Transmission of multidrug-resistant tuberculosis in the UK: a cross-sectional molecular and epidemiological study of clustering and contact tracing

BACKGROUND: Between 2000 and 2012 the number of multidrug-resistant (MDR) tuberculosis cases in the UK increased from 28 per year to 81 per year. We investigated the proportion of MDR tuberculosis cases arising from transmission in the UK and associated risk factors. METHOD: We identified patients with MDR tuberculosis notified in England, Wales, and Northern Ireland between Jan 1, 2004, and Dec 31, 2007, by linking national laboratory and surveillance data. Data for laboratory isolates, including drug sensitivities and 24-mycobacterial interspersed repetitive-unit-variable-number tandem repeat (MIRU-VNTR) typing were obtained routinely from the National Tuberculosis Reference laboratories as part of national tuberculosis surveillance. We investigated clusters of cases with indistinguishable MIRU-VNTR profiles to identify epidemiological links. We calculated transmission using the n-1 method and established associated risk factors by logistic regression. We also assessed the likelihood of transmission to additional secondary active tuberculosis cases, identified through conventional contact tracing. FINDINGS: 204 patients were diagnosed with MDR tuberculosis in the study period; 189 (92·6%) had an MIRU-VNTR profile. We identified 12 clusters containing 40 individuals and 149 unique strains. The proportion of cases attributable to recent transmission, on the basis of molecular data, was 15% (40 cases clustered-12 clusters/189 with a strain type). The proportion of cases attributable to recent transmission (ie, transmission within the UK) after adjustment for epidemiological links was 8·5% (22 cases with epidemiological links-six clusters/189 cases with a strain type). Being UK born (odds ratio 4·81; 95% CI 2·03-11·36, p=0·0005) and illicit drug use (4·75; 1·19-18·96, p=0·026) were significantly associated with clustering. The most common transmission setting was the household but 21 of 22 of epidemiological links were missed by conventional contact tracing. 13 secondary active tuberculosis cases identified by conventional contact tracing were mostly contacts of patients with MDR tuberculosis from countries of high tuberculosis burden. 11 (85%) of 13 shared the same country of birth as the index case, of whom ten did not share a strain type or drug resistance pattern. INTERPRETATION: Transmission of MDR tuberculosis in the UK is low and associated with being UK born or illicit drug use. MIRU-VNTR typing with cluster investigation was more successful at identifying transmission events than conventional contact tracing. Individuals with tuberculosis who have had contact with a known MDR tuberculosis source case from a country of high tuberculosis burden should have drug-sensitivity testing on isolates to ensure appropriate treatment is given. FUNDING: Public Health England

Propagation of atmospheric model errors to gravity potential harmonics—impact on GRACE de-aliasing

High-frequency, time-varying mass redistributions in the ocean and atmosphere have an impact on GRACE gravity field solutions due to the space-time sampling characteristics of signal and orbit. Consequently, aliasing of these signals into the GRACE observations is present and needs to be taken into account during data analysis by applying atmospheric and oceanic model data (de-aliasing). As the accuracy predicted prior to launch could not yet be achieved in the analysis of real GRACE data, the de-aliasing process and related geophysical model uncertainties are regarded as a potential error source in GRACE gravity field determination. Therefore, this study aims to improve the de-aliasing process in order to obtain a more accurate GRACE gravity field time-series. As these time-series provide estimates for the integrated mass transport in the Earth system, like the global water cycle and solid Earth geophysical processes, any increase in accuracy will lead to improvements in the geophysical interpretation of the results. So in conclusion, improving the de-aliasing is of relevance for a better understanding of geophysical processes. By no longer regarding the atmosphere and ocean model output as error-free, deeper insight into the impact of such uncertainties on the de-aliasing and on the resulting GRACE gravity field models can be obtained. For this purpose, in a first step, a full error propagation of the atmospheric and oceanic model parameters up to the de-aliasing gravity field coefficients is performed and the GRACE K-Band-Satellite-to-Satellite Tracking (KBR-SST) residuals, as an intermediate gravity field result, are analysed. The paper reviews the standard GRACE de-aliasing process and presents the mathematical model applied for the error propagation. Specifically, the effect of uncertainties in the atmospheric input parameters (temperature, surface pressure, specific humidity, geopotential) on the gravity field potential coefficients used for de-aliasing is shown in several scenarios. Finally, the impact of de-aliasing products (with and without error propagation) on a GRACE gravity field solution is investigated on the level of observation residuals. From the results obtained in this study it can be concluded that with respect to the current GRACE error budget, atmospheric model uncertainties do not play a prominent role in the error budget of current GRACE gravity field solutions. Nevertheless, in order to fully exploit the GRACE measurements towards the baseline accuracy, an optimized de-aliasing is needed. In this case, GRACE gravity field solutions are sensitive to uncertainties in atmospheric and oceanic models. Thus, the associated geophysical model errors shall be taken into account in the de-aliasing proces

