Introduction: Acute pharyngitis is a common emergency department (ED) presentation. The Centor (Modified/McIsaac) score uses five criteria (age, tonsillar exudates, swollen tender anterior cervical nodes, absence of a cough, and history of fever) to predict Group A Streptococcus (GAS) infection. The recommendation is patients with a Centor score of 0-1 should not undergo testing and should not be given antibiotics, patients with a score of 2-3 may warrant throat cultures, and for patients with a score ≥ 4, empiric antibiotics may be appropriate. Associated pain is often first managed with acetaminophen or non-steroidal anti-inflammatory drugs, however recent evidence suggests a short course of low-to-moderate dose corticosteroids as adjunctive therapy may reduce inflammation and provide pain relief. The objective of this study was to describe the ED management of acute pharyngitis for adult patients presenting to an academic ED over a two-year study period. Methods: This was a retrospective chart review of all adult (> 17 years) patients presenting to Mount Sinai Hospital ED with a discharge diagnosis of acute pharyngitis (ICD-10 code J02.9) from January 1st 2016 to December 31st 2018. Trained research personnel reviewed medical records and extracted data using a computerized, data abstraction form. Results: Of the 638 patients included in the study, 286 (44.8%) had a Centor score of 0-1, 328 (51.4%) had a score of 2-3, and 24 (3.8%) had a score of ≥ 4. Of those with a Centor score of 0-1, 83 (29.0%) had a throat culture, 88 (30.8%) were prescribed antibiotics, 15 (5.2%) were positive for GAS and 74 (25.9%) were given corticosteroids in the ED or at discharge. Of those with a Centor score of 2-3, 156 (47.6%) had a throat culture, 220 (67.1%) were prescribed antibiotics, 44 (13.4%) were positive for GAS, and 145 (44.2%) were given corticosteroids. Of those with a Centor score ≥ 4, 14 (58.3%) had a throat culture, 18 (75.0%) were prescribed antibiotics, 7 (29.2%) were positive for GAS and 12 (50.0%) were given corticosteroids. Conclusion: As predicted, a higher Centor score was associated with higher risk of GAS infection, increased antibiotic prescribing and use of corticosteroids. Many patients with low Centor scores were prescribed antibiotics and also had throat cultures. Further work is required to understand clinical decision making for the management of acute pharyngitis.

Flapping wings of insects can follow various complex-motion waveforms, influencing the flow structures over a wing and consequently the aerodynamic performance. However, most studies of insect-wing models incorporate either simple harmonic or robofly-like motion waveforms. The effects of other waveforms appear to be under-explored. Motivated by this, the present study investigates the individual and combined effects of the sweep- and pitch-motion waveforms for fixed flapping frequency and amplitude of a fruit-fly wing planform. Physical experiments are conducted to directly measure the forces and torques acting on the wing. Interestingly, the sweep waveform is observed to influence the overall variation in the lift coefficient ( $C_{L}$ ), whereas the pitch waveform is observed to influence only the instantaneous $C_{L}$ during stroke reversal. Carefully validated three-dimensional numerical simulations reveal that a change in the strength of the large-scale vortex over the wing as the sweep profile parameter is varied is responsible for the observed variations in $C_{L}$ . An exploration over wide ranges of the sweep and the pitch profile parameters shows that the waveforms maximising the mean lift coefficient are different from those maximising the power economy. Consistent with some previous experiments on robotic insects, the possibility of passive pitch motion is observed at slower pitching rates. Contours of the mean lift coefficient and power economy mapped on the planes of the sweep and the pitch profile parameters can help designers of flapping-wing micro air vehicles in selecting the waveforms appropriate for their design criteria.

Wing shape is an important factor affecting the aerodynamic performance of wings of monocopters and flapping-wing micro air vehicles. Here, an evolutionary structural optimisation method is adapted to optimise wing shape to enhance the lift force due to aerodynamic pressure on the wing surfaces. The pressure distribution is observed to vary with the span-based Reynolds number over a range covering most insects and samaras. Accordingly, the optimised wing shapes derived using this evolutionary approach are shown to adjust with Reynolds number. Moreover, these optimised shapes exhibit significantly higher lift coefficients ( ${\sim}50\,\%$ ) than the initial rectangular wing forebear. Interestingly, the optimised shapes are found to have a large area outboard, broadly in line with the features of high-lift forewings of multi-winged insects. According to specific aerodynamic performance requirements, this novel method could be employed in the optimisation of improved wing shapes for micro air vehicles.

