12·1% and −10·7%, respectively), after adjusting for IMD and LT. The largest differences in maternal pertussis coverage were in black-other and black-Caribbean women (−16·3% and −15·4%, respectively). Coverage was lowest in London LT for both programmes. Coverage decreased with increasing deprivation and was 14·0% lower in the most deprived quintile compared with the least deprived for the pertussis programme and 4·4% lower for rotavirus. Patients’ ethnicity and deprivation were therefore predictors of coverage which contributed to, but did not wholly account for, geographical variation in coverage in England.
Improving neurocognitive outcomes following treatment for brain metastases have become increasingly important. We propose that a brief telephone-based neurocognitive assessment may improve follow-up cognitive assessments in this palliative population. Aim: To prospectively assess the feasibility and reliability of a telephone based brief neurocognitive assessment compared to the same tests delivered face-to-face. Methods: Brain metastases patients to be treated with whole brain radiotherapy (WBRT) were assessed using a brief validated neurocognitive battery at baseline, at 1 month and 3 months following WBRT (in person and over the phone). The primary outcome was feasibility and inter-procedural (in person versus telephone) reliability. The secondary objective was to evaluate the change in neurocognitive function before and after WBRT. Results: Out of 39 patients enrolled, 82% of patients completed the baseline in-person and telephone neurocognitive assessments. However, at 1 month, only 41% of enrolled patients completed the in-person and telephone cognitive assessments and at 3 months, only 10% of patients completed them. Results pertaining to reliability and change in neurocognitive function will be updated. Conclusion: The pre-defined definition of feasibility (at least 80% completion for face to face and telephone neurocognitive assessments) was met at baseline. However, a large proportion of participants did not complete either telephone or in person neurocognitive follow-up at 1 month and at 3 months post-WBRT. Attrition remained a challenge for neurocognitive testing in this population even when a telephone-based brief assessment was used.
Competing models for the origin of the local component of the diffuse X-ray background span more than an order of magnitude in temperature. We propose to test these models with a new instrument, the GRating Array Diffuse EUV Spectrometer (GRADES), which is sensitive to diffuse emission in the 90 – 260 Å bandpass, and offers a peak spectral resolution of about λ/127.
We summarize the detections of extreme ultraviolet (EUV) emission from neutron stars. Three firm detections have been made of spin-powered pulsars: the aged millisecond pulsar PSR J0437−4715, the middle-aged X-ray pulsar Geminga, and the radio pulsar PSR B0656+14. These observations allow us to evaluate both power-law and thermal-law emission models as the source of the EUV flux. For the case of PSR B0656+14 the lack of flux modulation with pulse period argues that the EUV radiation originates from the cooling neutron star surface rather than from a hot polar cap. If the emission is from a thermalized neutron star surface, then limits can be placed on the surface temperature. For the case of Geminga we can explain the observed EUV flux using thermal models that are consistent with standard neutron cooling scenarios. We also have a weak indication that the EUV emission from Geminga is pulsed in a manner consistent with the lowest energy channel observed with Rosat. For the case of the millisecond pulsar PSR J0437−4715 standard neutron star cooling models require surface re-heating. We compare different heating models to the data on this object. We rule out re-heating by crust-core friction, and find that models for the accretion from the interstellar medium, accretion from the white dwarf companion and a particle-wind nebula do not account for the EUV luminosity. Models of pulsar re-heating by magnetic monopole catalysis of nucleon decay are used to establish new limits to the flux of monopoles in the Galaxy. A single power-law source with properties derived from X-ray data cannot explain the EUV flux from PSR J0437−4715. The strongest model for explaining the EUV emission consists of a large ~ 3 km2 polar cap heated from particle production in the pulsar magnetic field. We consider the prospects for detecting other neutron stars in the extreme ultraviolet.
The extreme ultraviolet (EUV) diffuse background is the most poorly known of any of the diffuse astronomical backgrounds. Only upper limits to this flux exist, obtained with spectrometers with very crude (from ≈ 15 to 30 Å) resolution; these limits are generally one to two orders of magnitude larger than the expected sources of cosmic flux. A variety of source mechanisms have been postulated to radiate in this bandpass; the most discussed is the hot phase of the interstellar medium. A speculative possibility is that hot dark matter in the form of massive, radiatively unstable neutrinos in our Galaxy will produce a unique line in this bandpass. We describe an instrument employing a new type of spectrometer which will provide ~5 Å resolution and unprecedented sensitivity for diffuse EUV radiation. The instrument will be carried aboard the newly developed Spanish Minisat satellite.
