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Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Antimicrobial use in pig farming is influenced by a range of risk factors, including herd characteristics, biosecurity level, farm performance, occurrence of clinical signs and vaccination scheme, as well as farmers’ attitudes and habits towards antimicrobial use. So far, the effect of these risk factors has been explored separately. Using an innovative method called multiblock partial least-squares regression, this study aimed to investigate, in a sample of 207 farrow-to-finish farms from Belgium, France, Germany and Sweden, the relative importance of the six above mentioned categories or ‘blocks’ of risk factors for antimicrobial use in pig production. Four country separate models were developed; they showed that all six blocks provided useful contribution to explaining antimicrobial use in at least one country. The occurrence of clinical signs, especially of respiratory and nervous diseases in fatteners, was one of the largest contributing blocks in all four countries, whereas the effect of the other blocks differed between countries. In terms of risk management, it suggests that a holistic and country-specific mitigation strategy is likely to be more effective. However, further research is needed to validate our findings in larger and more representative samples, as well as in other countries.
Item response theory has its origins in educational measurement and is now commonly applied in health-related measurement of latent traits, such as function and symptoms. This application is due, in large part, to gains in the precision of measurement attributable to item response theory and corresponding decreases in response burden, study costs, and study duration. The purpose of this paper is twofold: introduce basic concepts of item response theory and demonstrate this analytic approach in a worked example, a Rasch model (1PL) analysis of the Eating Assessment Tool (EAT-10), a commonly used measure for oropharyngeal dysphagia. The results of the analysis were largely concordant with previous studies of the EAT-10 and illustrate for brain impairment clinicians and researchers how IRT analysis can yield greater precision of measurement.
During Charles Francis Hall's second Arctic expedition (1864–1869) to find survivors and/or documents of Sir John Franklin's 1845 Northwest Passage expedition, two separate Inuit testimonies were recorded of a potential burial vault of a high-ranking officer. The first testimony was provided by a Boothia Inuk named Su-pung-er. The second testimony was documented by Captain Peter Bayne who, at the time, was employed by Hall. To date the vault has not been found. Recently, both the HMS Erebus and HMS Terror have been located. The discovery of these vessels was made possible, in part, by Inuit testimony of encounters with and observations of the Franklin expedition. The findings of the Erebus and Terror have significantly bolstered the view that the Inuit accurately reported their observations and interactions with the Franklin crew. The purpose of this paper is to publish in their entirety Hall's notes from conversations with Su-pung-er focused on the vaults and to compare these observations to those reported in the Bayne testimony. It is our hope that in so doing the final major archaeological site of the Franklin expedition may be located.
The effect on the Earth Rotation Parameters (ERP) of all the large earthquakes that occurred during 1977–1985 is evaluated. It is found that they cannot have caused the variations observed in the ERP during this time period.
Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security–Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of “what works for whom” in attachment intervention.
A full-pattern fitting procedure based on the Rietveld method was applied to electron diffraction ring patterns of a two-phase system, exhibiting the co-presence of zinc sulfide (sphalerite) and zinc oxide (Wurtzite). Bright and dark field (DF) images reveal the presence of micrometric aggregates, composed of quasi-spherical nanosized crystallites. These conventional transmission electron microscopy imaging methods provide a general morphological characterization of the specimens although, in the present case, they are not suitable for a detailed characterization of the microstructural features of the analyzed samples. Owing to the overlap and broadening of the diffraction rings of the two phases, DF images cannot provide a satisfactory picture of the individual crystallites of each single phase. To overcome this limit, the mentioned Rietveld approach was applied to model the electron diffraction data. The crystalline domain size and relevant shapes for both phases were successfully evaluated using the proposed methodological approach. The excellent results obtained in the microstructural characterization of the nanostructured multiphase samples demonstrate the capability of this technique, that may represents a fully quantitative method for the routine characterization of crystalline nanomaterials.
