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Atomic layer deposition (ALD) was used to deposit a laminate structure of alternating SiO2 and TiO2 monolayers onto a Si wafer. The resulting samples were analyzed in detail by X-ray photoelectron spectroscopy (XPS) revealing a distinct O 1s signature due to the presence of Si-O-Ti species. These findings are in good agreement with those reported for thin ALD films of TiO2 grown on SiO2.
We investigated longitudinal relations among gaze following and face scanning in infancy and later language development. At 12 months, infants watched videos of a woman describing an object while their passive viewing was measured with an eye-tracker. We examined the relation between infants' face scanning behavior and their tendency to follow the speaker's attentional shift to the object she was describing. We also collected language outcome measures on the same infants at 18 and 24 months. Attention to the mouth and gaze following at 12 months both predicted later productive vocabulary. The results are discussed in terms of social engagement, which may account for both attentional distribution and language onset. We argue that an infant's inherent interest in engaging with others (in addition to creating more opportunities for communication) leads infants to attend to the most relevant information in a social scene and that this information facilitates language learning.
We investigated the first cluster of pandemic influenza H1N1 2009 reported in Brazil in May 2009. The index case-patient had travelled from the USA and had contact with 11 relatives before she presented with symptoms. We conducted face-to-face or telephone interviews with the index case-patient and all suspect cases. We found evidence of pre-symptomatic transmission of the virus to four of her contacts. This finding has public health implications because it indicates that viral transmission in communities may not be prevented solely by isolating symptomatic case-patients.
We investigated a possible outbreak of H. pylori in a rural Northern Plains community. In a cross-sectional survey, we randomly sampled 244 households from a geocoded emergency medical system database. We used a complex survey design and global positioning system units to locate houses and randomly selected one eligible household member to administer a questionnaire and a 13C-urea breath test for active H. pylori infection (n = 166). In weighted analyses, active H. pylori infection was detected in 55·0% of the sample. Factors associated with infection on multivariate analysis included using a public drinking-water supply [odds ratio (OR) 12·2, 95% confidence interval (CI) 2·9–50·7] and current cigarette smoking (OR 4·1, 95% CI 1·7–9·6). People who lived in houses with more rooms, a possible indicator of decreased crowding in the home, were less likely to have active H. pylori infections (OR 0·7, 95% CI 0·5–0·9 for each additional room).
Visceral leishmaniasis (VL) is an endemic parasitic disease transmitted by the bite of sand flies. To describe trends and demographics of reported VL cases, we reviewed surveillance data from 1990–2009. Reported VL incidence per 100 000 population was 2·6 in 2007, 3·1 in 2008, and 4·8 in 2009, mostly in children aged <5 years. The number of cases varied greatly in step with prevailing economic and security conditions, raising concerns about the completeness and quality of surveillance data. Nevertheless, we conclude that VL remains an important endemic disease in Iraq and that surveillance system is recovering the capacity to detect cases as the country experiences greater stability. We recommend conducting formal entomological investigations, and evaluating existing control measures.
An outbreak of meningococcal disease (MD) with severe morbidity and mortality was investigated in midwestern Brazil in order to identify control measures. A MD case was defined as isolation of Neisseria meningitidis, or detection of polysaccharide antigen in a sterile site, or presence of clinical purpura fulminans, or an epidemiological link with a laboratory-confirmed case-patient, between June and August 2008. In 8 out of 16 MD cases studied, serogroup C ST103 complex was identified. Five (31%) cases had neurological findings and five (31%) died. The attack rate was 12 cases/100 000 town residents and 60 cases/100 000 employees in a large local food-processing plant. We conducted a matched case-control study of eight primary laboratory-confirmed cases (1:4). Factors associated with illness in single variable analysis were work at the processing plant [matched odds ratio (mOR) 22, 95% confidence interval (CI) 2·3–207·7, P<0·01], and residing <1 year in Rio Verde (mOR 7, 95% CI 1·11–43·9, P<0·02). Mass vaccination (>10 000 plant employees) stopped propagation in the plant, but not in the larger community.
