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We present very detailed images of the photosphere of an AGB star obtained with the PIONIER instrument, installed at the Very Large Telescope Interferometer (VLTI). The images show a well defined stellar disc populated by a few convective patterns. Thanks to the high precision of the observations we are able to derive the contrast and granulation horizontal scale of the convective pattern for the first time in a direct way. Such quantities are then compared with scaling relations between granule size, effective temperature, and surface gravity that are predicted by simulations of stellar surface convection.
Escherichia coli O157:H7 is the largest cause of hemolytic uremic syndrome (HUS). Previous studies proposed that HUS risk varies across the E. coli O157:H7 phylogenetic tree (hypervirulent clade 8), but the role of age in the association is unknown. We determined phylogenetic lineage of E. coli O157:H7 isolates from 1160 culture-confirmed E. coli O157:H7 cases reported in Washington State, 2004–2015. Using generalised estimating equations, we tested the association between phylogenetic lineage and HUS. Age was evaluated as an effect modifier. Among 1082 E. coli O157:H7 cases with both phylogenetic lineage and HUS status (HUS n = 76), stratified analysis suggested effect modification by age. Lineages IIa and IIb, relative to Ib, did not appear associated with HUS in children 0–9-years-old. For cases 10–59-years-old, lineages IIa and IIb appeared to confer increased risk of HUS, relative to lineage Ib. The association reversed in ⩾60-year-olds. Results were similar for clade 8. Phylogenetic lineage appears to be associated with HUS risk only among those ⩾10-years-old. Among children <10, the age group most frequently affected, lineage does not explain progression to HUS. However, lineage frequency varied across age groups, suggesting differences in exposure and/or early disease manifestation.
To test the hypothesis that long-term care facility (LTCF) residents with Clostridium difficile infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.
A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).
Veterans Affairs hospital and affiliated LTCF.
The study included 29 LTCF residents identified as asymptomatic carriers of toxigenic C. difficile based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.
Of the 37 CDI cases, 7 (18·9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11·5%) and 4 of 11 LTCF-associated cases (36·4%). Of the 7 transmissions linked to LTCF residents, 5 (71·4%) were linked to asymptomatic carriers versus 2 (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.
Our findings suggest that LTCF residents with asymptomatic carriage of C. difficile or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.
Rib bone biopsy samples are often used to estimate changes in skeletal mineral reserves in cattle but differences in sampling procedures and the bone measurements reported often make interpretation and comparisons among experiments difficult. ‘Full-core’ rib bone biopsy samples, which included the external cortical bone, internal cortical bone and trabecular bone (CBext, CBint and Trab, respectively), were obtained from cattle known to be in phosphorus (P) adequate (Padeq) or severely P-deficient (Pdefic) status. Experiments 1 and 2 examined growing steers and Experiment 3 mature breeder cows. The thickness of cortical bone, specific gravity (SG), and the amount and concentration of ash and P per unit fresh bone volume, differed among CBext, CBint and Trab bone. P concentration (mg/cc) was closely correlated with both SG and ash concentrations (pooled data, r=0.99). Thickness of external cortical bone (CBText) was correlated with full-core P concentration (FC-Pconc) (pooled data, r=0.87). However, an index, the amount of P in CBext per unit surface area of CBext (PSACB; mg P/mm2), was more closely correlated with the FC-Pconc (pooled data, FC-Pconc=37.0+146×PSACB; n=42, r=0.94, RSD=7.7). Results for measured or estimated FC-Pconc in 10 published studies with cattle in various physiological states and expected to be Padeq or in various degrees of Pdefic status were collated and the ranges of FC-Pconc indicative of P adequacy and P deficiency for various classes of cattle were evaluated. FC-Pconc was generally in the range 130 to 170 and 100 to 120 mg/cc fresh bone in Padeq mature cows and young growing cattle, respectively. In conclusion, the FC-Pconc could be estimated accurately from biopsy samples of CBext. This allows comparisons between studies where full-core or only CBext biopsy samples of rib bone have been obtained to estimate changes in the skeletal P status of cattle and facilitates evaluation of the P status of cattle.