In this case study, we evaluated a point-mapping method for simultaneously collecting data while controlling three invasive woody plant species: black locust, Chinese privet, and hardy orange. The study in Arkansas Post National Memorial included seven project areas ranging in size from 2.7 to 27.3 ha and spanned six field seasons (2010 to 2015). The control techniques varied depending on plant size and always included the application of herbicide, which also varied over the course of the study to include glyphosate, imazapyr, and triclopyr. Each person responsible for controlling plants simultaneously collected global positioning system point data to estimate the foliar cover of the plants treated. The resulting data demonstrated evidence of decreases in all three plant species in most project areas during the 6-yr period. Initial increases in area treated for some species–area combinations reflected differences in the preliminary efforts required to control invasive plants in entire project areas, but by 2012 six of seven project areas were treated in their entirety. Despite a high level of reduction, in some cases, the plants persisted at low levels even during the sixth year of the project. Our findings support the ability of this method to granularly detect changes in plant abundance while simultaneously controlling invasive plants. With several acknowledged limitations, this streamlined project-based monitoring approach provides data that allow managers to assess the effectiveness of weed control treatments.
This study aimed to examine the association between vitamin B6, folate and vitamin B12 biomarkers and plasma fatty acids in European adolescents. A subsample from the Healthy Lifestyle in Europe by Nutrition in Adolescence study with valid data on B-vitamins and fatty acid blood parameters, and all the other covariates used in the analyses such as BMI, Diet Quality Index, education of the mother and physical activity assessed by a questionnaire, was selected resulting in 674 cases (43 % males). B-vitamin biomarkers were measured by chromatography and immunoassay and fatty acids by enzymatic analyses. Linear mixed models elucidated the association between B-vitamins and fatty acid blood parameters (changes in fatty acid profiles according to change in 10 units of vitamin B biomarkers). DHA, EPA) and n-3 fatty acids showed positive associations with B-vitamin biomarkers, mainly with those corresponding to folate and vitamin B12. Contrarily, negative associations were found with n-6:n-3 ratio, trans-fatty acids and oleic:stearic ratio. With total homocysteine (tHcy), all the associations found with these parameters were opposite (for instance, an increase of 10 nmol/l in red blood cell folate or holotranscobalamin in females produces an increase of 15·85 µmol/l of EPA (P value <0·01), whereas an increase of 10 nmol/l of tHcy in males produces a decrease of 2·06 µmol/l of DHA (P value <0·05). Positive associations between B-vitamins and specific fatty acids might suggest underlying mechanisms between B-vitamins and CVD and it is worth the attention of public health policies.
The central theme of complex systems research is to understand the emergent macroscopic properties of a system from the interplay of its microscopic constituents. The emergence of macroscopic properties is often intimately related to the structure of the microscopic interactions. Here, we present an analytical approach for deriving necessary conditions that an interaction network has to obey in order to support a given type of macroscopic behaviour. The approach is based on a graphical notation, which allows rewriting Jacobi's signature criterion in an interpretable form and which can be applied to many systems of symmetrically coupled units. The derived conditions pertain to structures on all scales, ranging from individual nodes to the interaction network as a whole. For the purpose of illustration, we consider the example of synchronization, specifically the (heterogeneous) Kuramoto model and an adaptive variant. The results complete and extend the previous analysis of Do et al. (2012Phys. Rev. Lett.108, 194102).
The triennial report of Commission 19 was composed from the contributions of its members. Space does not permit a listing of their names, but their contributions are sincerely appreciated. Unfortunately because of limited space it is also not possible to provide in this report the extensive list of publication of the Commission members. The list of publications is however available on the Commission 19 web site at maia.usno.navy.mil/iauc19.
Whether the public stigma associated with mental illness negatively affects an individual, largely depends on whether the person has been labelled ‘mentally ill’. For labelled individuals concealing mental illness is a common strategy to cope with mental illness stigma, despite secrecy's potential negative consequences. In addition, initial evidence points to a link between stigma and suicidality, but quantitative data from community samples are lacking.
Based on previous literature about mental illness stigma and suicidality, as well as about the potential influence of labelling processes and secrecy, a theory-driven model linking perceived mental illness stigma and suicidal ideation by a mediation of secrecy and hopelessness was established. This model was tested separately among labelled and unlabelled persons using data derived from a Swiss cross-sectional population-based study. A large community sample of people with elevated psychiatric symptoms was examined by interviews and self-report, collecting information on perceived stigma, secrecy, hopelessness and suicidal ideation. Participants who had ever used mental health services were considered as labelled ‘mentally ill’. A descriptive analysis, stratified logistic regression models and a path analysis testing a three-path mediation effect were conducted.
