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Aim: A better understanding of health literacy (HL) within a local context is needed before developing and implementing interventions in Hong Kong. The current study aimed to explore factors associated with HL and functional HL and the underlying mechanism of functional HL. Subject and methods: The study recruited students from grades 4–6 in 18 Hong Kong primary schools. Self-administrated questionnaires with 49 items were given to children to assess their HL and 20 factors of interest (e.g., screen time, healthy behaviours). Data were analysed using logistic regression, with the levels of HL and functional HL as outcomes. Mediation analysis was used to assess whether the associations between factors of interest and functional HL were mediated by HL. Results: A sample of 405 students were included (mean age = 10.0 years, 54.6% female). The majority of students (n= 304, 75.1%) had low family socio-economic status. Higher HL levels were significantly associated with children’s higher self-rated health levels (good: OR = 2.23; very good: OR = 4.09), more health information sources (OR = 1.10), more healthy behaviours (hand washing: OR = 1.83; dental cleaning: OR = 1.76), better efficacy (OR = 4.45) and motivation (OR = 2.61), and less screen time on TV (school days: OR = 0.60; holidays: OR = 0.47). Children’s higher functional HL levels were significantly associated with regular breakfast eating (OR = 2.08), fewer health information sources (OR = 0.94), poorer personal hygiene (OR = 0.57), insufficient physical activity (OR = 0.66), and less screen time on games (OR = 0.52) and social media (school days: OR = 0.30; holidays: OR = 0.42). HL partially explained functional HL’s positive associations with hand hygiene (indirect effect = 0.078, SE = 0.033) and the number of health information sources (indirect effect = 0.011, SE = 0.004). Conclusion: The current study identified potential intervention targets for HL and functional HL. For greater intervention benefits, intervention should focus on specific targets that have direct effects on the functional HL outcome rather than factors mediated by HL. Continuing research with longitudinal data is needed to draw causal findings.

Many organizations are turning to employee creativity as a source of competitive advantage. Creativity fuels innovation, which allows organizations to create new products or services or improve existing ones. Many [...]

People with substance use disorder have a high risk of SARS-CoV-2 infection and subsequent poor outcomes. Few studies have evaluated COVID-19 vaccine effectiveness among people with substance use disorder. We aimed to estimate the vaccine effectiveness of BNT162b2 (Fosun-BioNTech) and CoronaVac (Sinovac) against SARS-CoV-2 omicron (B.1.1.529) infection and related hospital admission in this population.

The particulate methane monooxygenase (pMMO) is a copper monooxygenase that converts methane into methanol in methanotrophic bacteria. As this enzyme converts methane into methanol efficiently and selectively under ambient conditions, it has become the paradigm for understanding the design of nature to facilitate this process so that we could develop a biomimetic catalyst to accomplish this difficult C1 chemistry in the laboratory. With the advent of the recent 2.5 Å cryo‐electron microscopy structure of the pMMO from Methylococcus capsulatus(Bath), it is now evident that the catalytic site of hydroxylation in pMMO is a CuICuICuItricopper cluster (CuI: copper ions) sequestered within the transmembrane domain of this protein complex. With three reducing equivalents embodied in this structural motif, the tricopper cluster can react with O2to irreversibly cleave the OO bond to harness the highly reactive oxene for rapid and direct insertion into the CH bonds of methane. Here, we review the structural, biochemical, and biophysical studies over the past three decades that have culminated in this important advance in the chemistry of methane oxidation. Progress toward understanding biological methane oxidation in the particulate methane monooxygenase (pMMO) from Methylococcus capsulatus(Bath) is reviewed. A consistent picture of the pMMO has been developed based on various structural, spectroscopic, and biochemical studies over the past 30 years, including the recent 2.5 Å cryo‐electron microscopy structure that revealed the essential copper cofactors constituting the catalytic machinery of the enzyme.

