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Background Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes. Methods Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their child's recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms). Results The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission. Conclusions Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.

IL-2 is a critical regulator of immune homeostasis through its impact on both regulatory T (Treg) and effector T cells. However, the precise role of IL-2 in the maintenance and function of Treg cells in the adult peripheral immune system remains unclear. In this study, we report that neutralization of IL-2 in mice abrogated all IL-2R signaling in Treg cells, but was well tolerated and only gradually impacted Treg cell function and immune homeostasis. By contrast, despite substantially reduced IL-2 sensitivity, Treg cells maintained selective IL-2 signaling and prevented immune dysregulation following treatment with the inhibitory anti-CD25 Ab PC61. Reduction of Treg cells with a depleting version of the same CD25 Ab permitted CD8+ effector T cell proliferation before progressing to more widespread immune dysregulation. Thus, despite severely curtailed CD25 expression and function, Treg cells retain selective access to IL-2 that supports their anti-inflammatory functions in vivo. Ab-mediated targeting of CD25 is being actively pursued for treatment of autoimmune disease and prevention of allograft rejection, and our findings help inform therapeutic manipulation and design for optimal patient outcomes.

Background In 2015–2016, Mongolia experienced an unexpected large measles outbreak affecting mostly young children and adults. After two nationwide vaccination campaigns, measles transmission declined. To determine if there were any remaining immunity gaps to measles or rubella in the population, a nationally representative serosurvey for measles and rubella antibodies was conducted after the outbreak was over. Methods A nationwide, cross-sectional, stratified, three-stage cluster serosurvey was conducted in November-December 2016. A priori, four regional strata (Ulaanbaatar, Western, Central, and Gobi-Eastern) and five age strata (6 months-23 months, 2–7 years, 8–17 years, 18–30 years, and 31–35 years) were created. Households were visited, members interviewed, and blood specimens were collected from age-appropriate members. Blood specimens were tested for measles immunoglobulin G (IgG) and rubella IgG (Enzygnost® Anti-measles Virus/IgG and Anti-rubella Virus/IgG, Siemens, Healthcare Diagnostics Products, GmbH Marburg, Germany). Factors associated with seropositivity were evaluated. Results Among 4598 persons aged 6 months to 35 years participating in the serosurvey, 94% were measles IgG positive and 95% were rubella IgG positive. Measles IgG seropositivity was associated with increasing age and higher education. Rubella IgG seropositivity was associated with increasing age, higher education, smaller household size, receipt of MMR in routine immunization, residence outside the Western Region, non-Muslim religious affiliation, and non-Kazakh ethnicity. Muslim Kazakhs living in Western Region had the lowest rubella seroprevalence of all survey participants. Conclusions Nationally, high immunity to both measles and rubella has been achieved among persons 1–35 years of age, which should be sufficient to eliminate both measles and rubella if future birth cohorts have ≥ 95% two dose vaccination coverage. Catch-up vaccination is needed to close immunity gaps found among some subpopulations, particularly Muslim Kazakhs living in Western Region.

The incidence of hospitalized leptospirosis patients was positively associated with increased precipitation in Salvador, Brazil. However, Leptospira infection risk among a cohort of city residents was inversely associated with rainfall. These findings indicate that, although heavy rainfall may increase severe illness, Leptospira exposures can occur year-round.

National Institutes of Health (grant nos. R44 AI072856, U01 AI088752, R01 AI121207, D43 TW00919), the Fogarty International Clinical Research Scholars Program, the Duke Global Health Institute, and the Brazilian National Council for Scienti􀃒c and Technological Development (CNPq). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. M.G.R. and G.S.R. had scholarships from CNPq.

OBJECTIVE: Alterations in brain structure have been implicated in the onset and acute phases of several forms of psychopathology. However, there is a dearth of research investigating brain structure in persons with binge eating, contributing to poor understanding of mechanisms associated with binge eating. METHODS: Adolescent girls and women (aged 14 to 35 years) with binge eating (n = 56) and group age-matched girls and women without binge eating (n = 26) completed structural magnetic resonance imaging (MRI) scans and interview-based and self-report assessments of eating disorder and general psychopathology. MRI data were processed using FreeSurfer. Analysis of covariance tested mean differences in subcortical volume and cortical thickness of a priori selected regions of interest between binge eating and non-binge-eating groups, controlling for age, body mass index, purging frequency, depression, and medication use. Exploratory partial correlations tested associations between brain structure and eating disorder symptoms within participants with binge eating. RESULTS: We did not observe differences in regional subcortical volume and cortical thickness between girls and women with and without binge eating. Within participants with binge eating, severity of attitudinal eating disorder symptoms was inversely associated with caudal middle frontal gyrus, right precentral gyrus, right postcentral gyrus, superior parietal, left inferior parietal thickness, and left accumbens volume; however, these associations would not survive multiple-comparison corrections. DISCUSSION: Correlations between attitudinal eating disorder symptoms and frontoparietal thinning may represent a state marker of binge eating. Future research could investigate whether frontoparietal thinning worsens with illness duration or persists beyond binge eating cessation.

Purpose Bulimia nervosa (BN) is an eating disorder characterized by binge eating, inappropriate compensatory behaviors, and body image concerns in persons at or above a healthy weight. BN is a serious disorder with medical sequelae and marked psychosocial impairment. To reduce and eliminate symptoms of BN, psychological and pharmacologic treatments for BN have been developed. We review the current state-of-the-art treatments for BN. Methods We conducted a narrative review of the BN treatment literature to synthesize the current evidence base, provide recommendations, and propose future directions for BN treatment research. Findings Currently, the first-line, state-of-the-art treatment for adults with BN is cognitive-behavioral therapy (CBT). Interpersonal therapy is a second-line evidence-based treatment for adults with BN, and dialectical behavior therapy and integrative cognitive-affective therapy are also promising. For BN in adolescents, family-based treatment for BN or CBT are evidence-based approaches. Pharmacotherapy is best considered adjunctive to psychotherapy in adults with BN but may be helpful, depending on the type of psychotherapy and whether psychotherapy is ineffective or unavailable. Fluoxetine 60 mg/d is the medication of choice for adults with BN. Little is known with respect to pharmacologic treatment of BN in adolescents, although fluoxetine 60 mg/d holds promise. Implications Despite decades of treatment-development research in BN, there is room for improvement because nearly 60% of those with BN do not achieve remission with specialty treatment and strikingly few randomized controlled trials for BN in adolescents exist. Moreover, the field should address issues related to treatment dissemination, access, and cost.

