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Clostridium difficile, the most common cause of hospital-associated diarrhoea in developed countries, presents major public health challenges. The high clinical and economic burden from C. difficile infection (CDI) relates to the high frequency of recurrent infections caused by either the same or different strains of C. difficile. An interval of 8 weeks after index infection is commonly used to classify recurrent CDI episodes. We assessed strains of C. difficile in a sample of patients with recurrent CDI in Western Australia from October 2011 to July 2017. The performance of different intervals between initial and subsequent episodes of CDI was investigated. Of 4612 patients with CDI, 1471 (32%) were identified with recurrence. PCR ribotyping data were available for initial and recurrent episodes for 551 patients. Relapse (recurrence with same ribotype (RT) as index episode) was found in 350 (64%) patients and reinfection (recurrence with new RT) in 201 (36%) patients. Our analysis indicates that 8- and 20-week intervals failed to adequately distinguish reinfection from relapse. In addition, living in a non-metropolitan area modified the effect of age on the risk of relapse. Where molecular epidemiological data are not available, we suggest that applying an 8-week interval to define recurrent CDI requires more consideration.
Recent cases of acute kidney injury due to Seoul hantavirus infection from exposure to wild or pet fancy rats suggest this infection is increasing in prevalence in the UK. We conducted a seroprevalence study in England to estimate cumulative exposure in at-risk groups with contact with domesticated and wild rats to assess risk and inform public health advice. From October 2013 to June 2014, 844 individual blood samples were collected. Hantavirus seroprevalence amongst the pet fancy rat owner group was 34.1% (95% CI 23·9–45·7%) compared with 3·3% (95% CI 1·6–6·0) in a baseline control group, 2·4% in those with occupational exposure to pet fancy rats (95% CI 0·6–5·9) and 1·7% with occupational exposure to wild rats (95% CI 0·2–5·9). Variation in seroprevalence across groups with different exposure suggests that occupational exposure to pet and wild rats carries a very low risk, if any. However incidence of hantavirus infection among pet fancy rat owners/breeders, whether asymptomatic, undiagnosed mild viral illness or more severe disease may be very common and public health advice needs to be targeted to this at-risk group.
In an effort to better understand the consequences of early weaning (EW) for replacement beef heifers, a two-phase experiment was conducted investigating the impact on metabolic function and documenting reproductive characteristics. In phase 1, Angus×Simmental heifers (n=35) were stratified by BW and sire, and randomly assigned to either a normal weaning (NW, n=18) or EW (n=17) treatment. EW heifers were weaned at 107±3 days of age and provided access to a concentrate-based ration ad libitum with limit-fed mixed grass hay. NW heifers remained with their dams until 232±3 days of age, at which point heifers from both treatments were comingled and grazed on mixed summer pasture. Following NW, weekly blood samples were collected from all heifers for progesterone analyses used to determine the onset of puberty. Pelvic and ovarian size was measured before breeding. All heifers were subjected to an estrous synchronization protocol with timed artificial insemination (AI) at 437±4 days of age. During phase 2 of the experiment, a subset of pregnant heifers (n=16) were divided into two replicates and subjected to a glucose tolerance test, epinephrine challenge and progesterone clearance analysis. Neither age nor BW at puberty differed between EW and NW heifers. Likewise, no differences in pelvic area or ovarian size were observed. Thus, it appears that the reproductive maturity of EW and NW heifers was similar. Heifers studied during phase 2 of the experiment were restricted to those that had become pregnant to their first AI. Within this cohort, EW heifers tended to have lower overall circulating progesterone concentrations than those that were NW (P=0.14). Aspects of glucose and insulin dynamics were also altered, as EW heifers tended to have lower baseline glucose concentrations (P=0.10) despite similar baseline insulin concentrations. Compared with NW heifers, EW heifers had lower insulin area under the curve (P<0.05), which was partly the result of a tendency for lower peak insulin concentrations (P=0.11). Results of the glucose tolerance test indicate that a lesser insulin response was necessary to properly clear the glucose in the EW heifers, suggesting enhanced insulin sensitivity. Collectively, these results indicate that EW is not detrimental for the growth or reproductive development of replacement beef heifers, although some differences in glucose and insulin dynamics persist into adulthood.
The Chicago Region Environmental and Transportation Efficiency (CREATE) Program is a nationally prominent rail-infrastructure program. It is managed by the unique partnership of the United States Department of Transportation (DOT), the State of Illinois, the City of Chicago, Metra, Amtrak, Association of American Railroads, and six of the nation’s Class I freight railroads. The CREATE 75th Street Corridor Improvement Project (CIP) received a National Environmental Policy Act (NEPA) Environmental Impact Statement (EIS) Record of Decision in September 2014. As a result of 75th Street CIP and other completed preliminary engineering and project environmental reviews within the 70 rail-improvements program, CREATE has set a national-policy example with regard to mitigation under the environmental justice Executive Order (EO) 12898. This article provides some background on the CREATE Program and examines the development of the CREATE Environmental Justice Policy. It describes the impetus for creating the policy, namely noise impacts on low-income and minority populations resulting from the 75
th Street CIP and other CREATE Program rail projects. This article also discusses the extensive coordination among Federal and State agencies, among the public and private CREATE partners, and among Community Advisory Groups and residents, all of which led to the specific mitigations addressed in the CREATE environmental justice policy. The result of these encompassing efforts, led by Federal Highway Administration and the Illinois Department of Transportation’s Division of Public and Intermodal Transportation, is a precedent-setting framework for analyzing and, when necessary, mitigating the potential environmental justice impacts of the CREATE Program rail projects. The CREATE Environmental Justice Policy is precedent setting in a few ways: (a) it establishes policy where none currently exists and where existing highway-oriented policies do not seem appropriate or applicable; (b) it provides greater specificity with regard to what mitigation measures are “practicable” to address predicted noise impacts of CREATE Program rail projects on low-income and minority populations; (c) it clarifies the lead agencies’ intent to maintain the transportation linkage and focus when developing and evaluating practicable mitigation measures for other (i.e., non-noise) impacts; and (d) it helps assure the equity of the transportation investment by better balancing the distribution of burdens and benefits at the project level. This article identifies the steps, when considering disproportionately high and adverse impacts to low-income and/or minority populations, on how to evaluate other practicable mitigation measures with merit under EO 12898. This article also describes the lessons learned and the dialogue necessary to receive broad support from the CREATE partners for both needed rail improvements and additional mitigations to provide offsetting benefits and opportunities to enhance Chicago-area communities, neighborhoods, and residents’ quality of life.
