Case Report: Ocular Toxocariasis: A Report of Three Cases from the Mississippi Delta

Ocular toxocariasis can be vision threatening, and is commonly reported from tropical or subtropical regions. Knowledge of clinical manifestations from the United States, particularly in underserved areas such as the American South, is lacking. We report three cases of ocular toxocariasis in individuals from the Mississippi Delta, a rural community with prevalent poverty. Visual acuity was severely affected in two of the three cases. Increased awareness of ocular toxocariasis, which may have under-recognized frequency, will contribute to prompt diagnosis and treatment, which will ultimately improve patient health in the region

Prioritising primary care patients with unexpected weight loss for cancer investigation: diagnostic accuracy study (update)

Objective: To quantify the predictive value of unexpected weight loss for cancer according to patient’s age, sex, smoking status, and concurrent clinical features (symptoms, signs, and abnormal blood test results). Design: Diagnostic accuracy study (update). Setting: Data from Clinical Practice Research Datalink electronic health records linked to the National Cancer Registration and Analysis Service in primary care, England. Participants: 326 240 adults (≥18 years) with a code for unexpected weight loss from 1 January 2000 to 31 December 2019. Main outcome measures: Cancer diagnosis in the six months after the earliest weight loss code (index date). Codes for additional clinical features were identified in the three months before to one month after the index date. Diagnostic accuracy measures included positive and negative likelihood ratios, positive predictive values, and diagnostic odds ratios. Results: Of 326 240 adults with unexpected weight loss, 184 270 (56.5%) were women, 176 508 (54.1%) were aged ≥60 years, and 176 053 (54.0%) were ever smokers. 15 624 (4.8%) had a diagnosis of cancer within six months of the index date, of whom 15 051 (96.3%) were aged ≥50 years. The positive predictive value for cancer was above the 3% threshold recommended by the National Institute for Health and Care Excellence for urgent investigation in men aged ≥50 years and women aged ≥60 years. 17 additional clinical features were associated with cancer in younger men with unexpected weight loss, and eight in women. Positive likelihood ratios in men ranged from 1.43 (95% confidence interval 1.30 to 1.58) for fatigue to 21.00 (8.59 to 51.37) for rectal mass, and in women from 1.28 (1.16 to 1.41) for back pain to 19.46 (12.69 to 29.85) for pelvic mass. Abnormal blood test results associated with cancer included low albumin (positive likelihood ratio 3.24, 3.13 to 3.35) and raised platelets (3.48, 3.35 to 3.62), total white cell count (3.01, 2.89 to 3.14), and C reactive protein (3.13, 3.05 to 3.20). However, no normal blood test result in isolation ruled out cancer. Clinical features co-occurring with unexpected weight loss were associated with multiple cancer sites. Conclusion: The risk of cancer in younger adults with unexpected weight loss presenting to primary care is <3% and does not merit investigation under current UK guidelines. However, in men aged ≥50 years, women aged ≥60 years, and younger patients with concurrent clinical features, the risk of cancer warrants referral for invasive investigation. Clinical features typically associated with specific cancer sites are markers of several cancer types when they occur with unexpected weight loss. Readers’ note: This article is an updated version of a previously published BMJ paper that has since been retracted

Studies of Diffuse Interstellar Bands. V. Pairwise Correlations of Eight Strong DIBs and Neutral Hydrogen, Molecular Hydrogen, and Color Excess

We establish correlations between equivalent widths of eight diffuse interstellar bands (DIBs), and examine their correlations with atomic hydrogen, molecular hydrogen, and EB-V . The DIBs are centered at \lambda\lambda 5780.5, 6204.5, 6283.8, 6196.0, 6613.6, 5705.1, 5797.1, and 5487.7, in decreasing order of Pearson\^as correlation coefficient with N(H) (here defined as the column density of neutral hydrogen), ranging from 0.96 to 0.82. We find the equivalent width of \lambda 5780.5 is better correlated with column densities of H than with E(B-V) or H2, confirming earlier results based on smaller datasets. We show the same is true for six of the seven other DIBs presented here. Despite this similarity, the eight strong DIBs chosen are not well enough correlated with each other to suggest they come from the same carrier. We further conclude that these eight DIBs are more likely to be associated with H than with H2, and hence are not preferentially located in the densest, most UV shielded parts of interstellar clouds. We suggest they arise from different molecules found in diffuse H regions with very little H (molecular fraction f<0.01). Of the 133 stars with available data in our study, there are three with significantly weaker \lambda 5780.5 than our mean H-5780.5 relationship, all of which are in regions of high radiation fields, as previously noted by Herbig. The correlations will be useful in deriving interstellar parameters when direct methods are not available. For instance, with care, the value of N(H) can be derived from W{\lambda}(5780.5).Comment: Accepted for publication in The Astrophysical Journal; 37 pages, 11 figures, 6 table

