Reflective practice is increasingly being recognized as an important component of doctors’ professional development. Balint group practice is centered on the doctor–patient relationship: what it means, how it may be used to benefit patients, and why it commonly fails owing to a lack of understanding between doctor and patient. The COVID-19 pandemic led to unprecedented disruption to postgraduate medical training programs, including the mandatory Balint groups for psychiatric trainees. This editorial reports on the experience of online Balint groups in the North West of Ireland during the COVID-19 pandemic, and furthermore provides guidance for online Balint group practice into the future.

In this paper, we apply an indirect production function approach to analyze producers’ output and input allocation choices under expenditure constraints. Our estimation results show that financial constraints induced a nonoptimal usage of smallholder farm inputs, resulting in losses in potential productivity of approximately 25%. It appears that the presence of a binding expenditure constraint has led to an underutilization of fertilizer and manure as well as an overutilization of seed.

The flow of a suspension through a bifurcating channel is studied experimentally and by computational methods. The geometry considered is an ‘asymmetric T’, as flow in the entering branch divides to either continue straight or to make a right angle turn. All branches are of the same square cross-section of side length $D$, with inlet and outlet section lengths $L$ yielding $L/D=58$ in the experiments. The suspensions are composed of neutrally buoyant spherical particles in a Newtonian liquid, with mean particle diameters of $d=250~\unicode[STIX]{x03BC}\text{m}$ and $480~\unicode[STIX]{x03BC}\text{m}$ resulting in $d/D\approx 0.1$ to $d/D\approx 0.2$ for $D=2.4~\text{mm}$. The flow rate ratio $\unicode[STIX]{x1D6FD}=Q_{\Vert }/Q_{0}$, defined for the bulk, fluid and particles, is used to characterize the flow behaviour; here $Q_{\Vert }$ and $Q_{0}$ are volumetric flow rates in the straight outlet branch and inlet branch, respectively. The channel Reynolds number $Re=(\unicode[STIX]{x1D70C}DU)/\unicode[STIX]{x1D702}$ was varied over $0<Re<900$, with $\unicode[STIX]{x1D70C}$ and $\unicode[STIX]{x1D702}$ the fluid density and viscosity, respectively, and $U$ the mean velocity in the inlet channel; the inlet particle volume fraction was $0.05\leqslant \unicode[STIX]{x1D719}_{0}\leqslant 0.30$. Experimental and numerical results for single-phase Newtonian fluid both show $\unicode[STIX]{x1D6FD}$ increasing with $Re$, implying more material tending toward the straight branch as the inertia of the flow increases. In suspension flow at small $\unicode[STIX]{x1D719}_{0}$, inertial migration of particles in the inlet branch affects the flow rate ratio for particles ($\unicode[STIX]{x1D6FD}_{\mathit{particle}}$) and suspension ($\unicode[STIX]{x1D6FD}_{\mathit{suspension}}$). The flow split for the bulk suspension satisfies $\unicode[STIX]{x1D6FD}>0.5$ for $\unicode[STIX]{x1D719}_{0}<0.16$ while $\unicode[STIX]{x1D719}_{0}=0.16$ crosses from $\unicode[STIX]{x1D6FD}\approx 0.5$ to $\unicode[STIX]{x1D6FD}>0.5$ at $Re\approx 100$. For $\unicode[STIX]{x1D719}_{0}\geqslant 0.2$, $\unicode[STIX]{x1D6FD}<0.5$ at all $Re$ studied. A complex dependence of the mean solid fraction in the downstream branches upon inlet fraction $\unicode[STIX]{x1D719}_{0}$ and $Re$ is observed: for $\unicode[STIX]{x1D719}_{0}<0.1$, the solid fraction in the straight downstream branch initially decreases with $Re$, before increasing to surpass the inlet fraction at large $Re$ ($Re\approx 500$ for $\unicode[STIX]{x1D719}_{0}=0.05$). At $\unicode[STIX]{x1D719}_{0}>0.1$, the solid fraction in the straight branch satisfies $\unicode[STIX]{x1D719}_{\Vert }/\unicode[STIX]{x1D719}_{0}>1$, and this ratio grows with $Re$. Discrete-particle simulations employing immersed boundary and lattice-Boltzmann techniques are used to analyse these phenomena, allowing rationalization of aspects of this complex behaviour as being due to particle migration in the inlet branch.

