Background: Hereditary transthyretin-mediated (hATTR) amyloidosis a hereditary, multi-systemic and life-threatening disease resulting in neuropathy and cardiomyopathy. In the APOLLO study, patisiran, an investigational RNAi therapeutic targeting hepatic TTR production resulted in significant improvement in neuropathy and QoL compared to placebo and was generally well tolerated. Methods: APOLLO, a Phase 3 study of patisiran vs. placebo (NCT01960348) prespecified a cardiac subpopulation (n=126 of 225 total) that included patients with baseline left ventricular (LV) wall thickness ≥ 13mm and no medical history of aortic valve disease or hypertension. Cardiac measures included structure and function by electrocardiography, changes in NT-proBNP and 10-MWT gait speed. Results: At 18 months, patisiran treatment resulted in a mean reduction in LV wall thickness of 1 mm (p=0.017) compared to baseline, which was associated with significant improvements relative to placebo in LV end diastolic volume (+8.31 mL, p=0.036), global longitudinal strain (-1.37%, p=0.015) and NT-proBNP (55% reduction, p=7.7 x 10-8) (Figure 1). Gait speed was also improved relative to placebo (+0.35 m/sec, p=7.4 x 10-9). Rate of death or hospitalization was lower with patisiran. mNIS+7 results in the cardiac subpopulation will also be presented. Conclusions: These data suggest patisiran has the potential to halt or reverse cardiac manifestations of hATTR amyloidosis.

During the summer of 2016, the Hawaii Department of Health responded to the second-largest domestic foodborne hepatitis A virus (HAV) outbreak in the post-vaccine era. The epidemiological investigation included case finding and investigation, sequencing of RNA positive clinical specimens, product trace-back and virologic testing and sequencing of HAV RNA from the product. Additionally, an online survey open to all Hawaii residents was conducted to estimate baseline commercial food consumption. We identified 292 confirmed HAV cases, of whom 11 (4%) were possible secondary cases. Seventy-four (25%) were hospitalised and there were two deaths. Among all cases, 94% reported eating at Oahu or Kauai Island branches of Restaurant Chain A, with 86% of those cases reporting raw scallop consumption. In contrast, a food consumption survey conducted during the outbreak indicated 25% of Oahu residents patronised Restaurant Chain A in the 7 weeks before the survey. Product trace-back revealed a single distributor that supplied scallops imported from the Philippines to Restaurant Chain A. Recovery, amplification and sequence comparison of HAV recovered from scallops revealed viral sequences matching those from case-patients. Removal of product from implicated restaurants and vaccination of those potentially exposed led to the cessation of the outbreak. This outbreak further highlights the need for improved imported food safety.

Introduction: Clinical context is critical for accurate radiologic interpretation of neuroimaging investigations. The aim of this study was to determine the impact of a change in the Emergency Department (ED) computerized provider order entry (CPOE) interface on the quality of clinical information conveyed in ED neuroimaging requisitions for suspected stroke patients. Methods: Four local EDs utilizing a common CPOE ED Stroke order set were studied before and after the introduction of a mandatory blank free text field requiring clinical information for the radiologist before a computed tomography angiography (CTA) request could be submitted. Prior to this modification, the indication (acute stroke) was pre-filled in the CTA request for convenience with the option of providing additional information at the discretion of the ordering physician. ED physicians were informed of the change as well as the rationale for its implementation. A retrospective pre (90 days) post (30 days) analysis was conducted across four local EDs to evaluate the impact of the CPOE user interface change on the quality of clinical information provided on neuroimaging orders. Patients aged 18 with CTA head and/or neck orders submitted from the order set were included. Patients were excluded if the CTA order was submitted outside of the ED Stroke order set, if order entry was by non-physician personnel, or if the order was modified by the diagnostic imaging department after ED submission. Clinical information from CTA orders were scored as complete, partial, or absent/uninformative based on a standardized rubric of critical elements, including: description of neurological deficit(s), lateralization, and timing of symptom onset or duration. Results were analyzed using chi square analysis. Results: Pre-implementation data from Oct 1, 2015 Jan 1, 2016 (N=652) was compared to post-implementation data from Nov 1 30, 2016 (N=227). The proportion of complete, partial, and absent/uninformative clinical histories were: 45.3%, 31.4%, and 23.3% in the pre-implementation period and 62.6%, 37.4%, and 0% in the post-implementation period respectively. There was a 38.2% relative increase in complete clinical histories, a 19.1% relative increase in partial clinical histories, and a 100% reduction in absent/uninformative clinical histories (p<0.001). Conclusion: The introduction of a mandatory free text field significantly increased the overall quality of clinical information provided on ED neuroimaging orders. This CPOE strategy has the potential to improve diagnostic accuracy and reduce unnecessary delays to imaging interpretation caused by lack of clinical information.