While no significant differences between labelled and unlabelled participants were observed regarding perceived stigma and secrecy, labelled individuals reported significantly higher frequencies of suicidal ideation and feelings of hopelessness. More perceived stigma was associated with suicidal ideation among labelled, but not among unlabelled individuals. In the path analysis, this link was mediated by increased secrecy and hopelessness.
Results from this study indicate that among persons labelled ‘mentally ill’, mental illness stigma is a contributor to suicidal ideation. One explanation for this association is the relation perceived stigma has with secrecy, which introduces negative emotional consequences. If our findings are replicated, they would suggest that programmes empowering people in treatment for mental illness to cope with anticipated and experienced discrimination as well as interventions to reduce public stigma within society could improve suicide prevention.
Disease prevention through biosecurity measures is believed to be an important factor for improvement of the overall health status in animal production. This study aimed at assessing the levels of implementation of biosecurity measures in pig production in four European Union (EU) countries and to describe possible associations between the biosecurity level and farm and production characteristics. A cross-sectional study was conducted in 232 farrow-to-finish pig herds in Belgium, France, Germany and Sweden between December 2012 and December 2013. The biosecurity status in each of these herds was described and quantified by using the risk-based scoring tool Biocheck.UGentTM (www.biocheck.ugent.be). Production and management characteristics, obtained from the herd management system and by interviewing the farmer, were analysed for their association with the biosecurity level. A causal path was designed to study statistical associations. The results showed that there was substantial room for improvement in the biosecurity status on many pig farms. Significant differences (P<0.01) both in internal and external biosecurity levels were observed between countries. The external biosecurity status, combining all measures taken to prevent disease introduction into the herd, was highest in Germany and lowest in France. The internal biosecurity status, combining all measures taken to prevent within herd disease transmission, was highest in Sweden and lowest, with a large variation, in Belgium. External biosecurity scores were in general higher compared to internal biosecurity scores. The number of pathogens vaccinated against was significantly associated with internal biosecurity status, suggesting an overall more preventive approach towards the risk of disease transmission. A higher external biosecurity was associated with more weaned piglets per sow per year. Furthermore also the weaning age and the mortality till weaning were highly associated with the number of weaned piglets per sow per year. The negative association observed between the biosecurity level and the estimated frequency of treatment against certain clinical signs of disease as a proxy for disease incidence is consistent with the hypothesis that a higher biosecurity level results in healthier animals. These findings promote an improved biosecurity status at pig farms and are of relevance in the discussion on alternative ways to keep animals healthy with a reduced necessity of antimicrobials; Prevention is better than cure!
Due to its wide band-gap, Al2O3 is known to have a moderate leakage current and a good dielectric strength . Moreover, this dielectric has a fair permittivity and so constitutes interesting candidate as dielectric for Metal-Insulator-Metal (MIM) capacitor. Atomic Layer Deposition (ALD) allows obtaining a dense and thin Al2O3 amorphous layer. ALD limits problems of interlayer diffusion because Al2O3 is deposited underneath 400°C  which is essential when MIM are co-integrated with temperature sensitive structures.
The aim of our investigation is to attempt to tie aluminum oxide properties dielectric with reliability from the help of capacitors of the entire wafer. In this way, conduction mechanism analysis and capacitance measurements were statistically led on the wafer. We particularly focus our study on the quantification of defects and their influence on the leakage current in planar capacitor. Firstly, to estimate the fixed oxide charges densities in the bulk of Al2O3 and to analyze conduction mechanism, Metal-Oxide-Semiconductor (MOS) (Al/Al2O3/HR-Si) is developed. Then, a MIM stack (Al/TiN/Al2O3/TiN/HR-Si) is developed in order to evaluate the leakage current and the electrical reliability of thin films Al2O3 based MIM capacitors. Different performances are observed according to the area on the wafer. That could be explained by the quality of the Al2O3 layer and the interfaces between TiN and the oxide.