Familial risk for bipolar disorder (BD) or major depressive disorder (MDD) may lead to differential emotion processing signatures, resulting in unique neural vulnerability.Healthy offspring of a parent with BD (n = 29, "BD-risk") or MDD (n = 44, "MDD-risk") and healthy control youths without any personal or family psychopathology (n = 28, "HC") aged 8 to 17 years (13.64 ± 2.59 years) completed an implicit emotion-perception functional magnetic resonance imaging task. Whole-brain voxelwise and psychophysiological interaction analyses examined neural differences in activation and connectivity during emotion processing. Regression modeling tested for neural associations with behavioral strengths and difficulties and conversion to psychopathology at follow-up (3.71 ± 1.91 years).BD-risk youth showed significantly reduced bilateral putamen activation, and decreased connectivity between the left putamen and the left ventral anterior cingulate cortex (vACC) and the right posterior cingulate cortex (PCC) during positive-valence emotion processing compared to MDD-risk and HC (Z2.3; p .001). Decreased left putamen-right PCC connectivity correlated with subsequent peer problems in BD-risk (β = -2.90; p .05) and MDD-risk (β = -3.64; p .05) groups. Decreased left (β = -0.09; p .05) and right putamen activation (β = -0.07; p = .04) were associated with conversion to a mood or anxiety disorder in BD-risk youths. Decreased left putamen-right PCC connectivity was associated with a higher risk of conversion in BD-risk (HR = 8.28 , p .01) and MDD-risk (HR = 2.31, p = .02) groups.Reduced putamen activation and connectivity during positive emotion processing appear to distinguish BD-risk youths from MDD-risk and HC youths, and may represent a marker of vulnerability.

We demonstrate a silicon-on-insulator micro-ring resonator (MRR) modulator and defect-mediated (DM) detector operating at a wavelength near 2 µm for use in the thulium doped fiber amplifier wavelength band. The MRR modulator was critically coupled with an unbiased notch-depth of 20 dB and Q-factor of 4700. The resonance shift under reverse bias was 23 pm/V with a calculated VπLπ of 2.2 to 2.6 V·cm from -1 to -8 V, respectively. Simulations are in good agreement with the measured data. The experimental modulation bandwidth was 12.5 GHz, limited by the response of the commercial external detector used for this measurement. The DM detector was operated in avalanche mode, had 1.97 µm wavelength responsivities of 0.04 and 0.14 A/W, and had bandwidths greater than 16 and 7.5 GHz at -15 and -30 V biases, respectively. Large-signal measurement demonstrated open eye-diagrams at 5, 10, and 12.5 Gbps for the DM detector and also for an optical link consisting of the modulator and detector integrated on the same silicon chip.

We report on the design, fabrication and characterization of subwavelength grating metamaterial waveguides coated with tellurium oxide. The structures are first fabricated using a standard CMOS compatible process on a silicon-on-insulator platform. Amorphous tellurium oxide top cladding material is then deposited via post-process RF magnetron sputtering. The photonic bandstructure is controlled by adjustment of the device geometry, opening a wide range of operating regimes, including subwavelength propagation, slow light and the photonic bandgap, for various wavelength bands within the 1550 nm telecommunications window. Propagation loss of 1.0 ± 0.1 dB/mm is reported for the tellurium oxide-cladded device, compared to 1.5 ± 0.1 dB/mm propagation loss reported for the silicon dioxide-cladded reference structure. This is the first time that a high-index (n > 2) oxide cladding has been demonstrated for subwavelength grating metamaterial waveguides, thus introducing a new material platform for on-chip integrated optics.

Objective Several studies indicate that eating‐disorder (ED) psychopathology is elevated in athletes compared to non‐athletes. The assessment of excessive exercise among athletes is a challenge because, compared to non‐athletes, athletes are required to train at higher intensities and for longer periods of time. However, individuals participating in competitive sports are still susceptible to unhealthy physical‐activity patterns. Most ED assessments were developed and normed in non‐athlete samples and, therefore, do not capture the nuances of athletes’ training experiences. The purpose of the current study was to develop and validate a clinically useful, self‐report measure of unhealthy training behaviors and beliefs in athletes, the Athletes’ Relationships with Training Scale (ART). Method The initial item pool was administered to N = 267 women collegiate athletes who were participating in an ED prevention program study and N = 65 women athletes who were in ED treatment. Results Factor analyses indicated the ART had a four‐factor structure. Factorial and construct validity of the ART were demonstrated. ART scores significantly predicted health care utilization and differed between athletes with an ED versus athletes without an ED. For athletes in ED treatment, ART scores significantly decreased from treatment admission to discharge. Discussion The ART showed evidence of strong psychometric properties and clinical utility. The ART could be helpful for clinicians and athletic trainers to help gauge whether athletes are engaging in unhealthy training practices that may warrant clinical attention and for tracking clinical outcomes in athletes with EDs who are receiving treatment.

OBJECTIVE Rapid response to treatment, indicated by substantial decreases in eating-disorder (ED) symptoms within the first 4-6 weeks of treatment, is the most reliable predictor of treatment outcomes for EDs. However, there is limited research evaluating short-term longitudinal trajectories of ED symptoms during treatment. Thus, it is difficult to know which aspects of ED psychopathology are slow or fast to change. The purpose of this study was to elucidate three-month trajectories of ED psychopathology during treatment and test whether ED diagnosis influenced the direction and rate of change. METHOD Participants were Recovery Record users seeking treatment for an ED (N = 4,568; 86.8% female). Participants completed the Eating Pathology Symptoms Inventory once per month for 3 months. RESULTS Latent growth curve models indicated that ED diagnosis influenced the rate of ED behavior change. Anorexia nervosa was associated with faster reductions in cognitive restraint, excessive exercise, restricting, yet slower reductions in body dissatisfaction, and binge eating. Bulimia nervosa was associated with faster reductions in binge eating, cognitive restraint, excessive exercise, and purging. Binge-eating disorder was associated with faster reductions in body dissatisfaction and binge eating, yet slower reductions in restricting. CONCLUSIONS Our results have implications for future research by providing initial information about the direction and rate of ED change over the course of treatment. If clinicians and researchers know which ED symptoms are slow to change, on average, across diagnostic groups, treatment protocols could be adjusted to target slow changing symptoms more quickly, and therefore improve ED treatment outcomes.

