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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.
The effects of shape and thickness of a tin surface layer and of the energy of a 170 ps neodymium:yttrium-aluminum-garnet laser pulse on the conversion efficiency (CE) into extreme ultraviolet emission in the 13.5 nm region is investigated. Whereas a CE of up to 1.16% into the 2% reflection band of multilayer Mo/Si optics was measured for a bulk Sn target at a laser energy of 25 mJ, significant CE enhancement up to 1.49% is demonstrated for a 200-nm-thick Sn layer on a microstructured porous alumina substrate.
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.
Epidemiological studies have established an association between obesity, insulin resistance, type 2 diabetes and a number of cancer types. Research has focused predominantly on altered endocrine factors, growth factors and signalling pathways, with little known in man about the immune involvement in the relevant pathophysiological processes. Moreover, in an era of exciting new breakthroughs in cancer immunotherapy, there is also a need to study the safety and efficacy of immunotherapeutics in the complex setting of inflammatory-driven obesity-associated cancer. This review addresses key immune cell subsets underpinning obesity-associated inflammation and describes how such immune compartments might be targeted to prevent and treat obesity-associated cancer. We propose that the modulation, metabolism, migration and abundance of pro- and anti-inflammatory cells and tumour-specific T cells might be therapeutically altered to both restore immune balance, alleviating pathological inflammation, and to improve anti-tumour immune responses in obesity-associated cancer.
A number of observers have noted the presence of bright structures near the cores of the chromospheric rosettes when observed in the far wings of the Hα line (eg Hα ±7/8 Å). Dunn and Zirker observed these bright structures with the highest possible resolution using the Sacramento Peak vacuum solar telescope. They find that these bright regions exhibit a very intricate fine structure which can be followed out much further into the Hα line wing (eg Hα + 2 Å) and even into the continuum. They called this fine structure ‘solar filigree’, the name referring mainly to the collective appearance of the fine structure elements. The elements themselves appear as dot-like structures and frequently also as small wiggly structures called ‘crinkles’. The properties of the filigree structure are summarized as follows:
(i)Size: Measured diameter of the crinkles and dots equals 0.25, 0.40 and 0.60″ at Hα + 2 Å, Hα ± 7/8 Å and Hα ±5/8 Å respectively. The telescope resolution equals 0.22″ so that at Hα + 2 Å the structure is extremely small. The drawings in Figure 1 show typical sizes of the crinkles and network patterns in the filigree.
(ii)Contrast: Filigree is enhanced in the blue wing of the Hα line. Measured contrast, uncorrected for seeing, equals 5–10%.
(iii)Relation to the Granulation: The filigree structures tend to lie between the granules. This is, however, not a strict rule. It seems that in the course of their lifetime the granules move the filigree structures around with velocities of about 1.5 km s-1. Some of the crinkles also seem to wash out temporarily until compressed again by a new granule. The detailed structure of the filigree, therefore, changes significantly over times comparable to the granule lifetime. The overall structure is, however, preserved over much longer periods of time. The granulation pattern when observed in the continuum well outside the Hα line appears very peculiar in that it has substantially decreased in contrast. It appears ‘soft’ similar to granulation washed-out by seeing. This abnormal granulation can be traced over long times (> 30 min) and coincides in location to the filigree location. It is, therefore, definitely real.
(iv)Relation to the spicules: The filigree structure falls near the center of the Hα chromospheric rosettes. These rosettes consist of dark elongated mottles which should probably be identified with spicules. There is, therefore, at least a coarse relation between the occurrence of spicules and the filigree. There is no clear evidence that variations in the filigree pattern are related to the generation of spicules. Some spicules seem to originate from the spaces between the crinkles. Too few, however, to conclude a definite relation.
(v)Relation to the magnetic field: Beckers studied the filigree with the Universal Birefringent Filter in the magnesium b1 and b2 lines. It is very well visible in the far wing of the lines (eg. b1 ±0.8 Å). When traced into the line core the structures increase somewhat in size, as they do in Hα, and form structures similar to, and perhaps identical with, the so-called photospheric network. In the magnetically sensitive b2 line one sees a one-to-one correspondence between these network structures and the magnetic field so that, at least in the layers seen near the core of the b2 line, there is a one-to-one correspondence between the filigree structures and the enhancements in the magnetic field. Simon and Zirker (Solar Physics, submitted for publication) using a spectrograph also found that the filigree occurs in regions of enhanced magnetic field. However, in contrast to the filter observations, they found the magnetic field regions to be much more diffuse (2–3″) so that there is not a one-to-one spatial correspondence between filigree and magnetic field structure.
With prevention and treatment of mental disorders a challenge for primary care and increasing capability of electronic medical records (EMRs) to facilitate research in practice, we aim to determine the prevalence and treatment of mental disorders by using routinely collected clinical data contained in EMRs.
We reviewed EMRs of patients randomly sampled from seven general practices, by piloting a study instrument and extracting data on mental disorders and their treatment.
Data were collected on 690 patients (age range 18–95, 52% male, 52% GMS-eligible). A mental disorder (most commonly anxiety/stress, depression and problem alcohol use) was recorded in the clinical records of 139 (20%) during the 2-year study period. While most patients with the common disorders had been prescribed medication (i.e. antidepressants or benzodiazepines), a minority had been referred to other agencies or received psychological interventions. ‘Free text’ consultation notes and ‘prescriptions’ were how most patients with disorders were identified. Diagnostic coding alone would have failed to identify 92% of patients with a disorder.