Testing Spallation Processes With Beryllium and Boron

The nucleosynthesis of Be and B by spallation processes provides unique insight into the origin of cosmic rays. Namely, different spallation schemes predict sharply different trends for the growth of LiBeB abundances with respect to oxygen. ``Primary'' mechanisms predict BeB $\propto$ O, and are well motivated by the data if O/Fe is constant at low metallicity. In contrast, ``secondary'' mechanisms predict BeB $\propto$ O$^2$ and are consistent with the data if O/Fe increases towards low metallicity as some recent data suggest. Clearly, any primary mechanism, if operative, will dominate early in the history of the Galaxy. In this paper, we fit the BeB data to a two-component scheme which includes both primary and secondary trends. In this way, the data can be used to probe the period in which primary mechanisms are effective. We analyze the data using consistent stellar atmospheric parameters based on Balmer line data and the continuum infrared flux. Results depend sensitively on Pop II O abundances and, unfortunately, on the choice of stellar parameters. When using recent results which show O/Fe increasing toward lower metallicity, a two-component Be-O fits indicates that primary and secondary components contribute equally at [O/H]$_{eq}$ = -1.8 for Balmer line data; and [O/H]$_{eq}$ = -1.4 to -1.8 for IRFM. We apply these constraints to recent models for LiBeB origin. The Balmer line data does not show any evidence for primary production. On the other hand, the IRFM data does indicate a preference for a two-component model, such as a combination of standard GCR and metal-enriched particles accelerated in superbubbles. These conclusions rely on a detailed understanding of the abundance data including systematic effects which may alter the derived O-Fe and BeB-Fe relations.Comment: 40 pages including 11 ps figures. Written in AASTe

Second-harmonic generation induced by electric currents in GaAs

We demonstrate a new, nonlinear optical effect of electric currents. First, a steady current is generated by applying a voltage on a doped GaAs crystal. We demonstrate that this current induces second-harmonic generation of a probe laser pulse. Second, we optically inject a transient current in an undoped GaAs crystal by using a pair of ultrafast laser pulses, and demonstrate that it induces the same second-harmonic generation. In both cases, the induced second-order nonlinear susceptibility is proportional to the current density. This effect can be used for nondestructive, noninvasive, and ultrafast imaging of currents. These advantages are illustrated by the real-time observations of a coherent plasma oscillation and spatial resolution of current distribution in a device. This new effect also provides a mechanism for electrical control of the optical response of materials.Comment: 5 pages, 3 figure

Effect of Neutrino Heating on Primordial Nucleosynthesis

We have modified the standard code for primordial nucleosynthesis to include the effect of the slight heating of neutrinos by $e^\pm$ annihilations. There is a small, systematic change in the $^4$He yield, $\Delta Y \simeq +1.5\times 10^{-4}$, which is insensitive to the value of the baryon-to-photon ratio $\eta$ for 10^{-10}\la \eta \la 10^{-9}. We also find that the baryon-to-photon ratio decreases by about 0.5\% less than the canonical factor of 4/11 because some of the entropy in $e^\pm$ pairs is transferred to neutrinos. These results are in accord with recent analytical estimates.Comment: 14 pages/4 Figs (upon request

Measuring the complexity of general practice consultations:development and validation of a complexity measure

Background: The complexity of general practice consultations may be increasing and varies in different settings. A measure of complexity is required to test these hypotheses. Aim: To develop a valid measure of general practice consultation complexity applicable to routine medical records. Design and setting: Delphi study to select potential indicators of complexity followed by a cross-sectional study in English general practices to develop and validate a complexity measure. Method: The online Delphi study over two rounds identified potential indicators of consultation complexity. The cross-sectional study used an age–sex stratified random sample of patients and general practice face-to-face consultations from 2013/2014 in the Clinical Practice Research Datalink. The authors explored independent relationships between each indicator and consultation duration using mixed-effects regression models, and revalidated findings using data from 2017/2018. The proportion of complex consultations in different age–sex groups was assessed. Results: A total of 32 GPs participated in the Delphi study. The Delphi panel endorsed 34 of 45 possible complexity indicators after two rounds. After excluding factors because of low prevalence or confounding, 17 indicators were retained in the cross-sectional study. The study used data from 173 130 patients and 725 616 face-to-face GP consultations. On defining complexity as the presence of any of these 17 factors, 308 370 consultations (42.5%) were found to be complex. Mean duration of complex consultations was 10.49 minutes, compared to 9.64 minutes for non-complex consultations. The proportion of complex consultations was similar in males and females but increased with age. Conclusion: The present consultation complexity measure has face and construct validity. It may be useful for research, management and policy, and for informing decisions about the range of resources needed in different practices

Effective heat dissipation in an adiabatic near-field transducer for HAMR

To achieve a feasible heat-assisted magnetic recording (HAMR) system, a near-field transducer (NFT) is necessary to strongly focus the optical field to a lateral region measuring tens of nanometres in size. An NFT must deliver sufficient power to the recording medium as well as maintain its structural integrity. The self-heating problem in the NFT causes materials failure that leads to the degradation of the hard disk drive performance. The literature reports NFT structures with physical sizes well below 1 micron which were found to be thermo-mechanically unstable at an elevated temperature. In this paper, we demonstrate an adiabatic NFT to address the central challenge of thermal engineering for a HAMR system. The NFT is formed by an isosceles triangular gold taper plasmonic waveguide with a length of 6 µm and a height of 50 nm. Our study shows that in the full optically and thermally optimized system, the NFT efficiently extracts the incident light from the waveguide core and can improve the shape of the heating source profile for data recording. The most important insight of the thermal performance is that the recording medium can be heated up to 866 K with an input power of 8.5 mW which is above the Curie temperature of the FePt film while maintaining the temperature in the NFT at 390 K without a heat spreader. A very good thermal efficiency of 5.91 is achieved also. The proposed structure is easily fabricated and can potentially reduce the NFT deformation at a high recording temperature making it suitable for practical HAMR application