Louis J. Kraus, Womans Board Professor of Child and Adolescent Psychiatry and Chief Department of Child and Adolescent Psychiatry, Rush University Medical Center Marshal Field IV Building 1720 West Polk Street Chicago, IL 60612 USA,
Hollie Sobel, Assistant Professor of Psychiatry and Behavioral Sciences, Rush University Medical Center 1720 West Polk Street Chicago, IL 60612 USA
The post-adjudicatory evaluation serves to assess the child in association with review of all available collateral information. The referral for this type of evaluation typically comes from the court, possibly probation, or any of the involved attorneys. Consistency in the evaluation, knowledge of available community resources, and expertise in juvenile delinquency, in the context of a developmental framework, are all necessary so that appropriate interventions can be put into place. The post-adjudicatory, or dispositional, stage is considered the most critical decision-making component of juvenile court. An understanding of local and available facilities is important, including wraparound services, residential programs, and community-based services that can be included within the wraparound interventions. It is important to identify one's role within the evaluation, and for the youth to realize that the purpose of the assessment is not for treatment, nor is it confidential.
Dispersed community outbreaks of Shigella sonnei have occurred cyclically among traditionally observant Jews in the United States. In February 2000, we investigated a S. sonnei outbreak in one Jewish community in New York City. To determine risk factors for introduction of infection into households, we conducted a cohort study of households to compare risk factors for illness among primary subjects within households and age-matched well siblings. Isolates were subtyped by pulsed-field gel electrophoresis (PFGE). We used a random effects model to assess extra-household vs. intra-household transmission in households with multiple ill household members. Daycare or pre-school attendance [matched odds ratio (mOR) 16·1, P<0·001] and age <60 months (mOR 6·3, P<0·001) were independently associated with index subject illness. Outbreak isolates were closely related by PFGE analysis to the strain previously observed in Jewish community outbreaks. The random effects model strongly indicated that multiple illnesses in a single household are due to secondary transmission. Disease containment efforts should focus on reducing Shigella transmission in childcare settings and within homes.
The beneficial role of gastrointestinal endoscopy for the prevention, diagnosis, and treatment of many digestive diseases and cancer is well established. Like many sophisticated medical devices, the endoscope is a complex, reusable instrument that requires reprocessing before being used on subsequent patients. The most commonly used methods for reprocessing endoscopes result in high-level disinfection. To date, all published episodes of pathogen transmission related to gastrointestinal endoscopy have been associated with failure to follow established cleaning and disinfection/sterilization guidelines or use of defective equipment. Despite the strong published data regarding the safety of endoscope reprocessing, concern over the potential for pathogen transmission during endoscopy has raised questions about the best methods for disinfection or sterilization of these devices between patient uses.
We conducted a study in a squatter settlement in Karachi, Pakistan where residents report commonly washing their hands to determine if providing soap, encouraging hand washing, and improving wash-water quality would improve hand cleanliness. We allocated interventions to 75 mothers and collected hand-rinse samples on unannounced visits. In the final model compared with mothers who received no hand-washing intervention, mothers who received soap would be expected to have 65% fewer thermotolerant coliform bacteria on their hands (95% CI 40%, 79%) and mothers who received soap, a safe water storage vessel, hypochlorite for water treatment, and instructions to wash their hands with soap and chlorinated water would be expected to have 74% fewer (95% CI 57%, 84%). The difference between those who received soap alone, and those who received soap plus the safe water vessel was not significant (P = 0·26). Providing soap and promoting hand washing measurably improved mothers' hand cleanliness even when used with contaminated water.
In 1995, Salmonella Enteritidis (SE) cases in the state of Utah increased fivefold. Isolates were
identified as phage type 4 (PT4). Risk factors and sources of infection were investigated in two
case-control studies, a traceback of implicated foods, and environmental testing. Forty-three
patients with sporadic infections and 86 controls were included in a case-control study of risk
factors for infection. A follow-up case-control study of 25 case and 19 control restaurants
patronized by case and control patients examined risks associated with restaurant practices. In
the first case-control study, restaurant dining was associated with illness (P = 0·002). In the
follow-up case-control study, case restaurants were likelier to use > 2000 eggs per week
(P < 0·02), to pool eggs (P < 0·05), and to use eggs from cooperative ‘A’ (P < 0·009). Eggs
implicated in separately investigated SE PT4 outbreaks were traced to cooperative ‘A’, and SE
PT4 was cultured from one of the cooperative's five local farms. We conclude that SE PT4
transmitted by infected eggs from a single farm caused a fivefold increase in human infections
To evaluate the in vitro activity of antiseptics and detergents against Candida.
