Varicella is a vaccine-preventable infectious disease. Since 1 December 2018, the varicella vaccine has been included in the local Expanded Programme on Immunization (EPI) in Wuxi, China, and children born after 1 December 2014 are eligible for free vaccination. To evaluate the effect of varicella vaccination in Wuxi city, we selected 382 397 children born from 2012 to 2016 as subjects. Their disease data were obtained from the Chinese Disease Prevention and Control Information System, and their vaccination data were obtained from the Jiangsu Province Vaccination Integrated Service Management Information System. The incidence of breakthrough varicella cases increased in the first 4 years and reached the peak in the fifth year. With the increase of vaccination rate, the incidence of varicella decreased significantly. The vaccine effectiveness (VE) was found to be 88.17%–95.78% for one dose and 98.65%–99.93% for two doses. Although the VE per dose decreased from 99.57% in the first year to 93.04% in the eighth year, it remained high. These findings confirmed the effectiveness of varicella vaccination in children, supported the use of a two-dose varicella vaccination strategy to achieve better protection, and provided important insights into the optimal vaccination strategy for varicella prevention in children.

Varicella vaccination is optional and requires self-payment. On 1 December 2018, Wuxi City launched a free varicella vaccination program for children. This study aimed to evaluate the changes in varicella incidence before and after the implementation of the policy. The data were obtained from official information systems and statistical yearbooks. We divided the period into chargeable (January 2017 to November 2018) and free (December 2018 to December 2021) periods. Interrupt time series analysis was used to conduct a generalised least-squares regression analysis for the two periods. A total of 51,071 varicella cases were reported between January 2017 and December 2021. After the implementation of the policy, there was a statistically significant decrease in the incidence of varicella (β2 = −0.140, P = 0.017), and the slope of the incidence also decreased by 0.012 (P = 0.015). Following policy implementation, the incidence decreased in all age groups, with the largest decline observed among children aged 8–14 years (β2 = −1.109, P = 0.009), followed by children aged ≤7 years (β2 = −0.894, P = 0.013). Our study found a significant reduction in the incidence of varicella in the total population after the introduction of free varicella vaccination in Wuxi City.

Dongchuanite, ideally Pb4VIZnIVZn2(PO4)2(PO4)2(OH)2, is a new phosphate mineral with a new type of structure. It was found at the Dongchuan copper mine, Yunnan Province, People's Republic of China. Dongchuanite generally occurs as spherical aggregates with microscopic lamellar crystals, characterised by a turquoise–greenish blue colour. It is transparent, with a colourless streak and has a vitreous lustre without fluorescence. It is brittle with a Mohs hardness of 2–2½, and has good parallel cleavage to {011}, with insignificant parting and even fracture. According to the empirical formula and cell volume, it has a calculated density of 6.06 g/cm3. It easily dissolves in acid without gas being emitted. The mineral is biaxial (–), calculated n = 1.90 and maximum birefringence: δ = 0.010 and 2V=70°. Dispersion of the optical axes r < v is very weak. The mineral is pale blue to light blue and very weakly pleochroic in transmitted light. Dongchuanite crystallises in the triclinic space group P$\bar{1}$, with unit-cell parameters a = 4.7620(10) Å, b = 8.5070(20) Å, c = 10.3641(19) Å, α = 97.110(17)°, β = 101.465(17)°, γ = 92.273(18)°, V = 407.44(15) Å3 and Z = 1. The eight strongest reflections in the powder X-ray diffraction pattern [dobs, Å (I/I0) (hkl)] are: 3.442 (100) ($\bar{1}$12), 3.035 (50) (120), 4.652 (45) (100), 2.923 (40) ($\bar{1}\bar{1}$3), 2.384 (35) ($\bar{2}$01), 3.130 (30) ($\bar{1}$21), 2.811 (30) (030) and 2.316 (18) (032). The crystal structure (solved and refined from single-crystal X-ray diffraction data, R1 = 0.07) is a new layered structure consisting of corner-sharing tetrahedrons and octahedrons, where [PO4] tetrahedra and [ZnO4] tetrahedra share corners to form a double chain, and the another [PO4] tetrahedra is connected by corner-sharing with a [ZnO4(OH)2] octahedra to form a tetrahedral–octahedral chain, extending along the a-axis direction. The two types of chains are connected by corner-sharing between [ZnO4] and [PO4] tetrahedra forming a wrinkled layer parallel to (011). The Pb atoms occupy two independent sites between the wrinkled layers, both of which have typical lopsided coordination of Pb2+ with stereoactive 6s2 lone-pair electrons.

