Protocol for the unclassified primary antibody deficiency (unPAD) study:Characterization and classification of patients using the ESID online registry

BACKGROUND: Primary antibody deficiencies (PADs) without an identified monogenetic origin form the largest and most heterogeneous group of primary immunodeficiencies. These patients often remain undiagnosed for years and many present to medical attention in adulthood after several infections risking structural complications. Not much is known about their treatment, comorbidities, or prognosis, nor whether the various immunological forms (decreased total IgG, IgG subclass(es), IgM, IgA, specific antibody responses, alone or in combination(s)) should be considered as separate, clearly definable subgroups. The unclassified primary antibody deficiency (unPAD) study aims to describe in detail all PAD patients without an identified specific monogenetic defect regarding their demographical, clinical, and immunological characteristics at presentation and during follow-up. In constructing these patterns, the unPAD study aims to reduce the number of missed and unidentified PAD patients in the future. In addition, this study will focus on subclassifying unPAD to support the identification of patients at higher risk for infection or immune dysregulation related complications, enabling the development of personalized follow-up and treatment plans. METHODS AND ANALYSIS: We present a protocol for a multicenter observational cohort study using the ESID online Registry. Patients of all ages who have given informed consent for participation in the ESID online Registry and fulfill the ESID Clinical Working Definitions for ‘unclassified antibody deficiency’, ‘deficiency of specific IgG’, ‘IgA with IgG subclass deficiency’, ‘isolated IgG subclass deficiency’, ‘selective IgM deficiency’, ‘selective IgA deficiency’ or ‘common variable immunodeficiency’ will be included. For all patients, basic characteristics can be registered at first registration and yearly thereafter in level 1 forms. Detailed characteristics of the patients can be registered in level 2 forms. Consecutive follow-up forms can be added indefinitely. To ensure the quality of the collected data, all data will be fully monitored before they are exported from the ESID online Registry for analysis. Outcomes will be the clinical and immunological characteristics of unPAD at presentation and during follow-up. Subgroup analyses will be made based on demographical, clinical and immunological characteristics

Guidance, Navigation, and Control Performance for the GOES-R Spacecraft

The Geostationary Operational Environmental Satellite-R Series (GOES-R) is the first of the next generation geostationary weather satellites. The series represents a dramatic increase in Earth observation capabilities, with 4 times the resolution, 5 times the observation rate, and 3 times the number of spectral bands. GOES-R also provides unprecedented availability, with less than 120 minutes per year of lost observation time. This paper presents the Guidance Navigation & Control (GN&C) requirements necessary to realize the ambitious pointing, knowledge, and Image Navigation and Registration (INR) objectives of GOES-R. Because the suite of instruments is sensitive to disturbances over a broad spectral range, a high fidelity simulation of the vehicle has been created with modal content over 500 Hz to assess the pointing stability requirements. Simulation results are presented showing acceleration, shock response spectra (SRS), and line of sight (LOS) responses for various disturbances from 0 Hz to 512 Hz. Simulation results demonstrate excellent performance relative to the pointing and pointing stability requirements, with LOS jitter for the isolated instrument platform of approximately 1 micro-rad. Attitude and attitude rate knowledge are provided directly to the instrument with an accuracy defined by the Integrated Rate Error (IRE) requirements. The data are used internally for motion compensation. The final piece of the INR performance is orbit knowledge, which GOES-R achieves with GPS navigation. Performance results are shown demonstrating compliance with the 50 to 75 m orbit position accuracy requirements. As presented in this paper, the GN&C performance supports the challenging mission objectives of GOES-R

Guidance, Navigation, and Control Performance for the GOES-R Spacecraft

The Geostationary Operational Environmental Satellite-R Series (GOES-R) is the first of the next generation geostationary weather satellites, scheduled for delivery in late 2015 and launch in early 2016. Relative to the current generation of GOES satellites, GOES-R represents a dramatic increase in Earth and solar weather observation capabilities, with 4 times the resolution, 5 times the observation rate, and 3 times the number of spectral bands for Earth observations. GOES-R will also provide unprecedented availability, with less than 120 minutes per year of lost observation time. The Guidance Navigation & Control (GN&C) design requirements to achieve these expanded capabilities are extremely demanding. This paper first presents the pointing control, pointing stability, attitude knowledge, and orbit knowledge requirements necessary to realize the ambitious Image Navigation and Registration (INR) objectives of GOES-R. Because the GOES-R suite of instruments is sensitive to disturbances over a broad spectral range, a high fidelity simulation of the vehicle has been created with modal content over 500 Hz to assess the pointing stability requirements. Simulation results are presented showing acceleration, shock response spectrum (SRS), and line of sight responses for various disturbances from 0 Hz to 512 Hz. These disturbances include gimbal motion, reaction wheel disturbances, thruster firings for station keeping and momentum management, and internal instrument disturbances. Simulation results demonstrate excellent performance relative to the pointing and pointing stability requirements, with line of sight jitter of the isolated instrument platform of approximately 1 micro-rad. Low frequency motion of the isolated instrument platform is internally compensated within the primary instrument. Attitude knowledge and rate are provided directly to the instrument with an accuracy defined by the Integrated Rate Error (IRE) requirements. The allowable IRE ranges from 1 to 18.5 micro-rad, depending upon the time window of interest. The final piece of the INR performance is orbit knowledge. Extremely accurate orbital position is achieved by GPS navigation at Geosynchronous Earth Orbit (GEO). Performance results are shown demonstrating compliance with the 50 to 75 m orbit position accuracy requirements of GOES-R, including during station-keeping and momentum management maneuvers. As shown in this paper, the GN&C performance for the GOES-R series of spacecraft supports the challenging mission objectives of the next generation GEO Earth-observation satellites

