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Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high risk of mortality and morbidity. we report the impact of a dedicated NNCC team on short term mortality and morbidities. Methods: A retrospective cohort study on neonates with moderate to serve HIE between July 1st 2008 and December 31st 2017. primary outcome : a composite of death and/or brain injury on MRI. Secondary outcomes: rate of cooling, length of hospital stay, anti-seizure medication burden, and use of inotropes. A regression analysis was done adjusting for gestational age, birth weight, gender, out-born status, Apgar score at 10 minutes, cord blood pH, and HIE clinical staging Results: 216 neonates were included, 109 before NNCC implementation, and 107 thereafter. NNCC program resulted in reduction in the primary outcome (AOR: 0.28, CI: 0.14-0.54, p<0.001) and brain injury (AOR: 0.28, CI: 0.14-0.55, p<0.001). It decreased average length of stay/infants by 5 days (p=0.03), improved cooling rate (73% compared to 93% , p <0.001), reduced: seizure misdiagnosis (71% compared to 23%, P <0.001), anti-seizure medication burden (P = 0.001), and inotrope use (34% compared to 53%, p=0.004) Conclusions: NNCC program decreased mortality and brain injury , shortened the length of hospital stay and improved care of neonates with significant HIE.
The Middle East respiratory syndrome coronavirus (MERS-CoV) is caused by a novel coronavirus discovered in 2012. Since then, 1806 cases, including 564 deaths, have been reported by the Kingdom of Saudi Arabia (KSA) and affected countries as of 1 June 2016. Previous literature attributed increases in MERS-CoV transmission to camel breeding season as camels are likely the reservoir for the virus. However, this literature review and subsequent analysis indicate a lack of seasonality. A retrospective, epidemiological cluster analysis was conducted to investigate increases in MERS-CoV transmission and reports of household and nosocomial clusters. Cases were verified and associations between cases were substantiated through an extensive literature review and the Armed Forces Health Surveillance Branch's Tiered Source Classification System. A total of 51 clusters were identified, primarily nosocomial (80·4%) and most occurred in KSA (45·1%). Clusters corresponded temporally with the majority of periods of greatest incidence, suggesting a strong correlation between nosocomial transmission and notable increases in cases.
We present low resolution spectrophotometric and imaging ISO observations of a sample of 58 AGN's over the 2.5–11.6 μ range. The data strongly support unification schemes and set new constraints on models of the molecular torus.
ISO's infrared camera was used to make deep mid-infrared (MIR) images through three gravitationally lensing clusters of galaxies. Observations were made at 7 μm and 15 μm covering more than 50 square arcminutes, with the lensing increasing the sensitivity to background sources significantly.
A large number of MIR sources were detected behind the lenses and provide source counts, corrected for cluster contamination and lensing distortion effects, which exceed by a factor of 10 the expectation from local counts assuming a no-evolution model. The results are consistent with larger-area surveys and the detected population resolves a substantial fraction (of order 60%) of the background MIR radiation intensity into discrete sources.
We discuss the evidence, in large part derived from lensing cluster observations, for overlap of the ISO 15 μm faint galaxy population with the 850 μm submillimetre and the 0.5 to 7 keV X-ray populations. We find that the ISO data shows substantial overlap with both the submillimetre and the X-ray source populations, with roughly 25% of ISO sources being detected at submillimetre wavelengths and a significant number of Chandra X-ray sources being detected in the ISO data.