Coastal eutrophication and hypoxia remain a persistent environmental crisis despite the great efforts to reduce nutrient loading and mitigate associated environmental damages. Symptoms of this crisis have appeared to spread rapidly, reaching developing countries in Asia with emergences in Southern America and Africa. The pace of changes and the underlying drivers remain not so clear. To address the gap, we review the up-to-date status and mechanisms of eutrophication and hypoxia in global coastal oceans, upon which we examine the trajectories of changes over the 40 years or longer in six model coastal systems with varying socio-economic development statuses and different levels and histories of eutrophication. Although these coastal systems share common features of eutrophication, site-specific characteristics are also substantial, depending on the regional environmental setting and level of social-economic development along with policy implementation and management. Nevertheless, ecosystem recovery generally needs greater reduction in pressures compared to that initiated degradation and becomes less feasible to achieve past norms with a longer time anthropogenic pressures on the ecosystems. While the qualitative causality between drivers and consequences is well established, quantitative attribution of these drivers to eutrophication and hypoxia remains difficult especially when we consider the social economic drivers because the changes in coastal ecosystems are subject to multiple influences and the cause–effect relationship is often non-linear. Such relationships are further complicated by climate changes that have been accelerating over the past few decades. The knowledge gaps that limit our quantitative and mechanistic understanding of the human-coastal ocean nexus are identified, which is essential for science-based policy making. Recognizing lessons from past management practices, we advocate for a better, more efficient indexing system of coastal eutrophication and an advanced regional earth system modeling framework with optimal modules of human dimensions to facilitate the development and evaluation of effective policy and restoration actions.

Plasma vertical displacement control is essential for the stable operation of tokamak devices. The traditional plasma vertical displacement calculation method is not suitable for balancing speed and accuracy simultaneously, which is necessary for real-time feedback control. In this study, neural networks are used to rapidly detect vertical displacement recognition. Based on a fully connected neural network, the vertical displacement calculation model is trained and tested using magnetic data of approximately 2000 shots. To compare the effects of different inputs on vertical displacement calculation, different magnetic measurement diagnostic signals are used to train and test the model. Compared with a full magnetic measurement dataset, 39 magnetic measurement signals (38 magnetic probes and plasma current) show better accuracy with mean square error <0.0005. The model is tested using historical experimental data, and it demonstrates accurate vertical displacement calculation even in the case of a vertical displacement event. In general, neural network algorithm has great application potential in vertical displacement calculation.

In “The value of nothing: asymmetric attention to opportunity costs drives intertemporal decision making” Read, Olivola and Hardisty (2017) proposed an asymmetric subjective opportunity cost (ASOC) effect to explain and predict why impatience can be detected in intertemporal choice. This work deserves to be replicated and extended for its novel and potentially important findings. The present study aimed to examine the reliability and robustness of the evidence presented by Read et al. by conducting precise replications of their key findings in Study 1. The ASOC effect (Read, et al., 2017) was important for expanding its application and reported to be typically stronger when baseline larger-but-later option (LL) and smaller-but-sooner option (SS) preferences were closer to 50% in the authors’ original condition. Therefore, the present study also aimed to replicate and test the ASOC effect when baseline LL preferences were higher or lower than those in the original condition. We intended to set two additional conditions wherein either LL or SS is more obviously favored (i.e., baseline LL preferences were higher or lower than those in the original condition) by respectively applying the common difference effect (Kirby & Herrnstein, 1995) and the unit effect (Burson, Larrick & Lynch Jr., 2009; Pandelaere, Briers & Lembregts, 2011). Having successfully generated two more obviously favored conditions, the ASOC effect was replicated and confirmed under the original condition and one additional condition wherein SS was more obviously favored. However, the ASOC effect was not detected under the other additional condition wherein LL was more obviously favored. The implications of these findings were discussed.

Lower-crust-derived adakitic rocks in the Gangdese belt provide important constraints on the timing of Tibetan crustal thickening and on the relative contributions of magmatic and tectonic processes. Here we present geochronological and geochemical data for the Wangdui porphyritic monzogranites in the western Gangdese belt. Zircon U–Pb dating yields emplacement ages of 46–44 Ma. All samples have high Sr (321–599 ppm), low Yb (0.76–1.33 ppm) and Y (10.6–18.3 ppm) contents, with high La/Yb (51.1–72.3) and Sr/Y (21.0–51.4) ratios, indicating adakitic affinities. The low MgO (0.97–1.76 wt %), Cr (7.49–53.6 ppm) and Ni (4.75–29.1 ppm) contents, as well as high 87Sr/86Sr(i) (0.7143–0.7145), low ϵNd(t) (−10.4 to −9.8) and zircon ϵHf(t) (−17.7 to 0.4) values, suggest that the Wangdui pluton most likely originated from partial melting of the thickened ancient lower crust. In combination with previously published data, despite the east–west-trending heterogeneity of crustal composition in the Gangdese belt, the La/Yb ratios of magmatic rocks reveal that both western and eastern segments experienced remarkable crustal thickening in the Eocene. However, in contrast to the thickened juvenile lower crust in the eastern segment formed by the underplating of mantle-derived magmas, tectonic shortening plays a more crucial role in thickening of the ancient basement in western Gangdese. In fact, such Eocene-thickened ancient lower-crust-derived adakitic rocks are widely distributed in the central Himalayan–Tibetan orogen. This, together with the extensive development of fold–thrust belts, suggests that tectonic shortening might be the main mechanism accounting for the crustal thickening associated with the India–Asia collision.

