An agent-based model about the effects of fake news on a norovirus outbreak

Background; Concern about health misinformation is longstanding, especially on the Internet. Methods; Using agent-based models, we considered the effects of such misinformation on a norovirus outbreak, and some methods for countering the possible impacts of “good” and “bad” health advice. The work explicitly models spread of physical disease and information (both online and offline) as two separate but interacting processes. The models have multiple stochastic elements; repeat model runs were made to identify parameter values that most consistently produced the desired target baseline scenario. Next, parameters were found that most consistently led to a scenario when outbreak severity was clearly made worse by circulating poor quality disease prevention advice. Strategies to counter “fake” health news were tested. Results; Reducing bad advice to 30% of total information or making at least 30% of people fully resistant to believing in and sharing bad health advice were effective thresholds to counteract the negative impacts of bad advice during a norovirus outbreak. Conclusion: How feasible it is to achieve these targets within communication networks (online and offline) should be explored

Deglacial laminated facies on the NW European continental margin: The hydrographic significance of British-Irish Ice Sheet deglaciation and Fleuve Manche paleoriver discharges

[1] We have compiled results obtained from four high sedimentation rate hemipelagic sequences from the Celtic sector of the NW European margin ( NE Atlantic) to investigate the paleoceanographic and paleoclimatic evolution of the area over the last few climatic cycles. We focus on periods characteristic of deglacial transitions. We adopt a multiproxy sedimentological, geochemical, and micropaleontological approach, applying a sampling resolution down to ten microns for specific intervals. The investigation demonstrates the relationships between the Bay of Biscay hydrography and the glacial/deglacial history of both the proximal British-Irish Ice Sheet (BIIS) and the western European continent. We identify recurrent phases of laminae deposition concurrent with major BIIS deglacial episodes in all the studied cores. Evidence for abrupt freshwater discharges into the open ocean highlights the influence of such events at a regional scale. We discuss their impact at a global scale considering the present and past key location of the Bay of Biscay versus the Atlantic Meridional Overturning Circulation (AMOC)

Long-term variations in Iceland–Scotland overflow strength during the Holocene

The overflow of deep water from the Nordic seas into the North Atlantic plays a critical role in global ocean circulation and climate. Approximately half of this overflow occurs via the Iceland–Scotland (I–S) overflow, yet the history of its strength throughout the Holocene (~ 0–11 700 yr ago, ka) is poorly constrained, with previous studies presenting apparently contradictory evidence regarding its long-term variability. Here, we provide a comprehensive reconstruction of I–S overflow strength throughout the Holocene using sediment grain size data from a depth transect of 13 cores from the Iceland Basin. Our data are consistent with the hypothesis that the main axis of the I–S overflow on the Iceland slope was shallower during the early Holocene, deepening to its present depth by ~ 7 ka. Our results also reveal weaker I–S overflow during the early and late Holocene, with maximum overflow strength occurring at ~ 7 ka, the time of a regional climate thermal maximum. Climate model simulations suggest a shoaling of deep convection in the Nordic seas during the early and late Holocene, consistent with our evidence for weaker I–S overflow during these intervals. Whereas the reduction in I–S overflow strength during the early Holocene likely resulted from melting remnant glacial ice sheets, the decline throughout the last 7000 yr was caused by an orbitally induced increase in the amount of Arctic sea ice entering the Nordic seas. Although the flux of Arctic sea ice to the Nordic seas is expected to decrease throughout the next century, model simulations predict that under high emissions scenarios, competing effects, such as warmer sea surface temperatures in the Nordic seas, will result in reduced deep convection, likely driving a weaker I–S overflow

Prolonged enoxaparin therapy compared with standard-of-care antithrombotic therapy in opiate-treated patients undergoing primary percutaneous coronary intervention

A novel enoxaparin regimen consisting of intra-arterial bolus (0.75 mg/kg) followed by intravenous infusion (0.75 mg/kg/6 hours) has been developed as a possible solution to the delayed absorption of oral P2Y12 inhibitors in opiate-treated ST-elevation myocardial infarction (STEMI) patients undergoing primary angioplasty. We aimed to study the feasibility of this regimen as an alternative to standard-of-care treatment (SOC) with unfractionated heparin ± glycoprotein IIb/IIIa antagonist (GPI). One hundred opiate-treated patients presenting with STEMI and accepted for primary angioplasty were randomized (1:1) to either enoxaparin or SOC. Fifty patients were allocated enoxaparin (median age 61, 40% females) and 49 allocated SOC (median age 62, 22% females). One developed stroke before angiography and was withdrawn. One SOC patient had a gastrointestinal bleed resulting in 1 g drop in hemoglobin and early cessation of GPI infusion. Two enoxaparin patients had transient minor bleeding: one transient gingival bleed and one episode of coffee ground vomit with no hemoglobin drop or hemodynamic instability. Two SOC and no enoxaparin group patients had acute stent thrombosis. These preliminary data support further study of this novel 6-hour enoxaparin regimen in opiate-treated PPCI patients

Dynamic Changes in High-Sensitivity Cardiac Troponin I in Response to Anthracycline-Based Chemotherapy