Introduction: The purpose of this study is to determine if the introduction of a pre-arrival and pre-departure Trauma Checklist as a cognitive aid, coupled with an educational session, will improve clinical performance in a simulated environment. The Trauma Checklist was developed in response to a quality assurance review of high-acuity trauma activations. It focuses on pre-arrival preparation and a pre-departure review prior to patient transfer to diagnostic imaging or the operating room. We conducted a pilot, randomized control trial assessing the impact of the Trauma Checklist on time to critical interventions on a simulated pediatric patient by multidisciplinary teams. Methods: Emergency department teams composed of 2 physicians, 2 nurses and 2 confederate actors were enrolled in our study. In the intervention arm, participants watched a 10-minute educational video modelling the use of the trauma checklist prior to their simulation scenario and were provided a copy of the checklist. Teams participated in a standardized simulation scenario caring for a severely injured adolescent patient with hemorrhagic shock, respiratory failure and increased intracranial pressure. Our primary outcome of interest was time measurement to initiation of key clinical interventions, including intubation, first blood product administration, massive transfusion protocol activation, initiation of hyperosmolar therapy and others. Secondary outcome measures included a Trauma Task Performance score and checklist completion scores. Results: We enrolled 14 multidisciplinary teams (n=56 participants) into our study. There was a statistically significant decrease in median time to initiation of hyperosmolar therapy by teams in the intervention arm compared to the control arm (581 seconds, [509-680] vs. 884 seconds, [588-1144], p=0.03). Time to initiation of other clinical interventions was not statistically significant. There was a trend to higher Trauma Task Performance scores in the intervention group however this did not reach statistical significant (p=0.09). Pre-arrival and pre-departure checklist scores were higher in the intervention group (9.0 [9.0-10.0] vs. 7.0 [6.0-8.0], p=0.17 and 12.0 [11.5-12.0] vs. 7.5 [6.0-8.5], p=0.01). Conclusion: Teams using the Trauma Checklist did not have decreased time to initiation of key clinical interventions except in initiating hyperosmolar therapy. Teams in the intervention arm had statistically significantly higher pre-arrival and pre-departure scores, with a trend to higher Trauma Task Performance scores. Our study was a pilot and recruitment did not achieve the anticipated sample size, thus underpowered. The impact of this checklist should be studied outside tertiary trauma centres, particularly in trainees and community emergency providers, to assess for benefit and further generalizability.

The study investigated whether different dietary energy and protein sources affect laying performance, antioxidant status, fresh yolk fatty acid profile and quality of salted yolks in laying ducks. In all, 360 19-week-old Longyan ducks were randomly assigned to four diets in a factorial arrangement (2×2). The four diets consisted of two energy sources, corn (CO) or sorghum (SO) and two protein sources, soybean meal (SM) and rapeseed meal with corn distillers dried grains with solubles (RMD), and each treatment contained six replicates of 15 birds each. The experimental diets were isocaloric (metabolizable energy, 10.84 MJ/kg) and isonitrogenous (CP, 17%). The results showed that egg production, average egg weight, egg mass and feed conversion ratio were not affected by diets (P>0.05). Plasma contents of reduced glutathione (GSH), GSH/oxidized glutathione and total antioxidant capacity were lower (P<0.05) in ducks fed the RMD diets compared with those fed SM diets with a substantial increase (P=0.006) in plasma content of malondialdehyde (MDA). Egg yolks from ducks fed SO diets had higher proportions of polyunsaturated fatty acids (PUFA) and lower saturated and monounsaturated fatty acids compared with CO diets (P<0.001). Similarly, ducks fed RMD diets had a higher content of PUFA and n-6/n-3 ratio in fresh yolks (P<0.001), and increased salted yolk MDA, carbonylated proteins content and incidence of hard salted yolks (P<0.05) compared with SM diets. Scanning electron microscopy showed that salted yolks contained rougher polyhedral granules and fewer fat droplets, and were surrounded with a layer of bunchy fibers in ducks fed SO+RMD than those fed CO+SM diet. In conclusion, the current study showed that feeding laying ducks with diets containing SO or RMD reduced antioxidant capacity and increased egg yolk concentrations of PUFA. It appeared that egg yolks from ducks fed these diets were more sensitive to lipid peroxidation and protein oxidation during salting, and reduced the quality of salted yolks.

