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Introduction: The ECG diagnosis of acute coronary occlusion (ACO) in the setting of ventricular paced rhythm (VPR) is purported to be impossible. However, VPR has a similar ECG morphology to LBBB. The validated Smith-modified Sgarbossa criteria (MSC) have high sensitivity (Sens) and specificity (Spec) for ACO in LBBB. MSC consist of 1 of the following in 1 lead: concordant ST Elevation (STE) 1 mm, concordant ST depression 1 mm in V1-V3, or ST/S ratio <−0.25 (in leads with 1 mm STE). We hypothesized that the MSC will have higher Sens for diagnosis of ACO in VPR when compared to the original Sgarbossa criteria. We report preliminary findings of the Paced Electrocardiogram Requiring Fast Emergency Coronary Therapy (PERFECT) study Methods: The PERFECT study is a retrospective, multicenter, international investigation of ED patients from 1/2008 - 12/2016 with VPR on the ECG and symptoms suggestive of acute coronary syndrome (e.g. chest pain or shortness of breath). Data from four sites are presented. Acute myocardial infarction (AMI) was defined by the Third Universal Definition of AMI. A blinded cardiologist adjudicated ACO, defined as thrombolysis in myocardial infarction score 0 or 1 on coronary angiography; a pre-defined subgroup of ACO patients with peak cardiac troponin (cTn) >100 times the 99% upper reference limit (URL) of the cTn assay was also analyzed. Another blinded physician measured all ECGs. Statistics were by Mann Whitney U, Chi-square, and McNemars test. Results: The ACO and No-AMI groups consisted of 15 and 79 encounters, respectively. For the ACO and No-AMI groups, median age was 78 [IQR 72-82] vs. 70 [61-75] and 13 (86%) vs. 48 (61%) patients were male. The median peak cTn ratio (cTn/URL) was 260 [33-663] and 0.5 [0-1.3] for ACO vs. no-AMI. The Sens and Spec for the MSC and the original Sgarbossa criteria were 67% (95%CI 39-87) vs. 46% (22-72; p=0.25) and 99% (92-100) vs. 99% (92-100; p=0.5). In pre-defined subgroup analysis of ACO patients with peak cTn >100 times the URL (n=10), the Sens was 90% (54-100) for the MSC vs. 60% (27- 86) for original Sgarbossa criteria (p=0.25). Conclusion: ACO in VPR is an uncommon condition. The MSC showed good Sens for diagnosis of ACO in the presence of VPR, especially among patients with high peak cTn, and Spec was excellent. These methods and results are consistent with studies that have used the MSC to diagnose ACO in LBBB.
On 27 April 2015, Washington health authorities identified Escherichia coli O157:H7 infections associated with dairy education school field trips held in a barn 20–24 April. Investigation objectives were to determine the magnitude of the outbreak, identify the source of infection, prevent secondary illness transmission and develop recommendations to prevent future outbreaks. Case-finding, hypothesis generating interviews, environmental site visits and a case–control study were conducted. Parents and children were interviewed regarding event activities. Odds ratios (OR) and 95% confidence intervals (CI) were computed. Environmental testing was conducted in the barn; isolates were compared to patient isolates using pulsed-field gel electrophoresis (PFGE). Sixty people were ill, 11 (18%) were hospitalised and six (10%) developed haemolytic uremic syndrome. Ill people ranged in age from <1 year to 47 years (median: 7), and 20 (33%) were female. Twenty-seven case-patients and 88 controls were enrolled in the case–control study. Among first-grade students, handwashing (i.e. soap and water, or hand sanitiser) before lunch was protective (adjusted OR 0.13; 95% CI 0.02–0.88, P = 0.04). Barn samples yielded E. coli O157:H7 with PFGE patterns indistinguishable from patient isolates. This investigation provided epidemiological, laboratory and environmental evidence for a large outbreak of E. coli O157:H7 infections from exposure to a contaminated barn. The investigation highlights the often overlooked risk of infection through exposure to animal environments as well as the importance of handwashing for disease prevention. Increased education and encouragement of infection prevention measures, such as handwashing, can prevent illness.
