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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.
With respect to human health, nutritional guidelines emphasise on increasing the ratio poly-unsaturated/saturated fatty acids (P/S) (> 0.7) and reducing the n-6/n-3 ratio (< 5). Beef is generally characterised by a low P/S ratio (0.1), while the n-6/n-3 ratio may vary between 2 and 10 depending on the feeding strategy. Hence, the provision of n-3 fatty acids by the diet is crucial for optimising the fatty acid composition of meat. However, PUFA are hydrolysed and subsequently hydrogenated in the rumen to more saturated fatty acids and intermediates that are absorbed from the intestinal tract and transported to the tissues. Lipolysis and hydrogenation may thus affect the meat fatty acid composition. For ruminants, important sources of linolenic acid (C18:3n-3) are linseed and fresh grass. Prior to use in animal nutrition, linseed needs physical treatment like extrusion or crushing. The aim of the present in vitro experiment was to study lipolysis and biohydrogenation of linoleic acid (C18:2n-6) and C18:3n-3 in fresh grass and extruded or crushed linseed products.
Identification of priority populations such as men who have sex with men (MSM) is important in surveillance systems to monitor trends of sexually transmitted infections (STIs). We explored using routinely collected non-behavioural data as a means to establish MSM status in surveillance by assessing anorectal swab as a marker of male-to-male sexual exposure. We used chlamydia testing data from a sexual health clinic, 2007–2012. Men reporting any male sexual partner(s) in the previous 12 months were considered MSM. The dataset was split into development and validation samples to develop a univariate predictive model and assess the model fit. The dataset included 30 358 individual men and 48 554 episodes of STI testing; 45% were among reported MSM and an anorectal swab was performed in 40% of testing episodes. Anorectal swabbing had good diagnostic performance as a marker for MSM status (sensitivity = 87%, specificity = 99%, positive predictive value = 98·6%, negative predictive value = 90·3%). The model showed good fit against the internal validation sample (area under the curve = 0·93). Anorectal swabs are a valid marker of MSM behaviour in surveillance data from sexual health clinics, and they are likely to be particularly useful for monitoring STI trends among MSM with higher risk behaviour.
Since the emergence of Middle East respiratory syndrome coronavirus (MERS-CoV), Singapore has enhanced its national surveillance system to detect the potential importation of this novel pathogen. Using the guidelines from the Singapore Ministry of Health, a suspect case was defined as a person with clinical signs and symptoms suggestive of pneumonia or severe respiratory infection with breathlessness, and with an epidemiological link to countries where MERS-CoV cases had been reported within the preceding 14 days. This report describes a retrospective review of 851 suspected MERS-CoV cases assessed at the adult tertiary-care hospital in Singapore between September 2012 and December 2015. In total, 262 patients (31%) were hospitalized. All had MERS-CoV infection ruled out by RT–PCR or clinical assessment. Two hundred and thirty (88%) of the hospitalized patients were also investigated for influenza virus by RT–PCR. Of these, 62 (27%) tested positive for seasonal influenza. None of the patients with positive influenza results had been vaccinated in the year prior to hospital admission. Ninety-three (36%) out of the 262 hospitalized patients had clinical and/or radiological evidence of pneumonia. This study demonstrates the potential benefits of pre-travel vaccination against influenza and pneumococcal disease.
Introduction: Patients who are homeless and/or using substances rely heavily on emergency departments (ED) for medical care, and present with complex medical and social needs. Negative physician attitudes towards this population undermine the therapeutic relationship, compromising the quality of medical care provided. The objective of this study was to determine the attitudes of emergency physicians towards homeless and substance-using patients. Methods: Using a Modified Total Design approach, we conducted a cross-sectional survey of emergency physicians at five different healthcare locations in Calgary, Alberta, Canada. Attitudes were assessed using two validated measures, the Health Care Providers Attitudes Towards the Homeless Inventory (HPATHI), and the Short Understanding of Substance Use Scale (SUSS). Surveys were self-administered by respondents between March and December 2013. Results: A total of 117 physicians completed the survey (response rate 48%). 28% of respondents resented the amount of time it takes to see homeless patients, and 32% believed caring for homeless patients was not financially viable; 57% felt overwhelmed by the complexity of problems that homeless people have. Physicians with extra training in addiction medicine or health care for the homeless had more positive attitudes than physicians with no extra training; physician attitudes worsened over time towards both populations. Conclusion: Physicians feel overwhelmed when caring for patients who are homeless and/or substance using and negative attitudes worsened over time. Extra training in addiction medicine or healthcare for the homeless is associated with more positive attitudes. Possible strategies to improve attitudes should include a multifaceted approach addressing individual physician knowledge deficits, as well as expanded access to resources in the ED and community, designed to deal with the complex needs of these populations.
