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Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9–6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40–59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. Funding UK Research and Innovation and National Institute for Health Research.

Introduction and objectives: \ud Recently published NICE guidance has significantly expanded the approach to adult tuberculosis (TB) contact screening by recommending tuberculin skin testing (TST) for pulmonary and laryngeal contacts only, increasing the age threshold for screening and treatment to 65 years and defining a positive TST as induration ≥5 mm, regardless of BCG vaccination status. Interferon Gamma Release Assay (IGRA) is recommended only in situations where more evidence of infection is needed.\ud \ud Our institution has previously adopted an approach comprising a chest radiograph, TST and IGRA.\ud \ud The aim of our study was to evaluate the impact of NICE guidance on screening outcomes and resource capacity by applying the criteria to a well-defined historic cohort of TB contacts.\ud \ud Methods:\ud This was a retrospective, observational study carried out at a central London teaching hospital. The study population comprised 593 consecutive, adult TB contacts screened between 1/1/2008 and 31/12/2010. Data was collected through a retrospective review of TST and IGRA tests.\ud \ud Results:\ud Of the 593 contacts screened, 358 pulmonary contacts had TST and IGRA results. 56% had a TST ≥5 mm, regardless of BCG status, qualifying them for treatment as per the new NICE guidance. Of these, 61% were IGRA negative (discordant) and may therefore include false positive diagnoses, resulting in the potential for over treatment. In those with TST 5–14 mm, discordance rises to 84%. Conversely, 6% of those with TST < 5 mm are IGRA positive representing potentially missed cases.\ud \ud 16% of screened individuals were contacts of extra pulmonary TB. Not screening this group would reduce the demand for outpatient appointments by 151* in our cohort. In contrast, testing contacts > 35 years would require capacity for an additional 165* appointments. Furthermore, there were 162 additional LTBI cases in comparison to previous guidance requiring an additional 648* appointments. 72% of this group were IGRA negative.\ud \ud (*Approximate)\ud \ud Conclusions:\ud Our results show the revised guidance will require increased resource capacity largely due to more patients being classified as having latent TB. In addition to workforce planning to meet these demands, further debate is needed to decide if this new approach truly reduces the incidence of active TB or results in unnecessary treatment.

This paper reports on the findings of a multi-site qualitative case study research project designed to document the utility and perceived usefulness of weather station and imagery data associated with the online resource GeoVisage among northeastern Ontario farmers. Interviews were conducted onsite at five participating farms (three dairy, one cash crop, and one public access fruit/vegetable) in 2014–2016, and these conversations were transcribed and returned to participants for member checking. Interview data was then entered into Atlas.ti software for the purpose of qualitative thematic analysis. Fifteen codes emerged from the data and findings center around three overarching themes: common uses of weather station data (e.g., air/soil temperature, rainfall); the use of GeoVisage Imagery data/tools (e.g., acreage calculations, remotely sensed imagery); and future recommendations for the online resource (e.g., communication, secure crop imagery, mobile access). Overall, weather station data and tools freely accessible through the GeoVisage site were viewed as representing a timely, positive, and important addition to contemporary agricultural decision-making in northeastern Ontario farming.

The burn-in process is a part of the production process whereby manufactured products are operated for a short period of time before release. In this paper, a Bayesian method is developed for calculating the optimal burn-in duration for a batch of products whose life distribution is modeled as a mixture of two (denoted ‘strong’ and ‘weak’) exponential sub-populations. The criteria used is the minimization of a total expected cost function reflecting costs related to the burn-in process and to product failures throughout a warranty period. The expectation is taken with respect to the mixed exponential failure model and its parameters. The prior distribution for the parameters is constructed using a beta density for the mixture parameter and independent gamma densities for the failure rate parameters of the sub-populations. It is assumed that the optimal burn-in time is selected in advance and remains fixed throughout the burn-in process. When additional failure information is available prior to the burn-in process, the minimization of posterior total cost is used as the criteria for selecting the optimal burn-in time. Expressions for the joint posterior distribution and cost are provided for the case of both complete and truncated data. The method is illustrated with an example.

Much of Sir Michael Latham's report, Constructing the Team, 1994, revolves around the issue of moving the whole construction industry forward. He suggests that better informed clients and non-adversarial contracts could unite the many participants in the construction process into a mutually educative team. The £500 million project for Glaxo Wellcome Group Research Ltd in Stevenage, opened in April 1995, tackled many of the points raised in Latham's report. The new laboratories are one of the world's most advanced pharmaceutical research facilities, containing more than 130 000 m 2 state-of-the-art laboratories and pilot plants, plus support facilities for 2000 scientific staff engaged in novel product discovery. The project shows how high-level information systems were developed to control every stage of the process and made it possible to foresee problems and avoid irretrievable situations. This attitude of prevention rather than cure produced positive knock-on effects at all levels. The methods employed to address health and safety anticipated much of the Health and Safety Executive's 1994 Construction (Design and Management) Regulations. The Glaxo Wellcome Medicines Research Centre project demonstrates that the implementation of many of Latham's recommendations on large-scale building projects is achievable and were in fact fundamentally part of the project's philosophy.

