Diagnosis and Antiviral Intervention Strategies for Mitigating an Influenza Epidemic

BACKGROUND: Many countries have amassed antiviral stockpiles for pandemic preparedness. Despite extensive trial data and modelling studies, it remains unclear how to make optimal use of antiviral stockpiles within the constraints of healthcare infrastructure. Modelling studies informed recommendations for liberal antiviral distribution in the pandemic phase, primarily to prevent infection, but failed to account for logistical constraints clearly evident during the 2009 H1N1 outbreaks. Here we identify optimal delivery strategies for antiviral interventions accounting for logistical constraints, and so determine how to improve a strategy's impact. METHODS AND FINDINGS: We extend an existing SEIR model to incorporate finite diagnostic and antiviral distribution capacities. We evaluate the impact of using different diagnostic strategies to decide to whom antivirals are delivered. We then determine what additional capacity is required to achieve optimal impact. We identify the importance of sensitive and specific case ascertainment in the early phase of a pandemic response, when the proportion of false-positive presentations may be high. Once a substantial percentage of ILI presentations are caused by the pandemic strain, identification of cases for treatment on syndromic grounds alone results in a greater potential impact than a laboratory-dependent strategy. Our findings reinforce the need for a decentralised system capable of providing timely prophylaxis. CONCLUSIONS: We address specific real-world issues that must be considered in order to improve pandemic preparedness policy in a practical and methodologically sound way. Provision of antivirals on the scale proposed for an effective response is infeasible using traditional public health outbreak management and contact tracing approaches. The results indicate to change the transmission dynamics of an influenza epidemic with an antiviral intervention, a decentralised system is required for contact identification and prophylaxis delivery, utilising a range of existing services and infrastructure in a "whole of society" response

A multi-method assessment of 3D printed micromorphological osteological features

The evaluation of 3D printed osteological materials has highlighted the difficulties associated with accurately representing fine surface details on printed bones. Moreover, there is an increasing need for reconstructions to be demonstrably accurate and reliable for use in the criminal justice system. The aim of this study was to assess the surface quality of 3D prints (n = 9) that presented with micromorphological alterations from trauma, taphonomy and pathology processes. The archaeological bones were imaged using micro-CT scanning and 3D printed with selective laser sintering (SLS) printing. A multi-method experimental approach subsequently identified: (1) the 3D printed bones to be metrically accurate to within 1.0 mm; (2) good representation of micromorphological surface features overall, albeit with some loss of intricate details, depths, and fine textures that can be important for visual processing; (3) five of the nine 3D printed bones were quantitatively scored as accurate using the visual comparison method; and, (4) low mesh comparison distances (± 0.2 mm) between the original models and the digitised 3D print models. The findings offer empirical data that can be used to underpin 3D printed reconstructions of exhibits for use in courts of law. In addition, an adaptable pathway was presented that can be used to assess 3D print accuracy in future reconstructions

Hybrid energy and angle dispersive X-ray diffraction computed tomography

Pixelated energy resolving detectors enable acquisition of X-ray diffraction (XRD) signals using a hybrid energy- and angle- dispersive technique, potentially paving the way for the development of novel benchtop XRD imaging or computed tomography (XRDCT) systems, utilising readily available polychromatic X-ray sources. In this work, a commercially available pixelated cadmium telluride (CdTe) detector, HEXITEC (High Energy X-ray Imaging Technology), was used to demonstrate such an XRDCT system. Specifically, a novel fly-scan technique was developed and compared to the established step-scan technique, reducing the total scan time by 42% while improving the spatial resolution, material contrast and therefore the material classification

A novel technique for identifying the individual regions of the human colon at CT colonography

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Rarefaction effects on Galileo probe aerodynamics

Solutions of aerodynamic characteristics are presented for the Galileo Probe entering Jupiter's hydrogen-helium atmosphere at a nominal relative velocity of 47.4 km/s. Focus is on predicting the aerodynamic drag coefficient during the transitional flow regime using the direct simulation Monte Carlo (DSMC) method. Accuracy of the probe's drag coefficient directly impacts the inferred atmospheric properties that are being extracted from the deceleration measurements made by onboard accelerometers as part of the Atmospheric Structure Experiment. The range of rarefaction considered in the present study extends from the free molecular limit to continuum conditions. Comparisons made with previous calculations and experimental measurements show the present results for drag to merge well with Navier-Stokes and experimental results for the least rarefied conditions considered

First Study of a HEXITEC Detector for Secondary Particle Characterisation during Proton Beam Therapy

Online proton range verification is a rapidly emerging field characterised by its ability to reduce the error margins during proton beam therapy, as it is patient-specific and in vivo. In particular, secondary prompt gamma detection is a promising tool to monitor the dose delivery. The present research evaluates the capability of a HEXITEC detector to identify the prompt gammas produced during proton beam therapy, and assesses its potential for online range verification. To achieve this, the detector is placed at one side of a water phantom, which is irradiated at different proton energies in the University College London Hospital Proton Centre. For further analysis, Monte Carlo simulations are performed using Geant4 and the same geometry as the experiment. The results show that HEXITEC has the potential to be part of a detection system that could identify secondary prompt gammas within the secondary field produced inside the target, allowing for the in-detector discrimination of these particles via cluster size analysis. The comparison between data sets shows that there is a high level of accuracy between the model and the experimental measurements in terms of secondary flux and charge diffusion inside the detector, which poses the model as a fundamental tool for future optimisation studies

Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan.

Background: Few studies have examined the relationship between antenatal depression, anxiety and domestic violence in pregnant women in developing countries, despite the World Health Organization\u27s estimates that depressive disorders will be the second leading cause of the global disease burden by 2020. There is a paucity of research on mood disorders, their predictors and sequelae among pregnant women in Pakistan. Aims: To determine the prevalence of anxiety and depression and evaluate associated factors, including domestic violence, among pregnant women in an urban community in Pakistan. Methods: All pregnant women living in identified areas of Hyderabad, Pakistan were screened by government health workers for an observational study on maternal characteristics and pregnancy outcomes. Of these, 1,368 (76%) of eligible women were administered the validated Aga Khan University Anxiety Depression Scale at 20-26 weeks of gestation. Results: Eighteen per cent of the women were anxious and/or depressed. Psychological distress was associated with husband unemployment (p = 0.032), lower household wealth (p = 0.027), having 10 or more years of formal education ( p = 0.002), a first (p = 0.002) and an unwanted pregnancy ( p \u3c 0.001). The strongest factors associated with depression/anxiety were physical/sexual and verbal abuse, 42% of women who were physically and/or sexually abused and 23% of those with verbal abuse had depression/anxiety compared to 8% of those who were not abused. Conclusions: Anxiety and depression commonly occur during pregnancy in Pakistani women, rates are highest in women experiencing sexual/physical as well as verbal abuse, but they are also increased among women with unemployed spouses and those with lower household wealth. These results suggest that developing a screening and treatment programme for domestic violence and depression/anxiety during pregnancy may improve the mental health status of pregnant Pakistani women