Sugarcane is an important forage resource in sub-tropical and tropical areas as it is used during the winter or dry season when the growth rate of pastures is significantly reduced. The current research study assessed the effect of four vertical sections of sugarcane in a pen trial and the level of sugarcane utilization in a grazing trial on the ingestive behaviour and forage intake of two age groups of steers (1 and 2 years old). The pen trial was comprised of two simultaneous 4 × 4 balanced Latin square designs (one for each age group of animals) of four periods, four animals and four feeding treatments, which consisted of four equal vertical sections of sugarcane. Dry matter (DM) and digestible DM (DDM) intake per kilogram of metabolic weight declined gradually from top to bottom of the sugarcane, with no significant differences between the age groups of steers. This difference in intake was associated with a decline in intake of neutral detergent fibre (NDF) as a proportion of the liveweight of the animal and an increase of total chewing time per kilogram of DM or NDF from top to bottom of the sugarcane. It was concluded that the toughness of plant material played a significant role regulating intake, which was higher for the top sections of sugarcane. In the grazing trial, steers of both age groups grazed down sugarcane in three plots over 9 days. Steers grazed up to four distinctive grazing strata. Digestible DM intake (DDM intake) was high at low levels of horizontal utilization of the top grazing stratum but DDM intake started to decline sharply when this stratum was removed in 0·92 of paddock area (i.e. equivalent to 0·08 of the pasture area remaining un-grazed). It was concluded that the proportion of un-grazed area of the pasture can be used as a grazing management strategy to control forage intake for sugarcane.
The paper analyzes the issues relating to the applicability of innovative material systems for flexible composite armors. The authors made several samplings of aramid fibers (Kevlar 49) by replacing the epoxy resin base, which is often described in the literature, with the thermoplastic matrix - polyethylene (HDPE) and polypropylene (PP). The samples were fired with .38 Special Full Metal Jacketed (FMJ) ammunition produced by the S&B Company, and then the process of firing was modeled in the ABAQUS program. The advantages and disadvantages of the new material system including the possibility of its use in the construction of hybrid composite armors have been presented on the basis of the results of numerical analyses and ballistic tests.
Objectives: One of the most prominent features of schizophrenia is relatively lower general cognitive ability (GCA). An emerging approach to understanding the roots of variation in GCA relies on network properties of the brain. In this multi-center study, we determined global characteristics of brain networks using graph theory and related these to GCA in healthy controls and individuals with schizophrenia. Methods: Participants (N=116 controls, 80 patients with schizophrenia) were recruited from four sites. GCA was represented by the first principal component of a large battery of neurocognitive tests. Graph metrics were derived from diffusion-weighted imaging. Results: The global metrics of longer characteristic path length and reduced overall connectivity predicted lower GCA across groups, and group differences were noted for both variables. Measures of clustering, efficiency, and modularity did not differ across groups or predict GCA. Follow-up analyses investigated three topological types of connectivity—connections among high degree “rich club” nodes, “feeder” connections to these rich club nodes, and “local” connections not involving the rich club. Rich club and local connectivity predicted performance across groups. In a subsample (N=101 controls, 56 patients), a genetic measure reflecting mutation load, based on rare copy number deletions, was associated with longer characteristic path length. Conclusions: Results highlight the importance of characteristic path lengths and rich club connectivity for GCA and provide no evidence for group differences in the relationships between graph metrics and GCA. (JINS, 2016, 22, 240–249)
Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome.
“Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness” (CEDAR; ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. Between November 2009 and December 2010, adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Ulm, Germany; London, UK; Naples, Italy; Debrecen, Hungary; Aalborg, Denmark; and Zurich, Switzerland). Clinical decision making was assessed using two instruments which both have parallel patient and staff versions: (a) The Clinical Decision Making Style Scale (CDMS) measured preferences for decision making at baseline; and (b) the Clinical Decision Making Involvement and Satisfaction Scale (CDIS) measured involvement and satisfaction with a specific decision at all time points. Primary outcome was patient-rated unmet needs measured with the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Mixed-effects multinomial regression was used to examine differences and course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also controlled for nesting of patients within staff.
Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by patients (χ2 = 135.08; p < 0.001) and staff (χ2 = 368.17; p < 0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (−0.406 unmet needs per two months, p = 0.007) or shared (−0.303 unmet needs per two months, p = 0.015) decision making.
