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Disease surveillance in wildlife populations presents a logistical challenge, yet is critical in gaining a deeper understanding of the presence and impact of wildlife pathogens. Erinaceus coronavirus (EriCoV), a clade C Betacoronavirus, was first described in Western European hedgehogs (Erinaceus europaeus) in Germany. Here, our objective was to determine whether EriCoV is present, and if it is associated with disease, in Great Britain (GB). An EriCoV-specific BRYT-Green® real-time reverse transcription PCR assay was used to test 351 samples of faeces or distal large intestinal tract contents collected from casualty or dead hedgehogs from a wide area across GB. Viral RNA was detected in 10.8% (38) samples; however, the virus was not detected in any of the 61 samples tested from Scotland. The full genome sequence of the British EriCoV strain was determined using next generation sequencing; it shared 94% identity with a German EriCoV sequence. Multivariate statistical models using hedgehog case history data, faecal specimen descriptions and post-mortem examination findings found no significant associations indicative of disease associated with EriCoV in hedgehogs. These findings indicate that the Western European hedgehog is a reservoir host of EriCoV in the absence of apparent disease.
Uncontrolled pain in advanced cancer is a common problem and has significant impact on individuals’ quality of life and use of healthcare resources. Interventions to help manage pain at the end of life are available, but there is limited economic evidence to support their wider implementation. We conducted a case study economic evaluation of two pain self-management interventions (PainCheck and Tackling Cancer Pain Toolkit [TCPT]) compared with usual care.
We generated a decision-analytic model to facilitate the evaluation. This modelled the survival of individuals at the end of life as they moved through pain severity categories. Intervention effectiveness was based on published meta-analyses results. The evaluation was conducted from the perspective of the U.K. health service provider and reported cost per quality-adjusted life-year (QALY).
PainCheck and TCPT were cheaper (respective incremental costs -GBP148 [-EUR168.53] and -GBP474 [-EUR539.74]) and more effective (respective incremental QALYs of 0.010 and 0.013) than usual care. There was a 65 percent and 99.5 percent chance of cost-effectiveness for PainCheck and TCPT, respectively. Results were relatively robust to sensitivity analyses. The most important driver of cost-effectiveness was level of pain reduction (intervention effectiveness). Although cost savings were modest per patient, these were considerable when accounting for the number of potential intervention beneficiaries.
Educational and monitoring/feedback interventions have the potential to be cost-effective. Economic evaluations based on estimates of effectiveness from published meta-analyses and using a decision modeling approach can support commissioning decisions and implementation of pain management strategies.
To investigate whether amnestic mild cognitive impairment (aMCI) identified with visual memory tests conveys an increased risk of Alzheimer’s disease (risk-AD) and if the risk-AD differs from that associated with aMCI based on verbal memory tests.
4,771 participants aged 70.76 (SD = 6.74, 45.4% females) from five community-based studies, each a member of the international COSMIC consortium and from a different country, were classified as having normal cognition (NC) or one of visual, verbal, or combined (visual and verbal) aMCI using international criteria and followed for an average of 2.48 years. Hazard ratios (HR) and individual patient data (IPD) meta-analysis analyzed the risk-AD with age, sex, education, single/multiple domain aMCI, and Mini-Mental State Examination (MMSE) scores as covariates.
All aMCI groups (n = 760) had a greater risk-AD than NC (n = 4,011; HR range = 3.66 – 9.25). The risk-AD was not different between visual (n = 208, 17 converters) and verbal aMCI (n = 449, 29 converters, HR = 1.70, 95%CI: 0.88, 3.27, p = 0.111). Combined aMCI (n = 103, 12 converters, HR = 2.34, 95%CI: 1.13, 4.84, p = 0.023) had a higher risk-AD than verbal aMCI. Age and MMSE scores were related to the risk-AD. The IPD meta-analyses replicated these results, though with slightly lower HR estimates (HR range = 3.68, 7.43) for aMCI vs. NC.
Although verbal aMCI was most common, a significant proportion of participants had visual-only or combined visual and verbal aMCI. Compared with verbal aMCI, the risk-AD was the same for visual aMCI and higher for combined aMCI. Our results highlight the importance of including both verbal and visual memory tests in neuropsychological assessments to more reliably identify aMCI.