Avian influenza virus (AIV) type A subtype H9N2 usually causes mild asymptomatic infections, and is mostly undetected and is, therefore, under-reported. This has allowed the virus to rapidly evolve via mutations and reassortments in its genome with other avian influenza subtypes especially H1N1, H5N1 and H7N3 thereby introducing new variant strains and producing severe disease. It has been reported that the AIV H9N2 donated its internal genes for the devastating 1997 Hong Kong outbreak and furthermore, it may be the cause of the next influenza pandemic. There are many factors such as its wide host range, ability to cross the species barrier, ecological diversity, antiviral resistance and zoonotic importance that make it an excellent candidate for the next influenza pandemic. These and other factors like ineffective vaccination, negative immunological pressures, lack of surveillance, which contribute to its continuous persistence and evolutionary dynamics are discussed in this paper. It is important to take the necessary measures to control and prevent its unchecked circulation to prevent the future outbreaks.

The US Center for Medicare and Medicaid Services (CMS) requires nursing homes and long-term-care facilities to document residents' vaccination status on the Resident Assessment Instrument (RAI). Vaccinating residents can prevent costly hospital admissions and deaths. CMS and public health officials use RAI data to measure vaccination rates in long-term-care residents and assess the quality of care in nursing homes. We assessed the accuracy of RAI data against medical records in 39 nursing homes in Florida, Georgia, and Wisconsin. We randomly sampled residents in each home during the 2010–2011 and 2011–2012 influenza seasons. We collected data on receipt of influenza vaccination from charts and RAI data. Our final sample included 840 medical charts with matched RAI records. The agreement rate was 0·86. Using the chart as a gold standard, the sensitivity of the RAI with respect to influenza vaccination was 85% and the specificity was 77%. Agreement rates varied within facilities from 55% to 100%. Monitoring vaccination rates in the population is important for gauging the impact of programmes and policies to promote adherence to vaccination recommendations. Use of data from RAIs is a reasonable approach for gauging influenza vaccination rates in nursing-home residents.

Both objective and, more recently, subjective measures of low social status have been linked to poor health outcomes. It is unclear, however, through which precise physiological mechanisms such standing may influence health, although it has been proposed that those of lower status may have biomarker profiles that are more dysregulated (and hence pose a greater risk for poorer health). The main objective of this study was to investigate whether lower subjective social standing is associated with riskier neuroendocrine biomarker profiles. Data were from the Social Environment and Biomarkers of Aging Study (SEBAS), a nationally representative survey of Taiwanese men and women (ages 54–91) conducted in Taiwan in 2000. Five neuroendocrine markers (cortisol, dehydroepiandrosterone sulphate (DHEAS), adrenaline, noradrenaline and dopamine) were analysed both separately and collectively in an index termed neuroendocrine allostatic load (NAL) in relation to status – both self-reported and as measured through objective socioeconomic status (SES) indicators. For the biomarker DHEAS, some connection was found between its levels and the measures of status, but for the other markers and the NAL index almost no connection was found. The overall negative finding of this paper would be further supported with more and different measures of neuroendocrine system function and a reordering of the subjective social status questions in the survey such that the one probing about status in the community (that has no prompt) was asked before the one probing about status in all of Taiwan (which has a SES prompt).