The EURD instrument has been designed to measure diffuse emission in the extreme ultraviolet (350–1100 Å). This new design provides an unprecedented 4–5 Å spectral resolution and 200 photons/sec/cm2/sr sensitivity after only 100 hours of observations. One of the goals of this project is to search for spectral lines of highly ionized species from the high temperature component (105 – 106 K) of the interstellar medium that fills the Local Bubble. It is expected that EURD will detect lines due to a thermalized hot component of the interstellar medium, and it will also provide critical diagnostics of the physical properties of this gas. With EURD data we could also detect a spectral line due to the decay of massive neutrinos as well as study oxygen lines from the upper atmosphere airglow. EURD is on board the Spanish MINISAT-01 satellite.
Although rates of anxiety tend to decrease across late life, rates of anxiety increase among a subset of older adults, those with mild cognitive impairment (MCI) or dementia. Our understanding of anxiety in dementia is limited, in part, by a lack of anxiety measures designed for use with this population. This study sought to address limitations of the literature by developing a new measure of anxiety for cognitively impaired individuals, the anxiety in cognitive impairment and dementia (ACID) Scales, which includes both proxy (ACID-PR) and self-report (ACID-SR) versions.
The ACID-SR and ACID-PR were administered to 45 residents, aged 60 years and older, of three long-term care (LTC) facilities, and 38 professional caregivers at these facilities. Other measures of anxiety, and measures of depression, functional ability, cognition, and general physical and mental health were also administered.
Initial evaluation of its psychometric properties revealed adequate to good internal consistency for the ACID-PR and ACID-SR. Evidence for convergent validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by moderate-to-strong associations with measures of worry, depressive symptoms, and general mental health. Discriminant validity of measures obtained with the ACID-SR and ACID-PR was demonstrated by weak correlations with measures of cognition, functional ability, and general physical well-being.
The preliminary results suggest that the ACID-SR and ACID-PR can obtain reliable and valid measures of anxiety among individuals with cognitive impairment. Given the subjective nature of anxiety, it may be prudent to collect self-report of anxiety symptoms even among those with moderate cognitive impairment.
Accurate assessment of anxiety in later life is critical, as anxiety among older adults is associated with social and functional impairment and poorer quality of life. The Geriatric Anxiety Inventory (GAI) and the GAI–Short Form (GAI-SF) were designed to detect anxiety symptoms among community-dwelling older adults, but the usefulness of the GAI and GAI-SF in long-term care is unknown. The present study examined the psychometric properties of the GAI and GAI-SF among residents at a long-term care facility.
Seventy-five nursing home residents completed the GAI and measures of depression, executive functioning, and adaptive functioning. The mean age of residents was 69.60 years (SD = 10.76). Psychiatric diagnoses included dementia, psychotic disorders, mood disorders, anxiety disorders, substance abuse, sleep disorders, and mental retardation.
Internal consistency of the GAI was good (α = 0.92) and the GAI-SF was adequate (α = 0.73). GAI and GAI-SF scores were moderately correlated with depression scores, and weakly correlated with adaptive functioning scores and executive functioning scores, suggesting discriminant validity. Logistic regression analyses were conducted with GAI and GAI-SF scores predicting an anxiety disorders diagnosis. Results provided support for the predictive validity of the GAI and GAI-SF. Sensitivity, specificity, and the percentage of individuals correctly classified at various cut-off scores were also calculated.
Both the GAI and GAI-SF appear to be useful tools for assessing anxiety among nursing home residents with psychological disorders. The GAI-SF may be a viable replacement for the GAI as a screener for anxiety in long-term care.
