Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012

Coronaviruses have the potential to cause severe transmissible human disease, as demonstrated by the severe acute respiratory syndrome (SARS) outbreak of 2003. We describe here the clinical and virological features of a novel coronavirus infection causing severe respiratory illness in a patient transferred to London, United Kingdom, from the Gulf region of the Middle East

Developing 1D nanostructure arrays for future nanophotonics

There is intense and growing interest in one-dimensional (1-D) nanostructures from the perspective of their synthesis and unique properties, especially with respect to their excellent optical response and an ability to form heterostructures. This review discusses alternative approaches to preparation and organization of such structures, and their potential properties. In particular, molecular-scale printing is highlighted as a method for creating organized pre-cursor structure for locating nanowires, as well as vapor–liquid–solid (VLS) templated growth using nano-channel alumina (NCA), and deposition of 1-D structures with glancing angle deposition (GLAD). As regards novel optical properties, we discuss as an example, finite size photonic crystal cavity structures formed from such nanostructure arrays possessing highQand small mode volume, and being ideal for developing future nanolasers

Performance of Holstein calves having free access to milk and dosed with Megasphaera elsdenii

Megasphaera elsdenii converts lactate and glucose into butyrate, the main volatile fatty acid responsible of papillae development and may benefit calf performance. Twenty-six Holstein calves (BW = 34.5 ± 1.65 kg) were randomly assigned at birth to a control group (Meg0) and a group that received an oral dose of M. elsdenii NCIMB 41125 at 14 d of age (Meg14). Calves received colostrum for the first 3 d followed by free choice access to whole milk until weaning at 56 d. From d 4 onward, starter and water were offered ad libitum. Intakes were measured daily and body weights (BW) weekly. Blood samples were collected on day 7, 21, 28, 42, and 56 for β-hydroxybutyrate (BHBA) analysis. Performance was measured for an additional 14 d post-weaning. Pre-weaning milk intake was lower (p = 0.010) and starter DMI (dry matter intake) greater (p = 0.001) for Meg14 than Meg0 calves. Total DMI, metabolisable energy (ME) intake and average daily gain (ADG) were similar (p > 0.05) for both groups, but Meg14 calves had greater weaning BW (p = 0.012) and feed efficiency (p < 0.029). The average BHBA between d 21 and 56 was greater for Meg14 (p = 0.03) compared to Meg0 calves. After weaning, Meg14 calves had greater DMI (p = 0.027), ME intake (p = 0.023) and ADG (p = 0.002) and tended to have better feed efficiencies (p = 0.07) than Meg0 calves. Administering M. elsdenii NCIMB 41125 improved starter intake and feed efficiency, which was associated with high blood BHBA.This research was supported by the Agricultural Research Council, Animal Production Institute, South Africa, which is gratefully acknowledged.The Agricultural Research Council, Animal Production Institute, South Africahttp://www.scielo.br/scielo.php?script=sci_serial&pid=0103-9016&lng=en&nrm=isoam2017Animal and Wildlife Science

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

The replication problem and its implications for policy studies

In this article we re-examine the epistemological basis for claims to ‘best evidence’ and ‘best practice’ in policy studies by tracing these to a Popperian model of theory development and testing. This model outlines how only scientific explanations that survive repeated testing count as good theory. Yet repeated testing (replication) is scarce across the social sciences – this is the ‘replication problem’. More specifically, the lack of replications in policy studies undermines the epistemological basis for policy transfer based on ‘best practice’ and ‘best evidence’. To resolve this, we offer an innovative explanation of the replication problem drawing on Foucault's concept of Episteme. In doing so, we outline two respectively different accounts of replication: ‘scientific project,’ and ‘aesthetic object.’ The latter offers alternative bases from which to pursue ‘best practice’ and ‘best evidence’

Mechanical ventilation in patients with cardiogenic pulmonary edema : a sub-analysis of the LUNG SAFE study

Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmHO, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmHO, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmHO, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073

Genetic studies of body mass index yield new insights for obesity biology

Note: A full list of authors and affiliations appears at the end of the article. Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P 20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.</p