Spatial clusters of gonorrhoea in England with particular reference to the outcome of partner notification: 2012 and 2013

Background: This study explored spatial-temporal variation in diagnoses of gonorrhoea to identify and quantify endemic areas and clusters in relation to patient characteristics and outcomes of partner notification (PN) across England, UK. Methods: Endemic areas and clusters were identified using a two-stage analysis with Kulldorff’s scan statistics (SaTScan). Results Of 2,571,838 tests, 53,547 diagnoses were gonorrhoea positive (positivity = 2.08%). The proportion of diagnoses in heterosexual males was 1.5 times that in heterosexual females. Among index cases, men who have sex with men (MSM) were 8 times more likely to be diagnosed with gonorrhoea than heterosexual males (p<0.0001). After controlling for age, gender, ethnicity and deprivation rank, 4 endemic areas were identified including 11,047 diagnoses, 86% of which occurred in London. 33 clusters included 17,629 diagnoses (34% of total diagnoses in 2012 and 2013) and spanned 21 locations, some of which were dominated by heterosexually acquired infection, whilst others were MSM focused. Of the 53,547 diagnoses, 14.5% (7,775) were the result of PN. The proportion of patients who attended services as a result of PN varied from 0% to 61% within different age, gender and sexual orientation cohorts. A third of tests resulting from PN were positive for gonorrhoea. 25% of Local Authorities (n = 81, 95% CI: 20.2, 29.5) had a higher than expected proportion for female PN diagnoses as compared to 16% for males (n = 52, 95% CI: 12.0, 19.9). Conclusions: The English gonorrhoea epidemic is characterised by spatial-temporal variation. PN success varied between endemic areas and clusters. Greater emphasis should be placed on the role of PN in the control of gonorrhoea to reduce the risk of onward transmission, re-infection, and complications of infection

Fireside corrosion degradation of ferritic alloys at 600°C in oxy-fired conditions

This paper reports the results of a study carried out to investigate the effects of simulated coal/biomass combustion conditions on the fireside corrosion. The 1000 h deposit recoat exposure (5 × 200 h cycles) was carried out at 600 °C. In these tests ferritic alloys were used 15Mo3, T22, T23 and T91. Kinetics data were generated for the alloys exposed using both traditional weight change methods and metal loss measurements. The highest rate of corrosion based on EDX results occurred under D1 deposit where provoke mainly by the formation of alkali iron tri-sulphate phase

Understanding number line estimation in Williams syndrome and Down syndrome

Previous studies suggest that tasks dependent on the mental number line may be difficult for Williams Syndrome (WS) and Down Syndrome (DS) groups. However, few have directly assessed number line estimation in these groups. The current study assessed 28 WS, 25 DS and 25 typically developing (TD) participants in non-verbal intelligence, number familiarity, visuo-spatial skills and number line estimation. Group comparisons indicated no differences in number line estimation. However, the WS group displayed difficulties with visuo-spatial skills and the DS group displayed difficulties with number familiarity. Differential relationships between number line estimation and visuo-spatial/number familiarity skills were observed across groups. Data is discussed in the context of assessment of skills in neurodevelopmental disorders

Banks-Zaks fixed point analysis in momentum subtraction schemes

We analyse the critical exponents relating to the quark mass anomalous dimension and beta-function at the Banks-Zaks fixed point in Quantum Chromodynamics (QCD) in a variety of representations for the quark in the momentum subtraction (MOM) schemes of Celmaster and Gonsalves. For a specific range of values of the number of quark flavours, estimates of the exponents appear to be scheme independent. Using the recent five loop modified minimal subtraction (MSbar) scheme quark mass anomalous dimension and estimates of the fixed point location we estimate the associated exponent as 0.263-0.268 for the SU(3) colour group and 12 flavours when the quarks are in the fundamental representation.Comment: 33 latex pages, 25 tables, anc directory contains txt file with electronic version of renormalization group function

Impact of implementing a fast-track protocol and standardized guideline for the management of pediatric appendicitis