Scholars in the fields of instructional development and pedagogy note that learning outcomes can be improved when teachers use “narratives” to communicate how complex processes work or how problems are addressed. In this article, the authors describe a narrative-centered approach to graduate-level instruction in research methodology. This approach is intended to supplement, not replace, conventional graduate seminars in quantitative or qualitative methods. In a series of lectures, scholars reflected on how their published articles originally were framed, the trade-offs that were necessary to advance the investigation, the methodological challenges and non-findings that had to be addressed—but may not have been printed—and the evolution of a piece as it progressed through the peer-review stages. This approach to exposing graduate students to the entirety of the research process is termed Social Science Mechanics: A Look under the Hood at Innovative Research Designs. Surveys used to evaluate the series confirmed that graduate students who attended the presentations found them to be highly engaging and beneficial. Many faculty members also attended and found the lectures to be equally instructive.
Growth of GaN on Si(111) and Ge coated Si(111) using pulsed electron beam deposition (PED) process is reported. GaN was deposited on Si(111) and Ge/Si(111) at 600°C in an N2 environment without any surface pre-treatment such as pre-nitridation. X-ray diffraction confirmed that c-plane oriented GaN was grown. Photoluminescence showed near-band-edge emission, the intensity of which was improved with hydrogen passivation. Electrical characterization showed n-type conductivity with room temperature electron mobilities in the range of 300 cm2/V-sec.
In September 2010, an outbreak of cryptosporidiosis affected members of a swimming club. A cohort study was undertaken to identify the number affected and risk factors for infection. Of 101 respondents, 48 met the case definition for probable cryptosporidiosis. Multivariate analysis demonstrated a strong and highly significant association between illness and attendance at a training session on 13 September 2010 (adjusted odds ratio 28, P < 0·0001). No faecal incidents were reported and pool monitoring parameters were satisfactory. The competitive nature of club swimming requires frequent training and participation in galas, potentially facilitating contamination into other pools and amplification of outbreaks among wider groups of swimmers. There was a lack of awareness of the 2-week exclusion rule among swimmers and coaches, and a high level of underreporting of illness. The study demonstrates the benefits of rapid field epidemiology in identifying the true burden of illness, the source of infection and limiting spread.
The temperature dependence of cross-plane lattice thermal conductivity for thin film IV-VI semiconductors grown by molecular beam epitaxy was measured. Samples consisting of PbSe/PbSrSe multiple quantum wells (MQWs) on PbSe/PbSnSe superlattices (SLs) were grown with variations in SL layer thickness and the number of SL pairs. Localized lattice temperatures within the MQW layers were extracted from analysis of continuous wave photoluminescence (PL) emission spectra at heat sink temperatures between 100 K and 250 K. These data, finite element analysis, and electrical characterization were used to determine cross-plane lattice thermal conductivity of two different SL materials. A SL material with three different PbSe/PbSnSe thicknesses (1.2/1.2, 1.8/1.8, and 2.4/2.4 nm) exhibited a fairly constant lattice thermal conductivity from 1.2 to 1.3 W/mK as the sample was cooled from 250 K to 100 K. Another SL material with five different PbSe/PbSnSe thicknesses (0.5/0.5, 1.0/1.0, 1.6/1.6, 2.1/2.1, and 2.6/2.6 nm) exhibited very low lattice thermal conductivities from 0.46 to 0.47 W/mK 250 K to 100 K. These results are consistent with reflection of low energy heat transporting acoustic phonons within the SL material.
We investigated the effect of social inequalities on the uptake of human papillomavirus (HPV) vaccination, combining data from a feasibility study conducted in 2007–2008 in 2817 secondary schoolgirls in two UK primary-care trusts, with census and child health records. Uptake was significantly lower in more deprived areas (P<0·001) and in ethnic minority girls (P=0·013). The relatively small proportion of parents who actively refused vaccination by returning a negative consent form were more likely to come from more advantaged areas (P<0·001). Non-responding parents were from more deprived (P<0·001) and ethnic minority (P=0·001) backgrounds. Girls who did not receive HPV vaccination were less likely to have received all their childhood immunizations particularly measles, mumps and rubella (MMR). Different approaches may be needed to maximize HPV vaccine uptake in engaged and non-responding parents, including ethnic-specific approaches for non-responders.