Scald risk in social housing can be reduced through thermostatic control system without increasing Legionella risk: a cluster randomised trial.

OBJECTIVE: To quantify the effects of a thermostatic control system in social (public) housing on the prevalence of dangerous (>60°C) water temperatures and on fuel consumption. DESIGN: Pair-matched double-blind cluster randomised controlled trial. SETTING: Social housing in a deprived inner-London borough. PARTICIPANTS: 150 households recruited as clusters from 22 social housing estates. Four small estates were combined into two clusters (resulting in a total of 10 pairs of clusters). INTERVENTION: Social housing estate boiler houses were randomised to a thermostatic control sterilisation programme (heating water to 65°C during 00:00-06:00 h and to 50°C from 06:00 to 00:00 h daily) or to standard control (constant temperature 65°C). MAIN OUTCOME MEASURES: Water temperature over 60°C ('dangerous') after running taps for 1 min and daily fuel consumption (cubic feet of gas). RESULTS: 10 clusters (80 households) were allocated to the sterilisation programme and 10 clusters (70 households) to control, of which 73 and 67 households, respectively, were analysed. Prevalence of dangerous (>60°C) hot water temperatures at 1 min was significantly reduced with the sterilisation programme (mean of cluster prevalence 1% in sterilisation programme group vs 34% in control group; absolute difference 33%, 95% CI 12% to 54%; p=0.006). Prevalence of high (>55°C) hot water temperatures at 1 min was significantly reduced (31% sterilisation vs 59% control; absolute difference 28%, 95% CI 9% to 47%; p=0.009). Gas consumption per day reduced more in the control group than in the sterilisation programme group, although not statistically significantly (p=0.125). CONCLUSIONS: The thermostatic control with daily sterilisation was effective in capping hot water temperatures and therefore reduced scald risk. Although expected to save energy, fuel consumption was increased relative to the control group. Trial registration ClinicalTrials.gov ID: NCT00874692

GENERALIZED CYTOMEGALIC INCLUSION DISEASE

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Single flux quantum circuits with damping based on dissipative transmission lines

We propose and demonstrate the functioning of a special Rapid Single Flux Quantum (RSFQ) circuit with frequency-dependent damping. This damping is achieved by shunting individual Josephson junctions by pieces of open-ended RC transmission lines. Our circuit includes a toggle flip-flop cell, Josephson transmission lines transferring single flux quantum pulses to and from this cell, as well as DC/SFQ and SFQ/DC converters. Due to the desired frequency-dispersion in the RC line shunts which ensures sufficiently low noise at low frequencies, such circuits are well-suited for integrating with the flux/phase Josephson qubit and enable its efficient control.Comment: 6 pages incl. 6 figure

The Syriac Galen Palimpsest: A Tale of Two Texts

This article presents the Syriac Galen Palimpsest’s double history, of both the original manuscript and its subsequent reuse. The original medical manuscript contained Galen’s Book of Simple Drugs in Syriac translation, was probably produced in northern Mesopotamia or western Syria, and dates to the first half of the ninth century. After only two centuries, it was erased and reused to produce a liturgical text called Octṓēchos, probably at the monastery of Saint Elias on the Black Mountain. This palimpsest was later transferred to Saint Catherine’s monastery in the Sinai, where it remained for several centuries before being offered for sale in Leipzig in 1922 (perhaps due to the activities of Friedrich Grote). We pay close attention to the context, contents, codicology and palaeography of both the original manuscript and the palimpsest. We also contextualise both texts within the wider story of their transmission. Through the skeleton table we present the latest results of our almost complete identification of the undertext. We reconstruct the structure of the original codex through a collation diagram. We draw palaeographical parallels with a dated colophon of the well-known Sahdona-manuscript. This permits us to narrow done the time and place of production of the original manuscript

Ionisation-induced star formation III: Effects of external triggering on the IMF in clusters

We report on Smoothed Particle Hydrodynamics (SPH) simulations of the impact on a turbulent $\sim2\times10^{3}$ M$_{\odot}$ star--forming molecular cloud of irradiation by an external source of ionizing photons. We find that the ionizing radiation has a significant effect on the gas morphology, but a less important role in triggering stars. The rate and morphology of star formation are largely governed by the structure in the gas generated by the turbulent velocity field, and feedback has no discernible effect on the stellar initial mass function. Although many young stars are to be found in dense gas located near an ionization front, most of these objects also form when feedback is absent. Ionization has a stronger effect in diffuse regions of the cloud by sweeping up low--density gas that would not otherwise form stars into gravitationally--unstable clumps. However, even in these regions, dynamical interactions between the stars rapidly erase the correlations between their positions and velocities and that of the ionization front.Comment: 12 pages, 16 figures (some downgraded to fit on astro-ph), accepted for publication in MNRA

A reported 20-gene expression signature to predict lymph node-positive disease at radical cystectomy for muscle-invasive bladder cancer is clinically not applicable