Litigation in Mississippi required the Department of Corrections to ameliorate substandard conditions at the supermaximum Unit 32 of Mississippi State Penitentiary at Parchman, remove prisoners with serious mental illness from administrative segregation and provide them with adequate treatment, and reexamine the entire classification system. Pursuant to two federal consent decrees, the Department of Corrections greatly reduced the population in administrative segregation and established a step-down mental health treatment unit for the prisoners excluded from administrative segregation. This article describes and discusses not only the process of enacting the changes but also the outcomes, including the large reductions in rates of misconduct, violence, and use of force. Keywords: supermaximum security; administrative segregation; classification; use of force; mental health step-down unit

Background and objective: Assuming the hypothesis that the general practitioner (GP) can and should be a key player in making end-of-life decisions for hospitalised patients, perceptions of GPs' role assigned to them by hospital doctors in making withdrawal decisions for such patients were surveyed. Design: Questionnaire survey. Setting: Urban (districts located near Paris) and rural (southern France) areas. Participants: GPs. Results: The response rate was 32.2% (161/500), and it was observed that 70.8% of respondents believed that their participation in withdrawal decisions for their hospitalised patients was essential, whereas 42.1% believed that the hospital doctors were sufficiently skilled to make withdrawal decisions without input from the GPs. Most respondents were found to believe that they had the necessary skills (91.9%) and enough time (87.6%) to participate in withdrawal decisions. The last case of treatment withdrawal in hospital for one of their patients was described by 40% (65/161) of respondents, of whom only 40.0% (26/65) believed that they had participated actively in the decision process. The major factors in the multivariate analysis were the GP's strong belief that his or her participation was essential (p=0.01), information on admission of the patient given to the GP by the hospital department (p = 0.007), rural practice (p = 0.03), visit to the patient dying in hospital (p = 0.02) and a request by the family to be kept informed about the patient (p = 0.003). Conclusion: Strong interest was evinced among GPs regarding end-of-life issues, as well as considerable experience of patients dying at home. As GPs are more closely corrected to patients' families, they may be a good choice for third-party intervention in making end-of-life decisions for hospitalised patients.

Leigh syndrome is a subacute necrotising encephalomyopathy frequently ascribed to mitochondrial respiratory chain deficiency. This condition is genetically heterogeneous, as mutations in both mitochondrial (mt) and nuclear genes have been [...]

This article develops a psychometrically reliable and valid measurement instrument of community assessment and support for the development of an ecotourism project. Based on an application of this instrument, recommendations are made regarding the type and importance of activities and promotions needed to sustain an ecotourism project from the perceptions of the local residents who are willing to pay a fee to attend associated events and activities. Specifically, ecotourism sustainability is more likely to occur when (1) the community is actively involved in the design and development of an ecotourism project and consequently becomes more environmentally conscious, (2) the community leaders develop and support programs for families and children to learn more about environmental conservation and preservation, and (3) community tourism decision makers recognize the importance of promoting and publicizing the potential economic benefits as a result of a community's ecotourism development.

The promotion of, and implementation strategy for, evidence-based medicine in Australia is discussed.

The WHO Comprehensive Mental Health Action Plan 2013–2030 encourages routine collection and reporting of a set of essential mental health indicators, including the availability of psychotropic medicines. The global monitoring of country-level psychotropic medicine consumption trends can provide information on the extent of the availability of psychotropic medicines. The primary objective of this study was to investigate global trends in psychotropic medicines consumption from 2008 to 2019 across 65 countries and regions according to country income level and geographical region.

This study tests uses and gratifications theory with 1209 college students. The results find that students' media use and surveillance needs increase with year in college. Consistent with uses and gratifications theory, demographic differences and the gratifications sought drive news media use. More precisely, increasing surveillance needs results in increased use of all news media, while entertainment needs result in television news and CNN viewing. Only print media and CNN use, however, are related to current events knowledge.

Abstract This study analyzed expenditure data collected from winter visitors to determine their economic impact on the Lower Rio Grande Valley of South Texas. Winter visitor expenditures were estimated to [...]

Three compositions of lithium copper phosphates: Li2CuPO4, Li2Cu5(PO4)4, and Li2CuP2O7have been studied as potential high-voltage cathode materials for Li-ion batteries, following computational predictions of high operating voltages. An assisted-microwave preparation of Li2CuPO4, which is otherwise difficult to prepare in nearly pure form, has been developed. The electrochemical performance of all three compounds has been investigated. The cyclability of these materials is found to be poor due to structural changes, irreversible reduction to metallic copper at potentials as high as 2.5 V, and the possibility of dissolution into the electrolyte. Some general understanding in regard to the use of Cu compounds in redox electrodes is presented.

