This paper integrates seemingly disjoint studies on consumer behavior in micro and macroanalyses via an intertemporal two-stage budgeting procedure with durable goods and liquidity constraints. The model specifies an indirect utility function as a function of nondurable consumption, commodity (nondurables) prices, and durables stock, and derives the demand functions for nondurable goods. A demand function for durable goods is derived in an adjustment cost framework. The consumption growth equation accounts for relative price effects with precautionary saving, durables stock, and liquidity constraints. The stochastic discount factor is approximated by a time-varying linear function of nondurable consumption growth, commodity price growth, durables stock growth, and disposable income growth. The demand functions for six nondurable goods and services are jointly estimated with the Euler equations for bonds, stocks, and durable goods with allowance for liquidity constraints, using US data. Estimation provides new findings for intertemporal consumption and a multifactor consumption-based capital asset pricing model.

Although researchers have described numerous risk factors for salmonellosis and for infection with specific common serotypes, the drivers of Salmonella serotype diversity among human populations remain poorly understood. In this retrospective observational study, we partition records of serotyped non-typhoidal Salmonella isolates from human clinical specimens reported to CDC national surveillance by demographic, geographic and seasonal characteristics and adapt sample-based rarefaction methods from the field of community ecology to study how Salmonella serotype diversity varied within and among these populations in the USA during 1996–2016. We observed substantially higher serotype richness in children <2 years old than in older children and adults and steadily increasing richness with age among older adults. Whereas seasonal and regional variation in serotype diversity was highest among infants and young children, variation by specimen source was highest in adults. Our findings suggest that the risk for infection from uncommon serotypes is associated with host and environmental factors, particularly among infants, young children and older adults. These populations may have a higher proportion of illness acquired through environmental transmission pathways than published source attribution models estimate.

Introduction: When a patient is incapable of making medical decisions for themselves, choices are made according to the patient's previously expressed, wishes, values, and beliefs by a substitute decision maker (SDM). While interventions to engage patients in their own advance care planning exist, little is known about public readiness to act as a SDM on behalf of a loved one. This mixed-methods survey aimed to describe attitudes, enablers and barriers to preparedness to act as a SDM, and support for a population-level curriculum on the role of an SDM in end-of-life and resuscitative care. Methods: From November 2017 to June 2018, a mixed-methods street intercept survey was conducted in Ottawa, Canada. Descriptive statistics and logistic regression analysis were used to assess predictors of preparedness to be a SDM and understand support for a high school curriculum. Responses to open-ended questions were analyzed using inductive thematic analysis. Results: The 430 respondents were mostly female (56.5%) with an average age of 33.9. Although 73.0% of respondents felt prepared to be a SDM, 41.0% of those who reported preparedness never had a meaningful conversation with loved ones about their wishes in critical illness. The only predictors of SDM preparedness were the belief that one would be a future SDM (OR 2.36 95% CI 1.34-4.17), and age 50-64 compared to age 16-17 (OR 7.46 95% CI 1.25-44.51). Thematic enablers of preparedness included an understanding of a patient's wishes, the role of the SDM and strong familial relationships. Barriers included cultural norms, family conflict, and a need for time for high stakes decisions. Most respondents (71.9%) believed that 16 year olds should learn about SDMs. They noted age appropriateness, potential developmental and societal benefit, and improved decision making, while cautioning the need for a nuanced approach respectful of different maturity levels, cultures and individual experiences. Conclusion: This study reveals a concerning gap between perceived preparedness and actions taken in preparation to be an SDM for loved ones suffering critical illness. The results also highlight the potential role for high school education to address this gap. Future studies should further explore the themes identified to inform development of resources and curricula for improved health literacy in resuscitation and end-of-life care.

Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs – popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient–physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers’ clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients’ diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use.

Ten compounds are found in the Ba0-Y203-CuOx system. High temperature (≈950-1000°C) phases identified as Ba4Y2O7 , Ba2Y2O5 , Ba3Y4O9 , BaY2O4 , Y2Cu2O5 , BaCuO2+x, Ba3YCu2OZ BaY2Cu05 and BazYCu306+x are formed in this temperature range. In addition, a new compound with composition of 2BaO:CuO, which possibly has a melting point below 950°C, was prepared at 850°C. A summary o£ the crystallographic data of these 10 phases is given. In particular, results of x-ray studies pertaining to four compounds, BazYCu306+x, which is currently the most promising high To' superconductor material, Ba2Cu03 , BaY2Cu05 , and Ba3YCu20Z are reviewed.