To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).
Retrospective observational cohort study.
This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.
The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.
To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.
The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).
These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.
A controversy at the 2016 IUCN World Conservation Congress on the topic of closing domestic ivory markets (the 007, or so-called James Bond, motion) has given rise to a debate on IUCN's value proposition. A cross-section of authors who are engaged in IUCN but not employed by the organization, and with diverse perspectives and opinions, here argue for the importance of safeguarding and strengthening the unique technical and convening roles of IUCN, providing examples of what has and has not worked. Recommendations for protecting and enhancing IUCN's contribution to global conservation debates and policy formulation are given.
Sea ice is generally covered with snow, which can vary in thickness from a few centimeters to >1 m. Snow cover acts as a thermal insulator modulating the heat exchange between the ocean and the atmosphere, and it impacts sea-ice growth rates and overall thickness, a key indicator of climate change in polar regions. Snow depth is required to estimate sea-ice thickness using freeboard measurements made with satellite altimeters. The snow cover also acts as a mechanical load that depresses ice freeboard (snow and ice above sea level). Freeboard depression can result in flooding of the snow/ice interface and the formation of a thick slush layer, particularly in the Antarctic sea-ice cover. The Center for Remote Sensing of Ice Sheets (CReSIS) has developed an ultra-wideband, microwave radar capable of operation on long-endurance aircraft to characterize the thickness of snow over sea ice. The low-power, 100 mW signal is swept from 2 to 8 GHz allowing the air/snow and snow/ ice interfaces to be mapped with 5 cm range resolution in snow; this is an improvement over the original system that worked from 2 to 6.5 GHz. From 2009 to 2012, CReSIS successfully operated the radar on the NASA P-3B and DC-8 aircraft to collect data on snow-covered sea ice in the Arctic and Antarctic for NASA Operation IceBridge. The radar was found capable of snow depth retrievals ranging from 10 cm to >1 m. We also demonstrated that this radar can be used to map near-surface internal layers in polar firn with fine range resolution. Here we describe the instrument design, characteristics and performance of the radar.
We have built and operated an ultra-wideband UHF pulsed-chirp radar for measuring firn stratigraphy from airborne platforms over the ice sheets of Greenland and West Antarctica. Our analysis found a wide range of capabilities, including imaging of post firn–ice transition horizons and sounding of shallow glaciers and ice shelves. Imaging of horizons to depths exceeding 600 m was possible in the colder interior regions of the ice sheet, where scattering from the ice surface and inclusions was minimal. The radar’s high sensitivity and large dynamic range point to loss tangent variations as the dominant mechanism for these englacial reflective horizons. The radar is capable of mapping interfaces with reflection coefficients as low as −80 dB near the firn–ice transition and as low as −64 dB at depths of 600 m. We found that firn horizon reflectivity strongly mirrored density variance, a result of the near-unity interfacial transmission coefficients. Zones with differing compaction mechanisms were also apparent in the data. We were able to sound many ice shelves and areas of shallow ice. We estimated ice attenuation rates for a few locations, and our attenuation estimates for the Ross Ice Shelf, West Antarctica, appear to agree well with earlier reported results.
Obsessive-compulsive disorder (OCD) is associated with variable risk of suicide and prevalence of suicide attempt (SA). The present study aimed to assess the prevalence of SA and associated sociodemographic and clinical features in a large international sample of OCD patients.
A total of 425 OCD outpatients, recruited through the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) network, were assessed and categorized in groups with or without a history of SA, and their sociodemographic and clinical features compared through Pearson’s chi-squared and t tests. Logistic regression was performed to assess the impact of the collected data on the SA variable.
14.6% of our sample reported at least one SA during their lifetime. Patients with an SA had significantly higher rates of comorbid psychiatric disorders (60 vs. 17%, p<0.001; particularly tic disorder), medical disorders (51 vs. 15%, p<0.001), and previous hospitalizations (62 vs. 11%, p<0.001) than patients with no history of SA. With respect to geographical differences, European and South African patients showed significantly higher rates of SA history (40 and 39%, respectively) compared to North American and Middle-Eastern individuals (13 and 8%, respectively) (χ2=11.4, p<0.001). The logistic regression did not show any statistically significant predictor of SA among selected independent variables.