Solar irradiance and precipitation are the most likely drivers of the seasonal variation of net primary productivity (NPP) in tropical forests. Since their roles remain poorly understood, we use litter traps, dendrometer bands and census data collected from one hectare permanent plots to quantify the seasonality of above-ground NPP components and weather parameters in 13 sites distributed along a 2800-m altitudinal gradient ranging from lowland Amazonia to the high Andes. We combine canopy leaf area index and litterfall data to describe the seasonality of canopy production. We hypothesize that solar irradiance is the primary driver of canopy phenology in wetter sites, whereas precipitation drives phenology in drier systems. The seasonal rhythm of canopy NPP components is in synchrony with solar irradiance at all altitudes. Leaf litterfall peaks in the late dry season, both in lowland (averaging 0.54 ± 0.08 Mg C ha y−1, n = 5) and montane forests (averaging 0.29 ± 0.04 Mg C ha y−1, n = 8). Peaks in above-ground coarse woody NPP appears to be triggered by the onset of rainfall in seasonal lowland rain forests (averaging 0.26 ± 0.04 Mg C ha y−1, n = 5, in November), but not in montane cloud forests.
High-redshift quasars are unique probes of the evolution of supermassive black holes and the intergalactic medium at the end of the epoch of reionization. We present the optical spectra of eight new z ~ 6 quasars selected from the Panoramic Survey Telescope & Rapid Response System 1 (Pan-STARRS1). Details of the selection strategy can be found in Bañados et al. (2014). With this work we increase the number of known quasars at z < 5.7 by more than 10%. The quasars discovered here span a large range of luminosities (19.6 ≤ zP1 ≤ 21.2) and are remarkably heterogeneous in their spectral features: half of them show bright emission lines whereas the other half show weak or no Lyα emission line. We find a larger fraction of weak–line emission quasars than in lower redshift studies, although still based on low number statistics, this may imply that the quasar population could be more diverse than previously thought.
The Nuclear Decommissioning Authority (NDA) is developing a safety case for the long-term management of higher activity wastes. This includes safety assessments of transport to and operations at the repository. One of the main faults and hazards to be considered is waste package response to impact accidents.
The criteria of impact performance for waste packages are based upon activity release of particulates generated from the break up of the waste form during impact. The NDA approach to impact performance is based upon waste package response from finite element modelling in combination with break-up tests.
Previous break up research commissioned by the NDA has concentrated on commercial graphite and glass samples. These extended studies, undertaken by the National Nuclear Laboratory in collaboration with the Department of Aerosol Technology of the Fraunhofer Institute of Toxicology and Experimental Medicine, provide break-up data specific to nuclear facilities and waste materials. These include archived unirrradiated graphite used to construct Magnox reactor cores and reflectors, simulant high level waste glass, selected grout formulations and selected metal-in-grout formulations.
Childhood rubella infection in early pregnancy can lead to fetal death or congenital rubella syndrome (CRS) with multiple disabilities. Reduction of transmission via universal vaccination can prevent CRS, but inadequate coverage may increase CRS numbers by increasing the average age at infection. Consequently, many countries do not vaccinate against rubella. The World Health Organization recommends that for safe rubella vaccination, at least 80% coverage of each birth cohort should be sustained. The nonlinear relationship between CRS burden and infection dynamics has been much studied; however, how the complex interaction between epidemic and demographic dynamics affects minimum safe levels of coverage has not been quantitatively evaluated across scales necessary for a global assessment. We modelled 30-year CRS burdens across epidemiological and demographic settings, including the effect of local interruption of transmission via stochastic fadeout. Necessary minimum vaccination coverage increases markedly with birth and transmission rates, independent of amplitude of seasonal fluctuations in transmission. Susceptible build-up in older age groups following local stochastic extinction of rubella increased CRS burden, indicating that spatial context is important. In low birth-rate settings, 80% routine coverage is a conservative guideline, particularly if supplemented with campaigns and vaccination of women of childbearing age. Where birth and transmission rates are high, immunization coverage must be well above 80% and campaigns may be needed. Policy-makers should be aware of the potential negative effect of local extinction of rubella, since heterogeneity in vaccination coverage will shape extinction patterns, potentially increasing CRS burdens.
