Electromagnetic Waves in Variable Media

Two methods are explained to exactly solve Maxwell's equations where permittivity, permeability and conductivity may vary in space. In the constitutive relations, retardation is regarded. If the material properties depend but on one coordinate, general solutions are derived. If the properties depend on two coordinates, geometrically restricted solutions are obtained. Applications to graded reflectors, especially to dielectric mirrors, to filters, polarizers and to waveguides, plain and cylindrical, are indicated. New foundations for the design of optical instruments, which are centered around an axis, and for the design of invisibility cloaks, plain and spherical, are proposed. The variability of material properties makes possible effects which cannot happen in constant media, e.g. stopping the flux of electromagnetic energy without loss. As a consequence, spherical devices can be constructed which bind electromagnetic waves

Increased risk of A(H1N1)pdm09 influenza infection in UK pig industry workers compared to a general population cohort

Background: Pigs are mixing vessels for influenza viral reassortment but the extent of influenza transmission between swine and humans is not well understood. Objectives: To assess whether occupational exposure to pigs is a risk factor for human infection with human and swine-adapted influenza viruses. Methods: UK pig industry workers were frequency-matched on age, region, sampling month, and gender with a community-based comparison group from the Flu Watch study. HI assays quantified antibodies for swine and human A(H1) and A(H3) influenza viruses (titres≥40 considered seropositive and indicative of infection). Virus-specific associations between seropositivity and occupational pig exposure were examined using multivariable regression models adjusted for vaccination. Pigs on the same farms were also tested for seropositivity. Results: 42% of pigs were seropositive to A(H1N1)pdm09. Pig industry workers showed evidence of increased odds of A(H1N1)pdm09 seropositivity compared to the comparison group, albeit with wide confidence intervals (CI), Adjusted Odds Ratio after accounting for possible cross reactivity with other swine A(H1) viruses (aOR) 25.30, 95% CI [1.44-536.34], p=0.028. Conclusion: The results indicate that A(H1N1)pdm09 virus was common in UK pigs during the pandemic and subsequent period of human A(H1N1)pdm09 circulation, and occupational exposure to pigs was a risk factor for human infection. Influenza immunization of pig industry workers may reduce transmission and the potential for virus reassortment

Natural T cell–mediated protection against seasonal and pandemic Influenza: results of the Flu Watch cohort study

Rationale: A high proportion of influenza infections are asymptomatic. Animal and human challenge studies and observational studies suggest T cells protect against disease among those infected, but the impact of T-cell immunity at the population level is unknown. Objectives: To investigate whether naturally preexisting T-cell responses targeting highly conserved internal influenza proteins could provide cross-protective immunity against pandemic and seasonal influenza. Methods: We quantified influenza A(H3N2) virus–specific T cells in a population cohort during seasonal and pandemic periods between 2006 and 2010. Follow-up included paired serology, symptom reporting, and polymerase chain reaction (PCR) investigation of symptomatic cases. Measurements and Main Results: A total of 1,414 unvaccinated individuals had baseline T-cell measurements (1,703 participant observation sets). T-cell responses to A(H3N2) virus nucleoprotein (NP) dominated and strongly cross-reacted with A(H1N1)pdm09 NP (P < 0.001) in participants lacking antibody to A(H1N1)pdm09. Comparison of paired preseason and post-season sera (1,431 sets) showed 205 (14%) had evidence of infection based on fourfold influenza antibody titer rises. The presence of NP-specific T cells before exposure to virus correlated with less symptomatic, PCR-positive influenza A (overall adjusted odds ratio, 0.27; 95% confidence interval, 0.11–0.68; P = 0.005, during pandemic [P = 0.047] and seasonal [P = 0.049] periods). Protection was independent of baseline antibodies. Influenza-specific T-cell responses were detected in 43%, indicating a substantial population impact. Conclusions: Naturally occurring cross-protective T-cell immunity protects against symptomatic PCR-confirmed disease in those with evidence of infection and helps to explain why many infections do not cause symptoms. Vaccines stimulating T cells may provide important cross-protective immunity

The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis

Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data—medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York—were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%–0.096%), sCIR of 0.239% (0.134%–0.458%), and sCHR of 1.44% (0.83%–2.64%). Using self-reported ILI, we obtained estimates approximately 7–96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5–17 y. sCHR appears to be lowest in persons aged 5–17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn–winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0–4 and adults 18–64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed

Quality of provided care in vascular surgery : outcome assessment & improvement strategies

The aim of this thesis was to evaluate the quality of care in vascular surgery in end-stage renal disease (ESRD) and peripheral arterial occlusive disease (PAOD): intermittent claudication (IC) and critical lower limb ischaemia (CLI) patients. Therefore firstly it focused on the improvement of the quality of perioperative patient management concerning: (1) a systematic review concerning all quality initiatives in vascular surgery was conducted, (2) an assessed of the implementation of established recommended SP measures in patients with PAOD was established and (3) an evaluation of the implementation of a new optimised care protocol (OCP) outlined in a multidisciplinary meeting was done. Then, it further focused mainly on AEs (registration, occurrence, consequences) of PAOD patients. A (1) determination of risk factors for adverse events (AE) occurrence by assessing three different health care facilities was assessed, (2) an evaluation of the occurrence of cardiac AE after primary lower extremity arterial revascularization (LEAR) for CLI in order to evaluate the impact of cardiac AEs on the clinical outcome was done and (3) a calculation of the average estimated total costs of AEs after treatment for PAOD was performed. Furthermore, the thesis focussed on the quality of life (QOL) of PAOD patients after primary LEAR, concerning (1) the role of social support on the outcome and (2) the improvement of functional status after primary LEAR.Astra Zeneca BV Bard Benelux BV B. Braun Medical BV ChipSoft BV Cordis (Johnson & Johnson) Olympus Nederland BV Terumo BeNelux BVUBL - phd migration 201

Het paracervicale block tijdens de baring

De baring is het enige fysiologische gebeuren dat met pijn gepaard gaat. Dit wordt reeds aangeduid door het Nederlandse woord 11wee" en equivalente woorden in vele andere talen (dolor, douleur, pains, Wehe e.a.). De pijn is aanvankelijk vooral gelocaliseerd in de onderbuik en onder in de rug. In het laatste deel van de ontsluitingsperiade en tijdens de uitdrijving wordt de pijn daarbij ook in de bekkenbodem, de genitalia externa en het rectum aangegeven. De pijn wordt door de barende zichtbaar en hoorbaar tot uitdrukking gebracht door middel van motorische onrust, woorden waarin wanhoop wordt uitgedrukt en vraag naar verlossing (Buytendijk, 1943; van Eps, 1954). Volgens van Eps (1954) en anderen moet de fysiologische pijn tijdens de baring als ''wordingspijn'' worden onderscheiden van de pathologische "verstoringspijn". Er is slechts weinig onderzoek verricht naar factoren, die het optreden en de ernst van baringspijn bepalen. Zeker is wel, dat de pijnbeleving en de uitdrukking ervan samenhangt met de psychische gesteldheid van de barende. Deze psychische gesteldheid wordt in belangrijke mate gevormd door opvoeding en culturele achtergrond (Crawford, 1972; Phillips, 1975; van Eps, 1954). De houding van de zwangere ten opzichte van het toekomstige kind en de opvang door de echtgenoot en de verloskundige ten tijde van de baring zijn eveneens van belang. Behalve psychische factoren zijn ook somatische invloeden van betekenis voor de wijze waarop de baringspijn wordt beleefd en uitgedrukt