Mounting evidence suggests that the first few months of life are critical for the development of obesity. The relationships between the timing of solid food introduction and the risk of childhood obesity have been examined previously; however, evidence for the association of timing of infant formula introduction remains scarce. This study aimed to examine whether the timing of infant formula introduction is associated with growth z-scores and overweight at ages 1 and 3 years. This study included 5733 full-term (≥ 37 gestational weeks) and normal birth weight (≥ 2500 and < 4000 g) children in the Born in Guangzhou Cohort Study, a prospective cohort study with data collected at 6 weeks, 6, 12 and 36 months. Compared with infant formula introduction at 0–3 months, introduction at 4–6 months was associated with the lower BMI, weight-for-age and weight-for-length z-scores at 1 and 3 years old. Also, introduction at 4–6 months was associated with the lower odds of at-risk of overweight at age 1 (adjusted OR 0·72, 95 % CI 0·55, 0·94) and 3 years (adjusted OR 0·50, 95 % CI 0·30, 0·85). Introduction at 4–6 months also decreased the odds of overweight at age 1 year (adjusted OR 0·42, 95 % CI 0·21, 0·84) but not at age 3 years. Based on our findings, compared with introduction within the first 3 months, introduction at 4–6 months has a reduction on later high BMI risk and at-risk of overweight. However, these results need to be replicated in other well-designed studies before more firm recommendations can be made.

Evidence of couples’ BMI and its influence on birth weight is limited and contradictory. Therefore, this study aims to assess the association between couple’s preconception BMI and the risk of small for gestational age (SGA)/large for gestational age (LGA) infant, among over 4·7 million couples in a retrospective cohort study based on the National Free Pre-pregnancy Checkups Project between 1 December 2013 and 30 November 2016 in China. Among the live births, 256 718 (5·44 %) SGA events and 506 495 (10·73 %) LGA events were documented, respectively. After adjusting for confounders, underweight men had significantly higher risk (OR 1·17 (95 % CI 1·15, 1·19)) of SGA infants compared with men with normal BMI, while a significant and increased risk of LGA infants was obtained for overweight and obese men (OR 1·08 (95 % CI 1·06, 1·09); OR 1·19 (95 % CI 1·17, 1·20)), respectively. The restricted cubic spline result revealed a non-linear decreasing dose–response relationship of paternal BMI (less than 22·64) with SGA. Meanwhile, a non-linear increasing dose–response relationship of paternal BMI (more than 22·92) with LGA infants was observed. Moreover, similar results about the association between maternal preconception BMI and SGA/LGA infants were obtained. Abnormal preconception BMI in either women or men were associated with increased risk of SGA/LGA infants, respectively. Overall, couple’s abnormal weight before pregnancy may be an important preventable risk factor for SGA/LGA infants.

Giardia duodenalis is a common zoonotic intestinal pathogen. It has been increasingly reported in humans and animals; however, genotyping information for G. duodenalis in captive animals is still limited. This study was conducted to assess the prevalence and multilocus genotyping of G. duodenalis in captive animals in zoological gardens in Shanghai, China. A total of 678 fresh fecal samples were randomly collected from captive animals including non-human primates (NHPs) (n = 190), herbivores (n = 190), carnivores (n = 151), birds (n = 138) and reptiles (n = 9) in a zoo and were examined for the presence of G. duodenalis using nested polymerase chain reaction (nested PCR). All G. duodenalis positive samples were assayed with PCR followed by sequencing at β-giardin (bg), glutamate dehydrogenase (gdh) and triose phosphate isomerase (tpi) genes. In this study, 42 specimens (6.2%) were tested G. duodenalis-positive of the 678 fecal samples examined based on a single locus. A total of 30 (4.4%), 30 (4.4%) and 22 (3.2%) specimens were successfully amplified and sequenced at gdh, tpi and bg loci, respectively. Assemblages A and B were identified with assemblage B dominating in NHPs. Sequence analysis demonstrated that one, two and five new isolates were identified at bg, gdh and tpi loci. DNA sequences and new assemblage-subtypes of zoonotic G. duodenalis assemblages A and B were identified in the current study. Our data indicate the occurrence and molecular diversity of G. duodenalis and the potential zoonotic transmission in captive animals in China.