Decision making style of staff is a prime candidate for the development of targeted intervention. If proven effective in future trials, this would pave the ground for a shift from shared to active involvement of patients including changes to professional socialization through training in principles of active decision making.
MY Ser is an eclipsing early-type contact system. Both components are of spectral type O6 III. Using ESO archive spectra, we show that the radial velocity of the third body, which contributes about half of the total luminosity, changed from 2006 to 2009. The line profiles of the eclipsing system have peculiar shapes and strengths; namely around conjunctions, they are affected by circumbinary matter.
Ensembles of indium phosphide nanowires were grown on amorphous quartz substrates and their optical properties were examined at various cryogenic temperatures. Complex dynamics result from the large areal densities, random orientation, combination of both zincblende and wurtzite phases, and the geometries of the nanowires. Those complex dynamics are discussed in relation to their effect on the temperature dependence of photoluminescence and Raman spectroscopy. Five peaks are found to exist in the photoluminescence spectra at low temperatures which are attributed to radiative recombinations associated with quantum confined zinc blende, quantum confined excitons in zinc blende, quantum confined wurtzite, excitons in bulk zinc blende and impurity states. An energy transfer mechanism between two types of radiative recombinations among the five is proposed to explain intensity variations and the temperature dependence of the PL peaks is discussed. The Raman spectra is observed to have peaks created by a combination of zinc blende and wurtzite vibrational modes which is explained by folding the phonon dispersion.
In this study, we investigated the growth of silicon nanowires forced by small gallium droplet templates. Those gallium islands previously were deposited by a modified PECVD method. Two different delivery techniques of the trimethylgallium precursor (TMGa) were tested regarding their applicability. On the one hand standard liquid delivery was performed, on the other the precursor was transported by vapor draw out of the heated bubbler. The TMGa then was pulsed into the carrier gas flow. The effects on the deposited islands of both delivery methods were compared. As substrates <111> oriented p-doped silicon wafers were used. For the subsequent growth of the silicon wires similarly PECVD was used as growth method. Silane served as precursor. Argon and hydrogen were used as plasma enhanced gases. The effects of the Ga particles deposited by both process modes upon the generated wires were analyzed.
Evidence and consensus on best practices on the management of human bite injuries is lacking. Our objective was to identify factors that are associated with delay to emergency department (ED) presentation, antibiotic usage and patient admission.
We present a retrospective chart review of adults treated for human bites. Multivariable logistic regression models used demographic characteristics and bite circumstances and characteristics as factors associated with ED presentation more than 24 hours after the bite, antibiotic usage and hospital admission.
Of the 388 patients evaluated for a human bite, 66.5% were bitten during an altercation; 23.8% presented more than 24 hours after the bite; 50.3% were bitten on the hands or fingers, 23.5% on an extremity and 17.8% on the head or neck. Only 7.7% of all patients sustained closed-fist injuries; the majority had occlusional or other kinds of bites. The majority of patients (77.3%) received antibiotics and 11.1% were admitted to hospital. Patients who had greater odds of presenting more than 24 hours after the bite were black (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.02–3.13), Hispanic (OR 2.68, 95% CI 1.22–5.89) and those who had a non-occupational bite (OR 3.87, 95% CI, 1.68–8.90). Patients had a greater chance of receiving antibiotics if they were bitten during an altercation (OR 1.87, 95% CI, 1.09–3.20) and were bitten on the hands or fingers (OR 2.23, 95% CI 1.31-3.80). Patients had a greater chance of being admitted to the hospital if they were bitten during an altercation (OR 4.91, 95% CI 1.65–14.64), bitten on the hands or fingers (OR 5.26, 95% CI, 1.74–15.87) and if they presented ≥ 24 hours after the bite.
Most patients presented to the ED within 24 hours of their injury and received antibiotics. The circumstances surrounding the bite appeared to be associated with delay to ED presentation, receipt of antibiotics and admission to the hospital. There are ethnic background differences in delay to ED presentation. ED clinicians in our study favour antibiotic usage and admission based on the body location of the bite, despite little evidence to support these practices.