Introduction: Few African countries have introduced a birth dose of hepatitis B vaccine (HepB-BD) despite a World Health Organization (WHO) recommendation. HepB-BD given within 24 hours of birth, followed by at least two subsequent doses, is 90% effective in preventing perinatal transmission of hepatitis B virus. This article describes findings from assessments conducted to document the knowledge, attitudes, and practices surrounding HepB-BD implementation among healthcare workers in five African countries. Methods: Between August 2015 and November 2016, a series of knowledge, attitude and practices assessments were conducted in a convenience sample of public and private health facilities in Botswana, the Gambia, Namibia, Nigeria, and Sao Tome and Principe (STP). Data were collected from immunization and maternity staff through interviewer-administered questionnaires focusing on HepB-BD vaccination knowledge, practices and barriers, including those related to home births. HepB-BD coverage was calculated for each visited facility. Results: A total of 78 health facilities were visited: STP 5 (6%), Nigeria 23 (29%), Gambia 9 (12%), Botswana 16 (21%), and Namibia 25 (32%). Facilities in the Gambia attained high total coverage of 84% (range: 60–100%) but low timely estimates 7% (16–28%) with the median days to receiving HepB-BD of 11 days (IQR: 6–16 days). Nigeria had low total (23% [range: 12–40%]), and timely (13% [range: 2–21%]) HepB-BD estimates. Facilities in Botswana had high total (94% [range: 80—100%]), and timely (74% [range: 57—88%]) HepB-BD coverage. Coverage rates were not calculated for STP because the maternal Hepatitis B virus (HBV) status was not recorded in the delivery registers. The study in Namibia did not include a coverage assessment component. Barriers to timely HepB-BD included absence of standard operating procedures delineating staff responsible for HepB-BD, not integrating HepB-BD into essential newborn packages, administering HepB-BD at the point of maternal discharge from facilities, lack of daily vaccination services, sub-optimal staff knowledge about HepB-BD contraindications and age-limits, lack of outreach programs to reach babies born outside facilities, and reporting tools that did not allow for recording the timeliness of HepB-BD doses. Discussion: These assessments demonstrate how staff perceptions and lack of outreach programs to reach babies born outside health facilities with essential services are barriers for implementing timely delivery of HepB-BD vaccine. Addressing these challenges may accelerate HepB-BD implementation in Africa.

In 2005, the Regional Committee for the World Health Organization (WHO) Western Pacific Region (WPR)* established a goal for measles elimination† by 2012 (1). To achieve this goal, the 37 WPR countries and areas implemented the recommended strategies in the WPR Plan of Action for Measles Elimination (2) and the Field Guidelines for Measles Elimination (3). The strategies include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs), when required; 2) conducting high-quality case-based measles surveillance, including timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus for genotyping and molecular analysis; and 3) establishing and maintaining measles outbreak preparedness to ensure rapid response and appropriate case management. This report updates the previous report (4) and describes progress toward measles elimination in WPR during 2013-2017. During 2013-2016, estimated regional coverage with the first MCV dose (MCV1) decreased from 97% to 96%, and coverage with the routine second MCV dose (MCV2) increased from 91% to 93%. Eighteen (50%) countries achieved ≥95% MCV1 coverage in 2016. Seven (39%) of 18 nationwide SIAs during 2013-2017 reported achieving ≥95% administrative coverage. After a record low of 5.9 cases per million population in 2012, measles incidence increased during 2013-2016 to a high of 68.9 in 2014, because of outbreaks in the Philippines and Vietnam, as well as increased incidence in China, and then declined to 5.2 in 2017. To achieve measles elimination in WPR, additional measures are needed to strengthen immunization programs to achieve high population immunity, maintain high-quality surveillance for rapid case detection and confirmation, and ensure outbreak preparedness and prompt response to contain outbreaks.

Background India is responsible for 30% of the annual global cohort of unvaccinated children worldwide. Private practitioners provide an estimated 21% of vaccinations in urban centers of India, and are important partners in achieving high vaccination coverage. Methods We used an in-person questionnaire and on-site observation to assess knowledge, attitudes, and practices of private immunization service providers regarding delivery of immunization services in the urban settings of Surat and Baroda, in Gujarat, India. We constructed a comprehensive sampling frame of all private physician providers of immunization services in Surat and Baroda cities, by consulting vaccine distributors, local branches of physician associations, and published lists of private medical practitioners. All providers were contacted and asked to participate in the study if they provided immunization services. Data were collected using an in-person structured questionnaire and directly observing practices; one provider in each practice setting was interviewed. Results The response rate was 82% (121/147) in Surat, and 91% (137/151) in Baroda. Of 258 participants 195 (76%) were pediatricians, and 63 (24%) were general practitioners. Practices that were potential missed opportunities for vaccination (MOV) included not strictly following vaccination schedules if there were concerns about ability to pay (45% of practitioners), and not administering more than two injections in the same visit (60%). Only 22% of respondents used a vaccination register to record vaccine doses, and 31% reported vaccine doses administered to the government. Of 237 randomly selected vaccine vials, 18% had expired vaccine vial monitors. Conclusions Quality of immunization services in Gujarat can be strengthened by providing training and support to private immunization service providers to reduce MOVs and improve quality and safety; other more context specific strategies that should be evaluated may involve giving feedback to providers on quality of services delivered and working through professional societies to adopt standards of practice.

BACKGROUND. In 2015, a large nationwide measles outbreak occurred in Mongolia, with very high incidence in the capital city of Ulaanbaatar and among young adults. METHODS. We conducted an outbreak investigation including a matched case-control study of risk factors for laboratory-confirmed measles among young adults living in Ulaanbaatar. Young adults with laboratory-confirmed measles, living in the capital city of Ulaanbaatar, were matched with 2–3 neighborhood controls. Conditional logistic regression was used to estimate adjusted matched odds ratios (aMORs) for risk factors, with 95% confidence intervals. RESULTS. During March 1–September 30, 2015, 20 077 suspected measles cases were reported; 14 010 cases were confirmed. Independent risk factors for measles included being unvaccinated (adjusted matched odds ratio [aMOR] 2.0, P < .01), being a high school graduate without college education (aMOR 2.6, P < .01), remaining in Ulaanbaatar during the outbreak (aMOR 2.5, P < .01), exposure to an inpatient healthcare facility (aMOR 4.5 P < .01), and being born outside of Ulaanbaatar (aMOR 1.8, P = .02). CONCLUSIONS. This large, nationwide outbreak shortly after verification of elimination had high incidence among young adults, particularly those born outside the national capital. In addition, findings indicated that nosocomial transmission within health facilities helped amplify the outbreak.