The mammalian target of rapamycin (mTOR) has been shown to be involved in lipopolysaccharide (LPS)-induced immune responses in many mammal cells. Here, we suggest that the mTOR pathway is involved in the intestinal inflammatory responses evoked by LPS treatment in chicken embryos. The intestinal tissue from Specific pathogen free chick embryos was cultured in the presence of LPS for 2 h. Secretory immunoglobulin A (sIgA) concentrations, messenger RNA (mRNA) expression of cytokines, and protein levels of nuclear factor-κB (NF-κB), mitogen-activated protein kinase (MAPK), mTOR and p70 ribosomal S6 kinase (p70S6K) were determined. The results showed that LPS treatment increased sIgA concentrations in a dose-dependent manner. The mRNA levels of interleukine (IL)-6, IL-8, IL-10, tumor necrosis factor-α and Toll-like receptor (TLR) 4 were upregulated by LPS treatment (P<0.05). Lipopolysaccharide increased the phosphorylation of Jun N-terminal kinase (JNK), p38 MAPK and NF-κB (P<0.05) while decreasing the phosphorylation level of mTOR (P<0.05). Supplementation of leucine at doses of 10, 20 and 40 mM dose-dependently decreased sIgA production. Leucine supplementation at 40 mM restored the phosphorylation level of mTOR and p70S6K while suppressing the phosphorylation levels of NF-κB (P<0.05) and partially down-regulating the phosphorylation of p38 MAPK and JNK. The transcription of IL-6 was significantly decreased by leucine supplementation. These results suggested that leucine could alleviate LPS-induced inflammatory responses by down-regulating NF-κB signaling pathway and evoking mTOR/p70S6K signaling pathway, which may involve in the regulation of the intestinal immune system in chicken embryos.

The availability of relatively large format IR array detectors is incentive for reexamining the classic question of whether or not there are “dust rings” around the sun – a problem for which there are conflicting observational answers. The 1991 eclipse path included a high altitude observatory and provided a potentially ideal opportunity to study the infrared properties and dust content of the corona. Here we report results from an experiment conducted from Mauna Kea using a HgCdTe array detector sensitive to wavelengths between 1-2.5 μm. Surface brightness measurements in the H-band and polarization data in the J-band were obtained over a field-of-view of ±6 R ⊙ while K-band images further extend to 15 R ⊙ on the western side of the Sun. J-band polarization data and H and K-band surface brightness data clearly show the inhomogeneous structure in the K corona and the ecliptical flattening of the F corona. We see no evidence of a circumsolar, local dust corona (dust rings) out to 15 R ⊙.

Introduction: High-quality cardiopulmonary resuscitation (CPR) is essential for patient survival. Typically, CPR quality is only measured during the first 10 minutes of resuscitation. There is limited research examining the quality of CPR over the entire duration of resuscitation.Objective: To examine the quality of CPR over the entire duration of resuscitation and correlate the quality of CPR to patient survival. Methods: This was a retrospective observational study using data from the Toronto RescuNET Epistry-Cardiac Arrest database. We included consecutive, adult (>18) OHCA treated by EMS between January 1, 2014 and September 30, 2015. High-quality CPR was defined, in accordance with 2015 AHA Guidelines, as a chest compression rate of 100-120/min, depth of 5.0-6.0 cm and chest compression fraction (ccf) of >0.80. We further categorized high-quality resuscitation as meeting benchmarks >80% of the time, moderate-quality between 50-80% and low-quality meeting benchmarks <50% of the resuscitation. We used multivariable logistic regression to determine association between variables of interest, including CPR quality metrics, and survival to hospital discharge. Results: A total of 5,208 OHCA met our inclusion criteria with a survival rate of 8%. The median (IQR) duration of resuscitation was 23.0 min (15.0,32.7). Overall CPR quality was considered high-quality for ccf in 81% of resuscitation episodes, 41% for rate, and 7% for depth. The percentage of resuscitations meeting the quality benchmarks differed between survivors and non-survivors for both depth (15% vs 6%) and ccf (61% vs 83%) (P value <0.001). After controlling for Utstein variables maintaining a chest compression depth within recommendations for >80% showed a trend towards improved survival (OR 1.68, 95% CI 0.96, 2.92). Other variables associated with survival were public location, initial CPR by EMS providers or bystanders, witnessed cardiac arrest (EMS or bystander), and initial shockable rhythm. Increasing age and longer duration of resuscitation were associated with decreased survival. Conclusion: Overall, EMS providers were not able to maintain rate or depth within guideline recommendations for the majority of the duration of resuscitation. Maintaining chest compression depth for greater than 80% of the resuscitation showed a trend towards increased survival from OHCA.