Adenylylsulfate reductase (adenosine 5′-phosphosulfate reductase, APS reductase or APSR, E.C.1.8.99.2) catalyzes the conversion of APS to sulfite in dissimilatory sulfate reduction. APSR was isolated and purified directly from massive anaerobically grown Desulfovibrio gigas, a strict anaerobe, for structure and function investigation. Oligomerization of APSR to form dimers–α2β2, tetramers–α4β4, hexamers–α6β6, and larger oligomers was observed during purification of the protein. Dynamic light scattering and ultracentrifugation revealed that the addition of adenosine monophosphate (AMP) or adenosine 5′-phosphosulfate (APS) disrupts the oligomerization, indicating that AMP or APS binding to the APSR dissociates the inactive hexamers into functional dimers. Treatment of APSR with β-mercaptoethanol decreased the enzyme size from a hexamer to a dimer, probably by disrupting the disulfide Cys156Cys162 toward the C-terminus of the β-subunit. Alignment of the APSR sequences from D. gigasand A. fulgidusrevealed the largest differences in this region of the β-subunit, with the D. gigasAPSR containing 16 additional amino acids with the Cys156Cys162 disulfide. Studies in a pH gradient showed that the diameter of the APSR decreased progressively with acidic pH. To crystallize the APSR for structure determination, we optimized conditions to generate a homogeneous and stable form of APSR by combining dynamic light scattering, ultracentrifugation, and electron paramagnetic resonance methods to analyze the various oligomeric states of the enzyme in varied environments.

A Li-rich polyanionic compound based on V3+with a previously unknown structure, Li5VF4(SO4)2, has been developed as a high-voltage cathode material for Li-ion batteries. The solvothermal preparation of this material, crystal structure solution, and initial electrochemical characterization are presented. An analysis based on density functional theory electronic structure calculations suggests that a high voltage close to 5 V is required to extract two Li ions and to reach the oxidation state of V5+. However, the use of conventional carbonate-based electrolytes, which exhibit increasing degradation above a potential of 4.3 V, does not permit the full capacity of this compound to be achieved at this time.

Research looking into the management of blood transfusion services in hospitals, in New South Wales, Australia, found 83% of the hospitals did not have a blood transfusion committee. Some 144 hospitals took part in the study.

PNb9O25, a Wadsley–Roth compound whose structure is obtained by appropriate crystallographic shear of the ReO3structure, is a high-power electrode material that can reach 85% of the equilibrium capacity in 30 min and 67% in 6 min. Here we show that multielectron redox, as observed through X-ray absorption spectroscopy and X-ray photoelectron spectroscopy, and an insulator-to-metal transition upon lithium insertion, as suggested by a number of complementary techniques, contribute to the impressive performance. Chemically tuning the tetrahedral site between phosphorus and vanadium leads to significant changes in the electrochemistry and kinetics of lithium insertion in the structure, pointing to larger implications for the use of crystallographic shear phases as fast-charging electrode materials.

AbstractObjective:To describe the infection control preparedness measures undertaken for coronavirus disease (COVID-19) due to SARS-CoV-2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong.Methods:A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed.Results:From day 1 to day 42, 42 of 1,275 patients (3.3%) fulfilling active (n = 29) and enhanced laboratory surveillance (n = 13) were confirmed to have the SARS-CoV-2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7%, day 22 to day 32) to 27 of 29 confirmed cases (93.1%, day 33 to day 42; P< .001). Among them, 28 patients (66.6%) came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7%) had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS-CoV-2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 × 106copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 × 106copies/mL (saliva), respectively. SARS-CoV-2 was identified in 1 of 13 environmental samples (7.7%) but not in 8 air samples collected at a distance of 10 cm from the patient’s chin with or without wearing a surgical mask.Conclusion:Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS-CoV-2.