On the basis of air heater characteristics, a new computational model was developed in this paper, which was aimed at investigating acoustics and instabilities in air heaters. This model included the effects of mean flow, viscosity, entropy waves, non-linear acoustics and realistic boundary conditions. In addition, it was practical for air heaters with hundreds of injectors, complex configurations and geometries. Analytical solutions of acoustics in a closed rectangular cavity were used to verify and validate the computational model. It was shown that the predicted critical parameters of air heater agreed well with the experimental data or design values. This model predicted the self-excited spinning tangential modes without any preliminary assumptions about them. Traditional combustion response function assumes that combustion mainly takes place in a so-called rapid combustion zone, and this zone is usually modelled as a disc in the combustor near the injection head. However, in practice, the flame has a spatial distribution. This paper described the effect of flame spatial distribution on predictions of oscillation frequency and mode. It was found that frequency and mode shape of oscillations closely depended on the length of the heat release zone. Comparison of different heat release zones indicated that the increment of heat release length exhibited an increased tendency toward lower-order longitudinal modes, when the heat release zone was located near the faceplate where it was the pressure antinode of the longitudinal mode. Modulation of heat release length might cause bifurcations between standing and turning modes. A noticeable tendency was toward higher-order standing tangential mode with increasing heat release length. Finally, theoretical analysis of the modal behaviour, i.e. standing or spinning waves, was performed.

ABSTRACT IMPACT: Our study will integrate state-of-the-art methods in pathogen genomics, epidemiology, and geospatial analysis to identify both host- and pathogen-factors driving the MDR-TB transmission and the study outcome can inform the design of targeted interventions OBJECTIVES/GOALS: The emergence of multidrug-resistant tuberculosis (MDR-TB) poses serious challenges for the global eradication of tuberculosis. Recent research has shown that transmission is now the dominant driver of MDR-TB. However, our limited understanding of where and among whom MDR-TB is transmitted hampers efforts to control person-to-person spread. METHODS/STUDY POPULATION: We used several analytic approaches to characterize the dynamics of MDR-TB transmission in Shanghai, China. We identified all culture-confirmed MDR cases between 2009-2016 in the city and 1) estimated individual-level risk factors for MDR disease; 2) mapped the TB cases by their home addresses and used a Bayesian spatial disease mapping method to identify regions with an elevated risk of MDR-TB; and 3) we sequenced all MDR isolates to understand whether transmission explained variance in risk that was not attributable to the distribution of individual or location-specific risk variates. RESULTS/ANTICIPATED RESULTS: There were 1034 MDR-TB cases among 16,315 culture-confirmed TB cases during the study period. Bayesian disease mapping identified spatial heterogeneity of MDR-TB and determined four hotspots with an elevated risk of MDR-TB, none of which were fully explained by individual or regional-covariates (Figure 1). Sequencing revealed that more than 40% of the MDR-TB strains were in genomic clusters, indicating recent MDR-TB transmission. Most importantly, MDR-TB cases in three of the four large clades (>8 isolates) were spatially concentrated in three strain-specific hotspots (Figure 2). DISCUSSION/SIGNIFICANCE OF FINDINGS: With the combination of traditional epidemiological tools, geographical, and genomic methods, this study revealed multiple loci of transmission of specific MDR-TB clades within a single city. Identification of where and among whom MDR-TB is transmitted can inform the design of targeted interventions.