The Evolutionary Map of the Universe (EMU) is a proposed radio continuum survey
of the Southern Hemisphere up to declination + 30°, with the Australian
Square Kilometre Array Pathfinder (ASKAP). EMU will use an automated source
identification and measurement approach that is demonstrably optimal, to
maximise the reliability and robustness of the resulting radio source
catalogues. As a step toward this goal we conducted a “Data
Challenge” to test a variety of source finders on simulated images. The
aim is to quantify the accuracy and limitations of existing automated source
finding and measurement approaches. The Challenge initiators also tested the
current ASKAPsoft source-finding tool to establish how it could benefit from
incorporating successful features of the other tools. As expected, most finders
show completeness around 100% at ≈ 10σ dropping to about 10% by
≈ 5σ. Reliability is typically close to 100% at ≈
10σ, with performance to lower sensitivities varying between finders. All
finders show the expected trade-off, where a high completeness at low
signal-to-noise gives a corresponding reduction in reliability, and vice versa.
We conclude with a series of recommendations for improving the performance of
the ASKAPsoft source-finding tool.
On 30 May 2012, Surrey and Sussex Health Protection Unit was called by five nurseries reporting children and staff with sudden onset vomiting approximately an hour after finishing their lunch that day. Over the following 24 h 50 further nurseries supplied by the same company reported cases of vomiting (182 children, 18 staff affected). Epidemiological investigations were undertaken in order to identify the cause of the outbreak and prevent further cases. Investigations demonstrated a nursery-level attack rate of 55 out of 87 nurseries (63·2%, 95% confidence interval 52·2–73·3). Microbiological tests confirmed the presence of Bacillus cereus in food and environmental samples from the catering company and one nursery. This was considered microbiologically and epidemiologically consistent with toxin from this bacterium causing the outbreak. Laboratory investigations showed that the conditions used by the caterer for soaking of pearl haricot beans (known as navy bean in the USA) used in one of the foods supplied to the nurseries prior to cooking, was likely to have provided sufficient growth and toxin production of B. cereus to cause illness. This large outbreak demonstrates the need for careful temperature control in food preparation.
The rapid rise in syphilis cases has prompted a number of public health campaigns to assist men who have sex with men (MSM) recognize and present early with symptoms. This study aimed to investigate the temporal trend of the duration of self-report symptoms and titre of rapid plasma reagin (RPR) in MSM with infectious syphilis. Seven hundred and sixty-one syphilis cases in MSM diagnosed at the Melbourne Sexual Health Centre (MSHC) from 2007–2013 were reviewed. Median duration of symptoms and RPR titres in each year were calculated. The median durations of symptoms with primary and secondary syphilis were 9 [interquartile range (IQR) 6–14] days and 14 (IQR 7–30) days, respectively. The overall median titre of RPR in secondary syphilis (median 128, IQR 64–256) was higher than in primary syphilis (median 4, IQR 1–32) and in early latent syphilis (median 32, IQR 4–64). The median duration of symptoms for primary syphilis, secondary syphilis and titre of RPR level did not change over time. Public health campaigns were not associated with a significant shorter time from onset of symptoms to treatment. Alternative strategies such as more frequent testing of MSM should be promoted to control the syphilis epidemic in Australia.
Food packages were objectively assessed to explore differences in nutrition labelling, selected promotional marketing techniques and health and nutrition claims between countries, in comparison to national regulations.
Chip and sweet biscuit packages were collected from sixteen countries at different levels of economic development in the EPOCH (Environmental Profile of a Community’s Health) study between 2008 and 2010.
Seven hundred and thirty-seven food packages were systematically evaluated for nutrition labelling, selected promotional marketing techniques relevant to nutrition and health, and health and nutrition claims. We compared pack labelling in countries with labelling regulations, with voluntary regulations and no regulations.