AimsHelminth infections are becoming uncommon in high-income countries and laboratory staff may lose expertise in their morphological identification, especially in histological sections where speciation of helminths is challenging. Commercially available molecular diagnostic panels for faecal specimens only offer tests for protozoa but not helminths. We aim to improve the identification accuracy of helminths using a multiplex PCR assay.MethodsWe designed three pairs of PCR primers and probes targeting multicopy genes for a multiplex single-tube real-time PCR assay which covers 16 trematode (28S rRNA gene), 24 cestode (cox1gene) and 33 nematode (cox1gene) species. Helminths (n=27) from faecal samples (n=10), fresh parasites (n=11), formalin-fixed specimens (n=4), cerebrospinal fluid (n=1) and bile (n=1) were examined morphologically and tested by PCR. Fifty stool samples negative for parasites by microscopy were also tested.ResultsThe PCR assay correctly identified the genera of all tested helminths. Agarose gel electrophoresis and sequencing of the purified PCR amplicons confirmed that the PCR products were of correct sizes with 100% correlation with the respective species. Sequencing of the cox1gene failed to identify Capillariaspp. in one sample owing to the lack of corresponding sequences in GenBank. PCR and sequencing of the nematode 18S rRNA gene using consensus primers showed 100% homology with Capillariaspp. sequence. No positive PCR products were found in the negative stool samples.ConclusionsThe highly specific test correctly identified all helminths in our cohort. It is a useful adjunct to helminth identification in difficult situations such as histological sections.

Is relief available for the symptoms that are brought on by post-polio syndrome? Can the 120,000 to 240,000 post-polio syndrome (PPS) persons be free from the pain, weakness, fatigue and […]

OBJECTIVEMultidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.METHODSFrom July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus(MRSA), carbapenem-resistant Acinetobacter species(CRA), and extended-spectrum β-lactamse (ESBL)–producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.RESULTSThe overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).CONCLUSIONSThe direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.Infect Control Hosp Epidemiol2018;39:571–577

AimsGranulomatous mastitis due to Corynebacterium kroppenstedtiiis an increasingly recognised cause of an indolent and distressing mastitis in non-lactating females. This slow-growing lipophilic organism is not reliably isolated using routine culture methods. A novel selective culture medium (CKSM) is designed to optimise the isolation of this organism from clinical specimens.MethodsCKSM contains 10% galactose and Tween 80 (10%) to enhance the growth of C. kroppenstedtii, fosfomycin (100 µg/mL) to suppress the other bacteria, and differentiate C. kroppenstedtiifrom non-kroppenstedtiilipophilic corynebacteria by esculin hydrolysis. The medium was evaluated for its ability to support the growth of C. kroppenstedtii, selection and differentiation of C. kroppenstedtiifrom other bacteria in non-sterile clinical specimens.ResultsC. kroppenstedtiigrew as 1–2 mm colonies with black halo on CKSM within 72 hours of incubation, compared with barely visible pinpoint colonies on routine blood agars. During the four-month period of evaluation with 8896 respiratory specimens, 103 breast specimens, 1903 female genital tract specimens, 617 newborn surface swabs and 10 011 miscellaneous specimens, 186 C. kroppenstedtiiwere isolated, including 127 (1.4%) respiratory and 59 (0.5%) miscellaneous specimens, 184 of them were found only on CKSM. Besides the three (2.9%) positive breast specimens, 27 (1.4%) high vaginal and endocervical swabs, and 11 (1.8%) surface swabs of newborns were positive for C. kroppenstedtii.ConclusionsCKSM is a useful addition to routine agar media for the isolation of C. kroppenstedtii,and will be helpful for studying the epidemiology and transmission of this unusual Corynebacteriumcausing granulomatous mastitis.

Le nombre de consultations aux urgences augmente d'année en année, y compris aux urgences pédiatriques. Les enfants et adultes qui y ont recours pour des pathologies non-urgentes sont une des illustrations du mésusage des urgences qui risque de surcharger les services. Afin d'aider à la mise en place de politiques publiques adaptées, l'objectif de cette étude était de déterminer s'il existe une association entre le niveau de précarité et le recours aux urgences pédiatriques pour des consultations non-urgentes.

