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Pneumonia is a leading cause of death in New York City (NYC). We identified spatial clusters of pneumonia-associated hospitalisation for persons residing in NYC, aged ⩾18 years during 2010–2014. We detected pneumonia-associated hospitalisations using an all-payer inpatient dataset. Using geostatistical semivariogram modelling, local Moran's I cluster analyses and χ2 tests, we characterised differences between ‘hot spots’ and ‘cold spots’ for pneumonia-associated hospitalisations. During 2010–2014, there were 141 730 pneumonia-associated hospitalisations across 188 NYC neighbourhoods, of which 43.5% (N = 61 712) were sub-classified as severe. Hot spots of pneumonia-associated hospitalisation spanned 26 neighbourhoods in the Bronx, Manhattan and Staten Island, whereas cold spots were found in lower Manhattan and northeastern Queens. We identified hot spots of severe pneumonia-associated hospitalisation in the northern Bronx and the northern tip of Staten Island. For severe pneumonia-associated hospitalisations, hot-spot patients were of lower mean age and a greater proportion identified as non-Hispanic Black compared with cold spot patients; additionally, hot-spot patients had a longer hospital stay and a greater proportion experienced in-hospital death compared with cold-spot patients. Pneumonia prevention efforts within NYC should consider examining the reasons for higher rates in hot-spot neighbourhoods, and focus interventions towards the Bronx, northern Manhattan and Staten Island.
The world’s largest outbreak of Ebola virus disease began in West Africa in 2014. Although few cases were identified in the United States, the possibility of imported cases led US public health systems and health care facilities to focus on preparing the health care system to quickly and safely identify and respond to emerging infectious diseases. In New York City, early, coordinated planning among city and state agencies and the health care delivery system led to a successful response to a single case diagnosed in a returned health care worker. In this article we describe public health and health care system preparedness efforts in New York City to respond to Ebola and conclude that coordinated public health emergency response relies on joint planning and sustained resources for public health emergency response, epidemiology and laboratory capacity, and health care emergency management. (Disaster Med Public Health Preparedness. 2017;11:370–374).
Contaminated water is one of the main sources of norovirus (NoV) gastroenteritis outbreaks globally. Waterborne NoV outbreaks are infrequently attributed to GII.4 NoV. In September 2009, a NoV outbreak affected a small school in Guangdong Province, China. Epidemiological investigations indicated that household use water, supplied by a well, was the probable source (relative risk 1·9). NoV nucleic acid material in concentrated well-water samples was detected using real-time RT–PCR. Nucleotide sequences of NoV extracted from diarrhoea and well-water specimens were identical and had the greatest sequence identity to corresponding sequences from the epidemic strain GII.4-2006b. Our report documents the first laboratory-confirmed waterborne outbreak caused by GII.4 NoV genotype in China. Our investigations indicate that well water, intended exclusively for household use but not for consumption, caused this outbreak. The results of this report serve as a reminder that private well water intended for household use should be tested for NoV.
In this paper it is shown that a stationary plasma can be accelerated by a moving neutral gas only if the velocity of the neutral gas exceeds Alfvén's critical velocity. An expression for the terminal velocity of the interaction is given which shows that, in the limit of high incoming neutral gas speeds, the composite plasma is accelerated up to one quarter of the gas speed. We also discuss terminal velocities associated with the inverse problem, namely the deceleration of a magnetized plasma as a result of its motion through, and interaction with, a stationary neutral gas.
Thailand is one of 22 countries designated by the World Health Organization as “high burden” with regard to tuberculosis. Preventing nosocomial tuberculosis transmission remains an important, unmet need. We investigated the adequacy of current practices to evaluate hospitalized patients for tuberculosis, which is critical in preventing delayed diagnosis and nosocomial tuberculosis transmission.
Thailand conducts active, population-based surveillance for pneumonia in 2 rural provinces. Case report forms are completed for all persons who are hospitalized and meet a case definition of having clinical pneumonia. We analyzed how frequently patients had an adequate diagnostic evaluation for infectious pulmonary tuberculosis, in accordance with national guidelines. We conducted multivariate analyses to determine patient and health-system factors associated with an inadequate diagnostic evaluation for tuberculosis and with tuberculosis disease.