One strain each of Candida albicans, Candida tropicalis, Candida lusitaniae, Candida parapsilosis, Candida kefyr, Candida glabrata, and an American Type Culture Collection strain of Escherichia coli (control) were studied. Clinical isolates were obtained from patients in a bone marrow unit of a large tertiary hospital. Antiseptic and disinfectant agents studied were used in the hospital where isolates were identified for cleaning of inanimate surfaces or hand washing. In vitro susceptibility was determined using a broth macrodilution method with exposure times to antiseptic or disinfectant agent of 15 seconds to 4 minutes and concentrations of agents that ranged from undiluted to 1:10,000 dilution.
A 900-bed teaching hospital.
Of disinfectants tested, Vestal and Sparquat inhibited growth of all species at dilutions of ≤1:100 at all contact times for all species. Clorox showed inhibition of growth at 1:100 dilution after 30 seconds of contact time for all isolates. Of antiseptics studied, Hibiclens inhibited growth of all species except C tropicalis at dilutions of ≤1:100 at all contact times and for C tropicalis after 60 seconds. Clinidine inhibited growth of all species at dilutions of ≤1:100 at all contact times for all species with the exception of C glabrata and C tropicalis, which grew at the undiluted concentration. Ultradex failed to demonstrate killing of any species for any dilutions tested.
The results of this study show varying degrees of in vitro inhibition of growth by a variety of antiseptics and disinfectants against clinical isolates of Candida species from hospitalized patients.
Lack of reliable data about street vendors, who are difficult to survey, has hampered efforts to
improve the safety of street-vended food. A two-phase method for sampling vendors, surveying
first in areas of concentrated vending activity identified by local authorities and second in
randomly selected areas, was developed and implemented in two Guatemalan cities where
street-vended food had been implicated in cholera transmission. In a 4-day survey in Escuintla,
59 vendors (42 from phase 1, 17 from phase 2) were interviewed. They demonstrated good
knowledge of food safety and cholera but unsafe practices, implying that more effective,
practical training was needed. In a 6-day survey in Guatemala City, 78 vendors (77 from phase
1, 1 from phase 2) were interviewed. Sixty-eight (87%) vendors stored water, usually in wide-mouthed vessels prone to contamination; this led to a field test of a new system for safe water
storage. Useful information for public health planning and intervention can be gathered rapidly
with this new method for surveying street vendors.
In a job-shop manufacturing environment, consider a model in which the “job” is processed at several stages with random yields. Nondefective items move through the stages to supply a possibly random demand. At each stage there are linear costs of processing and work-in-process inventories and there are convex costs of end-item inventory. Decisions specify the lot sizes that are processed at the various stages. Easy computations specify a simply structured decision rule that minimizes the expected total cost.
Assigning each arriving customer to the fastest idle server is shown to maximize throughput (equivalently, minimize blocking probability) in a queueing model with Poisson arrivals, heterogeneous exponential servers, and no waiting room. If a cost structure is imposed on this model, under specified conditions the same policy minimizes the expected discounted cost and the long-run average cost per unit time.
Formulae are presented for the variance and higher moments of the present value of single-stage rewards in a finite Markov decision process. Similar formulae are exhibited for a semi-Markov decision process. There is a short discussion of the obstacles to using the variance formula in algorithms to maximize the mean minus a multiple of the standard deviation.
This essay is arranged in three sections. In the first I consider interaction problems that can frustrate maximizers. My object here is to add to the kind of case discussed by Gauthier, another in which maximizers would not do well. In the next section I set out conditions under which ‘straight’ or ordinary maximizers could avoid their problems as surely and as easily as could Gauthier's ‘constrained’ maximizers. And in the last section I comment on the relative merits of straight and ‘constrained’ maximization. Attention here is paid first to the suggestion that straight maximizers in view of their problems would choose not to be straight maximizers, would indeed choose to be ‘constrained’ maximizers, and that this shows that there is something wrong with straight maximization. Rejecting this inference, I turn in conclusion to the idea that it follows from the ‘incompleteness’ of straight maximization, from the fact that it is not always possible, that there is something wrong with it. This inference too is rejected.
Nonzero-sum N-person stochastic games are a generalization of Shapley's two-person zero-sum terminating stochastic game. Rogers and Sobel showed that an equilibrium point exists when the sets of states, actions, and players are finite. The present paper treats discounted stochastic games when the sets of states and actions are given by metric spaces and the set of players is arbitrary. The existence of an equilibrium point is proven under assumptions of continuity and compactness.
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