Interleukin-2 (IL-2) is a critical regulator of immune homeostasis through its impact on both regulatory T (Treg) and effector T (Teff) cells. However, the precise role of IL-2 in the maintenance and function of Treg cells in the adult peripheral immune system remains unclear. Here, we report that neutralization of IL-2 abrogated all IL-2 receptor signaling in Treg cells, resulting in rapid dendritic cell (DC) activation and subsequent Teff cell proliferation. By contrast, despite substantially reduced IL-2 sensitivity, Treg cells maintained selective IL-2 signaling and prevented immune dysregulation following treatment with the inhibitory anti-CD25 antibody PC61, even when CD25hi Treg cells were depleted. Thus, despite severely curtailed CD25 expression and function, Treg cells retain selective access to IL-2 that supports their anti-inflammatory functions in vivo. Antibody-mediated targeting of CD25 is being actively pursued for treatment of autoimmune disease and preventing allograft rejection, and our findings help inform therapeutic manipulation and design for optimal patient outcomes.

Sao Tome and Principe (STP) uses a selective hepatitis B birth-dose vaccination (HepB-BD) strategy targeting infants born to mothers who test positive for hepatitis B virus (HBV) surface antigen. We conducted a field assessment and economic analysis of the HepB-BD strategy to provide evidence to guide development of cost-effective policies to prevent perinatal HBV transmission in STP. We interviewed national stakeholders and key informants to understand policies, knowledge, and practices related to HepB-BD, vaccine management, and data recording/reporting. Cost-effectiveness of the existing strategy was compared with an alternate approach of universal HepB-BD to all newborns using a decision analytic model. Incremental cost-effectiveness ratios (ICERs) were calculated in 2015 USD per HBV-associated death and per chronic HBV case prevented, from the STP health-care system perspective. We found that STP lacked national or facility-specific written policies and procedures related to HepB-BD. Timely HepB-BD to eligible newborns was considered a high priority, although timeliness of HepB-BD was not monitored. Compared with the existing selective vaccination strategy, universal HepB-BD would result in a 19% decrease in chronic HBV infections per year at overall cost savings of approximately 44% (savings of USD 5,441 each year). We estimate an ICER of USD 5,012 saved per HBV-associated death averted. The existing selective HepB-BD strategy in STP could be improved through documentation of policies, procedures, and timeliness of HepB-BD. Expansion to universal newborn HepB-BD without maternal screening is feasible and could result in cost savings if actual implementation costs and effectiveness fall within the ranges modeled.

The mid-infrared wavelength region is important for a number of application areas, two of which are optical fibre and free space communications. Silicon photonics can provide inexpensive photonic chips for such applications due to excellent electronic and photonic properties. In this paper, the realisation of active silicon and germanium photonic devices for the mid-infrared spectral region are given. High speed Si depletion type modulators, Si and Ge injection modulators operating at wavelengths up to 8 micrometers, and high speed Si detectors are presented. These devices are integrated with drivers and amplifiers and show very good performance, e.g. data rate in excess of 20 Gb/s.

Purpose Falls from standing (FFS) have become the most common mechanism of injury at many trauma centers. Liberal imaging of low energy trauma has questionable value. We hypothesize that torso trauma intervention is rare in the FFS population, and physical examination sufficiently screens for torso injuries needing intervention. Methods We queried our ACS-verified Level 1 trauma center registry for falls from standing from 1/1/14 to 12/31/16. Exclusion criteria were: falls from height, falls associated with penetrating trauma, lack of an abdominal or chest CT, a Glasgow Coma Scale Score (GCS) less than 15, and surgical intervention at another facility prior to arrival at our center. Demographics, historical details, hemodynamics, injuries, injury severity, procedures, initial vital signs, and outcome were recorded. Results 1,654 patients had a FFS during our study period. 728 had an abdominal or chest CT and a GCS of 15 and comprised the evaluable population. Mean age was 56.5 years. 55.8% were female. The mortality rate was 8%. There were 179 chest injuries in 121 patients, and 54 abdominal injuries in 43 patients. 379 patients had a GCS of 15 and underwent thoracic CT, yet only 11 (3%) underwent intervention. The negative predictive value for physical exam was 100% for chest intervention. 349 patients had a GCS of 15 and abdominal CT, yet only 13 (3.7%) underwent procedural intervention. Abdominal physical exam had a negative predictive value of 99.7% for intervention, but when combined with vital signs, the value was 100%. Conclusion Torso injuries in FFS are rare. Of our study population, 13 abdominal injuries underwent intervention, and 11 chest injuries underwent intervention. Screening patients by physical examination and vital signs is sufficient and safely allows for the use of selective abdominal and chest CT.

High-speed and low-power silicon optical modulators are key in realising low cost photonic circuits for data transmission purposes. Depending on the application, different wavelength bands are preferred and therefore designs of optical modulator, which operate in these bands, are required. Here we present our recent work on silicon optical modulators at 1310, 1550, 2000 and 3800 nm wavelengths.

Silicon photonics micro-ring resonator (MRR) and Mach-Zehnder waveguide based sensors have attracted much attention in recent years because of their capacity for high sensitivity, small footprint and mass-scalable (low cost) potential. This type of sensor is based on the detection of changes in optical amplitude/phase due to small changes in local, near-field refractive index (RI) in the environment surrounding the waveguide device. Sensitivity to ever smaller changes in RI are sought, e.g. for vapour/gas based sensing, which may be realised by designing devices based around the slot waveguide. Furthermore, tailoring resonant line-shapes to generate asymmetric (or Fano-like) modes through series, parallel or ‘nested’ arrangements of coupled MRRs also demonstrates the potential for such sensitivity enhancement. This type of device is likely to be of interest, for example where sensing of volatile organic compounds (VOCs) is important, e.g. in industrial process and environmental monitoring. We demonstrate a number of such photonic sensing platforms, combining both the slot waveguide and both established and novel ‘photonic molecule’ structures, fabricated on silicon-on-insulator using standard foundry fabrication processes. Integrated TiN heaters provide the capacity for thermal tuning in order to manipulate the spectral characteristics of our devices and the sensitivity of the devices to a range of VOCs; benzene, toluene and xylene, are investigated as exemplars using a custom-made vapour delivery system. Sensor performance is established with the assistance of device modelling and comparison made with conventional single MRR devices as a reference. The potential of adding functional layers to the devices as a method for achieving chemical selectivity will also be discussed.