We report the temperature dependence of Er optical centers in GaN epilayers prepared by metal-organic chemical vapor deposition under the resonant excitation (4 I 15/2 → 4 I 9/2) excitation using a Ti:Sapphire laser (λexc = 809 nm). High resolution infrared spectroscopy and temperature dependence measurements of photoluminescence intensity from Er ions in GaN have been performed to identify the crystal filed splitting of the first excited state, 4 I 13/2. Here, we have employed a simple approach to determine activation energies which are related to the thermal population of electrons from the lowest level to the higher level of the crystal field splitting of the first excited state.

In linear system, in-plane motions are decoupled from out-of-plane motions for planar frame structures. A theoretical method is proposed that permits the efficient calculations of modal characteristics of planar multi-story frame structures. There are 3 × m beam components for a planar m-story frame structure. By analyzing the transverse and longitudinal motions of each component simultaneously and considering the compatibility requirements across each frame joint, the undetermined variables of the entire m-story frame structure system can be reduced to six, regardless of the number of stories, and that can be determined by the application of the boundary conditions. The main feature of this method is to decrease the dimensions of the matrix involved in the finite element methods and certain other analytical methods.

The study investigates three-dimensional kinematics of lower limb for female Chinese population during normal squatting activity. 25 young female and 25 elder female Chinese subjects were recruited. With each subject's data collected, the means of three-dimensional rotation angles of knee, hip, and ankle joints of those two groups were calculated and analyzed. Measured results showed that the maximal eccentric range of hip flexion/extension of 128.6° for the young female group (P < 0.05) was compared with that of 158.8° for the elder female group. Thus, the elder female undergoes more hip flexion/extension angles than the young female in the posture of squatting. The mean range of motion (ROM) of knee flexion/extension was 140.2° for the young female group and 138.7° (significant level P > 0.05) for the elder female group. The mean ROM of ankle flexion/extension was 47.90° for the young female group and 31.9° (P > 0.05) for the elder female group. The ROMs obtained in the experiment during squatting were greater than the reported ones achieved after joint arthroplasty. These data may be invaluable in providing designers of lower limb prosthesis with basic mechanical parameters, and assessing the effect of kinematics of low limb on rehabilitation for the Chinese population.

Gilliland et al. (2000) have reported HST photometric observations of 34000 stars in the globular cluster 47 Tuc, showing an absence of close-in giant planets in that cluster relative to their frequency in the solar neighborhood. Here we describe the methods of time-series analysis that were used to search the 47 Tuc data for transits by giant extrasolar planets, and the means by which these methods were validated.

This study explored the target sound source location at unknown situation and processed the received signal to determine the location of the target, including the reconstructed signal of source immediately. In this paper, it used triangulation sound sources localization and time reversal method (TRM) to reconstruct the source signals. The purpose is to use a sound source localization method with a simple device to quickly locate the position of the sound source. This method uses the microphone array to measure signal from the target sound source. Then, the sound source location is calculated and is indicated by Cartesian coordinates. The sound source location is then used to evaluate free field impulse response function which can replace the impulse response function used in time-reversal method. This process reduces the computation time greatly which makes possible for a real time source localization and source signal separation.