A high gain ZnO nanowire (NW) based photodetector was fabricated, which was sensitive to photoexcitation at or below 370 nm corresponding to the band-edge of ZnO. At an incident wavelength of 370 nm and a bias field of 5 kV/cm, the maximum responsivity was over 105 A/W corresponding to an extremely high photoconductive gain of the order of 106. Through this work we provide experimental evidence of the role of surface and defects in carrier dynamics, resulting in enhanced photoresponse. Using intensity and temperature dependence of the rise and decay rates of photocurrent, we present a detailed analysis that provides an estimate of the activation energies of carrier trapping mechanisms.
The importance of ZnxMg1-xO is increasing day by day because of its wider bandgap than ZnO. This ternary semiconductor finds its application in the fields of optoelectronics, spintronics, superlattices due to its unique blueshifted UV-luminescent property. n- to p-type conduction which is the motive of the project can be achieved with increasing Mg content in ZnMgO. The optical characteristics of the nitrogen doped ZnxMg1-xO (x=0.85) grown on 2 inch Si <100>wafer by RF sputtering are studied and analyzed thoroughly using low temperature (15K) photoluminescence measurements. Nitrogen implantation was carried out by Plasma immersion Ion Implantation technique on the sample. Rapid Thermal Process was employed to remove defects resulting from implantation. The samples were annealed at 700°C, 800°C, 900°C, and 1000o C for 10 seconds in an oxygen ambient. Photoluminescence (PL) measurements were performed at low temperature (15K) which exhibited acceptor-bound-exciton peak (A°X) and donor-bound-acceptor pair (DAP) at 3.336 eV and 3.236 eV respectively. At 3.364 eV, S peak was found for the sample annealed at 800°C after implantation. This peak was attributed to the existence of ZnO-like composition. Localized and de-localized exciton peaks were found around 3.42 and 3.45 eV respectively. This result is very important because though dominant acceptor peak was not found but proper optimization of the parameters can lead to p-type ZnMgO which is the main motive of this project.
The role of ferroelectric LiNbO3 (LNB) in altering the frequency dependence of the capacitance of CaCu3Ti4O12 (CCTO) thin films has been investigated. A cost effective spin coating deposition process was used to integrate the oxide heterostructures onto silicon substrates. This study showed that the frequency stability of the CCTO/LNB structure was much improved when the crystallization conditions and physical dimension of each layer were optimized. To integrate this structure with current silicon technology, heterostructures of CCTO and LNB thin films were fabricated on HF terminated Si using chemical solution deposition. It was found that the order of deposition of the two layers was important for the structural quality of the heterostructures with the CCTO layer followed by the LNB layer being the preferred structure. In addition to improvement of the capacitance variation with frequency, the heterostructures also provide a path to tuning the frequency of operation.
At the present moment, zinc oxide is primarily being used as an electronic material for low-field thin-film transistor and transparent conducting oxide device applications. In this paper, we present some recent results on the steady-state electron transport within zinc oxide suggesting that this material may also be considered as an alternative material to gallium nitride for high-power and high-frequency electron device applications. The expected device performance that may be obtained from zinc oxide-based devices is then projected and contrasted with that expected from gallium nitride-based devices. It is shown that zinc oxide-based devices have a slight advantage when compared with the case of gallium nitride.
This article provides expert opinion on the use of cardiovascular magnetic resonance (CMR) in young patients with congenital heart disease (CHD) and in specific clinical situations. As peculiar challenges apply to imaging children, paediatric aspects are repeatedly discussed. The first section of the paper addresses settings and techniques, including the basic sequences used in paediatric CMR, safety, and sedation. In the second section, the indication, application, and clinical relevance of CMR in the most frequent CHD are discussed in detail. In the current era of multimodality imaging, the strengths of CMR are compared with other imaging modalities. At the end of each chapter, a brief summary with expert consensus key points is provided. The recommendations provided are strongly clinically oriented. The paper addresses not only imagers performing CMR, but also clinical cardiologists who want to know which information can be obtained by CMR and how to integrate it in clinical decision-making.