Oxygen superstructures throughout the phase diagram of (Y,Ca)Ba2Cu3O6+x\bf (Y,Ca)Ba_2 Cu_3 O_{6+x}

Short-range lattice superstructures have been studied with high-energy x-ray diffuse scattering in underdoped, optimally doped, and overdoped $\rm (Y,Ca)Ba_2 Cu_3 O_{6+x}$. A new four-unit-cell superstructure was observed in compounds with $x\sim 0.95$. Its temperature, doping, and material dependence was used to attribute its origin to short-range oxygen vacancy ordering, rather than electronic instabilities in the $\rm CuO_2$ layers. No significant diffuse scattering is observed in YBa$_2$Cu$_4$O$_{8}$. The oxygen superstructures must be taken into account when interpreting spectral anomalies in $\rm (Y,Ca)Ba_2 Cu_3 O_{6+x}$

Nutritional profile of Syrian refugee children before resettlement

Background The year 2015 marked the highest number of refugees globally and included record numbers of Syrians moving to neighboring countries. Half of the Syrians were children aged ≤18 years. Our study sought to examine undernutrition and overnutrition among a group of Syrian refugee children who underwent medical screening by IOM for resettlement. Methods This is a retrospective review of Syrian refugee children aged 6 to 59 months from January 1, 2015 to December 31, 2016. The World Health Organization (WHO) Stata package computed Z-scores based on available weight and height data. Prevalence estimates of undernutrition (wasting and stunting) and overnutrition (overweight and obesity) were made using WHO standards. Multivariate analysis was used to determine the factors associated with wasting, stunting, and overnutrition, adjusting for age, sex, family size, and country of health assessment. Results A total of 14,552 Syrian refugee children aged 6 to 59 months underwent health assessments in Jordan (43·1%), Lebanon (38·8%), Turkey (7·0%), Greece (6·7%), Egypt (2·4%), and Iraq (2·1%). Overall, this group of Syrian refugee children had a low prevalence of wasting (< 5%) and stunting (< 10%), and high prevalence of overweight or obese (10.6%). Differences were observed in the prevalence of wasting by country of health assessment. In the multiple regression analysis, the prevalence of stunting and overnutrition decreased with increasing age, and being male was associated with overnutrition but not wasting and stunting. Conclusions Findings revealed an overall low prevalence of undernutrition among this group of Syrian children assessed, although prevalence varied by age group. This low prevalence may reflect the effectiveness, as well as expose possible gaps, of refugee nutrition programs or interventions in countries of asylum. Further studies are recommended to evaluate other possible contributors to malnutrition in this refugee group

The Compact Nucleus of the Deep Silicate Absorption Galaxy NGC 4418

High resolution, Hubble Space Telescope (HST) near-infrared and Keck mid-infrared images of the heavily extinguished, infrared luminous galaxy NGC 4418 are presented. These data make it possible to observe the imbedded near-infrared structure on scales of 10-20 pc, and to constrain the size of the mid-infrared emitting region. The 1.1-2.2 um data of NGC 4418 show no clear evidence of nuclear star clusters or of a reddened active galactic nucleus. Instead, the nucleus of the galaxy consists of a ~100-200 pc linear structure with fainter structures extending radially outward. The near-infrared colors of the linear feature are consistent with a 10-300 Myr starburst suffering moderate levels (few magnitudes) of visual extinction. At 7.9-24.5 um, NGC 4418 has estimated size upper limits in the range of 30-80 pc. These dimensions are consistent with the highest resolution radio observations obtained to date of NGC 4418, as well as the size of 50-70 pc expected for a blackbody with a temperature derived from the 25 um, 60 um, and 100 um flux densities of the galaxy. Further, a spectral energy distribution constructed from the multi-wavelength mid-infrared observations show the strong silicate absorption feature at 10 um, consistent with previous mid-infrared observations of NGC 4418. An infrared surface brightness of 2.1x10^13 L_sun kpc^-2 is derived for NGC 4418. Such a value, though consistent with the surface brightness of warm ultraluminous infrared galaxies (ULIGs: L_IR [8-1000 um] >~ 10^12 L_sun) such as IRAS 05189-2524 and IRAS 08572+3915, is not large enough to distinguish NGC 4418 as a galaxy powered by an Active Galactic Nucleus (AGN), as opposed to a lower surface brightness starburst.Comment: LaTex, 7 pages, including 2 jpg figures and 3 postscript figures, AJ, in press (May, 2003

Nutritional profile of Syrian refugee children before resettlement.