Aims: Treatment advances have improved cancer-related outcomes and shifted interest towards minimising long-term iatrogenic complications, particularly chemotherapy-related cardiotoxicity. High-sensitivity cardiac troponin I (hs-cTnI) assays accurately quantify very low concentrations of plasma troponin and enable early detection of cardiomyocyte injury prior to the development of myocardial dysfunction. The profile of hs-cTnI in response to anthracycline-based treatment has not previously been described. Materials and methods: This was a multicentre prospective observational cohort study. Female patients with newly diagnosed invasive breast cancer scheduled to receive anthracycline-based (epirubicin) chemotherapy were recruited. Blood sampling was carried out before and 24 h after each cycle. Hs-cTnI concentrations were measured using the Abbott ARCHITECTSTAT assay. Results: We recruited 78 women with a median (interquartile range) age of 52 (49–61) years. The median baseline troponin concentration was 1 (1–4) ng/l and the median cumulative epirubicin dose was 394 (300–405) mg/m2. Following an initial 33% fall 24 h after anthracycline dosing (P < 0.001), hs-cTnI concentrations increased by a median of 50% (P < 0.001) with each successive treatment cycle. In total, 45 patients had troponin measured immediately before the sixth treatment cycle, 21 (46.6%) of whom had hs-cTnI concentrations ≥16 ng/l, indicating myocardial injury. Plasma hs-cTnI concentrations before the second treatment cycle were a strong predictor of subsequent myocardial injury. Conclusions: Cardiotoxicity arising from anthracycline therapy is detectable in the earliest stages of breast cancer treatment and is cumulative with each treatment cycle. This injury is most reliably determined from blood sampling carried out before rather than after each treatment cycle

Does the extended Glasgow Outcome Scale add value to the conventional Glasgow Outcome Scale?

The Glasgow Outcome Scale (GOS) is firmly established as the primary outcome measure for use in Phase III trials of interventions in traumatic brain injury (TBI). However, the GOS has been criticized for its lack of sensitivity to detect small but clinically relevant changes in outcome. The Glasgow Outcome Scale-Extended (GOSE) potentially addresses this criticism, and in this study we estimate the efficiency gain associated with using the GOSE in place of the GOS in ordinal analysis of 6-month outcome. The study uses both simulation and the reanalysis of existing data from two completed TBI studies, one an observational cohort study and the other a randomized controlled trial. As expected, the results show that using an ordinal technique to analyze the GOS gives a substantial gain in efficiency relative to the conventional analysis, which collapses the GOS onto a binary scale (favorable versus unfavorable outcome). We also found that using the GOSE gave a modest but consistent increase in efficiency relative to the GOS in both studies, corresponding to a reduction in the required sample size of the order of 3–5%. We recommend that the GOSE be used in place of the GOS as the primary outcome measure in trials of TBI, with an appropriate ordinal approach being taken to the statistical analysis

Principles of crystal growth of intermetallic and oxide compounds from molten solutions

We present a tutorial on the principles of crystal growth of intermetallic and oxide compounds from molten solutions, with an emphasis on the fundamental principles governing the underlying phase equilibria and phase diagrams of multicomponent systems.Comment: 43 pages, 24 figures; Philosophical Magazine, 201

Validation of four-dimensional flow cardiovascular magnetic resonance for aortic stenosis assessment

The management of patients with aortic stenosis (AS) crucially depends on accurate diagnosis. The main aim of this study were to validate the four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) methods for AS assessment. Eighteen patients with clinically severe AS were recruited. All patients had pre-valve intervention 6MWT, echocardiography and CMR with 4D flow. Of these, ten patients had a surgical valve replacement, and eight patients had successful transcatheter aortic valve implantation (TAVI). TAVI patients had invasive pressure gradient assessments. A repeat assessment was performed at 3–4 months to assess the remodelling response. The peak pressure gradient by 4D flow was comparable to an invasive pressure gradient (54 ± 26 mmHG vs 50 ± 34 mmHg, P = 0.67). However, Doppler yielded significantly higher pressure gradient compared to invasive assessment (61 ± 32 mmHG vs 50 ± 34 mmHg, P = 0.0002). 6MWT was associated with 4D flow CMR derived pressure gradient (r = −0.45, P = 0.01) and EOA (r = 0.54, P < 0.01) but only with Doppler EOA (r = 0.45, P = 0.01). Left ventricular mass regression was better associated with 4D flow derived pressure gradient change (r = 0.64, P = 0.04). 4D flow CMR offers an alternative method for non-invasive assessment of AS. In addition, 4D flow derived valve metrics have a superior association to prognostically relevant 6MWT and LV mass regression than echocardiography

Norms and trust-shaping relationships among food-exporting SMEs in Ghana

There is a marked paucity of empirically rigorous research that focuses on the impact that indigenous institutional influences can have on the internationalization strategies of entrepreneurs operating in developing countries. This study therefore explores the complex processes through which owner-managers of food-exporting SMEs in Ghana draw on cultural norms to build networks that enable internationalization, in the absence of formal institutional support. The results facilitate a better understanding of the hybridization of indigenous and global norms that underpin SME internationalization in Ghana and other developing economies, particularly in Africa. The study contributes to the theory and practice of interorganizational relationships and to international entrepreneurship in an African context