A two-year (2015 and 2016) grazing study was established to compare ewe and lamb performance when grazed on a perennial ryegrass only sward compared to more diverse sward types. In that study four sward types were investigated: a perennial ryegrass (Lolium perenne) only sward receiving 163 kg nitrogen per hectare per year (N/ha/yr) (PRG); a perennial ryegrass and white clover (Trifolium repens) sward receiving 90 kg N/ha/yr (PRGWC); a six species sward (two grasses (perennial ryegrass and timothy (Phleum pratense)), two legumes (white and red clover (Trifolium pratense)) and two herbs (ribwort plantain (Plantago lanceolata) and chicory (Cichorium intybus)) receiving 90 kg N/ha/yr (6S); and a nine species sward containing cocksfoot (Dactylis glomerata), greater birdsfoot trefoil (Lotus pedunculatus) and yarrow (Achillea millefolium) in addition to the six species listed above, receiving 90 kg N/ha/yr (9S). Each sward type was managed as a separate farmlet and stocked with 30 twin-rearing ewes at a stocking rate of 12.5 ewes/ha under rotational grazing management from turnout post-lambing until housing. Lamb live weight was recorded fortnightly and lambs were drafted for slaughter at 45 kg. Ewe live weight and body condition score (BCS) were recorded on five occasions annually. Lamb faecal egg count (FEC) was recorded fortnightly and lambs were treated with anthelmintics when mean lamb FEC per sward type was above 400 eggs per gram. Ewes grazing the 6S and 9S swards had heavier (P < 0.01) live weights and BCS throughout the study than the ewes grazing the PRG sward. Lambs grazing the 6S sward were heavier than lambs grazing all other sward types of 14 weeks old (P < 0.05). Lambs grazing the PRG sward required more days to reach slaughter weight than lambs grazing all other sward types (P < 0.001). Lambs grazing the 6S and 9S swards required fewer anthelmintic treatments than lambs grazing the PRG or PRGWC swards. In conclusion, grazing multispecies swards improved ewe and lamb performance and reduced the requirement for chemical anthelmintics.

The individual and combined influences of aspect ratio ( $A$ ), Reynolds number ( $Re$ ) and Rossby number ( $Ro$ ) on the leading-edge vortex (LEV) of a rotating wing of insect-like planform are investigated numerically. A previous study from our group has determined the wingspan to be an appropriate length scale governing the large-scale LEV structure. In this study, the $A$ range considered is further extended, to show that this scaling works well as $A$ is varied by a factor of 4 ( $1.8\leqslant A\leqslant 7.28$ ) and over a $Re$ range of two orders of magnitude. The present study also extends this scaling for wings with an offset from the rotation axis, which is typically the case for actual insects and often for experiments. Remarkably, the optimum range of $A$ based on the lift coefficients at different $Re$ coincides with that observed in nature. The scaling based on the wingspan is extended to the acceleration terms of the Navier–Stokes equations, suggesting a modified scaling of $Ro$ , which decouples the effects of $A$ . A detailed investigation of the flow structures, by increasing $Ro$ in a wide range, reveals the weakening of the LEV due to the reduced spanwise flow, resulting in a reduced lift. Overall, the use of span-based scaling of $Re$ and $Ro$ , together with $A$ , may help reconcile apparent conflicting trends between observed variations in aerodynamic performance in different sets of experiments and simulations.

Childhood adversity is associated with increased risk for psychopathology. Neurodevelopmental pathways underlying this risk remain poorly understood. A recent conceptual model posits that childhood adversity can be deconstructed into at least two underlying dimensions, deprivation and threat, that are associated with distinct neurocognitive consequences. This model argues that deprivation (i.e., a lack of cognitive stimulation and learning opportunities) is associated with poor executive function (EF), whereas threat is not. We examine this hypothesis in two studies measuring EF at multiple levels: performance on EF tasks, neural recruitment during EF, and problems with EF in daily life. In Study 1, deprivation (low parental education and child neglect) was associated with greater parent-reported problems with EF in adolescents (N = 169; 13–17 years) after adjustment for levels of threat (community violence and abuse), which were unrelated to EF. In Study 2, low parental education was associated with poor working memory (WM) performance and inefficient neural recruitment in the parietal and prefrontal cortex during high WM load among adolescents (N = 51, 13–20 years) after adjusting for abuse, which was unrelated to WM task performance and neural recruitment during WM. These findings constitute strong preliminary evidence for a novel model of the neurodevelopmental consequences of childhood adversity.