Echinococcus granulosus is an important zoonotic parasite that is distributed worldwide. The EG95 vaccine was developed to assist with control of E. granulosus transmission through the parasite's livestock intermediate hosts. The vaccine is based on a recombinant antigen encoded by a gene which is a member of a multi-gene family. With the recent availability of two E. granulosus draft genomes, we sought to map the eg95 gene family to the genomes. We were unable to map unequivocally any of the eg95 gene family members which had previously been characterized by cloning and sequencing both strands of genomic DNA fragments. Our inability to map EG95-related genes to the genomes has revealed limitations in the assembled sequence data when utilized for gene family analyses. This study contrasts with the expectations expressed in often high-profile publications describing draft genomes of parasitic organisms, highlighting deficiencies in currently available genomic resources for E. granulosus and provides a cautionary note for research which seeks to utilize these genome datasets.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
We present the preliminary results of a frequency analysis of 1457 fundamental mode RR Lyrae (RR0) stars in the Large Magellanic Cloud (LMC) from MACHO Project photometry. We find the same classes of pulsational behavior as were found in our earlier survey of first overtone RR Lyrae (RR1) stars. Variables whose prewhitened power spectra contain one or two peaks close to the main frequency component in the original power spectra are commonly known as Blazhko-type variables. The present analysis shows the overall frequency of Blazhko-type stars in the total RR0 population analysed to date to be ≈ 10%. This is lower than the often cited Galactic field/globular rate of 20-30% (Szeidl, 1988).
The incidence rate of Blazhko-type variability in the LMC appears to be about three times higher in RR0 stars than in RR1 stars. This puts important constraints on possible models of the Blazhko effect.
We present the first massive frequency analysis of the 1200 first overtone RR Lyrae stars in the Large Magellanic Cloud observed in the first 4.3 yr of the MACHO project. Besides the many new double-mode variables, we also discovered stars with closely spaced frequencies. These variables are most probably nonradial pulsators.
Specific antibody responses were assessed in pigs immunized with the Taenia solium vaccine TSOL18. Anti-TSOL18 responses were compared 2 weeks after secondary immunization, where the interval between primary and secondary immunization was 4, 8, 12, 16 or 20 weeks. All animals responded to the vaccine and there was no diminution in antibody responses in animals receiving their second injection after an interval up to 20 weeks. Pigs receiving vaccinations at an interval of 12 weeks developed significantly increased antibody responses compared with animals receiving immunizations 4 weeks apart (P = 0·046). The ability to deliver TSOL18 vaccination effectively where the revaccination schedule can be delayed for up to 12–16 weeks in pigs increases the options available for designing T. solium control interventions that incorporate TSOL18 vaccination.
Although prior work has shown that employees with ethical leaders are less likely to engage in deviant or unethical behaviors, it is unknown whether all employees respond this way or to the same extent. Drawing on social learning theory as a conceptual framework, this study develops and tests hypotheses suggesting that two follower characteristics—conscientiousness and core self-evaluation—moderate the negative relationship between ethical leadership and workplace incivility. Data from employees of a U.S. public school district supported our predictions. Implications and future research directions are discussed.
Nitride-Arsenide materials were grown by molecular beam epitaxy (MBE) using a radio frequency (rf) nitrogen plasma. The plasma conditions that maximize the amount of atomic nitrogen versus molecular nitrogen were determined using the emission spectrum of the plasma. Under constant plasma source conditions and varying group III flux, the nitrogen concentration in the film is inversely proportional to the group III flux (i. e. the nitrogen sticking coefficient is unity). The relationship between nitrogen concentration in the film and lattice parameter of the film is not linear for nitrogen concentrations above 2.9 mole % GaN, indicating that some nitrogen is incorporated on other locations than the group V lattice sites. For films with these higher nitrogen concentrations, XPS indicates that the nitrogen exists in two configurations: a Gallium-Nitrogen bond and another type of nitrogen complex in which nitrogen is less strongly bonded to Gallium atoms. Annealing removes this nitrogen complex and allows some of the nitrogen to diffuse out of the film. Annealing also improves the crystal quality of GaAsN quantum wells.