Photo-detection in the wavelength range 1850 to 2000 nm using evanescently-coupled germanium detectors grown on silicon waveguides is described. Devices were fabricated at a silicon photonics foundry using a process flow associated with operation in the O , C and L bands, and as such offer a solution for extended wavelength detection which is readily available. Intrinsic sensitivity is via indirect band transitions, which is enhanced by tensile strain and we postulate that it may be further enhanced by defects which arise from the thermal processes associated with Ge on Si growth. The responsivity of p-i-n detectors is 20 mA/W at 1850 nm falling to 5 mA/W at 2000 nm, for a detector length of 50 μm. Responsivity is suppressed by electrical doping in the germanium detector which provides parasitic absorption from free carriers. Modifications to the current design are suggested such that integrated germanium p-i-n detectors, directly grown on silicon waveguides would be suitable for high-bandwidth photo-detection up to at least a wavelength of 2000 nm. A Separate-Absorption-Charge-Multiplication Avalanche Photo-Detector is fabricated exploiting the same indirect transition. This detector has a responsivity of 0.31 A/W at 1850 nm and 0.08 A/W at 1970 nm, for a detector length of only 14 μm.

Background Surveillance data from a large measles outbreak in Mongolia suggested increased case fatality ratio (CFR) in the second of 2 waves. To confirm the increase in CFR and identify risk factors for measles death, we enhanced mortality ascertainment and conducted a case-control study among infants hospitalized for measles. Methods We linked national vital records with surveillance data of clinically or laboratory-confirmed infant (aged Results Infant measles deaths increased from 3 among 2224 cases (CFR: 0.13%) in wave 1 to 113 among 4884 cases (CFR: 2.31%) in wave 2 (P < .001). Inpatient admission, 7–21 days before measles rash onset, for pneumonia or influenza (amOR: 4.5; CI, 2.6–8.0), but not other diagnoses, was significantly associated with death. Discussion Measles infection among children hospitalized with respiratory infections likely increased deaths due to measles during wave 2. Preventing measles virus nosocomial transmission likely decreases measles mortality.

We demonstrate a single-arm Mach-Zehnder interferometer (SAMZI) modulator based on asymmetric long-period gratings for TE0-TE1 mode conversion integrated with a p-n junction doped waveguide for relative phase modulation between these modes via the electro-optic effect. The device consists of two long-period grating sections, with the active waveguide modulator section in-between, and inverse tapers at the input (to couple in only the TE0 mode), and the output (to filter out the excited TE1 mode). The periodicity dictates a central mode conversion wavelength and thus the region of operation for the modulator. Simulations are performed to investigate passive device properties, such as central wavelength sensitivity, free spectral range, and coupling coefficient, as well as active performance of the modulator. A fabricated device was characterized with a central wavelength of 1490 nm, a free spectral range of 0.975 nm, and a thermal stability of −0.521 rad/K or 42.4 pm/K. By balancing the lengths of each section, the device can be made athermal. Steady-state characterization shows a maximum on-off extinction ratio of 3.96 dB for a voltage difference of −8 V. The total phase-shift of the measured device agrees with simulation, with a phase-shift of 0.34π at −8 V. The VL of the measured device is 2.96 Vcm at −1 V and 6.37 Vcm at −8 V.

Rapid activation of the hypothalamic pituitary adrenal axis and the sympathetic nervous system are hallmarks of the acute stress response and these systems interact with the immune system by signaling though glucocorticoid and adrenergic receptors on immune cells. There is limited information about the effect of these physiologic responses on immunologic parameters of pet dogs enrolled in clinical studies. The objective of this study was to evaluate how travel, instrumentation, and hospitalization alter immunologic parameters in pet dogs. Blood was collected from healthy dogs in a home environment and from healthy dogs at the time of presentation to the hospital and after instrumentation and 24 hours of hospitalization. We found that lipopolysaccharide (LPS)-induced downregulation of toll like receptor 4 (TLR4) was blunted in dogs exposed to stress. Neutrophil and monocyte major histocompatibility complex class II (MHCII) expression increased after transportation to the veterinary hospital but then became similar to that of the control dogs at the end of hospitalization. Peripheral blood mononuclear cell cytotoxicity function was blunted in dogs exposed to the stress of transportation as well as hospitalization. Neutrophil apoptosis was greater in dogs exposed to stress compared to controls although this effect significantly decreased after hospitalization stress. Conversely, stress did not alter induced or spontaneous cytokine production from leukocytes, neutrophil or monocyte expression of TLR4, LPS-induced downregulation of monocyte TLR4, LPS-induced neutrophil and monocyte expression of MHCII or peripheral blood lymphocyte phenotype. Transportation and instrumentation/hospitalization stress should be considered when interpreting immunologic studies in pet dogs.

We demonstrate the operation of a monolithic, mid-IR (∼2μm) optical interconnect featuring a micro-ring resonator modulator and a defect-mediated silicon detector. Preliminary measurements show excellent DC modulator performance and a maximum detector responsivity of ∼0.045 A/W.

Background Human movement is likely an important risk factor for environmentally-transmitted pathogens. While epidemiologic studies have traditionally focused on household risk factors, individual movement data could provide critical additional information about risk of exposure to such pathogens. We conducted global positioning system (GPS) tracking of urban slum residents to quantify their fine-scale movement patterns and evaluate their exposures to environmental sources of leptospirosis transmission. Methodology/Principal findings We recruited participants from an ongoing cohort study in an urban slum in Brazil and tracked them for 24 hours at 30-second intervals. Among 172 subjects asked to participate in this cross-sectional study, 130 agreed to participate and 109 had good quality data and were included in analyses. The majority of recorded locations were near participant residences (87.7% within 50 meters of the house), regardless of age or gender. Similarly, exposure to environmental sources of leptospirosis transmission did not vary by age or gender. However, males, who have higher infection rates, visited a significantly larger area during the 24-hour period than did females (34,549m2 versus 22,733m2, p = 0.005). Four male participants had serologic evidence of Leptospira infection during the study period. These individuals had significantly larger activity spaces than uninfected males (61,310m2 vs 31,575m2, p = 0.006) and elevated exposure to rodent activity (p = 0.046) and trash deposits (p = 0.031). Conclusions/Significance GPS tracking was an effective tool for quantifying individual mobility in the complex urban slum environment and identifying risk exposures associated with that movement. This study suggests that in addition to source reduction, barrier interventions that reduce contact with transmission sources as slum residents move within their communities may be a useful prevention strategy for leptospirosis., Author summary Environmental features of urban slums including inadequate sanitation, substandard housing, and population crowding predispose residents to numerous infections. Despite this shared environment, not all slum residents, even within households, have equal risk of infection with specific pathogens and we do not know why. Individual movement data will help us better understand how slum residents interact with their environment. We conducted GPS tracking of 109 urban slum residents in Brazil to quantify their movement patterns and how these influence exposure to leptospirosis, an environmentally transmitted infection common in urban slums. Slum inhabitants, regardless of age and gender, spent most of their time close to home and had similar exposures to environmental features associated with leptospirosis infection. However, males visited a larger area on a daily basis, which may explain their higher leptospirosis risk. Based on screening of the slum population conducted at six-month intervals, four individuals (all male) became infected with Leptospira during our study. These individuals visited a significantly larger area than other males and had higher exposure to rodents and trash deposits than did other participants. GPS tracking allowed us to identify movement and movement-induced exposure as risk factors for leptospirosis infection and could provide similarly important information for other environmentally-transmitted pathogens.