A numerical study of the flow-induced vibration of two elastically mounted cylinders in tandem and staggered arrangements at Reynolds number $Re=200$ is presented. The cylinder centres are set at a streamwise distance of 1.5 cylinder diameters, placing the rear cylinder in the near-wake region of the front cylinder for the tandem arrangement. The cross-stream or lateral offset is varied between 0 and 5 cylinder diameters. The two cylinders are identical, with the same elastic mounting, and constrained to oscillate only in the cross-flow direction. The variation of flow behaviours is examined for static cylinders and for elastic mountings of a range of spring stiffnesses, or reduced velocity. At least seven major modes of flow response are identified, delineated by whether the oscillation is effectively symmetric, and the strength of the influence of the flow through the gap between the two cylinders. Submodes of these are also identified based on whether or not the flow remains periodic. More subtle temporal behaviours, such as period doubling, quasi-periodicity and chaos, are also identified and mapped. Across all of these regimes, the amplitudes of vibration and the magnitude of the fluid forces are quantified. The modes identified span the parameter space between two important limiting cases: two static bodies at varying lateral offset; and two elastically mounted bodies in a tandem configuration at varying spring stiffnesses. Some similarity in the response of extremely stiff or static bodies and extremely slack bodies is shown. This is explained by the fact that the slack bodies are free to move to an equilibrium position and stop, effectively becoming a static system. However, the most complex behaviour appears between these limits, when the bodies are in reasonably close proximity, and the natural structural frequency is close to the vortex shedding frequency of a single cylinder. This appears to be driven by the interplay between a series of time scales, including the vortex formation time, the advection time across the gap between the cylinders and the oscillation period of both bodies. This points out an important difference between this multi-body system and the classic single-cylinder vortex-induced vibration: two bodies in close proximity will not oscillate in a synchronised, periodic manner when their natural structural frequencies are close to the nominal vortex shedding frequency of a single cylinder.

Our study aimed to evaluate changes in the epidemiology of pathogens causing surgical site infections (SSIs) in England between 2000 and 2013 in the context of intensified national interventions to reduce healthcare-associated infections introduced since 2006. National prospective surveillance data on target surgical procedures were used for this study. Data on causative organism were available for 72% of inpatient-detected SSIs meeting the standard case definitions for superficial, deep and organ-space infections (9767/13 531) which were analysed for trends. A multivariable logistic linear mixed model with hospital random effects was fitted to evaluate trends by pathogen. Staphylococcus aureus was the predominant cause of SSI between 2000 (41%) and 2009 (24%), decreasing from 2006 onwards reaching 16% in 2013. Data for 2005–2013 showed that the odds of SSI caused by S. aureus decreased significantly by 14% per year [adjusted odds ratio (aOR) 0·86, 95% confidence interval (CI) 0·83–0·89] driven by significant decreases in methicillin-resistant S. aureus (MRSA) (aOR 0·71, 95% CI 0·68–0·75). However a small significant increase in methicillin-sensitive S. aureus was identified (aOR 1·06, 95% CI 1·02–1·10). Enterobacteriaceae were stable during 2000–2007 (12% of cases overall), increasing from 2008 (18%) onwards, being present in 25% of cases in 2013; the model supported these increasing trends during 2007–2013 (aOR 1·12, 95% CI 1·07–1·18). The decreasing trends in S. aureus SSIs from 2006 and the increases in Enterobacteriaceae SSIs from 2008 may be related to intensified national efforts targeted at reducing MRSA bacteraemia combined with changes in antibiotic use aimed at controlling C. difficile infections.

Ground-based observations of Type III bursts made with spectrographs and spectro-polarimeters, at frequencies above the ionospheric cut-off, reveal that most bursts (excluding storm Type IIIs) have fundamental (F) and harmonic (H) structure (Wild et al. 1959; Dulk and Suzuki 1980). An example of F-H bursts is given by Sheridan (1978). Such bursts are produced by streams of electrons travelling along open magnetic field lines and exciting plasma oscillations which are converted to electro-magnetic waves at both the F and H frequencies of the local plasma frequency in the corona.