Of 8,853 cases of clinical pneumonia between September 2003 and March 2006,73% were in patients not adequately evaluated for tuberculosis. Acid-fast bacilli (AFB)–positive tuberculosis was diagnosed in 188 cases, which was 2% of all pneumonia cases and 12% of pneumonia cases in patients adequately evaluated for tuberculosis. Diagnostic evaluations for tuberculosis were less commonly performed among those who were younger than 25 years of age, were female, and lacked cough, sputum production, hemoptysis, and dyspnea. Among patients adequately evaluated, a clinical syndrome of no cough, no hemoptysis, and normal chest radiography findings had a 95% negative predictive value.
The prevalence of AFB-positive, pulmonary tuberculosis was high among adults hospitalized with clinical pneumonia in Thailand. Most patients were not adequately evaluated for tuberculosis. Efforts are needed to improve identification and diagnosis of infectious tuberculosis cases in hospitalized patients.
Fabrication of Nanodots on semiconductor surfaces has immense importance due to their application in memory and optoelectronic devices. Ion irradiation methods display an easy and cost effective route for developing self assembled structures. We have studied the formation of Nano-dots on InP(111) surfaces by 3keV Ar ion irradiation. The distribution of nano Dots on InP surfaces has been investigated by Scanning Probe Microscopy (SPM). A 5 min irradiation of InP surface with Ar ions leads to the appearance of dots on the surface. The density of dots is, however very small. These dots have been obtained at room temperature, in the absence of sample rotation, with an angle of 15 degree between the ion axis and the sample normal. After an irradiation of 10 min a large density of dots appear on InP surface and display a narrow distribution of size and height. The dots at this stage have an average diameter of 25nm and a height of 4nm. With increased irradiation time the average size and the height of the dots increase and their distribution also become broader. This scenario, however, changes after a 40 min irradiation where large rectangular shaped dots of about 100 nm diameters and 40 nm height are observed. Surprisingly, for larger irradiation times a reduction in the size and heights is observed. The studies suggest “Critical Time” tc at t= 40 min such that the dot structures grow with time below tc but diminish in size beyond it.
Active surveillance for laboratory-confirmed Salmonella serotype Enteritidis (SE) infection revealed a decline in incidence in the 1990s, followed by an increase starting in 2000. We sought to determine if the fluctuation in SE incidence could be explained by changes in foodborne sources of infection. We conducted a population-based case-control study of sporadic SE infection in five of the Foodborne Diseases Active Surveillance Network (FoodNet) sites during a 12-month period in 2002–2003. A total of 218 cases and 742 controls were enrolled. Sixty-seven (31%) of the 218 case-patients and six (1%) of the 742 controls reported travel outside the United States during the 5 days before the case's illness onset (OR 53, 95% CI 23–125). Eighty-one percent of cases with SE phage type 4 travelled internationally. Among persons who did not travel internationally, eating chicken prepared outside the home and undercooked eggs inside the home were associated with SE infections. Contact with birds and reptiles was also associated with SE infections. This study supports the findings of previous case-control studies and identifies risk factors associated with specific phage types and molecular subtypes.
Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.
To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.
Historic prospective study. Standardised assessments of course and outcome.
About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.
A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
To investigate a cluster of hepatitis B virus (HBV) infections between December 1995 and May 1996 among chronic hemodialysis patients in one county.
Two dialysis centers (A and B) and a hospital (C) in one county.
Six case-patients who were dialyzed in one of two centers, A and B, and had all been hospitalized between January and February 1996 at hospital C.
Patient 1, usually dialyzed in center A sero-converted to hepatitis B surface antigen (HBsAg) in December 1995 and could have been the source of infection for the others, who seroconverted between March and April 1996. Two cohort studies were conducted: one among patients dialyzed in center A to determine where transmission had occurred, and one among patients dialyzed at hospital C at the time patient 1 was hospitalized, to identify factors associated with infection.