Silicon photonics has traditionally focused on near infrared wavelengths, with tremendous progress seen over the past decade. However, more recently, research has extended into mid infrared wavelengths of 2 μm and beyond. Optical modulators are a key component for silicon photonics interconnects at both the conventional communication wavelengths of 1.3 μm and 1.55 μm, and the emerging mid-infrared wavelengths. The mid-infrared wavelength range is particularly interesting for a number of applications, including sensing, healthcare and communications. The absorption band of conventional germanium photodetectors only extends to approximately 1.55 μm, so alternative methods of photodetection are required for the mid-infrared wavelengths. One possible CMOS compatible solution is a silicon defect detector. Here, we present our recent results in these areas. Modulation at the wavelength of 2 μm has been theoretically investigated, and photodetection above 25 Gb/s has been practically demonstrated.

The 2 μm wavelength band has become a promising candidate to be the next communication window. We demonstrate high-speed modulators based on a 220 nm silicon-on-insulator platform working at a wavelength of 1950 nm, using the free carrier plasma dispersion effect in silicon. A Mach–Zehnder interferometer modulator and a microring modulator have been characterized. At 1950 nm, the carrier-depletion modulator operates at a data rate of 20 Gbit/s with an extinction ratio of 5.8 dB and insertion loss of 13 dB. The modulation efficiency (V𝜋��·L𝜋��) is 2.68 V·cm at 4 V reverse bias. The device operation is broadband, and we also characterize its performance at 1550 nm. At 1550 nm, an open eye is obtained at 30 Gbit/s. The difference in bandwidth is caused by the bandwidth limit of the 2 μm measurement setup. We also show a ring modulator paired with a low power integrated driver working in hybrid carrier depletion and injection mode at a data rate of 3 Gbit/s with power consumption of 2.38 pJ/bit in the 2 μm wavelength range. This work is a proof of principle demonstration and paves a route toward a full silicon-based transceiver in the 2 μm window. NRF (Natl Research Foundation, S’pore) Published version

Measles is a highly transmissible infectious disease that causes serious illness and death worldwide. Efforts to eliminate measles through achieving high immunization coverage, well-performing surveillance systems, and rapid and effective outbreak response mechanisms while strategically engaging and strengthening health systems have been termed a diagonal approach. In March 2015, a large nationwide measles epidemic occurred in Mongolia, 1 year after verification of measles elimination in this country. A multidisciplinary team conducted an outbreak investigation that included a broad health system assessment, organized around the Global Health Security Agenda framework of Prevent-Detect-Respond, to provide recommendations for evidence-based interventions to interrupt the epidemic and strengthen the overall health system to prevent future outbreaks of measles and other epidemic-prone infectious threats. This investigation demonstrated the value of evaluating elements of the broader health system in investigating measles outbreaks and the need for using a diagonal approach to achieving sustainable measles elimination.

Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities.

Measles virus is highly infectious and can spread rapidly where vaccine coverage is low and isolation precautions suboptimal. We describe healthcare-associated measles transmission during the 2015-2016 measles outbreak in Mongolia, describe infection prevention gaps, and outline preventive strategies.

Early detection of leptospirosis with field-ready diagnostics may improve clinical management and mitigate outbreaks. We previously validated the point-of-care Dual Path Platform (DPP) for leptospirosis with sera in the laboratory. This prospective study compares the diagnostic accuracy and clinical utility of the DPP using finger stick blood (FSB) against the serum DPP, venous whole blood (VWB) DPP, IgM-ELISA, and clinical impression. We sequentially enrolled 98 patients hospitalized for acute febrile illnesses, of which we confirmed 32 by leptospirosis reference tests. Among syndromes consistent with classic leptospirosis, the FSB DPP showed similar sensitivity and specificity (Se 93% and Sp 80%), and positive and negative predictive values (PPV 74% and NPV 95%), to VWB DPP (Se 96%, Sp 75%, PPV 68%, and NPV 97%), serum DPP (Se 85%, Sp 87%, PPV 79%, and NPV 91%) and IgM-ELISA (Se 81%, Sp 100%, PPV 100%, and NPV 90%). The FSB DPP provided a favorable likelihood ratio profile (positive LR 4.73, negative LR 0.09) in comparison to other assays and clinical impression alone. Additionally, we identified four of five leptospirosis-associated meningitis patients by whole blood DPP, none of which clinicians suspected. This demonstrates potential for the DPP in routine detection of this less common syndrome. The FSB DPP demonstrated similar discrimination for severe human leptospirosis compared with serum assays, and it is a simpler option for diagnosing leptospirosis. Its performance in other epidemiological settings and geographic regions, and for detecting atypical presentations, demands further evaluation., Author summary The reliable, portable, point-of-care DPP assay effectively discriminates case status for patients presenting to hospital with acute febrile syndromes consistent with classic leptospirosis. Diagnostic accuracy of the finger stick DPP using the initial acute-phase specimen at the bedside is similar to serum DPP and IgM-ELISA, yet diagnosticians can perform the DDP assay in 20 minutes without laboratory equipment. The finger stick DPP expands rapid diagnostic options at the bedside for severe leptospirosis in humans.

Eating disorders are serious mental-health concerns that will affect over 30 million individuals in the USA at some point in their lives. Eating disorders occur across the lifespan, in a variety of ethnicities and races, in both men and women, and across the socioeconomic spectrum. Given the prevalence and severity of eating disorders, it is important that clinicians and researchers have access to appropriate assessment tools to aid in the early identification and treatment referral, differential diagnosis, treatment planning, and progress monitoring, and to ensure valid research findings. In this review, we describe novel and innovative assessment tools that were developed within the past 5 years for utilization in research and/or clinical practice with individuals with eating disorders. We identified six multidimensional assessments for eating disorders, all of which can be administered online (with some also offering paper-and-pencil versions). Strengths of the measures included good internal consistency, test-retest reliability, and convergent validity. However, in part, due to problematic scale construction methods, certain scales had poor discriminant validity and most were developed and validated in mostly female samples. There are promising new eating disorder measures from which to choose; however, many measures continue to be limited by poor discriminant validity and need additional validation prior to incorporation into routine research and clinical practice.