Background: In 2017, a provincial guideline was created to fast track and standardize care for pediatric appendicitis in Alberta. We conducted a study to determine the impact of implementation of the guideline at our institution on length of stay (LOS), antibiotic stewardship efforts and costs. Methods: We performed a retrospective review of the charts of all patients younger than 18 years of age who underwent appendectomy at our institution in 2 periods: before guideline implementation (Dec. 1, 2016, to May 31, 2017) and after implementation (Dec. 1, 2017, to May 31, 2018). We compared LOS, duration of antibiotic therapy, 30-day postdischarge complication rates and variable cost between the 2 cohorts. Results: Of the 276 total appendectomy procedures performed, 185 were for simple appendicitis (81 before guideline implementation and 104 after implementation), and 91 were for complicated appendicitis (44 and 47, respectively). The median LOS was shorter in the postimplementation cohort for both simple and complicated appendicitis (15.5 h [interquartile range (IQR) 12-19 h] v. 17.0 h [IQR 13-22 h], p = 0.03; and 3.0 d [IQR 2-4 d] v. 3.0 d [IQR 3-5 d], p = 0.05, respectively). Patients with complicated appendicitis had fewer antibiotic days after guideline implementation; the difference was statistically significant for patients without diffuse peritoneal contamination or abscess formation (p = 0.02). There were no differences between the cohorts with respect to 30-day rates of complications, including emergency department visits, readmission and surgical site infections. After guideline implementation, the average variable cost per patient was reduced by $230, equating to a total average annual cost savings of$75 842 for our institution. Conclusion: The implementation of a provincial guideline aimed at standardizing care in pediatric appendicitis at our institution was associated with shortened LOS, improved antibiotic stewardship efforts and reduced cost of care. Other institutions may replicate our model of a standardized pathway in the management of pediatric appendicitis in an effort to improve the quality of patient care and reduce health care costs

Prediction of relativistic electron flux at geostationary orbit following storms: Multiple regression analysis

Many solar wind and magnetosphere parameters correlate with relativistic electron flux following storms. These include relativistic electron flux before the storm, seed electron flux, solar wind velocity and number density (and their variation), IMF Bz, AE and Kp indices, and ultra low frequency (ULF) and very low frequency (VLF) wave power. However, as all these variables are intercorrelated, we use multiple regression analyses to determine which are the most predictive of flux when other variables are controlled. Using 219 storms (1992-2002), we obtained hourly averaged electron fluxes for outer radiation belt relativistic electrons (>1.5 MeV) and seed electrons (100 keV) from LANL spacecraft (geosynchronous orbit). For each storm, we found the log10 maximum relativistic electron flux 48-120 hours after the end of the main phase of each storm. Each predictor variable was averaged over the 12 hours before the storm, main phase, and the 48 hours following minimum Dst. High levels of flux following storms are best modeled by a set of variables. In decreasing influence, ULF, seed electron flux, Vsw and its variation, and after-storm Bz were the most significant explanatory variables. Kp can be added to the model, but it adds no further explanatory power. Although we included ground-based VLF power from Halley, Antarctica, it shows little predictive ability. We produced predictive models using the coefficients from the regression models, and assessed their effectiveness in predicting novel observations. The correlation between observed values and those predicted by these empirical models ranged from .645 to .795

The prevalence of blinding trachoma in northern states of Sudan.

BACKGROUND: Despite historical evidence of blinding trachoma, there have been no widespread contemporary surveys of trachoma prevalence in the northern states of Sudan. We aimed to conduct district-level surveys in this vast region in order to map the extent of the problem and estimate the need for trachoma control interventions to eliminate blinding trachoma. METHODS AND FINDINGS: Separate, population based cross-sectional surveys were conducted in 88 localities (districts) in 12 northern states of Sudan between 2006 and 2010. Two-stage cluster random sampling with probability proportional to size was used to select the sample. Trachoma grading was done using the WHO simplified grading system. Key prevalence indicators were trachomatous inflammation-follicular (TF) in children aged 1-9 years and trachomatous trichiasis (TT) in adults aged 15 years and above. The sample comprised 1,260 clusters from which 25,624 households were surveyed. A total of 106,697 participants (81.6% response rate) were examined for trachoma signs. TF prevalence was above 10% in three districts and between 5% and 9% in 11 districts. TT prevalence among adults was above 1% in 20 districts (which included the three districts with TF prevalence >10%). The overall number of people with TT in the population was estimated to be 31,072 (lower and upper bounds = 26,125-36,955). CONCLUSION: Trachoma mapping is complete in the northern states of Sudan except for the Darfur States. The survey findings will facilitate programme planning and inform deployment of resources for elimination of trachoma from the northern states of Sudan by 2015, in accordance with the Sudan Federal Ministry of Health (FMOH) objectives

Adaptive response and enlargement of dynamic range

Many membrane channels and receptors exhibit adaptive, or desensitized, response to a strong sustained input stimulus, often supported by protein activity-dependent inactivation. Adaptive response is thought to be related to various cellular functions such as homeostasis and enlargement of dynamic range by background compensation. Here we study the quantitative relation between adaptive response and background compensation within a modeling framework. We show that any particular type of adaptive response is neither sufficient nor necessary for adaptive enlargement of dynamic range. In particular a precise adaptive response, where system activity is maintained at a constant level at steady state, does not ensure a large dynamic range neither in input signal nor in system output. A general mechanism for input dynamic range enlargement can come about from the activity-dependent modulation of protein responsiveness by multiple biochemical modification, regardless of the type of adaptive response it induces. Therefore hierarchical biochemical processes such as methylation and phosphorylation are natural candidates to induce this property in signaling systems.Comment: Corrected typos, minor text revision