In England, people with a serious mental illness are offered a standardized care plan under the Care Programme Approach (CPA). A crisis plan is a mandatory part of this standard; however, the quality and in particular the level of individualisation of these crisis plans are unknown. In this context, the aim of this study was to assess the quality of crisis planning and the impact of exposure to a specialized crisis planning intervention.
The crisis plans of 424 participants were assessed, before and after exposure to the Joint Crisis Plan (JCP) intervention, for ‘individualisation’ (i.e., at least one item of specific and identifiable information about an individual). Associations of individualisation were investigated.
A total of 15% of crisis plans were individualised at baseline. There was little or no improvement following exposure to the JCP. Individualised crisis plans were not associated with a history of prior crises or incidences of harm to self and others.
Routine crisis planning for individuals with serious mental illness is not influenced by clinical risk profiles. ‘Top down’ implementation of the policy is unlikely to generate the best practice and compliance if clinicians do not perceive the clinical value in the process.
Cellulose degradation products (CDPs) can complex with radioelements causing solubility enhancement and sorption reduction, effects which are detrimental to the containment of radionuclides in the near field of a geological disposal facility and surrounding geosphere. Isosaccharinic acid (ISA) is the principal component of CDPs formed under the alkaline anaerobic conditions of a cement-based near field and appears to be largely responsible for the impact of CDPs on radionuclide solubility and sorption under near-field conditions. However, the situation appears to be more complicated under near-neutral pH geosphere conditions.
A combined experimental and modelling study was undertaken to compare the impact of a CDP leachate to ISA in a simple model ternary sorption system consisting of hematite as a single mineral substrate, thorium as the radioelement and ISA or a CDP leachate as the complexant. Thorium sorbs strongly to hematite. A triple layer model for thorium sorption to hematite was refined to fit to the experimental data in the absence of ISA or CDP leachate; the effect of ISA on thorium sorption was then predicted.
In the presence of CDP leachate, a significant reduction in thorium sorption was observed from pH 6 to 12 in good agreement with model predictions based on a high concentration of ISA. However, only a limited impact of ISA on thorium sorption was observed at pH 6 to 12, in contrast to predictions. The effects of ISA could be accounted for by assuming the formation of a ternary thorium–ISA–surface complex. The model has yet to be extended to the more complex CDP systems. Differences in the thorium speciation in solution due to the formation of a ternary calcium–thorium–ISA complex in the CDP leachate, which is absent from solutions with ISA only, provides the most likely explanation for the differences observed experimentally.
Magnesium hydroxyfluoride, Mg(OH)F, has been synthesized by a subcritical hydrothermal route from a 1:1 molar mixture of brucite, Mg(OH)2, and sellaite, MgF2 with a rutile type structure, in excess water. Using a combination of synchrotron X-ray and time-of-flight neutron powder diffraction, the structure of Mg(OH)F has been solved in the diaspore space group Pnma with a = 10.116(3), b = 4.6888(10) and c = 3.0794(7) Å at ambient conditions. The most intense diffraction lines are [dobs (hkl) Iobs]: 2.291 (211) 10, 4.253 (101) 7, 1.747 (212) 7, 2.229 (401) 6 and 1.480 (610) (4) Å, with the largest d-spacing at 5.058 Å. Sharp infrared stretching bands are located at 3679 and 3645 cm–1, with a broader band at 3535 cm–1. The topology of the structure is intermediate between that of the OH and F endmembers, being derived through notional shearing nearly normal to the sheets of octahedra of the CdI2/Mg(OH)2-type structure. Further similar shearing at an interval 1/2a would lead to a Cd(OH)F-type structure, which is also related to the rutile structure type. The observations and model presented here indicate a close correlation between the structural properties of the endmembers and Mg(OH)F.