Bitter gourd (Momordica charantia L.) is an important market vegetable in the tropics. The objectives of this study were to (1) conduct a preliminary evaluation of genetic diversity in bitter gourd flesh (without seeds) for phytonutrient (carotenoid, ascorbic acid and tocopherol) contents with the aim to understand which phytonutrients might be increased through breeding, (2) assess the association between fruit traits and phytonutrient contents and (3) evaluate the effect of the fruit harvest stage on phytonutrient contents. A total of 17 diverse bitter gourd entries of various commercial market types were evaluated for fruit traits and phytonutrient contents for 2 years. Significant differences (P= 0.05) among the entries were detected for total carotenoids, total tocopherols, dry matter and fruit traits. Mean total carotenoid contents of the entries ranged from 10 to 1335 μg/100 g fresh weight in year 1 and 10 to 1185 μg/100 g fresh weight in year 2. Mean ascorbic acid contents were 69 and 61 mg/100 g fresh weight in year 1 and year 2, respectively. Total tocopherol contents among the entries ranged from 480 to 1345 and 445 to 2145 μg/100 g fresh weight in year 1 and year 2, respectively. Total carotenoid and ascorbic acid contents were highest at 12 days after fruit set (DAFS), but total tocopherol contents were highest from 14 to 20 DAFS. A 100 g portion of bitter gourd fruit can meet 190, 17 and 8% of the recommended daily allowances of vitamin C, vitamin E and vitamin A, respectively, for adults.

In late 2014, a gastroenteritis outbreak occurred in a school in Shandong Province, eastern China. Hundreds of individuals developed the symptoms of diarrhoea and vomiting. Epidemiological investigation showed that food consumption was not linked to this outbreak, and unboiled direct drinking water was identified as the independent risk factor with a relative risk of 1·37 (95% confidence interval 1·03–1·83). Furthermore, examination of common bacterial and viral gastroenteritis pathogens was conducted on different specimens. Norovirus GI.1, GI.2, GI.6, GII.4, GII.6 and GII.13 were detected in clinical specimens and a water sample. GII.4 sequences between clinical specimens and the water sample displayed a close relationship and belonged to GII.4 variant Sydney 2012. These results indicate that direct drinking water contaminated by norovirus was responsible for this gastroenteritis outbreak. This study enriches our knowledge of waterborne norovirus outbreaks in China, and presents valuable prevention and control practices for policy-makers. In future, strengthened surveillance and supervision of direct drinking-water systems is needed.

In many small solar flares the ∼10–100 keV electrons accelerated during the flash phase contain the bulk of the total flare energy output. In large flares, such as those in the period 1972, August 2–7, the flash phase electrons are present in substantially greater numbers. These electrons can explosively heat the chromosphere-lower corona and eject flare material. The ejected matter can produce a shock wave which will then accelerate nucleons and electrons to relativistic energies. We analyze energetic particle, radio, X-ray, gamma ray and interplanetary shock observations of the 1972 August flares to obtain quantitative estimates of the energy contained in each facet of these large flares. In general these observations are consistent with the above hypothesis. In particular:

1. (1)From the X-ray emission (van Beek et al., 1973) the energy contained in >25 keV electrons is calculated to be 2 × 1032 erg for the 1972, August 4 event. Since the lower energy cutoff to the electron spectrum is known to be below 25 keV and possibly below 10 keV, the electrons contain enough energy to produce the following interplanetary shock wave, which has by far the bulk of the energy dissipated in the flare. Similar numbers are obtained for the large August 7 flare event.
2. (2)From the γ-ray emission (Chupp et al., 1973) the energy in protons dumped at the same level of the atmosphere, assuming a thick target situation, is at least a factor of three smaller than the electrons. Moreover the γ-ray emission indicates that the bulk of the protons are accelerated at least several minutes after the electrons. Thus it is more likely that the electrons are responsible for the flare optical (Hα and white light) emissions which occur in the chromosphere.
3. (3)Approximately 5% of the electrons and 99% of the protons escape into the interplanetary medium to be observed by spacecraft. This situation is consistent with the hypothesis of shock acceleration of the protons high in the solar corona.
4. (4)The four most intense X-ray bursts observed during the period July 31–August 11 are the only bursts followed by an interplanetary shock wave and a new injection of energetic protons into the interplanetary medium.

This paper intends to develop a target trajectory estimation algorithm with application to the ballistic target estimation in the terminal phase. The proposed design is based on the application of a second-order extended state observer (ESO) technique using target information acquired from the seeker to estimate the trajectory of manoeuverable ballistic targets. Satisfactory results have been received while applying the design in estimation of either two-dimenional or three-dimentional target evasive acceleration via computer simulation.