Our international study found a history of SA prevalence of ~15% in OCD patients, with higher rates of psychiatric and medical comorbidities and previous hospitalizations in patients with a previous SA. Along with potential geographical influences, the presence of the abovementioned features should recommend additional caution in the assessment of suicide risk in OCD patients.
Volumetric atrophy and microstructural alterations in diffusion tensor imaging (DTI) measures of the hippocampus have been reported in people with Alzheimer's disease (AD) and mild cognitive impairment (MCI). However, no study to date has jointly investigated concomitant microstructural and volumetric changes of the hippocampus in dementia with Lewy bodies (DLB).
A total of 84 subjects (23 MCI, 17 DLB, 14 AD, and 30 healthy controls) were recruited for a multi-modal imaging (3T MRI and DTI) study that included neuropsychological evaluation. Freesurfer was used to segment the total hippocampus and delineate its subfields. The hippocampal segmentations were co-registered to the mean diffusivity (MD) and fractional anisotropy (FA) maps obtained from the DTI images.
Both AD and MCI groups showed significantly smaller hippocampal volumes compared to DLB and controls, predominantly in the CA1 and subiculum subfields. Compared to controls, hippocampal MD was elevated in AD, but not in MCI. DLB was characterized by both volumetric and microstructural preservation of the hippocampus. In MCI, higher hippocampal MD was associated with greater atrophy of the hippocampus and CA1 region. Hippocampal volume was a stronger predictor of memory scores compared to MD within the MCI group.
Through a multi-modal integration, we report novel evidence that the hippocampus in DLB is characterized by both macrostructural and microstructural preservation. Contrary to recent suggestions, our findings do not support the view that DTI measurements of the hippocampus are superior to volumetric changes in characterizing group differences, particularly between MCI and controls.
We studied neuroinflammation in individuals with late-life, depression, as a
risk factor for dementia, using [11C]PK11195 positron emission
tomography (PET). Five older participants with major depression and 13
controls underwent PET and multimodal 3T magnetic resonance imaging (MRI),
with blood taken to measure C-reactive protein (CRP). We found significantly
higher CRP levels in those with late-life depression and raised
[11C]PK11195 binding compared with controls in brain regions
associated with depression, including subgenual anterior cingulate cortex,
and significant hippocampal subfield atrophy in cornu ammonis 1 and
subiculum. Our findings suggest neuroinflammation requires further
investigation in late-life depression, both as a possible aetiological
factor and a potential therapeutic target.
The main purpose of coatings is to increase the lifetime of cutting tools, to perform continuous and economical material removal process, reducing the frequency of sharpening or replacement of the tool, which contributes to increase quality of product. Therefore, hafnium nitride (HfN) single layer coatings were deposited on High-speed steel by Magnetron Sputtering physical vapour deposition (PVD). The machining on AISI 1020 steel samples were carried out in a computer numerical control (CNC) machine, using coated and uncoated tools, the temperature of the different components were measured (steel bar and tool), due to continuous temperature measurement help to predict tool wear and the quality of finished piece  . In order to evaluate wear resistance and performance, not only temperature data were compared, the tool wear morphological analysis for flank wear was carried using Scanning Electron Microscopy (SEM), and work pieces roughness were checked through their surfaces in an Atomic Force Microscopy (AFM). In most of the parameters evaluated differences between the tools were identified, and results reveals that on HfN coating, occurs less wear, due the proportionality between the energy transfer and the tool deterioration, also the coating improves surface finish of the machined part; all of them are reflected in changes on process temperatures. The use of single layer HfN coating on cutting tools could increase their lifetime, improve the quality of the work piece, and even reduce process time and cost.
The San Francisco Fire Department’s (SFFD; San Francisco, California USA) Homeless Outreach and Medical Emergency (HOME) Team is the United States’ first Emergency Medical Services (EMS)-based outreach effort using a specially trained paramedic to redirect frequent users of EMS to other types of services. The effectiveness of this program at reducing repeat use of emergency services during the first seven months of the team’s existence was examined.
A retrospective analysis of EMS use frequency and demographic characteristics of frequent users was conducted. Clients that used emergency services at least four times per month from March 2004 through May 2005 were contacted for intervention. Patterns for each frequent user before and after intervention were analyzed. Changes in EMS use during the 15-month study interval was the primary outcome measurement.