In situ atomic force microscopy (AFM) was used to investigate the kinetics of demineralization of human dentin collagen fibrils. Individual dentin collagen fibrils containing intrafibrillar mineral were isolated, transferred onto a glass slide and exposed to water for a day prior to demineralization studies. The fibrils then were exposed to trypsin for removal of non-collagenous proteins and subsequently demineralized in 10 vol % citric acid. Topographic images showed a gradual increase in gap-overlap depth of the fibril. The gap-overlap depth varied linearly with the square root of time before saturation at 7 nm in approximately sixty minutes, suggesting a diffusion process for demineralization of intrafibrillar mineral. Micro Raman studies of partially demineralized dentin revealed the existence of a phosphate peak at wave number close to 960 cm-1. The peak gradually disappeared in 60 minutes as the samples were exposed to 10% citric acid, supporting the notion that AFM topography may be correlated to the degree of intrafibrillar mineralization.
We have studied the properties of two types of transparent conducting oxides grown by pulsed laser deposition (PLD) on quartz substrates. We have grown films of ITO with resistivity as low as 250 μΩ-cm and with absorption coefficient < 600 cm−1 throughout the visible spectrum. Even films deposited at room temperature can have ρ < 500 μΩ-cm, although the optical transmission characteristics are worse than those of commercially available ITO. Important parameters governing film quality include the oxygen partial pressure during film deposition and substrate temperature. GaInO3 is a recently identified transparent conducting material which is structurally distinct from ITO. Films have been grown with no intentional dopants and with either Ge substitution for Ga or Sn substitution for In. Doping concentrations as high as 10 at. % have been studied. There is no evidence for dopant segregation. Films with resistivities as low as 3 μΩ-cm have been achieved, and the absorption coefficient can be less than 500 cm−1 throughout the entire visible spectrum.
A novel polymer has been developed for use as a thin film dielectric in the interconnect structure of high density integrated circuits. The coating is applied to the substrate as an oligomeric solution, SiLK*, using conventional spin coating equipment and produces highly uniform films after curing at 400 °C to 450 °C. The oligomeric solution, with a viscosity of ca. 30 cPs, is readily handled on standard thin film coating equipment. Polymerization does not require a catalyst. There is no water evolved during the polymerization. The resulting polymer network is an aromatic hydrocarbon with an isotropie structure and contains no fluorine.
The properties of the cured films are designed to permit integration with current ILD processes. In particular, the rate of weight-loss during isothermal exposures at 450 °C is ca. 0.7 wt.%/hour. The dielectric constant of cured SiLK has been measured at 2.65. The refractive index in both the in-plane and out-of-plane directions is 1.63. The flow characteristics of SiLK lead to broad topographic planarization and permit the filling of gaps at least as narrow as 0.1 μm. The glass transition temperature for the fully cured film is greater than 490 °C. The coefficient of thermal expansivity is 66 ppm/°C below the glass transition temperature. The stress in fully cured films on Si wafers is ca. 60 MPa at room temperature. The fracture toughness measured on thin films is 0.62 MPa m ½. Thin coatings absorb less than 0.25 wt.% water when exposed to 80% relative humidity at room temperature.
The near-EF electronic structure and Fermi surface of Bi2212 has been mapped out with ARPES. A key feature of our measured bandstructure is the existence of an extended region of flat CuO2-derived bands at EF. Comparative analysis of this data with that from NdCeCuO and YBCO7 suggests that many of the anomalous (normal) physical properties of Bi2212 and YBCO7 (NdCeCuO) may be related to the existence (absence) of such bands at EF. Superconducting gap anisotropy at least an order of magnitude larger than that of the conventional superconductors has been observed in the a-b plane of Bi2212 in ARPES. For samples with Tc of 88K, the gap size reaches a maximum of approximately 20 meV along the Cu-O bond direction, and a minimum of much smaller or vanishing magnitude 45° away. The experimental data is discussed within the context of various theoretical models. In particular, a detailed comparison with what is expected from a superconductor with a dx2-y2 order parameter is carried out, yielding a consistent picture.