Background Neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) provides a small but significant survival benefit. Nevertheless, controversies on applying NAC remain because the limited benefit must be weight against chemotherapy-related toxicity and the delay of definitive local treatment. Therefore, there is a clear clinical need for tools to guide treatment decisions on NAC in MIBC. Here, we aimed to validate a previously reported 20-gene expression signature that predicted lymph node-positive disease at radical cystectomy in clinically node-negative MIBC patients, which would be a justification for upfront chemotherapy. Methods We studied diagnostic transurethral resection of bladder tumors (dTURBT) of 150 MIBC patients (urothelial carcinoma) who were subsequently treated by radical cystectomy and pelvic lymph node dissection. RNA was isolated and the expression level of the 20 genes was determined on a qRT-PCR platform. Normalized Ct values were used to calculate a risk score to predict the presence of node-positive disease. The Cancer Genome Atlas (TCGA) RNA expression data was analyzed to subsequently validate the results. Results In a univariate regression analysis, none of the 20 genes significantly correlated with nodepositive disease. The area under the curve of the risk score calculated by the 20-gene expression signature was 0.54 (95% Confidence Interval: 0.44-0.65) versus 0.67 for the model published by Smith et al. Node-negative patients had a significantly lower tumor grade at TURBT (p = 0.03), a lower pT stage (p<0.01) and less frequent lymphovascular invasion (13% versus 38%, p<0.01) at radical cystectomy than node-positive patients. In addition, in the TCGA data, none of the 20 genes was differentially expressed in node-negative versus node-positive patients. Conclusions We conclude that a 20-gene expression signature developed for nodal staging of MIBC at radical cystectomy could not be validated on a qRT-PCR platform in a large cohort of dTURBT specimens

Continuing research on the Syriac Galen Palimpsest:Collaborative Implementation within the Framework of Two European Projects

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Spatial Light Modulators for the Manipulation of Individual Atoms

We propose a novel dipole trapping scheme using spatial light modulators (SLM) for the manipulation of individual atoms. The scheme uses a high numerical aperture microscope to map the intensity distribution of a SLM onto a cloud of cold atoms. The regions of high intensity act as optical dipole force traps. With a SLM fast enough to modify the trapping potential in real time, this technique is well suited for the controlled addressing and manipulation of arbitrarily selected atoms.Comment: 9 pages, 5 figure

Guillain-Barré syndrome following varicella-zoster virus infection

We describe the frequency, clinical features, and electrophysiological and immunological phenotypes of Guillain-Barré Syndrome (GBS) patients treated at a single institution in Bangladesh who had preceding chicken pox (primary Varicella-zoster virus [VZV] infection) within 4 weeks of GBS onset. A literature review of GBS cases preceding VZV infection is also provided. Diagnosis of GBS was based on the National Institute of Neurological Disorders and Stroke criteria for GBS. Serum anti-VZV IgM and IgG antibodies were quantified by indirect chemiluminescence immunoassay (CLIA); anti-Campylobacter jejuni IgG, IgM, and IgA antibodies and anti-ganglioside GM1 IgM and IgG antibodies, by enzyme-linked immunosorbent assays. Neurophysiologic subtypes were categorized following the Hadden criteria. Of 536 patients with GBS, 7 (1.3%) had chicken pox within 4 weeks before GBS onset. Four of the seven cases were male (age range, 23 to 40 years old). All seven patients were bed-bound, six had sensory symptoms, and three required mechanical ventilation for respiratory failure. All seven patients had CSF albuminocytologic dissociation and evidence of demyelination in nerve conduction studies. Anti-VZV IgM antibodies were present and anti-GM1 and anti-Campylobacter jejuni lipo-oligosaccharides (LOS) were negative in all cases. All patients had excellent outcome at 1 year (able to run). A systematic literature review of GBS cases related to VZV revealed 39 previously reported patients with comparable clinical presentations and outcomes, of which 36 had neurophysiologic evidence of demyelination. VZV infection is associated with the demyelinating subtype of GBS, clearly distinct from the axonal form of GBS that predominate in countries like Bangladesh

Long-term follow-up of retrograde colonic irrigation for defaecation disturbances

Objective. Irrigation of the distal part of the large bowel is a nonsurgical alternative for patients with defaecation disturbance. In our institution, all patients with defaecation disturbances, not responding to medical treatment and biofeedback therapy, were offered retrograde colonic irrigation (RCI). This study is aimed at evaluating the long-term feasibility and outcome of RCI. Methods. Between 1989 and 2001, a consecutive series of 267 patients was offered RCI. All patients received instructions about RCI by one of our enterostomal therapists. Twenty-eight patients were lost to follow-up. A detailed questionnaire was sent by mail to 239 patients. The total response rate was 79% (190 patients). Based on the returned questionnaires it became clear the 21 (11%) patients never started RCI. The long-term feasibility and outcome of RCI was therefore assessed in the remaining group of 169 patients. Thirty-two patients were admitted with soiling, 71 patints with faecal incontinence, 37 patients with obstructed defaecation and 29 had defaecation disturbance after low anterior resection or pouch surgery. Results. According to the returned questionnaires, RCI was considered effective by 91 (54%) patients. Among patients with soling and faecal incontinence, RCI was found to be effective in, respectively, 47 and 41% of the subjects. Despite of the reported effectiveness, 10 (67%) patients with soiling and 5 (17%) patients with faecal incontinence decide to stop. Among patients with obstructed defaecation and those with defaecation disturbances after low anterior resection or pouch surgery the effectiveness of RCI was found to be 65 and 79%, respectively. None of these patients ceased their therapy. The overall succes-rate of long-term RCI was therefore 45%. Conclusions. Long-term RCI is beneficial for 45% of patients with defaecation disturbance. In the group of patients who considered RCI effective and beneficial, discontinuation of therapy was only observe among those with soiling and faecal incontinence