Emergent Intra-Pair Sex Differences and Organized Behavior in Pair Bonded Prairie Voles (Microtus ochrogaster)

In pair bonding animals, coordinated behavior between partners is required for the pair to accomplish shared goals such as raising young. Despite this, experimental designs rarely assess the behavior of both partners within a bonded pair. Thus, we lack an understanding of the interdependent behavioral dynamics between partners that likely facilitate relationship success. To identify intra-pair behavioral correlates of pair bonding, we used socially monogamous prairie voles (Microtus ochrogaster) and tested both partners using social choice and non-choice tests at short- and long-term pairing timepoints. Females developed a preference for their partner more rapidly than males, with preference driven by different behaviors in each sex. Further, as bonds matured, intra-pair behavioral sex differences and organized behavior emerged—females consistently huddled more with their partner than males did regardless of overall intra-pair affiliation levels. When animals were allowed to freely interact with a partner or a novel vole in sequential free interaction tests, pairs spent more time interacting together than either animal did with a novel vole, consistent with partner preference in the more commonly employed choice test. Total pair interaction in freely moving voles was correlated with female, but not male, behavior. Via a social operant paradigm, we found that pair-bonded females, but not males, are more motivated to access and huddle with their partner than a novel vole. Together, our data indicate that as pair bonds mature, sex differences and organized behavior emerge within pairs, and that these intra-pair behavioral changes are likely organized and driven by the female animal

Expert stakeholders’ perspectives on a Data-to-Care strategy for improving care among HIV-positive individuals incarcerated in jails

Data-to-Care (D2C) uses surveillance data (e.g., laboratory, Medicaid billing) to identify out-of-care HIV-positive persons to re-link them to care. Most US states are implementing D2C, yet few studies have explored stakeholders’ perspectives on D2C, and none have addressed these perspectives in the context of D2C in jail. This article reports findings from qualitative, semi-structured interviews conducted with expert stakeholders regarding their perspectives on the ethical challenges of utilizing D2C to understand and improve continuity of care among individuals incarcerated in jails. Participants included 47 professionals with expertise in ethics and privacy, public health and HIV care, the criminal justice system, and community advocacy. While participants expressed a great deal of support for extending D2C to jails, they also identified many possible risks. Stakeholders discussed many issues specific to D2C in jails, such as heightened stigma in the jail setting, the need for training of jail staff and additional non-medical community-based resources, and the high priority of this vulnerable population. Many experts suggested that the actual likelihood of benefits and harms would depend on contextual details. Implementation of D2C in jails may require novel strategies to minimize risk of disclosing out-of-care patients’ HIV status

Role of hospital surfaces in the transmission of emerging health care- associated pathogens: Norovirus, Clostridium difficile, and Acinetobacter species

Health care-associated infections (HAI) remain a major cause of patient morbidity and mortality. Although the main source of nosocomial pathogens is likely the patient's endogenous flora, an estimated 20% to 40% of HAI have been attributed to cross infection via the hands of health care personnel, who have become contaminated from direct contact with the patient or indirectly by touching contaminated environmental surfaces. Multiple studies strongly suggest that environmental contamination plays an important role in the transmission of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus spp. More recently, evidence suggests that environmental contamination also plays a role in the nosocomial transmission of norovirus, Clostridium difficile, and Acinetobacter spp. All 3 pathogens survive for prolonged periods of time in the environment, and infections have been associated with frequent surface contamination in hospital rooms and health care worker hands. In some cases, the extent of patient-to-patient transmission has been found to be directly proportional to the level of environmental contamination. Improved cleaning/disinfection of environmental surfaces and hand hygiene have been shown to reduce the spread of all of these pathogens. Importantly, norovirus and C difficile are relatively resistant to the most common surface disinfectants and waterless alcohol-based antiseptics. Current hand hygiene guidelines and recommendations for surface cleaning/disinfection should be followed in managing outbreaks because of these emerging pathogens

Process simulations of post-combustion CO2 capture for coal and natural gas-fired power plants using a polyethyleneimine/silica adsorbent

The regeneration heat for a polyethyleneimine (PEI)/silica adsorbent based carbon capture system is first assessed in order to evaluate its effect on the efficiency penalty of a coal or natural gas power plant. Process simulations are then carried out on the net plant efficiencies for a specific supercritical 550 MWe pulverized coal (PC) and a 555 MWe natural gas combined cycle (NGCC) power plant integrated with a conceptually designed capture system using fluidized beds and PEI/silica adsorbent. A benchmark system applying an advanced MEA absorption technology in a NETL report (2010) is used as a reference system. Using the conservatively estimated parameters, the net plant efficiency of the PC and NGCC power plant with the proposed capture system is found to be 1.5% and 0.6% point higher than the reference PC and NGCC systems, respectively. Sensitivity analysis has revealed that the moisture adsorption, working capacity and heat recovery strategies are the most influential parameters to the power plant efficiency. Under an optimal scenario with improvements in increasing the working capacity by 2% points and decreasing moisture adsorption by 1% point, the plant efficiencies with the proposed capture system are 2.7% (PC) and 1.9% (NGCC) points higher than the reference systems