This study investigates neighbourhood variation in rates of pneumococcal bacteraemia and community-level factors associated with neighbourhood heterogeneity in disease risk. We analysed data from 1416 adult and paediatric cases of pneumococcal bacteraemia collected during 2005–2008 from a population-based hospital surveillance network in metropolitan Philadelphia. Cases were geocoded using residential address to measure disease incidence by neighbourhood and identify potential neighbourhood-level risk factors. Overall incidence of pneumococcal bacteraemia was 36·8 cases/100 000 population and varied significantly (0–67·8 cases/100 000 population) in 281 neighbourhoods. Increased disease incidence was associated with higher population density [incidence rate ratio (IRR) 1·10/10 000 people per mile2, 95% confidence interval (CI) 1·0–1·19], higher percent black population (per 10% increase) (IRR 1·07, 95% CI 1·04–1·09), population aged ⩽5 years (IRR 3·49, CI 1·8–5·18) and population aged ⩾65 years (IRR 1·19, CI 1·00–1·38). After adjusting for these characteristics, there was no significant difference in neighbourhood disease rates. This study demonstrates substantial small-area variation in pneumococcal bacteraemia risk that appears to be explained by neighbourhood sociodemographic characteristics. Identifying neighbourhoods with increased disease risk may provide valuable information to optimize implementation of prevention strategies.
Reduced vancomycin susceptibility (RVS) may lead to poor clinical outcomes in Staphylococcus aureus bacteraemia. We conducted a cohort study of 392 patients with S. aureus bacteraemia within a university health system. The association between RVS, as defined by both Etest [vancomycin minimum inhibitory concentration (MIC) >1·0 μg/ml] and broth microdilution (vancomycin MIC ⩾1·0 μg/ml), and patient and clinical variables were evaluated to create separate predictive models for RVS. In total, 134 (34·2%) and 73 (18·6%) patients had S. aureus isolates with RVS by Etest and broth microdilution, respectively. The final model for RVS by Etest included methicillin resistance [odds ratio (OR) 1·51, 95% confidence interval (CI) 0·97–2·34], non-white race (OR 0·67, 95% CI 0·42–1·07), healthcare-associated infection (OR 0·56, 95% CI 0·32–0·96), and receipt of any antimicrobial therapy ⩽30 days prior to the culture date (OR 3·06, 95% CI 1·72–5·44). The final model for RVS by broth microdilution included methicillin resistance (OR 2·45, 95% CI 1·42–4·24), admission through the emergency department (OR 0·54, 95% CI 0·32–0·92), presence of an intravascular device (OR 2·24, 95% CI 1·30–3·86), and malignancy (OR 0·51, 95% CI 0·26–1·00). The availability of an easy and rapid clinical prediction rule for early identification of RVS can be used to help guide the timely and individualized management of these serious infections.
Staphylococcus aureus is a cause of community- and healthcare-acquired infections and is associated with substantial morbidity, mortality, and costs. Vancomycin minimum inhibitory concentrations (MICs) among S. aureus have increased, and reduced vancomycin susceptibility (RVS) may be associated with treatment failure. We aimed to identify clinical risk factors for RVS in S. aureus bacteremia.
Academic tertiary care medical center and affiliated urban community hospital.
Cases were patients with RVS S. aureus isolates (defined as vancomycin E-test MIC >1.0 μg/mL). Controls were patients with non-RVS S. aureus isolates.
Of 392 subjects, 134 (34.2%) had RVS. Fifty-eight of 202 patients (28.7%) with methicillin-susceptible S. aureus (MSSA) isolates had RVS, and 76 of 190 patients (40.0%) with methicillin-resistant S. aureus (MRSA) isolates had RVS (P = .02). In unadjusted analyses, prior vancomycin use was associated with RVS (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.00–4.32; P = .046). In stratified analyses, there was significant effect modification by methicillin susceptibility on the association between vancomycin use and RVS (P = .04). In multivariate analyses, after hospital of admission and prior levofloxacin use were controlled for, the association between vancomycin use and RVS was significant for patients with MSSA infection (adjusted OR, 4.02; 95% CI, 1.11–14.50) but not MRSA infection (adjusted OR, 0.87; 95% CI, 0.36–2.13).
A substantial proportion of patients with S. aureus bacteremia had RVS. The association between prior vancomycin use and RVS was significant for patients with MSSA infection but not MRSA infection, suggesting a complex relationship between the clinical and molecular epidemiology of RVS in S. aureus.
