Septic Arthritis Caused by Legionella dumoffii in a Patient with Systemic Lupus Erythematosus-Like Disease

We describe a patient with systemic lupus erythematosus (SLE)-like disease on immunosuppressive treatment who developed septic arthritis of the knee involving Legionella dumoffii. Cultures initially remained negative. A broad-range 16S PCR using synovial fluid revealed L. dumoffii rRNA genes, a finding that was subsequently confirmed by positive Legionella culture results

PyTAG: Challenges and Opportunities for Reinforcement Learning in Tabletop Games

In recent years, Game AI research has made important breakthroughs using Reinforcement Learning (RL). Despite this, RL for modern tabletop games has gained little to no attention, even when they offer a range of unique challenges compared to video games. To bridge this gap, we introduce PyTAG, a Python API for interacting with the Tabletop Games framework (TAG). TAG contains a growing set of more than 20 modern tabletop games, with a common API for AI agents. We present techniques for training RL agents in these games and introduce baseline results after training Proximal Policy Optimisation algorithms on a subset of games. Finally, we discuss the unique challenges complex modern tabletop games provide, now open to RL research through PyTAG

For-profit hospitals have thrived because of generous public reimbursement schemes, not greater efficiency: a multi-country case study

For-profit hospitals’ market share has increased in many nations over recent decades. Previous studies suggest that their growth is not attributable to superior performance on access, quality of care, or efficiency. We analyzed other factors that we hypothesized may contribute to the increasing role of for-profit hospitals. We studied the historical development of the for-profit hospital sector across 4 nations with contrasting trends in for-profit hospital market share: the United States, the United Kingdom, Germany, and the Netherlands. We focused on 3 factors that we believed might help explain why the role of for-profits grew in some nations but not in others: (1) the treatment of for-profits by public reimbursement plans, (2) physicians’ financial interests, and (3) the effect of the political environment. We conclude that access to subsidies and reimbursement under favorable terms from public health care payors is an important factor in the rise of for-profit hospitals. Arrangements that aligned financial incentives of physicians with the interests of for-profit hospitals were important in stimulating for-profit growth in an earlier era, but they play little role at present. Remarkably, the environment for for-profit ownership seems to have been largely immune to political shifts

Multiple decisions about one object involve parallel sensory acquisition but time-multiplexed evidence incorporation.

The brain is capable of processing several streams of information that bear on different aspects of the same problem. Here, we address the problem of making two decisions about one object, by studying difficult perceptual decisions about the color and motion of a dynamic random dot display. We find that the accuracy of one decision is unaffected by the difficulty of the other decision. However, the response times reveal that the two decisions do not form simultaneously. We show that both stimulus dimensions are acquired in parallel for the initial ∼0.1 s but are then incorporated serially in time-multiplexed bouts. Thus, there is a bottleneck that precludes updating more than one decision at a time, and a buffer that stores samples of evidence while access to the decision is blocked. We suggest that this bottleneck is responsible for the long timescales of many cognitive operations framed as decisions

Evaluation of Human Interindividual Variation in Bioactivation of Estragole Using Physiologically Based Biokinetic Modeling

The present study investigates interindividual variation in liver levels of the proximate carcinogenic metabolite of estragole, 1′-hydroxyestragole, due to variation in two key metabolic reactions involved in the formation and detoxification of this metabolite, namely 1′-hydroxylation of estragole and oxidation of 1′-hydroxyestragole. Formation of 1′-hydroxyestragole is predominantly catalyzed by P450 1A2, 2A6, and 2E1, and results of the present study support that oxidation of 1′-hydroxyestragole is catalyzed by 17β-hydroxysteroid dehydrogenase type 2 (17β-HSD2). In a first approach, the study defines physiologically based biokinetic (PBBK) models for 14 individual human subjects, revealing a 1.8-fold interindividual variation in the area under the liver concentration-time curve (AUC) for 1′-hydroxyestragole within this group of human subjects. Variation in oxidation of 1′-hydroxyestragole by 17β-HSD2 was shown to result in larger effects than those caused by variation in P450 enzyme activity. In a second approach, a Monte Carlo simulation was performed to evaluate the extent of variation in liver levels of 1′-hydroxyestragole that could occur in the population as a whole. This analysis could be used to derive a chemical-specific adjustment factor (CSAF), which is defined as the 99th percentile divided by the 50th percentile of the predicted distribution of the AUC of 1′-hydroxyestragole in the liver. The CSAF was estimated to range between 1.6 and 4.0, depending on the level of variation that was taken into account for oxidation of 1′-hydroxyestragole. Comparison of the CSAF to the default uncertainty factor of 3.16 for human variability in biokinetics reveals that the default uncertainty factor adequately protects 99% of the populatio

Susceptibility of Thymocytes for Infection by Chicken Anemia Virus is Related to Pre- and Posthatching Development

To investigate the age-dependent mechanism of susceptibility for chicken anemia virus (CAV) infection, we inoculated embryos and chickens of ages between day 9 of embryonic development and day 28 after hatching with CAV. Chicken embryos inoculated at days 9 and 11 of development showed no CAV-infected cells in the thymus, nor in other lymphoid organs. Many CAV-infected cells were detected in the thymic cortex of all chicken embryos inoculated at days 13 and 16 of development and of all chickens inoculated 1, 3, and 7 days after hatching. All embryos and chickens that contained CAV-infected cells in the thymus also contained CAV-infected cells in the bone marrow, but not in the bursa of Fabricius or the spleen. In chickens inoculated at days 14 and 21, only few CAV-infected cells were detected in the thymus, whereas these cells were not detected in thymi of 28-day-old inoculated chickens. Depletion of the thymic cortex was only detected in chickens inoculated from day 16 of embryonic development till day 21 after hatching. Only hematocrit values of the chickens inoculated 1 and 3 days after hatching were below normal. The rationale for the simultaneous susceptibility of cells of the T-cell lineage and cells of the erythrocyte lineage is discussed. As far as the thymus is concerned, the absence of clinical and microscopical signs of CAV infection in older chickens and the inability of CAV to infect embryos at days 9 and 11 of embryonic development may be caused by a lack of susceptible thymocytes. In view of the three waves of thymic precursor cells that populate the thymus during ontogeny, as described by Le Douarin and colleagues, we hypothesize that CAV only infects thymocytes derived from the second wave of precursor cells

Infrared imaging and acoustic sizing of a bubble inside a MEMS piezo ink channel

Piezo drop-on-demand inkjet printers are used in an increasing number of applications because of their reliable deposition of droplets onto a substrate. Droplets of a few picoliters are ejected from an inkjet nozzle at frequencies of up to 100 kHz. However, the entrapment of an air microbubble in the ink channel can severely impede the productivity and reliability of the printing system. The air bubble disturbs the channel acoustics, resulting in disrupted drop formation or failure of the jetting process. Here we study a micro-electro-mechanical systems-based printhead. By using the actuating piezo transducer in receive mode, the acoustical field inside the channel was monitored, clearly identifying the presence of an air microbubble inside the channel during failure of the jetting process. The infrared visualization technique allowed for the accurate sizing of the bubble, including its dynamics, inside the intact printhead. A model was developed to calculate the mutual interaction between the channel acoustics and the bubble dynamics. The model was validated by simultaneous acoustical and infrared detection of the bubble. The model can predict the presence and size of entrapped air bubbles inside an operating ink channel purely from the acoustic response