Background: The year 2015 marked the highest number of refugees globally and included record numbers of Syrians moving to neighboring countries. Half of the Syrians were children aged ≤18 years. Our study sought to examine undernutrition and overnutrition among a group of Syrian refugee children who underwent medical screening by IOM for resettlement. Methods: This is a retrospective review of Syrian refugee children aged 6 to 59 months from January 1, 2015 to December 31, 2016. The World Health Organization (WHO) Stata package computed Z-scores based on available weight and height data. Prevalence estimates of undernutrition (wasting and stunting) and overnutrition (overweight and obesity) were made using WHO standards. Multivariate analysis was used to determine the factors associated with wasting, stunting, and overnutrition, adjusting for age, sex, family size, and country of health assessment. Results: A total of 14,552 Syrian refugee children aged 6 to 59 months underwent health assessments in Jordan (43·1%), Lebanon (38·8%), Turkey (7·0%), Greece (6·7%), Egypt (2·4%), and Iraq (2·1%). Overall, this group of Syrian refugee children had a low prevalence of wasting (< 5%) and stunting (< 10%), and high prevalence of overweight or obese (10.6%). Differences were observed in the prevalence of wasting by country of health assessment. In the multiple regression analysis, the prevalence of stunting and overnutrition decreased with increasing age, and being male was associated with overnutrition but not wasting and stunting. Conclusions: Findings revealed an overall low prevalence of undernutrition among this group of Syrian children assessed, although prevalence varied by age group. This low prevalence may reflect the effectiveness, as well as expose possible gaps, of refugee nutrition programs or interventions in countries of asylum. Further studies are recommended to evaluate other possible contributors to malnutrition in this refugee group

VLBA Continuum and H I Absorption Observations of the Ultra-Luminous Infrared Galaxy IRAS 17208-0014

We present phase-referenced VLBI observations of the radio continuum emission from, and the neutral hydrogen 21 cm absorption toward, the Ultra-Luminous Infrared Galaxy IRAS 17208-0014. The observations were carried out at 1362 MHz using the Very Long Baseline Array, including the phased Very Large Array as an element. The high-resolution radio continuum images reveal a nuclear starburst region in this galaxy, which is composed of diffuse emission approximately 670 x 340 pc on the plane of the sky, and a number of compact sources. These sources are most likely to be clustered supernova remnants and/or luminous radio supernovae. Their brightness temperatures range over (2.2-6.6) x 10^{5} K, with radio spectral luminosities between (1-10) x 10^{21} W Hz^{-1}. The total VLBI flux density of the starburst region is ~52 mJy, which is about 50% of the total flux density detected with the VLA at arcsecond resolution. For this galaxy, we derive a massive star formation rate of ~84pm13 M{_\odot} yr^{-1}, and a supernova rate of ~4pm1 yr^{-1}. H I absorption is detected in multiple components with optical depths ranging between 0.3 and 2.5, and velocity widths between 58 and 232 km s^{-1}. The derived column densities, assuming T_{s}=100 K, range over (10-26) x 10^{21} cm^{-2}. The H I absorption shows a strong velocity gradient of 453 km s^{-1} across 0.36 arcsec (274 pc). Assuming Keplerian motion, the enclosed dynamical mass is about 2.3 x 10^9 sin^{-2}i M{_\odot}, comparable to the enclosed dynamical mass estimated from CO observations.Comment: 26 pages total, 6 figures. ApJ accepted. To appear in the April 1, 2003 issue of ApJ. For a version with better images, see http://www.aoc.nrao.edu/~emomjian/IRAS.p

Decarbonising South Africa’s paratransit with hydrogen : a simulated case study

Papers presented virtually at the 41st International Southern African Transport Conference on 10-13 July 2023.As fuel prices climb and the global automotive sector migrates to more sustainable vehicle technologies, the future of South Africa’s minibus taxis is in flux. The authors’ previous research has found that battery electric technology struggles to meet all the mobility requirements of minibus taxis. They investigate the technical feasibility of powering taxis with hydrogen fuel cells instead. The following results are projected using a custom-built simulator, and tracking data of taxis based in Stellenbosch, South Africa. Each taxi requires around 12 kg of hydrogen gas per day to travel an average distance of 360 km. 465 kWh of electricity, or 860 m2 of solar panels, would electrolyse the required green hydrogen. An economic analysis was conducted on the capital and operational expenses of a system of ten hydrogen taxis and an electrolysis plant. Such a pilot project requires a minimum investment of € 3.8 million (R 75 million), for a 20 year period. Although such a small scale roll-out is technically feasible and would meet taxis’ performance requirements, the investment cost is too high, making it financially unfeasible. They conclude that a large scale solution would need to be investigated to improve financial feasibility; however, South Africa’s limited electrical generation capacity poses a threat to its technical feasibility. The simulator is uploaded at: https://gitlab.com/eputs/ev-fleet-sim-fcv-model

Majorana Neutrinos and Gravitational Oscillation

We analyze the possibility of encountering resonant transitions of high energy Majorana neutrinos produced in Active Galactic Nuclei (AGN). We consider gravitational, electromagnetic and matter effects and show that the latter are ignorable. Resonant oscillations due to the gravitational interactions are shown to occur at energies in the PeV range for magnetic moments in the $10^{-17} \mu_B$ range. Coherent precession will dominate for larger magnetic moments. The alllowed regions for gravitational resonant transitions are obtained.Comment: 11 pages, 8 figures, Latex; requires revtex and epsf.tex submitted to Physical Review