A total of 59 clients were included. The target population had a median age of 55.1 years and was 68% male. Additionally, 38.0% of the target population was homeless, 43.4% had no primary care, 88.9% had a substance abuse disorder at time of contact, and 83.0% had a history of psychiatric disorder. The HOME Team undertook 320 distinct contacts with 65 frequent users during the study period. The average EMS use prior to HOME Team contact was 18.72 responses per month (SD=19.40), and after the first contact with the HOME Team, use dropped to 8.61 (SD=10.84), P<.001.
Frequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage.
TangherliniN, VillarJ, BrownJ, RodriguezRM, YehC, FriedmanBT, WadaP. The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS. Prehosp Disaster Med. 2016;31(6):603–607.
A new radiocarbon accelerator mass spectrometry (AMS) laboratory for carbon cycle studies has been established at the University of California, Irvine. The 0.5MV AMS system was installed in mid-2002 and has operated routinely since October of that year. This paper briefly describes the spectrometer and summarizes lessons learned during the first year of operation. In the process of setting up the system, we identified and largely suppressed a previously unreported 14C AMS background: charge exchange tails from 14N beams derived from nitrogen-containing molecular ions produced near the entrance of the accelerator.
Radiocarbon (Δ14C) measurements of monthly samples from a Galapagos surface coral are among the first data sets from the new Keck Carbon Cycle Accelerator Mass Spectrometry laboratory at the University of California, Irvine. An average Δ14C value of −62 is obtained for 144 measurements of samples from monthly coral bands that lived from about AD 1760–1771 (±6 yr). High Δ14C values were found during January through March, when upwelling was weak or absent at the Galapagos Islands. Low Δ14C values were obtained mid-year during strong upwelling. The average seasonal variability of Δ14C was 15–25, which is greater than that at other tropical and subtropical locations in the Pacific Ocean because of intense seasonal upwelling at this site. Periods of sustained high Δ14C values were found during 1762–1763 and 1766. A spectral analysis revealed that the spectral density for the Δ14C data displays most of its variance at the 5-yr cycle, which is reflective of El Niño periodicity during the 20th century.
Primary and secondary standards are essential in radiocarbon analyses for the purpose of reporting and comparing data among laboratories, as well as for internal laboratory data quality control. ANU sucrose is one of the IAEA-certified 14C standards (C-6) with a consensus value of 1.5061 ± 0.0011 fraction modern (Fm). All of our measurements of ANU sucrose (n = 351) as a secondary standard over the last 7 yr result in an average value of 1.5016 ± 0.0005 Fm (2-σ standard error). After applying the same outlier tests used for IAEA reference standards, a weighted average value of 1.5016 ± 0.0002 Fm (n = 294) was calculated. This value is significantly lower than the IAEA C-6 consensus value (t test with unequal variance; p = 0.023). In contrast, our measurements of other secondary standards over the same time period are in excellent agreement with their respective consensus values. Since ANU is the only secondary standard measured in our lab that does not agree with the consensus values, and we have measured a larger number analyses compared to what went into the definition of the consensus value, we suggest that the consensus value of ANU sucrose might be too high by ∼0.0045 ± 0.0011 Fm. Given that some labs routinely use ANU sucrose as a primary standard, our results suggest that revisiting the consensus value of ANU sucrose may be necessary.
As the population ages, older people account for a greater proportion of the health and social care budget. Whereas some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people.
To evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England.
A pilot pragmatic individual randomised controlled trial comparing group singing with usual activities in those aged 60 years or more.
A total of 258 participants were recruited across five centres in East Kent. At 6 months post-randomisation, significant differences were observed in terms of mental health-related quality of life measured using the SF12 (mean difference = 2.35; 95% CI = 0.06–4.76) in favour of group singing. In addition, the intervention was found to be marginally more cost-effective than usual activities. At 3 months, significant differences were observed for the mental health components of quality of life (mean difference = 4.77; 2.53–7.01), anxiety (mean difference =–1.78; –2.5 to –1.06) and depression (mean difference =–1.52; –2.13 to –0.92).
Community group singing appears to have a significant effect on mental health-related quality of life, anxiety and depression, and it may be a useful intervention to maintain and enhance the mental health of older people.