Augmented Reality (AR) has emerged as a rapidly developing technology, capable of a wide scope of applications across a variety of domains. AR technologies allow for a virtual experience to be overlaid on top of a physical environment, creating a hybrid experience in which virtual objects become a part of the user’s perceptual and physical environment. Rapid progression of the AR field requires that effective and validated methods of design evaluation be developed. Failure to consider the usability of AR applications during the design process will result in an increase in user errors and accidents, limiting user trust of the technology and undermining user perceptions of the technology, for both AR and Virtual Reality (VR) technologies (Nordrum, 2016). Through a robust and iterative process, a set of Design Heuristics for AR were developed for multidimensional augmented environments with the aim of advancing AR design methods for human factors, ergonomics, and user experience practitioners within the expanding AR community.

Radiotherapy of nasopharyngeal carcinoma patients with parapharyngeal space (PPS) involvement may deliver high dose to the parotid gland. This study evaluated parotid gland changes during and up to 3 months after radiotherapy. Kilovoltage computed tomography (CT) scans of head and neck region of 39 nasopharyngeal carcinoma patients with PPSinvolvement were performed at pre-radiotherapy, 10th, 20th and 30th fractions and 3 months after treatment. The parotid glands were contoured in pre-radiotherapy planning CTscan and in subsequent scans. Dice similarity coefficient (DSC), percentage volume change and centroid movement between the planning CTand the subsequent CTs were obtained from the contouring software. In addition, the distance between medial and lateral borders of parotid glands from the mid-line at various time intervals were also measured. The ipsilateral parotid gland received a mean dose of about 5 Gy higher than the contralateral side. The mean DSCand parotid volume decreased by more than 30% at 20th fraction and reached the minimum at 30th fraction. Partial recovery was observed at 3 months after treatment. The centroid displacement followed a similar pattern, which moved medially and superiorly by an average of 0.30 cm and 0.18 cm, respectively, at 30th fraction. The changes in ipsilateral gland were slightly greater than the contralateral side. Substantial volume change and medial movement of parotid gland were observed with slightly greater magnitude in the ipsilateral side. Adaptive radiotherapy was suggested at around 15th to 20th fraction so as to optimise the original dose distribution of the plan. This study evaluated the parotid gland changes during and after radiotherapy in nasopharyngeal carcinoma patients. The results showed that there was significant volume change and medical movement of the gland. Partial recovery was seen at 3 months after treatment.

ABSTRACTHaemophilus influenzaeis associated with severe invasive disease, while Haemophilus haemolyticusis considered part of the commensal flora in the human respiratory tract. Although the addition of a custom mass spectrum library into the matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) system could improve identification of these two species, the establishment of such a custom database is technically complicated and requires a large amount of resources, which most clinical laboratories cannot afford. In this study, we developed a mass spectrum analysis model with 7 mass peak biomarkers for the identification of H. influenzaeand H. haemolyticususing the ClinProTools software. We evaluated the diagnostic performance of this model using 408 H. influenzaeand H. haemolyticusisolates from clinical respiratory specimens from 363 hospitalized patients and compared the identification results with those obtained with the Bruker IVD MALDI Biotyper. The IVD MALDI Biotyper identified only 86.9% of H. influenzae(311/358) and 98.0% of H. haemolyticus(49/50) clinical isolates to the species level. In comparison, the ClinProTools mass spectrum model could identify 100% of H. influenzae(358/358) and H. haemolyticus(50/50) clinical strains to the species level and significantly improved the species identification rate (McNemar's test, P< 0.0001). In conclusion, the use of ClinProTools demonstrated an alternative way for users lacking special expertise in mass spectrometry to handle closely related bacterial species when the proprietary spectrum library failed. This approach should be useful for the differentiation of other closely related bacterial species.