The Clyde Estuary is recovering from gross pollution. In the early 1970s high densities of a small number of species of intertidal invertebrates tolerant of organic enrichment and low oxygen levels provided rich feeding for large numbers of dunlin, redshank, lapwing, oystercatcher and curlew. Winter numbers of the first three species have now declined considerably. The declines cannot be attributed to national changes in wader numbers and are not due to changes in breeding habitats or lack of reproductive success in particular regions, since each species wintering on the Clyde Estuary breeds in a different area. The most likely explanation of the decline, which is most pronounced in the species highly dependent on Corophium volutator, is either that reduced organic pollution has reduced the densities of the main prey, or that higher oxygen levels over the mudflats have allowed fish, particularly flounders, to enter the estuary and compete with the waders for the available prey. Although there is evidence of some birds having moved to other wintering areas, the fate of most birds is unknown.
The hydrography of the Forth estuary is described, and various modelling studies that have been carried out are briefly summarised. The description of the hydrography includes information on the currents, salinity, temperature, tidal elevations, and turbidity, as well as physical dimensions and freshwater inputs. The vertical salinity structure of the estuary varies from the well-mixed state to the partially-mixed state, depending on the freshwater input and the tidal range (which determines the amount of turbulent kinetic energy available for mixing). The tides in the estuary exhibit double high and low waters because of shallow-water effects, and there are observations of a small tidal bore. The resuspended solids are found to account for a large fraction of the biochemical oxygen demand in the water column. The modelling studies range from an early physical model, to an analytical model of water-quality, to more recent numerical models produced by the Forth River Purification Board and Imperial Chemical Industries, which were developed in order to assess the impact of proposed discharges on water-quality. Finally, currently active projects are described and suggestions for future work given.
Polarization versus applied field (P-E) hysteresis loop measurements on Pb(Zr,Ti)O3 (PZT) thin films were performed using a controlled-atmosphere probe station. Measurements were made using two different capacitor configurations, each producing differing results. The capacitor configurations included using either the typical arrangement of two top electrodes (planar) or an arrangement using contacts to the top and the bottom electrodes (sandwich). The films included PZT films deposited using pulsed laser deposition (PLD) and commercially-available rfsputtered PZT thin films. Qualitatively similar results were obtained for both types of films. For both PLD and Ramtron PZT films, translation of ferroelectric hysteresis loops along the polarization axis was observed for sandwich capacitors. The magnitude of this voltage was strongly dependent on the partial pressure of oxygen at room temperature. Translations were not observed for the same films using the planar capacitor configuration. However, for both sandwich and planar configurations, the thin film capacitance was sensitive to changes in pO2.
Due to its favorable electronic and thermal properties GaN has been considered as a rare-earth host material for solid state amplifier and laser applications. To this end, we performed spatially resolved combined excitation emission spectroscopy (CEES) on Nd ions which were in-situ-doped into GaN epitaxial films grown by plasma assisted molecular beam epitaxy (PA-MBE) on c-plane sapphire substrate. For a wide range of concentration (up to 8at%) we find in the emission a dominant incorporation site, which can be identified with good certainty as a substitutional ‘Ga’ site. Energy levels and electron-phonon coupling to a localized mode can be identified. For the majority site, confocal spectral imaging under selective excitation show changes in emission intensity, excitation and emission wavelength on a submicron length scale suggesting spatial inhomogeneities in terms of Nd3+ ion concentration.