Overall 86 % of the packages had nutrition labels, 30 % had health or nutrition claims and 87 % displayed selected marketing techniques. On average, each package displayed two marketing techniques and one health or nutrition claim. In countries with mandatory nutrition labelling a greater proportion of packages displayed nutrition labels, had more of the seven required nutrients present, more total nutrients listed and higher readability compared with those with voluntary or no regulations. Countries with no health or nutrition claim regulations had fewer claims per package compared with countries with regulations.
Nutrition label regulations were associated with increased prevalence and quality of nutrition labels. Health and nutrition claim regulations were unexpectedly associated with increased use of claims, suggesting that current regulations may not have the desired effect of protecting consumers. Of concern, lack of regulation was associated with increased promotional marketing techniques directed at children and misleadingly promoting broad concepts of health.
There is little known regarding the transmissibility of human papillomavirus (HPV) between different sites in men who have sex with men (MSM) and heterosexual individuals. We conducted a retrospective analysis investigating all new patients attending the Melbourne Sexual Health Centre in Australia between 2002 and 2013. We describe the prevalence and ratio of the first episode of anogenital warts in MSM and heterosexual males and females. The proportion of new MSM clients with anal and penile warts was 4·0% (362/8978) and 1·6% (141/8978), respectively; which gave an anal-to-penile wart ratio of 1:2·6. About 13·7% (1656/12112) of heterosexual males had penile warts and 10·0% (1121/11166) of females had vulval warts, which yielded a penile-to-vulval wart ratio of 1:0·7. Penile–anal transmission has a higher ratio than penile–vulval transmission, suggesting that the anal epithelium may be more susceptible to HPV infection than the vulval epithelium in females; these ratios are important in modelling the control of HPV in MSM.
To examine the effects of complex cognitive (mahjong) and physical (Tai Chi) activities on dementia severity in nursing home residents with dementia.
Cluster-randomized open-label controlled design. 110 residents were randomized by nursing home into three conditions: mahjong, Tai Chi, and simple handicrafts (control). Activities were conducted three times a week for 12 weeks. Clinical Dementia Rating (CDR) was taken at 0 (baseline), 3 (post-treatment), 6, and 9 months. The outcome measure was CDR sum-of-box, which is a composite measure of both cognitive and functional deterioration in dementia.
Intent-to-treat analyses were performed using multilevel regression models. Apolipoprotein E ε4 allele and education were included as covariates. Neither treatments had effects on the cognitive and functional components of the CDR, but mahjong had a significant interaction with time on the CDR sum-of-box total, suggesting a slower rate of global deterioration in the mahjong group as compared with the control group.
Mahjong led to a gradual improvement in global functioning and a slightly slower rate of dementia progression over time. The effect was generalized and was not specific to cognition or daily functioning.
Suppose fλ: ℝ→ℝ, fλ(0) = 0 and the fixed point zero undergoes a generic supercritical period doubling bifurcation at λ = 0. We characterise those small values of ε > 0, λ ∈ ℝ for which there are periodic solutions of period approximately two of the equation
Alternate layers of pure copper and gold were vapor deposited on a sodium chloride substrate, the average concentration of the films being Cu-16at% Au and the layering periodicity (modulation wavelength) being 3.31 nm. The composition modulation gives rise to satellite diffraction peaks around the (200) Bragg reflections. Synchrotron radiation at SSRL was able to detect up to third order satellite intensity the evolution of which was measured as a function of annealing time at 515 K. Although the first order satellite intensity decayed as expected exponentially with time, intensities of both second and third order satellites decreased very rapidly at first, then increased before decaying exponentially. These results are in conformity with theoretical models of satellite evolution during annealing in a onedimensional modulated system governed by a nonlinear diffusion equation.
Hybrid organic-inorganic xerogel films were deposited as porous thin films by spinning the precursor sol on silicon substrates. Films of various compositions were prepared using combinations of the following precursors: methyltrimethoxysilane, dimethoxydimethylsilane and tetramethoxysilane (TMOS). The hybrid films exhibited excellent gap-filling capabilities (0.45 micron trenches). Thermal desorption experiments indicate that heating to ∼130 C removes moisture and volatile organic constituents present in the as-cast film. Curing was found to increase the adhesion between the xerogel and the silicon substrate. Moisture was found to be responsible for an increase in the dielectric constant. That is, in ambient, the dielectric constant for a cured film was found to be 4.4; but in a dry atmosphere, it decreased to 2.5. Current-voltage measurements show the cured hybrid film possesses a breakdown field of 3.4 MV/cm.