We are developing a device, the MEMS flux concentrator, that will greatly decrease the effect of 1/f noise in magnetic sensors. It does this by modulating the incoming signal and thus shifting the operating frequency of the sensor. This is accomplished by placing flux concentrators on MEMS structures that oscillate at kHz frequencies. Depending upon the sensor, shifting the operating frequency reduces the 1/f noise by one to three orders of magnitude at one Hz. We have succeeded in fabricating the necessary MEMS structures and observing the desired kHz normal mode resonant frequency. Only microwatts are required to drive the motion. We have used spin valves for our magnetic sensors. The measured field enhancement provided by the flux concentrators agrees to within 3% with the value estimated from finite element calculations. Noise measurements provide strong evidence that the device is likely to reduce the effect of 1/f noise. Flip chip bonding is likely to allow us to fabricate complete, fully functioning sensors.
XANES (X-ray Absorption Near Edge Spectroscopy) has been employed to evaluate the efficacy of a process designed to encapsulate and reduce TcO4- in cement matrices, thereby immobilizing Tc. The oxidation state of Se following bioremediation of Se by bacteria has also been determined by XANES. The XANES measurements were performed at the Stanford Synchrotron Radiation Laboratory (SSRL) and the National Synchrotron Light Source (NSLS) at the respective K edges of Tc (21.0 keV) and Se (12.7 keV). Comparison of the XANES spectra of Tc in untreated cement to Tc in slag treated cement and to the chemical shifts of reference materials, shows that the oxidation state of Tc is the same in both cements. Thus, the addition of a reducing agent to the cement formulation does not significantly reduce the TcO4-. The common soil bacterium, Bacillus subtilis, is known to incorporate Se on or within the cell wall when exposed to a Se(IV) solution. The Se XANES spectra of B. subtilis, as well as bacillus isolated from selenium rich soil, show that the organisms reduce selenite to the red allotrope of elemental Se.
Uranium L3-edge x-ray absorption spectra have been measured for uranium-mineral sorption systems. An expansible layer silicate, vermiculite, was treated to obtain a collapsed phase, thereby limiting access to the interior cation exchange sites. Samples were prepared by exposing the finely powdered mineral, in the natural and modified form, to aqueous solutions of uranyl chloride. EXAFS spectra of the encapsulated samples were measured at the Stanford Synchrotron Radiation Laboratory. Results indicate that the uranyl ion possesses a more symmetric local structure for the natural vermiculite than for the collapsed form, suggesting structural differences between uranyl species within the interlayer regions of vermiculite and on the external surfaces.
A multilayer sample of amorphous SiC (α-SiC) and polycrystalline Ni was prepared by ionbeam sputtering, and was used as a model, prototype system to study the stability of metal contacts with SiC against interdiffusion reactions near the interface. The modulation wavelength is around 80 nm and with equal thickness of α-SiC and Ni layers. By use of XRD, TEM and energy dispersive spectroscopy (EDS), information on the structural evolution and composition distribution during heat treatment was obtained. The diffusion of Ni into the SiC layer, and Si and C into the Ni layer appears to take place concurrently during the annealing process. An amorphous reaction layer was formed during the heat treatment that is distinct from the α-SiC. The increase in thickness of the reaction layer followed a parabolic time dependence in the initial stage, until further reaction was limited by the precipitation of a graphite layer near the original α-SiC/Ni interface. A metastable intermediate phase and a NiSi phase were identified in the original Ni layer due to the diffusion of Si and C based on the decomposition of the α-SiC.
The oxidation of Si catalyzed by 170-nm-thick Cu3Si at elevated temperatures has been investigated by transmission electron microscopy and Auger electron spectroscopy. For wet oxidation at 140–180 °C, the growth rate of the oxide layer was increased with the temperature. On the other hand, as the temperature was increased above 200 °C, the growth rate slowed down. The growth kinetics of oxide was investigated. Controlling mechanisms for the growth of oxide owing to the grain growth of Cu3Si are discussed. The activation energy for the linear growth of oxide was measured to be 0. 19 ± 0.1 eV.
Interfacial reactions of high-temperature sputtered Ti thin films on preamorphized (001)Si have been investigated by high-resolution transmission electron microscopy in conjunction with auto-correlation function analysis. Simultaneous presence of multiphases was found to occur in the amorphous TiSix layer at the Ti/Si interface. The enhanced transformation of C54-TiSi2 in high-temperature deposited samples is attributed to the more extensive presence of silicide crystallites, which serve as nucleation sites, in the a-TiSix layer than that in samples deposited at room temperature.