Nonselective fishing gears extract a great many small marine species, with limited documentation or assessment of their impacts. Among those species, seahorses (genus Hippocampus) are unusual because this genus has been the focus of scientific surveys and international trade regulation. Our review of published and unpublished data sources analyzed data on seahorse bycatch for five gear-type categories and 22 countries. The median catch per unit effort of seahorse bycatch across all five gear types was 0.96 seahorses per vessel−1day−1. Nonetheless, fleet sizes were so large that annual catches were estimated at approximately 37 million seahorses across our sampled countries. Fisher interviews suggested that seahorse catches were declining (although information on changes in effort over time were not available). Furthermore, international export data did not capture the magnitude of seahorses in bycatch. Our work emphasizes the importance of evaluating bycatch, even for taxa where reported daily catch rates are low.

Synthetic analogs based on the DNA bis-intercalating natural product peptides sandramycin and quinaldopeptin were investigated as antibody drug conjugate (ADC) payloads. Synthesis, biophysical characterization, and in vitropotency of 34 new analogs are described. Conjugation of an initial drug-linker derived from a novel bis-intercalating peptide produced an ADC that was hydrophobic and prone to aggregation. Two strategies were employed to improve ADC physiochemical properties: addition of a solubilizing group in the linker and the use of an enzymatically cleavable hydrophilic mask on the payload itself. All ADCs showed potent in vitrocytotoxicity in high antigen expressing cells; however, masked ADCs were less potent than payload matched unmasked ADCs in lower antigen expressing cell lines. Two pilot in vivostudies were conducted using stochastically conjugated DAR4 anti-FRα ADCs, which showed toxicity even at low doses, and site-specific conjugated (THIOMAB) DAR2 anti-cMet ADCs that were well tolerated and highly efficacious.

As Li-ion batteries are more widely adopted, it becomes important to identify new battery electrode materials made from a greater diversity of elements while improving stability, extracted power, and the ability to charge and discharge rapidly. Early transition metals, such as Nb and Mo, are relatively earth-abundant elements, with oxides that are candidates for next-generation anode materials. However, Mo oxides are limited as battery electrodes due to their intermediate redox voltages. Lowering this voltage could open the door for high-performance Mo-based oxide anodes. Oxidation of the voltage can be employed by adding redox-inactive cations of electropositive elements. This strategy is named the induction effect and has been proposed as a design principle to increase cathode voltages. However, its use on the anode side appears less common. Here, we compare the ionization energy, electrochemistry, and Li diffusivity of the compound Li2Mo4O13with MoO3, which both start out as Mo6+compounds before lithiation. The ionization energy values extracted from ultraviolet photoemission spectroscopy support the hypothesis that the alkali metal cation pushes up the valence band. Electrochemical studies in half-cells against Li/Li+indicate that Li2Mo4O13can reversibly take up two additional Li ions in the unit cell. Moreover, the addition of Li to the molybdenum oxide structure lowers the voltage by 300 mV for the Mo6+/5+couple compared to the same redox couple in MoO3and retains high Li+diffusivity. This work, in conjunction with experimental redox voltages extracted from prior literature on Ti4+/3+and Nb5+/4+redox couples, demonstrates the utility of using inductive effects to tailor the operating voltage of candidate anode materials.

Ocular Mucous Membrane Pemphigoid (OcMMP) is an orphan disease characterized by chronic autoimmune-driven conjunctival inflammation leading to progressive scarring, debilitating symptoms, and blinding sequelae. This feasibility study aims to demonstrate conjunctival genetic transcriptomic analyses as a putative tool for interrogation of pathogenic signaling pathways in OcMMP.

OBJECTIVETo study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).METHODSWe analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.RESULTSOf 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).CONCLUSIONSConcomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.Infect Control Hosp Epidemiol2016;1418–1425

Operator trust in autonomous capability is a critical factor affecting the success of fielded unmanned systems. However, current means of identifying trusted system behavior do not sufficiently inform guidelines for designing an engineering solution. We present a novel Trust Assessment Framework for providing actionable and formative feedback for building an unmanned system that promotes operators’ initial adoption of and reliance on its autonomous capabilities. Based on a review of the unmanned systems literature and a series of inquiries focusing on operators of unmanned aerial vehicles, we have identified a set of Heuristics for Trusted Autonomy and behaviorally anchored Trust Assessment Scales that enable quantitative feedback for each heuristic category. The Heuristics and Scales were incorporated into a Trust Assessment Process consisting of a Heuristic Evaluation and subsequent scoring. This trust assessment methodology can be applied directly to assessing autonomous aerial systems. Extensions to other platforms and domains are being investigated.