Sources of the Type I storms are thought to lie on closed magnetic loop systems above bipolar sunspots. Usually one sunspot is stronger than the other in the bipolar magnetic structure, and accordingly only one radio source associated with the stronger sunspot is usually observed. Occasionally however a double radio source is observed in conjunction with the bipolar sunspots. In such a case the double radio source should be intrinsically bipolar, viz. the two components should emit opposite senses of circular polarization (in this paper we use the word polarity for simplicity).

Data-constrained modeling is a method that enables three-dimensional distribution of mineral phases and porosity in a sample to be modeled based on micro-computed tomography scans acquired at different X-ray energies. Here we describe an alternative method for measuring porosity, synchrotron K-edge subtraction using xenon gas as a contrast agent. Results from both methods applied to the same Darai limestone sample are compared. Reasonable agreement between the two methods and with other porosity measurements is obtained. The possibility of a combination of data-constrained modeling and K-edge subtraction methods for more accurate sample characterization is discussed.

Recent experimental research on rotating cylinder wakes has found that a previously numerically predicted subharmonic instability mode, mode C, occurs for considerably lower rotation rates than predicted through stability analysis, yet other mode transitions occur closer to the predicted onset. One difference between the theoretical and experimental set-ups is the use of a small-diameter hydrogen bubble visualisation wire placed upstream of the rotating cylinder. The current paper tests the hypothesis that a wire, of only $1/100$ th of the cylinder diameter, placed five diameters upstream of the cylinder, sufficiently perturbs the flow to substantially affect certain wake transitions, including the onset of mode C. This is achieved using stability analysis of a flow that includes the upstream wire. The results indeed show that the wire of a tiny diameter induces a non-negligible asymmetry in the flow, triggering the subharmonic mode at substantially lower rotation rates. Furthermore, at higher rotation rates, the onset of two other three-dimensional modes are delayed to higher Reynolds numbers. These results make the point that even seemingly minute perturbations caused by minimally intrusive methods may result in substantially altered experimental flow behaviour.

This study investigates the free transverse flow-induced vibration (FIV) of an elastically mounted low-mass-ratio square cylinder in a free stream, at three different incidence angles: ${{\alpha }}=0^\circ $ , $20^\circ $  and $45^\circ $ . This geometric setup presents a body with an angle of attack, sharp corners and some afterbody, and therefore is a generic body that can be used to investigate a wide range of FIV phenomena. A recent study by Nemes et al. (J. Fluid Mech., vol. 710, 2012, pp. 102–130) provided a broad overview of the flow regimes present as a function of both the angle of attack ${{\alpha }}$  and reduced flow velocity  ${U^{*}}$ . Here, the focus is on the three aforementioned representative angles of attack: ${{\alpha }}=0^\circ $ , where the FIV is dominated by transverse galloping; ${{\alpha }}=45^\circ $ , where the FIV is dominated by vortex-induced vibration (VIV); and an intermediate value of ${{\alpha }}=20^\circ $ , where the underlying FIV phenomenon has previously been difficult to determine. For the ${{\alpha }}=0^\circ $ case, the amplitude of oscillation increases linearly with the flow speed except for a series of regimes that occur when the vortex shedding frequency is in the vicinity of an odd-integer multiple of the galloping oscillation frequency, and the vortex shedding synchronizes to this multiple of the oscillation frequency. It is shown that only odd-integer multiple synchronizations should occur. These synchronizations explain the ‘kinks’ in the galloping amplitude response for light bodies first observed by Bearman et al. (J. Fluids Struct., vol. 1, 1987, pp. 19–34). For the ${{\alpha }}=45^\circ $ case, the VIV response consists of a number of subtle, but distinctly different regimes, with five regimes of high-amplitude oscillations, compared to two found in the classic VIV studies of a circular cylinder. For the intermediate ${{\alpha }}=20^\circ $ case, a typical VIV ‘upper branch’ occurs followed by a ‘higher branch’ of very large-amplitude response. The higher branch is caused by a subharmonic synchronization between the vortex shedding and the body oscillation frequency, where two cycles of vortex shedding occur over one cycle of oscillation. It appears that this subharmonic synchronization is a direct result of the asymmetric body. Overall, the FIV of the square cylinder is shown to be very rich, with a number of distinct regimes, controlled by both ${{\alpha }}$ and ${U^{*}}$ . Importantly, ${{\alpha }}$ controls the underlying FIV phenomenon, as well as controlling the types of possible synchronization between the oscillation and vortex shedding.