We provide an investigation of in situ doping of GaN with the RE element Nd by plasma assisted-molecular beam epitaxy (PA-MBE). GaN epilayers are grown on c-plane sapphire and free standing GaN substrates and the Nd doping is controlled by an effusion cell. The ideal growth conditions for Nd incorporation maintaining crystal quality in GaN were investigated. The optical absorption characteristics indicate that the GaN:Nd epilayer remains transparent at the Nd emission wavelength of interest. For the highest Nd effusion cell temperatures, Rutherford backscattering and secondary ion mass spectrometry data indicate ˜5 at. % in epilayers grown on c-plane sapphire. X-ray diffraction found no evidence of phase segregation up to ˜1 at. % Nd. The highest luminescence intensities correspond to a doping range 0.05-1 at. %, with the strongest emission occurring at 1.12 eV (1107 nm). We also present the Stark energy sublevels of Nd3+ ions in GaN as determined by luminescence spectra. Photoluminescence excitation spectra reveal an optimal excitation energy of 1.48 eV (836 nm). We correlate the photoluminescence spectra with transitions from the 4F3/2 excited state to the 4I9/2, 4I11/2, and 4I13/2 multiplets of the Nd3+ ion for above (325nm) and below (836nm) bandgap excitation. Spectral correlation of the Nd emission multiplets in addition to site-selective spectroscopy studies using combined excitation-emission spectroscopy with confocal microscopy indicate enhanced substantial doping at the Ga site compared to other techniques (ion implantation and co-sputtering).
We probe the transitions between solid-like and fluid-like granular states in the presence of shaking in the horizontal and vertical directions. These transitions are fundamental to other aspects of granular flow such as avalanche flow, in which there is a free surface. Key control parameters include accelerations in the vertical and horizontal directions, Γi = Aiω2i/g, for shaking of the form si = Ai cos(ωit + φi), i = h, v. Here, g is the acceleration of gravity. Also important is the relative phase between the two modes of shaking. We focus on low to moderate dimensionless accelerations, 0 < Γv,h < 1.6. We consider first the case Γv = 0, i.e. pure horizontal shaking. In this case, there is a hysteretic transition between solid and fluid states, where the fluid state consists of a sloshing layer of material of height H plus additional transverse flow. The hysteresis is lifted in the presence of a modest amount of fluidization by gas flow, or if a slight overburden is provided. We also identify a time scale, τ, for the transition between the phases that diverges inversely as the distance ε = (Γh–Γhc)/Γhc, from the appropriate transition points, i.e. as τ α ε-1. We identify a new convective mechanism, associated with horizontal shearing at the walls, as the mechanism that drives the transverse convective flow. For combined horizontal and vertical shaking, there exist a related set of novel dynamics and stability properties. These include the spontaneous formation of a static heap and a transition to flow, similar to the flow state under horizontal shaking, when the vertical acceleration Γv < 1. A simple friction model provides a good description of the steady states and a reasonably good description of the transition to flow. Horizontal and vertical shaking frequencies that differ by a small amount can lead to a novel switching state, as the relative phase, φh—φv, shifts over time.
The factors underlying the temporal dynamics of rubella outside of Europe and North America are not well known. Here we used 20 years of incidence reports from Mexico to identify variation in seasonal forcing and magnitude of transmission across the country and to explore determinants of inter-annual variability in epidemic magnitude in rubella. We found considerable regional variation in both magnitude of transmission and amplitude of seasonal variation in transmission. Several lines of evidence pointed to stochastic dynamics as an important driver of multi-annual cycles. Since average age of infection increased with the relative importance of stochastic dynamics, this conclusion has implications for the burden of congenital rubella syndrome. We discuss factors underlying regional variation, and implications of the importance of stochasticity for vaccination implementation.
Measles vaccine efficacy is higher at 12 months than 9 months because of maternal immunity, but delaying vaccination exposes the children most vulnerable to measles mortality to infection. We explored how this trade-off changes as a function of regionally varying epidemiological drivers, e.g. demography, transmission seasonality, and vaccination coverage. High birth rates and low coverage both favour early vaccination, and initiating vaccination at 9–11 months, then switching to 12–14 months can reduce case numbers. Overall however, increasing the age-window of vaccination decreases case numbers relative to vaccinating within a narrow age-window (e.g. 9–11 months). The width of the age-window that minimizes mortality varies as a function of birth rate, vaccination coverage and patterns of access to care. Our results suggest that locally age-targeted strategies, at both national and sub-national scales, tuned to local variation in birth rate, seasonality, and access to care may substantially decrease case numbers and fatalities for routine vaccination.