[This corrects the article DOI: 10.1371/journal.ppat.1005943.].

With the increase in integration of variable renewable generation into power grids, challenges regarding the utilization of their variable output power has increased. During low demand periods with highly wind power penetration, system reliability, stability and flexibility are disturbed. To eliminate these challenges, power curtailment appears to be one of the key solutions. With proper understanding of the amount of power to be curtailed, system flexibility can be improved. This paper provides quantification of wind power curtailment which helps system operators determine whether to utilize or curtail the generated power to increase system flexibility. The paper employs probabilistic approach in estimating wind output power to determine the amount of power to be curtailed at different buses during different seasons. A radial distribution system with 5 buses is used as a test system to demonstrate the effectiveness of the proposed method. Annual hourly wind speed and electric load data are considered in this study.

Micro-ring modulators for use in high-speed telecommunication transceivers designed for silicon-on-insulator (SOI) for 2 μm wavelength operation are described and simulated with comparison to 1.55 μm. Device simulations show improved DC modulation performance due to the free-carrier effect described in the plasma dispersion relations which is stronger for longer wavelengths. WDM applications are described and simulated. Micro-ring modulator devices were designed and fabricated at A*STAR IME and are pending measurement.

Leptospirosis is a zoonotic disease that causes severe manifestations such as Weil's disease and pulmonary hemorrhage syndrome. The aim of this study was to evaluate whether reactive oxygen species (ROS) production and antioxidant reduced glutathione (GSH) levels are related to complications in patients hospitalized with leptospirosis. The ROS production and GSH levels were measured in blood samples of 12 patients and nine healthy controls using chemiluminescence and absorbance assays. We found that ROS production was higher and GSH levels were lower in leptospirosis patients compared with healthy individuals. Among patients, GSH depletion was correlated with thrombocytopenia and elevated serum creatinine, whereas a strong positive correlation was observed between ROS production and elevated serum potassium. Additional investigation of the biological significance of ROS production and GSH levels is warranted as they may guide the development of novel adjuvant therapies for leptospirosis targeting oxidative stress.

Food safety training materials, targeted for residential childcare institution (RCCI) staff of facilities of 20 residents or less, were developed, piloted, and evaluated. The goal was to assist in the implementation of a Hazard Analysis Critical Control Points (HACCP)-based food safety plan as required by Food and Nutrition Service/United States Department of Agriculture. RCCI staff and instructor training manuals, Food Safety Basics: Food Safety Education for RCCIs was developed and pilot tested in RCCIs in both Rhode Island and Massachusetts. The program was evaluated by participants and pre-/posttraining onsite inspector and microbial assessments. The core curriculum contained 3 modules and corresponding activities: Module 1: cause, prevention, and strategies to reduce foodborne illness; Module 2: components of a HACCP-based food safety plan and standard operating procedures; and Module 3: actual food safety plan development, including instructions for implementation and corresponding monitoring procedures required. There were 50 to 82 RCCI staff members that attended 2 or 3 modules. Participants rated the modules 4.5 ± 0.4, 4.3 ± 0.4, and 4.4 ± 0.4 out of 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) for teaching modules 1, 2, and 3, respectively. The evaluations assessed their understanding of key topic areas taught. Onsite inspections showed improvement in many critical food safety issues. Some deficiencies still appeared to be problematic, such as refrigerator temperature monitoring and issues with storage and cross-contamination.

Texto completo: acesso restrito. p.359-363 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2015-03-06T14:50:28Z No. of bitstreams: 1 Wildo Navegantes de Araújo.pdf: 469736 bytes, checksum: 6a3c3d1fbf68162baf4150cee7c160dd (MD5) Approved for entry into archive by Flávia Ferreira (flaviaccf@yahoo.com.br) on 2015-05-11T16:21:59Z (GMT) No. of bitstreams: 1 Wildo Navegantes de Araújo.pdf: 469736 bytes, checksum: 6a3c3d1fbf68162baf4150cee7c160dd (MD5) Made available in DSpace on 2015-05-11T16:21:59Z (GMT). No. of bitstreams: 1 Wildo Navegantes de Araújo.pdf: 469736 bytes, checksum: 6a3c3d1fbf68162baf4150cee7c160dd (MD5) Previous issue date: 2013 Leptospirosis disproportionately affects residents of urban slums. To understand the knowledge, attitudes, and practices regarding leptospirosis, we conducted a cross-sectional study among residents of an urban slum community in Salvador, Brazil. Of the 257 residents who were interviewed, 225 (90%) were aware of leptospirosis and more than two-thirds of respondents correctly identified the modes of disease transmission and ways to reduce exposure. However, study participants who performed risk activities such as cleaning open sewers had limited access to protective clothing such as boots (33%) or gloves (35%). Almost all respondents performed at least one activity to prevent household rat infestation, which often included use of an illegal poison. Our findings support the need for interventions targeted at the individual and household levels to reduce risk of leptospirosis until large-scale structural interventions are available to residents of urban slum communities.

Leptospirosis causes significant morbidity and mortality worldwide; however, the role of the host immune response in disease progression and high case fatality (>10–50%) is poorly understood. We conducted a multi-parameter investigation of patients with acute leptospirosis to identify mechanisms associated with case fatality. Whole blood transcriptional profiling of 16 hospitalized Brazilian patients with acute leptospirosis (13 survivors, 3 deceased) revealed fatal cases had lower expression of the antimicrobial peptide, cathelicidin, and chemokines, but more abundant pro-inflammatory cytokine receptors. In contrast, survivors generated strong adaptive immune signatures, including transcripts relevant to antigen presentation and immunoglobulin production. In an independent cohort (23 survivors, 22 deceased), fatal cases had higher bacterial loads (P = 0.0004) and lower anti-Leptospira antibody titers (P = 0.02) at the time of hospitalization, independent of the duration of illness. Low serum cathelicidin and RANTES levels during acute illness were independent risk factors for higher bacterial loads (P = 0.005) and death (P = 0.04), respectively. To investigate the mechanism of cathelicidin in patients surviving acute disease, we administered LL-37, the active peptide of cathelicidin, in a hamster model of lethal leptospirosis and found it significantly decreased bacterial loads and increased survival. Our findings indicate that the host immune response plays a central role in severe leptospirosis disease progression. While drawn from a limited study size, significant conclusions include that poor clinical outcomes are associated with high systemic bacterial loads, and a decreased antibody response. Furthermore, our data identified a key role for the antimicrobial peptide, cathelicidin, in mounting an effective bactericidal response against the pathogen, which represents a valuable new therapeutic approach for leptospirosis., Author Summary Leptospirosis causes over one million cases and nearly 60,000 deaths annually. Infection with the spirochetal bacterium results in a spectrum of symptoms, ranging from mild febrile illness to life-threatening pulmonary hemorrhage syndrome and acute kidney injury. Despite leptospirosis being a leading cause of zoonotic morbidity worldwide, little is known about the human immune response to Leptospira infections, and less about the pathogenic mechanisms resulting in severe disease outcomes. Here, we used a systems biology approach to discover transcripts and immunoprofiles associated with case fatality. We identified new risk factors for high bacterial loads and fatal leptospirosis, including the antimicrobial peptide, cathelicidin, which we validated in an animal model. Cathelicidin therefore represents a potential novel treatment for severe cases of leptospirosis.