Although mental disorders are common in general practice, this study suggests their formal diagnosis, disease coding and access to psychological treatments are priorities for future research efforts.
Observation of GaN-based islands surrounded by V-defects in the barrier layer of green LED is reported for InGaN MQWs deposited under no hydrogen or at growth temperatures of less than 800°C. Nanoscale mechanical properties of the areas enclosed and outside of the ring defects does not show any appreciable variation as measured by UFM. Chemical etching of the MQW structure in addition to cross-sectional TEM analysis ruled out the possibility of growth of inversion domains of N-polar GaN in a Ga-polar GaN matrix.
Decompression of the endolymphatic sac for Ménière's disease gives unpredictable results. This may be because the sac is difficult to identify and decompress accurately without causing surgical trauma.
In order to test this idea, transmastoid decompression was simulated in 5 cadaver half heads and the anatomy of the endolymphatic sac was reviewed in a further 14 specimens.
The endolymphatic sac was found and confirmed by histology in all five simulated decompressions. A newly described feature, a trapezoid thickening of dura, was a useful guide. The review showed that the sac was constant proximally, but variable distally. The posterior semicircular canal, posterior fossa dura and sigmoid sinus are at risk during dissection.
The endolymphatic sac may be identified on inspection by an overlying patch of dura, thereby reducing exploratory dissection. It is best to decompress the sac as far proximally as possible, whilst protecting the posterior semicircular canal.
The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009–August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.
It is uncertain whether antipsychotic long-acting injection (LAI) medication in schizophrenia is associated with better clinical outcomes than oral preparations.
To examine the impact of prior treatment delivery route on treatment outcomes and whether any differences are moderated by adherence.
Analysis of data from two pragmatic 1-year clinical trials in which patients with schizophrenia were randomised to either an oral first-generation antipsychotic (FGA), or a non-clozapine second-generation antipsychotic (SGA, CUtLASS 1 study), or a non-clozapine SGA or clozapine (CUtLASS 2 study).
Across both trials, 43% (n = 155) of participants were prescribed an FGA-LAI before randomisation. At 1-year follow-up they showed less improvement in quality of life, symptoms and global functioning than those randomised from oral medication. This difference was confined to patients rated as less than consistently adherent pre-randomisation. The relatively poor improvement in the patients prescribed an LAI pre-randomisation was ameliorated if they had been randomised to clozapine rather than another SGA. There was no advantage to being randomly assigned from an LAI at baseline to a non-clozapine oral SGA rather than an oral FGA.
A switch at randomisation from an LAI to an oral antipsychotic was associated with poorer clinical and functional outcomes at 1-year follow-up compared with switching from one oral antipsychotic to another. This effect appears to be moderated by adherence, and may not extend to switching to clozapine. This has implications for clinical trial design: the drug from which a participant is randomised may have a greater effect than the drug to which they are randomised.
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.
Epifluorescence microscopy was utilized to enumerate halophilic bacterial
populations in two studies involving inoculated, actual radioactive
waste/brine mixtures and pure brine solutions. The studies include an
initial set of experiments designed to elucidate potential transformations
of actinide-containing wastes under salt-repository conditions, including
microbially mediated changes.
The first study included periodic enumeration of bacterial populations of a
mixed inoculum initially added to a collection of test containers. The
contents of the test containers are the different types of actual
radioactive waste that could potentially be stored in nuclear waste
repositories in a salt environment. The transuranic waste was generated from
materials used in actinide laboratory research. The results show that cell
numbers decreased with time. Sorption of the bacteria to solid surfaces in
the test system is discussed as a possible mechanism for the decrease in
The second study was designed to determine radiological and/or chemical
effects of 239Pu, 243Am, 237Np,
232Th and 238U on the growth of pure and mixed
anaerobic, denitrifying bacterial cultures in brine media. Pu, Am, and Np
isotopes at concentrations of ≤1×10–5M, ≤5×10–6M and ≤5×10-4 M
respectively, and Th and U isotopes at concentrations of ≤4×10-3
M were tested in these media. The results indicate that high actinide
concentrations affected both the bacterial growth rate and morphology.
However, relatively minor effects from Am were observed at all tested
concentrations with the pure culture.
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°.
Previous research has suggested that depressed mood may predict outcome
and moderate response to treatment in chronic fatigue syndrome, although
findings have differed between studies.
To examine potential moderators of response to pragmatic rehabilitation
v. general practitioner treatment as usual in a
recent randomised trial for patients with chronic fatigue syndrome in
primary care (IRCTN74156610).
Simple regressions, with weighting adjustments to allow for missing data,
were calculated. Demographic, medical and psychological variables, and
treatment arm, were entered separately and as an interaction term. The
outcome variable in each case was change in Chalder Fatigue Scale scores,
from baseline to 1-year follow-up, our primary outcome point.
Longer illness durations predicted poorer outcome across the two
treatment arms. For patients allocated to pragmatic rehabilitation
compared with those allocated to treatment as usual, higher levels of
depressive symptoms at baseline were associated with smaller improvements
in fatigue (P = 0.022).
For patients in primary care with higher levels of depressive symptoms,
either more intensive or longer pragmatic rehabilitation, or
cognitive–behavioural therapy, may be required in order to show a
significant improvement in fatigue.