Carbapenem-resistant Acinetobacter baumannii(CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization.Infect Control Hosp Epidemiol2016;37:983–986

ABSTRACTA broad range of viral and bacterial pathogens can cause acute respiratory tract infection. For rapid detection of a broad respiratory pathogen spectrum, multiplex real-time PCR is ideal. This study evaluated the performance of the new Luminex NxTAG Respiratory Pathogen Panel (NxTAG-RPP) in comparison with the BioFire FilmArray Respiratory Panel (FA-RP) or singleplex real-time PCR as reference. A total of 284 clinical respiratory specimens and 3 influenza A/H7N9 viral culture samples were tested. All clinical specimens were processed and analyzed in parallel using NxTAG-RPP and the reference standard method. The H7N9 viral culture samples were tested using NxTAG-RPP only. Overall, the NxTAG-RPP demonstrated =93% sensitivity and specificity for all respiratory targets except human coronavirus OC43 (HCoV-OC43) and HCoV-HKU1. The H7N9 virus was detected by the influenza A virus matrix gene target, while other influenza A virus subtyping gene targets in the panel remained negative. Complete concordance between NxTAG-RPP and FA-RP was observed in 98.8% (318/322) of positive results (kappa = 0.92). Substantial agreement was found for most respiratory targets, but significant differences were observed in human metapneumovirus (P= 0.001) and parainfluenza virus type 3 (P= 0.031). NxTAG-RPP has a higher sample throughput than FA-RP (96 samples versus 1 sample per run) while the turnaround times for NxTAG-RPP and FA-RP were 5 h (up to 96 samples) and 1 h (for one sample), respectively. Overall, NxTAG-RPP demonstrated good diagnostic performance for most respiratory pathogens. The high sample throughput with reasonable turnaround time of this new assay makes it a suitable multiplex platform for routine screening of respiratory specimens in hospital-based laboratories.

ABSTRACTInhibition of ABC transporters is a common mechanism underlying drug-drug interactions (DDIs). We determined the inhibitory potential of antifungal drugs currently used for invasive fungal infections on ABC transporters P-glycoprotein (P-gp), MRP1 to MRP5, BCRP, and BSEP in vitro. Membrane vesicles isolated from transporter-overexpressing HEK 293 cells were used to investigate the inhibitory potential of antifungal drugs (250 μM) on transport of model substrates. Concentration-inhibition curves were determined if transport inhibition was >60%. Fifty percent inhibitory concentrations (IC50s) for P-gp and BCRP were both 2 μM for itraconazole, 5 and 12 μM for hydroxyitraconazole, 3 and 6 μM for posaconazole, and 3 and 11 μM for isavuconazole, respectively. BSEP was strongly inhibited by itraconazole and hydroxyitraconazole (3 and 17 μM, respectively). Fluconazole and voriconazole did not inhibit any transport for >60%. Micafungin uniquely inhibited all transporters, with strong inhibition of MRP4 (4 μM). Anidulafungin and caspofungin showed strong inhibition of BCRP (7 and 6 μM, respectively). Amphotericin B only weakly inhibited BCRP-mediated transport (127 μM). Despite their wide range of DDIs, azole antifungals exhibit selective inhibition on efflux transporters. Although echinocandins display low potential for clinically relevant DDIs, they demonstrate potent in vitroinhibitory activity. This suggests that inhibition of ABC transporters plays a crucial role in the inexplicable (non-cytochrome P450-mediated) DDIs with antifungal drugs.