Background: Infection Prevention and Control (IPC) for Alberta Health Services and Covenant Health in the province of Alberta, Canada conducts surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) on all individuals admitted to acute-care and acute tertiary-care rehabilitation care facilities. Objective: The objective of this study was to determine the consistency and accuracy of infection decisions for MRSA and VRE. Methods: Surveillance cases of antibiotic-resistant organisms (AROs) collected using the provincial data entry surveillance platform between April 1, 2015, and March 31, 2017, across the province were reabstracted by infection control professionals and physicians using the NHSN infection definitions and compared to the original case severity decisions. Interrater agreement (Cohen’s ) and validity (sensitivity, specificity and predictive values) were calculated to compare the original and reabstracted infection decisions. Results: Collectively, 97% (87 of 90) of the IPC program staff and physicians who were initially invited re-abstracted 264 MRSA cases and 103 VRE cases within the review period. Provincially, 20% of the ARO cases reviewed (74 of 367) differed from the original infection decision. Among these 74 cases, 46 cases (34 MRSA and 12 VRE cases) changed from infection (original decision) to colonization (reabstracted decision) and 28 cases (21 MRSA and 7 VRE cases) changed from colonization to infection. The Cohen values for MRSA and VRE were 0.55 and 0.56, respectively, suggesting a moderate level of agreement for decisions made among IPC program staff. The sensitivity of the infection decision was higher with MRSA (86.5%) than for VRE (74.1%), meaning that there were more MRSA cases than VRE cases classified as infection in the original decision that remained infection following the review. Conclusions: Observed discordances on infection decisions were identified and may be attributed (1) to variations in the interpretation of the NHSN definitions, (2) to additional information that may have been available in the re-abstracted review compared to the original review, or (3) a difference in the information that was accessed to perform the original review compared to the reabstraction. This data-quality review provided an opportunity for IPC staff and physicians to become more familiar with infection definitions and such reviews will continue to be a regular process used to assess data quality within the IPC department.

Funding: None

Disclosures: None

Renal fibrosis is common especially in the elderly population. Recently, we found that vitamin D deficiency caused prostatic hyperplasia. This study aimed to investigate whether vitamin D deficiency promotes renal fibrosis and functional impairment. All mice except controls were fed with vitamin D-deficient (VDD) diets, beginning from their early life. The absolute and relative kidney weights on postnatal week 20 were decreased in VDD diet-fed male pups but not in female pups. A mild pathological damage was observed in VDD diet-fed male pups but not in females. Further analysis showed that VDD-induced pathological damage was aggravated, accompanied by renal dysfunction in 40-week-old male pups. An obvious collagen deposition was observed in VDD diet-fed 40-week-old male pups. Moreover, renal α-smooth muscle actin (α-SMA), a marker of epithelial–mesenchymal transition (EMT), and Tgf-β mRNA were up-regulated. The in vitro experiment showed that 1,25-dihydroxyvitamin D3 alleviated transforming growth factor-β1 (TGF-β1)-mediated down-regulation of E-cadherin and inhibited TGF-β1-evoked up-regulation of N-cadherin, vimentin and α-SMA in renal epithelial HK-2 cells. Moreover, 1,25-dihydroxyvitamin D3 suppressed TGF-β1-evoked Smad2/3 phosphorylation in HK-2 cells. These results provide experimental evidence that long-term vitamin D deficiency promotes renal fibrosis and functional impairment, at least partially, through aggravating TGF-β/Smad2/3-mediated EMT in middle-aged male mice.

Coronavirus disease 2019 (COVID-19) patients were classified into four clinical stages (uncomplicated illness, mild, severe and critical pneumonia) depending on disease severity. We aim to investigate the corresponding clinical, radiological and laboratory characteristics between different clinical stages. A retrospective, single-centre study of 101 confirmed patients with COVID-19 at Renmin Hospital of Wuhan University from 2 January to 28 January 2020 was enrolled; follow-up endpoint was on 8 February 2020. Clinical data were collected and compared during the course of illness. The median age of the 101 patients was 51.0 years and 33.6% were medical staff. Fever (68%), cough (50%) and fatigue (23%) are the most common symptoms. About 26% patients underwent the mechanical ventilation and 98% patients were treated with antibiotics. Thirty-seven per cent patients were cured and 11 died. On admission, the number of patients with uncomplicated illness, mild, severe and critical pneumonia were 2 [2%], 86 [85%], 11 [11%] and 2 [2%]. Forty-four of the 86 mild pneumonia progressed to severe illness within 4 days, with nine patients worsened due to critical pneumonia within 4 days. Two of the 11 severe patients improved to mild condition while three others deteriorated. Significant differences were observed among groups of different clinical stages in numbers of influenced pulmonary segments (6 vs. 12 vs. 17, P < 0.001). A significantly upward trend was witnessed in ground-glass opacities overlapped with striped shadows (33% vs. 42% vs. 55% vs. 80%, P < 0.001), while pure ground-glass opacities gradually decreased as disease progressed (45% vs. 35% vs. 24% vs. 13%, P < 0.001) within 12 days. Lymphocytes, prealbumin and albumin showed a downtrend as disease progressed from mild to severe or critical condition, an uptrend was found in white blood cells, C-reactive protein, neutrophils and lactate dehydrogenase. The proportions of serum amyloid A > 300 mg/l in mild, severe and critical conditions were 18%, 46% and 71%, respectively.