Wind and Solar power are the most promising and rapidly developing renewable energy technologies that exist in our world today. They are also termed variable energy resources since their natural resources, wind speed and solar irradiance, are intermittent in nature. This variability is a critical factor when estimating the annual energy of wind and solar sources. Capital and operational costs associated with their implementation are highly affected when inaccurate estimations are carried out. This paper presents a new forecasting model for solar irradiance and wind speed by utilizing historical hourly data to outline an annual eight-segment probabilistic model of wind and solar. The proposed methodology employs a probabilistic approach to estimate the hourly wind speeds and solar irradiance for a year. The model is used to estimate the annual energy produced by a 42.5 MW wind farm and a 1.5 MW PV array. The results are compared with a four-season estimation approach, which have shown a substantial improvement in the estimation accuracy of the total energy produced.

Despite the enormous health and nutritional benefits that could be derived from the consumption of fruits, studies have shown that most adolescents and adults do not consume fruits as per the recommended daily intake. This study aimed at identifying the factors that hamper the consumption of fruits among university students. Four hundred and fifty -six (n = 456) out of a total population of nine thousand (N = 9000) undergraduate students were considered for the study . A pre -tested structured questionnaire was used to solicit answers to questions on: fruit intake and preferences, perception on fruit consumption, fruit availability, and factors that hamper students’ fruit intake. Descriptive statistical techniques (frequency counts, percentage, mean and standard deviations) as well as inferential tools (one -sample T -test, Pearson product -moment correlation, Chi -square one variable test, and Binomial test) were used in the data analysis , and statistical significance determined at the 5% level (P≤0.05). Major findings from the study were that, students (65%), against expectation, do not eat the recommended serving of fruits in a day (P0.05) influence the intake of fruits by the respondents ( x ̄ 0.05). Price scores ( x ̄ = 3.21) as well as satiety scores ( x ̄ = 3.32) were the significant variable s found to hinder students’ fruit intake (P

This study demonstrates how the mean zonal wind affects the propagation of tidal energy from the troposphere to the mesosphere-lower thermosphere (MLT) region (60–120 km). We diagnose the seasonal-latitudinal variation of the eastward-propagating diurnal tide with zonal wavenumber 3 (DE3), which is a prominent tidal component and agrees well between model and observation in recent studies. It is shown that during the course of a year the seasonal-latitudinal variation of mean zonal wind modulates and filters DE3 energy propagating upwards from tropospheric radiative and latent heating sources. Our results are based upon ISCCP and TRMM troposphere heating rates, SABER-derived zonal mean gradient wind, SABER tidal signatures and GSWM (the global-scale wave model) diagnoses. The tropospheric tidal heating rates are derived from ISCCP (International Satellite Cloud Climatology Project) radiative fluxes and TRMM (Tropical Rainfall Measuring Mission) latent heating profiles together with TRMM rainfall rates. The zonal mean winds are derived from measurements of geopotential height from the SABER (sounding of the atmosphere with broadband emission radiometry) instrument on the TIMED (thermosphere, ionosphere, mesosphere energetics and dynamics) spacecraft, and the tidal signatures are determined from SABER temperature measurements.

BACKGROUND From January 2014-July 2014, more than 46 000 unaccompanied children (UC) from Central America crossed the US-Mexico border. In June-July, UC aged 9-17 years in 4 shelters and 1 processing center in 4 states were hospitalized with acute respiratory illness. We conducted a multistate investigation to interrupt disease transmission. METHODS Medical charts were abstracted for hospitalized UC. Nonhospitalized UC with influenza-like illness were interviewed, and nasopharyngeal and oropharyngeal swabs were collected to detect respiratory pathogens. Nasopharyngeal swabs were used to assess pneumococcal colonization in symptomatic and asymptomatic UC. Pneumococcal blood isolates from hospitalized UC and nasopharyngeal isolates were characterized by serotyping and whole-genome sequencing. RESULTS Among 15 hospitalized UC, 4 (44%) of 9 tested positive for influenza viruses, and 6 (43%) of 14 with blood cultures grew pneumococcus, all serotype 5. Among 48 nonhospitalized children with influenza-like illness, 1 or more respiratory pathogens were identified in 46 (96%). Among 774 nonhospitalized UC, 185 (24%) yielded pneumococcus, and 70 (38%) were serotype 5. UC transferring through the processing center were more likely to be colonized with serotype 5 (odds ratio, 3.8; 95% confidence interval, 2.1-6.9). Analysis of core pneumococcal genomes detected 2 related, yet independent, clusters. No pneumococcus cases were reported after pneumococcal and influenza immunization campaigns. CONCLUSIONS This respiratory disease outbreak was due to multiple pathogens, including Streptococcus pneumoniae serotype 5 and influenza viruses. Pneumococcal and influenza vaccinations prevented further transmission. Future efforts to prevent similar outbreaks will benefit from use of both vaccines.

Exclusive breastfeeding has been associated with a reduced risk of late vertical HIV transmission as compared to an infant diet composed of breast milk mixed with supplemental foods or liquids. Hypothesized mechanisms include increased infectivity of breast milk from mothers who practice mixed breastfeeding (MBF), or mechanisms such as increased gastrointestinal permeability in the infant caused by mixed feeding. It has been proposed that MBF may result in subclinical mastitis and higher breast milk HIV titers. However, little is known about the relationship between feeding strategy and breast milk viral load. We measured the HIV-1 concentration in breast milk in a sub-cohort of women enrolled in a mother-to-child HIV transmission prevention trial (the "Mashi" study). We report no observed relationship between MBF and measured breast milk viral RNA load. Our findings suggest that the increased transmission risk associated with higher breast milk HIV-1 RNA during MBF is unlikely.