Objectives: Insulin-like growth factor-1 may serve some regulatory function in the immune system. Rheumatic mitral stenosis is related to autoimmune heart valve damage after streptococcal infection. The aim of this study was to assess the level of insulin-like growth factor-1 and its correlation with the Wilkins score in patients with rheumatic mitral stenosis. Methods: A total of 65 patients with rheumatic mitral stenosis and 62 age- and sex-matched control subjects were enrolled in this study. All subjects underwent transthoracic echocardiography. The mitral valve area and Wilkins score were evaluated for all patients. Biochemical parameters and serum insulin-like growth factor-1 levels were measured. Results: Demographic data were similar in the rheumatic mitral stenosis and control groups. The mean mitral valve area was 1.6±0.4 cm2 in the rheumatic mitral stenosis group. The level of insulin-like growth factor-1 was significantly higher in the rheumatic mitral stenosis group than in the control group (104 (55.6–267) versus 79.1 (23.0–244.0) ng/ml; p=0.039). There was a significant moderate positive correlation between insulin-like growth factor-1 and thickening of leaflets score of Wilkins (r=0.541, p<0.001). Conclusions: The present study demonstrated that serum insulin-like growth factor-1 levels were significantly higher in the rheumatic mitral stenosis group compared with control subjects and that insulin-like growth factor-1 level was also correlated with the Wilkins score. It can be suggested that there may be a link between insulin-like growth factor-1 level and immune pathogenesis of rheumatic mitral stenosis.

Copper oxide (CuO) and zinc oxide (ZnO) nanostructures complement each other since CuO is unintentional p-type and ZnO unintentional n-type. Using the low temperature chemical growth approach, the effect on morphology of varying the pH of the grown ZnO nanostructures and CuO micro structures is monitored. For both materials the variation of the pH was found to lead to a large variation on the morphology achieved. The grown ZnO NRs and CuO micro flowers material were used to fabricate devices. We demonstrate results from ZnO nanorods (NRs)/polymer p-n hybrid heterojunctions chemically grown on paper and using a process on paper for light emitting diodes (LEDs) applications as well as some large area light emitting diodes LEDs. The growth of CuO micro flowers indicated good quality material for sensing applications. The grown CuO micro flowers were employed as pH sensors. The results indicated a superior performance as expect due to the catalytic properties of this material.

In order to understand how the malaria vector Anopheles arabiensis Patton exists in the extremely hot and arid environment (mean annual rainfall 21 mm) in Northern Province, Sudan, regular sampling from breeding places and resting sites was undertaken during 1978 and 1979 at four villages along the River Nile downstream (i.e. northwards) from Dongola. The population density of A. arabiensis was lowest during the flood season (July—October) and increased as the river flow decreased during November—June. Thus there was an inverse relationship between the Nile water level and A. arabiensis production. Prolific breeding in riverside pools was the main source of A. arabiensis as the river receded. During the annual flood, when riverside pools were all inundated, A. arabiensis continued breeding at low densities in sheltered sites such as wells and pits. Breeding also occurred in all months in association with the weed Potamogeton crispus in slow reaches of the river. Adult females fed regularly on blood, with gonotrophic concordance in all months, and there was no evidence of aestivation. Outdoor biting activity occurred throughout the night, with a peak between 2100 and 0500 h. Daytime searches indoors and outdoors indicated that resting females A. arabiensis are almost entirely endophilic in the study area.

125I-Schistosoma mansoni schistosomulum surface antigens were immunoprecipitated with human antibodies from individual Egyptian patients diagnosed as being either acutely or chronically infected with S. mansoni. Both sets of patients were found to have IgG antibodies in their sera capable of immunoprecipitating the major Mr > 200, 38 and 32K antigens. However, the immunoprecipitation of the Mr 200K antigen was found to constitute a significantly greater proportion of the total precipitate achieved with acute sera than with chronic sera. The Mr 38 and 32K antigens were more variably precipitated by the acute sera than the chronic sera but the proportion of the total precipitation that these two antigens constituted was not found to be significantly different between the two sets of sera. Immunoprecipitation with pooled antibodies absorbed with egg and adult worm homogenates which had been treated to remove either carbohydrate or polypeptide epitopes demonstrated that the Mr > 200K antigen was the principal target of egg-cross-reactive anti-carbohydrate antibody amongst the antigens detected. The Mr 38 and 32K antigens were found to be precipitated by antibodies to protease-sensitive and periodate-insensitive polypeptide epitopes. These results are consistent with egg-cross-reactive anti-carbohydrate IgG antibody making a greater contribution to schistosomulum surface recognition in acute infection than in chronic infection. Indeed the presence of a higher level of egg-cross-reactive and anti-carbohydrate antibody directed against schistosomulum surface epitopes in an acute serum pool than in a chronic serum pool was confirmed by measurement of antibody binding to whole schistosomula.