in situ Spectroscopic Ellipsometry (SE) is an optical technique which is well suited for the monitoring of epitaxial semiconductor growth, due to its high surface sensitivity and non-invasive nature. In this work, SE systems were installed on both MBE and MOCVD deposition systems to monitor the epitaxial growth of InxGa1−xAs and InxAl1−xAs compounds on InP substrates. The structures grown include thick lattice matched In0.53Ga0.47As buffer layers (for HBT collectors), and strained RTD structures. SE was used to monitor in real-time layer composition and thickness during growth. To enhance the precision and accuracy of the SE determined growth parameters, it was necessary to optimize the SE data analysis strategies. A methodology to determine the best spectral region for the SE data analysis in the presence of noise and systematic effects (such as angle of incidence uncertainty, detector wavelength shifts, surface roughness, uncertainty in surface temperature, non-ideal growth modes, etc.) is presented. Using the optimized data analysis strategies, long term SE-determined InxGa1−�As composition accuracy (as verified by ex situ x-ray measurements) of ±0.002 in ‘x’ was achieved. SE thickness measurements of ultra-thin (<30Å) strained AlAs barrier layers were also in excellent agreement (±0.5Å) with real-time photo-emission oscillation measurements.
Materials studies of high Al-content (> 30%) AlGaN epilayers and the performance of AlGaN-based LEDs with emission wavelengths shorter than 300 nm are reported. N-type AlGaN films with Al compositions greater than 30% reveal a reduction in conductivity with increasing Al composition. The reduction of threading dislocation density from the 1–5 × 1010 cm-2 range to the 6–9 × 109cm-2 range results in an improvement of electrical conductivity and Al0.90Ga0.10N films with n= 1.6e17 cm-3 and μ=20 cm2/Vs have been achieved. The design, fabrication and packaging of flip-chip bonded deep UV LEDs is described. Large area (1 mm × 1 mm) LED structures with interdigitated contacts demonstrate output powers of 2.25 mW at 297 nm and 1.3 mW at 276 nm when operated under DC current. 300 μm × 300 μm LEDs emitting at 295 nm and operated at 20 mA DC have demonstrated less than 50% drop in output power after more than 2400 hours of operation. Optimization of the electron block layer in 274 nm LED structures has enabled a significant reduction in deep level emission bands, and a peak quantum well to deep level ratio of 700:1 has been achieved for 300 μm × 300 μm LEDs operated at 100 mA DC. Shorter wavelength LED designs are described, and LEDs emitting at 260 nm, 254nm and 237 nm are reported.
The periodic silane burst technique was employed during metalorganic chemical vapor deposition of epitaxial GaN on AlN buffer layers grown on Si (111). Periodic silicon delta doping during growth of both the AlN and GaN layers led to growth of GaN films with decreased tensile stresses and decreased threading dislocation densities, as well as films with improved quality as indicated by x-ray diffraction, micro-Raman spectroscopy, atomic force microscopy, and transmission electron microscopy. The possible mechanism of the reduction of tensile stress and the dislocation density is discussed in the paper.
This paper describes a microbiological study of 84 young adult men with clinical otitic infections. Gram-negative aerobic bacilli were frequently isolated from these patients diagnosed as having otitis externa or chronic suppurative otitis media, of which Pseudomonasspecies predominated.
Staphylococcus aureus, S. epidermidis and aerobic Corynebacterium species (diphtheroids) were also found. About 40% of ear infections were attributed to otomycoses, chiefly from Aspergillus species and Candida parapsilosis. Antimicrobial susceptibility testing of the bacterial isolates revealed that Pseudomonas species were generally resistant to antibiotics commonly employed in general practice: ampicillin, erythromycin, co-trimoxazole, tetracycline and cephaloridine. However, polymjwin B, gentamicin and neomycin were active against some Pseudomonas isolates. Other Gram-negative bacilli were also mainly sensitiveto gentamicin, neomycin as well as co-trimoxazole. Disc diffusion and minimum inhibitor concentration studies demonstrated good activity of ceftazidime, cefoperazone, tobramycin and carbenicillin against strains of Pseudomonas species and other Gram-negative rods. Cefotaxime and cefoxitin were active against Gram-negative bacilli other than Pseudomonas species. Beta-lactamase production did not appear to be the main mechanism of resistance in these communityacquired Gram-negative bacillary isolates. The antimicrobial therapy of otological infections is reviewed.