Four (15%) of the 26 susceptible patients dialyzed at center A became infected with HBV. Hospitalization at hospital C when patient 1 was hospitalized was associated with infection (P=.002). A cohort study of the 10 susceptible patients dialyzed at hospital C during the time patient 1 was hospitalized did not identify specific risk factors for infection. However, supplies and multidose vials were shared routinely among patients, providing opportunities for transmission.
When chronic hemodialysis patients require dialysis while hospitalized, their HBsAg status should be reviewed, and no instrument, supplies, or medications should be shared among them.
We have previously shown that the neurovascular anatomy and length
long head of biceps femoris
(LHBF) is suitable for its possible use in the creation of a dynamic perianal
myoplasty to restore faecal
continence. If intramuscular arterioarterial anastomoses exist between
muscle's vascular pedicles then the
delay procedure, i.e. ligating the vascular pedicles to the transposed
the muscle, 4–6 wk before
transposition, can be used to improve blood flow to the distal part of
transposed muscle. The
intramuscular arterial anatomy of 20 biceps femoris muscles was shown by
dissection (14) or
radiographically (6). The mean entry point of the upper major vascular
to the LHBF was 12 cm
(s.d. 3.3) and the mean length of the LHBF was 36.8 cm (s.d. 1.8). Therefore
ratio between upper
major vascular pedicle entry point and muscle length in 95% of specimens
0.33 (0.2). In the present
study intramuscular arterioarterial anastomoses were found between the
pedicles to the non-transposed and transposed sections of the LHBF and
the long and short heads of this muscle.
Using the delay procedure would therefore theoretically allow the intramuscular
between the arterial pedicle to the nontransposed and transposed sections
the LHBF to open up
enhancing blood flow to the distal part of the myoplasty.
Let pn(x) be a real algebraic polynomial of degree n, and consider the Lp norms on I = [−1, 1]. A classical result of A. A. Markoff states that if ‖pn‖. ∞ ≤ 1, then ‖P′n‖∞ ≤ n2. A generalization of Markoff's problem, first suggested by P. Turán, is to find upper bounds for ‖pn(J)‖p if ∣pn(x)∣≤ ψ(x)x ∈ I. Here ψ(x) is a given function, a curved majorant. In this paper we study extremal properties of ‖p′n‖2 and ‖p″n‖2 if pn(x) has the parabolic majorant ∣p(x)∣≤ 1 − x2, x ∈ I. We also consider the problem, motivated by a well-known result of S. Bernstein, of maximising ‖(1 − x2)
In 1955, J. Surányi and P. Turán (8) initiated the problem of existence and uniqueness of interpolatory polynomials of degrees less than or equal to 2n — 1 when their values and second derivatives are prescribed on n given nodes. This kind of interpolation was termed (0, 2)-interpolation. Later, Balázs and Turán (1) gave the explicit representation of the interpolatory polynomials for the case when the n given nodes (n even) are taken to be the zeros of πn(x) = (1 — x2)Pn′(x), where Pn–i(x) is the Legendre polynomial of degree n — 1. In this case the explicit representation of interpolatory polynomials turns out to be simple and elegant.
Balázs and Turán (2) proved the convergence of these polynomials when f(x) has a continuous first derivative satisfying certain conditions of modulus of continuity. They noted (1) that a significant application of lacunary interpolation could possibly be given in the theory of a differential equation of the form y′ + A(x)y= 0.
Investigations of the natural history of the virus of Kyasanur Forest disease since its discovery during 1957 in Shimoga District, Mysore State, south India have concentrated much attention on ticks of the genus Haemaphysalis in the region, as virus has repeatedly been isolated from them.
Keys are provided for larvae, nymphs and adults of both sexes of the 14 species of Haemaphysalis that have been taken in the area, with supplementary comments on six other species of the genus recorded, or likely to occur, elsewhere in south India. Illustrations are given showing the characters of the larvae and nymphs that are used in the keys.
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