Two isolates of Schistosoma mansoni from Puerto Rico and Egypt were examined to determine if there were differences in surface antigens of the schistosomulum and to assess the ability of the two isolates to induce protection against one another in vivo. Immune mouse and human patient antisera recognized the same antigens on the schistosomulum surface of both isolates. However, mice immunized with schistosomula-released products from the Egyptian isolate recognized an additional antigen of Mr 13K on the Egyptian schistosomulum surface which was not present in the Puerto Rican isolate. In quantitative radioimmunoassay, sera from mice vaccinated with irradiated Egyptian cercariae bound more strongly to Egyptian schistosomula than to Puerto Rican parasites. Both isolates cross-protected against each other, but mice were less immune to challenge with Egyptian cercariae after being immunized with Puerto Rican irradiated cercariae. There was no difference in immunity to challenge when Egyptian irradiated cercariae were used to immunize. Although this evidence suggested some heterogeneity within the Egyptian isolate, cloned cercariae of the Egyptian isolate did not vary in their ability to cross-protect against each other. Furthermore, antisera from mice immunized with clones of Egyptian cercariae recognized the same schistosomulum surface antigens. The results reported here indicate that although there were small differences between the two isolates the major surface antigens are conserved.

The relationship between antigens associated with the surface of newly transformed schistosomula of Schistosoma mansoni and the tegumental surface membrane of adult S. mansoni worms has been further explored. Immunoprecipitation of detergent-solubilized 125I-tegumental surface membrane antigens of adult S. mansoni with antibodies from mice vaccinated with highly irradiated S. mansoni cercariae revealed major antigens of Mr 32, 20, 15 and 8K. The Mr 32 and 20K antigens have been previously demonstrated to be antigenically and electrophoretically identical to major antigens on the schistosomulum surface. The Mr 15 and 8K antigens, on the other hand, have not been identified by the immunoprecipitation of 125I-schistosomulum surface antigens, although a distinct schistosomulum surface antigen of Mr 15K is precipitated by antibodies from mice vaccinated with highly irradiated cercariae. Nevertheless, it was shown that antibodies to the Mr 15 and 8K antigens were specifically absorbed from vaccinated mouse serum by intact, live schistosomula, demonstrating that the Mr 15 and 8K antigens are exposed on or released from the schistosomulum surface. In contrast, absorption of the antiserum with eggs failed to remove antibody against any of the four tegumental membrane antigens examined. The Mr 15 and 8K antigens were shown to be recognized via polypeptide epitopes and not periodate-sensitive carbohydrate epitopes, further emphasizing the similarity of these to the well-characterized Mr 32 and 20K tegumental surface membrane antigens. A general relationship between schistosomulum surface, adult tegumental membrane and egg antigens was demonstrated by ELISA, using antibodies raised against the three antigenic fractions. It was shown that both the egg and adult tegumental membrane antigens cross-react with the schistosomulum surface, but that the egg and adult membrane antigens exhibit very little, if any, mutual cross-reactivity. This antigen divergence possibly enables the host to dissociate pathological, anti-egg responses from potentially protective anti-membrane responses during the course of natural infection. It also suggests that adult membrane antigens could be used in an anti-schistosome vaccine without the possible complication of inducing pathological responses.