The IceCube experiment has recently released 3 years of data of the first ever detected high-energy (≳30TeV) neutrinos, which are consistent with an extraterrestrial origin. In this talk, we compute the compatibility of the observed track-to-shower ratio with possible combinations of neutrino flavors with relative proportion (αe:αμ:ατ)⊕. Although this observation is naively favored for the canonical (1 : 1 : 1)⊕at Earth, once we consider the IceCube expectations for the atmospheric muon and neutrino backgrounds, this flavor combination presents some tension with data. We find that, for an astrophysical neutrino Eν−2energy spectrum, (1 : 1 : 1)⊕at Earth is currently disfavored at 92% C.L. We discuss the trend of this result by comparing the results with the 2-year and 3-year data. We obtain the best-fit for (1 : 0 : 0)⊕at Earth, which cannot be achieved from any flavor ratio at sources with averaged oscillations during propagation. Although it is not statistically significant at present, if confirmed, this result would suggest either a misunderstanding of the expected background events, or a misidentification of tracks as showers, or even more compellingly, some exotic physics which deviates from the standard scenario.

The article presents the January 1, 2016 issue of the Metropolitan Museum of Art Bulletin on topics including works of cabinetmaker George A. Schastey, exhibition of artistic furniture, and art patronage.

X-linked intellectual disability (XLID) is a clinically and genetically heterogeneous disorder. During the past two decades in excess of 100 X-chromosome ID genes have been identified. Yet, a large number of families mapping to the X-chromosome remained unresolved suggesting that more XLID genes or loci are yet to be identified. Here, we have investigated 405 unresolved families with XLID. We employed massively parallel sequencing of all X-chromosome exons in the index males. The majority of these males were previously tested negative for copy number variations and for mutations in a subset of known XLID genes by Sanger sequencing. In total, 745 X-chromosomal genes were screened. After stringent filtering, a total of 1297 non-recurrent exonic variants remained for prioritization. Co-segregation analysis of potential clinically relevant changes revealed that 80 families (20%) carried pathogenic variants in established XLID genes. In 19 families, we detected likely causative protein truncating and missense variants in 7 novel and validated XLID genes (CLCN4, CNKSR2, FRMPD4, KLHL15, LAS1L, RLIM and USP27X) and potentially deleterious variants in 2 novel candidate XLID genes (CDK16 and TAF1). We show that the CLCN4 and CNKSR2 variants impair protein functions as indicated by electrophysiological studies and altered differentiation of cultured primary neurons from Clcn4−/−mice or after mRNA knock-down. The newly identified and candidate XLID proteins belong to pathways and networks with established roles in cognitive function and intellectual disability in particular. We suggest that systematic sequencing of all X-chromosomal genes in a cohort of patients with genetic evidence for X-chromosome locus involvement may resolve up to 58% of Fragile X-negative cases.

The article explains the findings that creative people are more likely to be dishonest and describes the relationship between creativity and unethical behavior.

ABSTRACTMacrolide-resistant Mycoplasma pneumoniae(MRMP) is rapidly emerging in Asia, but information on the temporal relationship between the increase in macrolide resistance and changes in strain types is scarce. Between 2011 and 2014, M. pneumoniaeinfection was diagnosed by PCR as part of routine care in a health care region in Hong Kong. Testing was initiated by clinicians, mainly in patients with suspected M. pneumoniaepneumonia. Specimens positive for M. pneumoniaewere retrospectively investigated by macrolide resistance genotyping and a four-locus (Mpn13 to -16) multilocus variable-number tandem-repeat analysis (MLVA) scheme. The overall percentage of M. pneumoniae-positive specimens was 17.9%, with annual rates ranging from 9.8% to 27.2%. The prevalence of MRMP had rapidly increased from 13.6% in 2011 to 30.7% in 2012, 36.6% in 2013, and 47.1% in 2014 (P= 0.038). Two major MLVA types, 4-5-7-2 and 3-5-6-2, accounted for 75% to 85% of the infections each year. MLVA types 4-5-7-2 and 3-5-6-2 predominated among macrolide-resistant and macrolide-sensitive groups, respectively. The increase in MRMP was mainly caused by increasing macrolide resistance in the prevalent MLVA type 4-5-7-2, changing from 25.0% in 2011 to 59.1% in 2012, to 89.7% in 2013, and to 100% in 2014 (P< 0.001). In conclusion, increasing MRMP in Hong Kong was linked to a single MLVA type, which was both prevalent and increasingly resistant to macrolides.