A foodborne outbreak with 49 cases (22 culture positive for Campylobacter sp.) following a wedding party in the East of England was investigated. A retrospective cohort study identified an association between consumption of chicken liver pâté and infection with Campylobacter jejuni/coli. There was a statistically significant association between dose (amount of chicken liver pâté eaten) and the risk of disease [‘tasted’: odds ratio (OR) 1·5, 95% confidence interval (CI) 0·04–∞; ‘partly eaten’: OR 8·4, 95% CI 1·4–87·5; ‘most or all eaten’: OR 36·1, 95% CI 3·3–2119). The local authority found evidence that the preparation of chicken livers breached Food Standards Agency's guidelines. This epidemiological investigation established a clear dose–response relationship between consumption of chicken liver pâté and the risk of infection with Campylobacter. The continuing need to raise public awareness of the risk to human health posed by undercooked chicken liver is evident.

A study of the flow past an oscillatory rotating cylinder has been conducted, where the frequency of oscillation has been matched to the natural frequency of the vortex street generated in the wake of a stationary cylinder, at Reynolds number 300. The focus is on the wake transition to three-dimensional flow and, in particular, the changes induced in this transition by the addition of the oscillatory rotation. Using Floquet stability analysis, it is found that the fine-scale three-dimensional mode that typically dominates the wake at a Reynolds number beyond that at the second transition to three-dimensional flow (referred to as mode B) is suppressed for amplitudes of rotation beyond a critical amplitude, in agreement with past studies. However, the rotation does not suppress the development of three-dimensionality completely, as other modes are discovered that would lead to three-dimensional flow. In particular, the longer-wavelength mode that leads the three-dimensional transition in the wake of a stationary cylinder (referred to as mode A) is left essentially unaffected at low amplitudes of rotation. At higher amplitudes of oscillation, mode A is also suppressed as the two-dimensional near wake changes in character from a single- to a double-row wake; however, another mode is predicted to render the flow three-dimensional, dubbed mode D (for double row). This mode has the same spatio-temporal symmetries as mode A.

We investigated the incidence of cases of nosocomial pathogens and risk factors in an intensive treatment unit ward to determine if the number of cases is dependent on location of patients and the colonization/infection history of the ward. A clustering approach method was developed to investigate the patterns of spread of cases through time for five microorganisms [methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter spp., Klebsiella spp., Candida spp., and Pseudomonas aeruginosa] using hospital microbiological monitoring data and ward records of patient-bed use. Cases of colonization/infection by MRSA, Candida and Pseudomonas were clustered in beds and through time while cases of Klebsiella and Acinetobacter were not. We used structural equation modelling to analyse interacting risk factors and the potential pathways of transmission in the ward. Prior nurse contact with colonized/infected patients, mediated by the number of patient-bed movements, were important predictors for all cases, except for those of Pseudomonas. General health and invasive surgery were significant predictors of cases of Candida and Klebsiella. We suggest that isolation and bed movement as a strategy to manage MRSA infections is likely to impact upon the incidence of cases of other opportunist pathogens.

A multi-state outbreak of Salmonella enterica serovar Saintpaul infection occurred in Australia during October 2006. A case-control study conducted in three affected jurisdictions, New South Wales, Victoria and Australian Capital Territory, included 36 cases with the outbreak-specific strain of S. Saintpaul identified by multiple locus variable-number tandem repeat analysis (MLVA) in a faecal specimen and 106 controls. Consumption of cantaloupe (rockmelon) was strongly associated with illness (adjusted OR 23·9 95%, 95% CI 5·1–112·4). S. Saintpaul, with the outbreak MLVA profile, was detected on the skin of two cantaloupes obtained from an implicated retailer. Trace-back investigations did not identify the specific source of the outbreak strain of S. Saintpaul, but multiple Salmonella spp. were detected in environmental samples from farms and packing plants investigated during the trace-back operation. Cantaloupe production and processing practices pose a potential public health threat requiring regulatory and community educational interventions.