The present experimental investigation characterises the dynamic response and wake structure of a sinusoidally rotating circular cylinder with a low mass ratio (defined as the ratio of the total oscillating mass to the displaced fluid mass) undergoing cross-stream flow-induced vibration (FIV). The study covers a wide parameter space spanning the forcing rotary oscillation frequency ratio $0\leqslant f_{r}^{\ast }\leqslant 4.5$ and the forcing rotation speed ratio $0\leqslant \unicode[STIX]{x1D6FC}_{r}^{\ast }\leqslant 2.0$ , at reduced velocities associated with the vortex-induced vibration (VIV) upper and lower amplitude response branches. Here, $f_{r}^{\ast }=f_{r}/f_{nw}$ and $\unicode[STIX]{x1D6FC}_{r}^{\ast }=\unicode[STIX]{x1D6FA}_{o}D/(2U)$ , where $f_{r}$ is the forcing rotary oscillation frequency, $f_{nw}$ is the natural frequency of the system in quiescent fluid (water), $\unicode[STIX]{x1D6FA}_{o}$ is the peak angular rotation speed, $D$ is the cylinder diameter and $U$ is the free-stream velocity; the reduced velocity is defined by $U^{\ast }=U/(\,f_{nw}D)$ . The fluid–structure system was modelled using a low-friction air-bearing system in conjunction with a free-surface recirculating water channel, with axial rotary motion provided by a microstepping motor. The cylinder was allowed to vibrate with only one degree of freedom transverse to the oncoming free-stream flow. It was found that in specific ranges of $f_{r}^{\ast }$ , the body vibration frequency may deviate from that seen in the non-rotating case and lock onto the forcing rotary oscillation frequency or its one-third subharmonic. The former is referred to as the ‘rotary lock-on’ (RLO) region and the latter as the ‘tertiary lock-on’ (TLO) region. Significant increases in the vibration amplitude and suppression of VIV could both be observed in different parts of the RLO and TLO regions. The peak amplitude response in the case of $U^{\ast }=5.5$ (upper branch) was observed to be $1.2D$ , an increase of approximately $50\,\%$ over the non-rotating case, while in the case of $U^{\ast }=8.0$ (lower branch), the peak amplitude response was $2.2D$ , a remarkable increase of $270\,\%$ over the non-rotating case. Notably, the results showed that the amplitude responses at moderate Reynolds numbers ( $Re=UD/\unicode[STIX]{x1D708}=2060$ and $2940$ , where $\unicode[STIX]{x1D708}$ is the kinematic viscosity of the fluid) in the present study showed significant differences from those of a previous low-Reynolds-number ( $Re=350$ ) numerical study at similar reduced velocities by Du & Sun (Phys. Fluids, vol. 14 (8), 2015, pp. 2767–2777). Remarkably, in an additional study examining the cylinder vibration as a function of $U^{\ast }$ while the fixed forcing rotary oscillation parameters were kept constant at $(f_{r}^{\ast },\unicode[STIX]{x1D6FC}_{r}^{\ast })=(1.0,1.0)$ , the cylinder experienced substantially larger oscillations than in the non-rotating case, and a rotation-induced galloping response was observed for $U^{\ast }>12$ , where the amplitude increased monotonically to reach approximately $3.0D$ at the highest reduced velocity ( $U^{\ast }=20$ ) tested. Furthermore, new wake modes were identified in the RLO and TLO regions using particle image velocimetry measurements at selected points in the $f_{r}^{\ast }-\unicode[STIX]{x1D6FC}_{r}^{\ast }$ parameter space.

BACKGROUND: IGTS is a rare phenomenon of paradoxical germ cell tumor (GCT) growth during or following treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of IGTS in patients in 21 North-American and Australian institutions. METHODS: Patients with IGTS diagnosed from 2000-2017 were retrospectively evaluated. RESULTS: Out of 739 GCT diagnoses, IGTS was identified in 33 patients (4.5%). IGTS occurred in 9/191 (4.7%) mixed-malignant GCTs, 4/22 (18.2%) immature teratomas (ITs), 3/472 (0.6%) germinomas/germinomas with mature teratoma, and in 17 secreting non-biopsied tumours. Median age at GCT diagnosis was 10.9 years (range 1.8-19.4). Male gender (84%) and pineal location (88%) predominated. Of 27 patients with elevated markers, median serum AFP and Beta-HCG were 70 ng/mL (range 9.2-932) and 44 IU/L (range 4.2-493), respectively. IGTS occurred at a median time of 2 months (range 0.5-32) from diagnosis, during chemotherapy in 85%, radiation in 3%, and after treatment completion in 12%. Surgical resection was attempted in all, leading to gross total resection in 76%. Most patients (79%) resumed GCT chemotherapy/radiation after surgery. At a median follow-up of 5.3 years (range 0.3-12), all but 2 patients are alive (1 succumbed to progressive disease, 1 to malignant transformation of GCT). CONCLUSION: IGTS occurred in less than 5% of patients with GCT and most commonly after initiation of chemotherapy. IGTS was more common in patients with IT-only on biopsy than with mixed-malignant GCT. Surgical resection is a principal treatment modality. Survival outcomes for patients who developed IGTS are favourable.

Largely as a result of the expansion of oil palm Elaeis guineensis, forest fragmentation has occurred on a large scale in Borneo. There is much concern about how forest-dependent species, such as the Vulnerable sun bear Helarctos malayanus, can persist in this landscape. The absence of sufficient natural food in forest fragments could drive sun bears into oil palm plantations, where they risk coming into conflict with people. We interviewed oil palm plantation workers and farmers in the Lower Kinabatangan region of Sabah, Malaysian Borneo, to ascertain if sun bears were utilizing plantations, if they were causing damage to the crop, and how the bears were perceived by people. To obtain a comparative baseline we extended these questions to include other species as well. We found that bears were rarely encountered in plantations and were not considered to be destructive to the oil palm crop, although they were generally feared. Other species, such as macaques Macaca spp., bearded pigs Sus barbatus, and elephants Elephas maximus, had more destructive feeding habits. Sun bears could use this readily available food resource without being targeted for retribution, although incidental human-related mortality remains a risk. Although bears could gain some nutritional benefit from oil palm, plantations do not provide the diversity of food and cover available in a natural forest.