Everybody has won and all must have prizes, said the Dodo in Alice's Adventures in Wonderland. This quote, used by Sir Michael Latham in his report Constructing the Team, 1994, describes a 'win-win' situation. The £500 million project for Glaxo Wellcome Group Research Ltd in Stevenage has set the example of a win-win project. Opened by the Queen in April 1995, the new laboratories are one of the world's most advanced pharmaceutical research facilities. They contain more than 130 000 m 2 state-of-the-art laboratories and pilot plants, plus support facilities for some 2000 scientific staff engaged in novel product discovery. Anticipating many of Latham's recommendations, aspects of this project's realization could be considered as 'models' through which to show the construction industry a means of achieving the highest standards, on time, within budget and in a non-adversarial working environment. Its execution has challenged the traditional organization of the building team, pioneered methods of design control and applied computer technology on an extensive scale. The creative results of these efforts point to ways in which the building industry can improve the quality and efficiency of its products and processes to the benefit of its clients and all those who work within it.

The aim of this chapter is to highlight the international trends in GeoGebra usage since its emergence as a powerful, open-source mathematics software in 2002. GeoGebra Institutes are being formed around the globe under the auspices of the International GeoGebra Institute (IGI), and the GeoGebra Wiki and User Forum are being well used by an increasing number of academics and enthusiasts. Within this chapter, comments made by a variety of these international users will be highlighted to address the questions of democratic access and software sustainability vis-a-vis the open source context, and to offer insight into the meaningful and expanding role that the software now plays in many regions of the world.

Background Intrathoracic lymph node tuberculosis (ITLNTB) is an extra-pulmonary manifestation of tuberculosis (TB) and a predominant feature of primary TB in children. Historical literature supports the key role of lymph nodes in tuberculosis pathogenesis yet there is a paucity of literature describing ITLNTB in adults. Methods This study comprehensively reviewed the clinical, radiological and pathological features of ITLNTB from 2009–2012 at a busy urban tuberculosis clinic. Results 113 adult patients with ITLNTB were identified between 2009–2012. Patients were usually male, with a mean age of 41.5 ± 15.8 years and mostly from White, Black-African or Indian ethnic groups. 86% were non-UK born and most presented within 5–10 years of entering the country. 43% were asymptomatic. A subgroup of patients who were mycobacterial culture positive on endobronchial ultrasound sampling (EBUS) of intrathoracic lymph nodes were identified as patients with definite mycobacterial infection of the lymph nodes (n = 27). Comparisons between symptomatic and asymptomatic groups in the whole cohort and EBUS culture positive subgroup demonstrated significant associations between symptoms and disease dissemination (p = 0.0002 and p = 0.01 respectively); and symptoms and cytological response in the lymph nodes (p = 0.02 and p = 0.01 respectively), suggesting the presence of a spectrum of disease reflected in congruent clinical and pathological responses (Table 1). Comparisons between disease sites affected also showed a significant association between host response in the lymph nodes and disease dissemination (p = 0.006). The presence of radiological necrosis, number of affected nodal stations, and largest node size were significantly greater in symptomatic patients in the whole cohort; with a similar trend observed in the EBUS culture positive subgroup. In the EBUS culture positive subgroup, asymptomatic patients were identified significantly earlier following entry to the UK (p = 0.01). Discussion This study provides the first comprehensive clinical description of ITLNTB in adults. There is a spectrum of disease based on clinical severity, disease phenotype and diagnostic and radiological findings. Host response in the lymph nodes is reflected by both symptom manifestation and disease dissemination, implicating the lymph nodes in a critical role in the natural history of TB infection. Finally, a subclinical phenotype was identified, suggesting an early stage of disease progression in TB.

This paper provides an inspector's view of quality control procedures followed for the repair of the Baltimore Area's Southwestern Transmission Main literally from the inside out . A 2006 condition assessment of the Southwest Transmission Main which serves Baltimore City, Maryland and several adjoining Counties identified deficiencies that were sufficiently serious that, to avoid a potential catastrophic failure of the main, the engineering consultant recommended that repairs be made before the main was returned to service. A number of reaches of the transmission main which were comprised of 54-, 48- and 36-inch diameter pre-stressed concrete cylinder pipe (PCCP) exhibited significant numbers of pre-stressing wire breaks, longitudinal cracking and delamination of the concrete core. Restoration of service required that three methods of pipe rehabilitation be undertaken: 1) pipe replacement, 2) slip-lining with steel pipe, and 3) lining with a carbon-fiber composite system (CFCS). In Baltimore County, 5,000 feet of 54-inch main was replaced in its entirety with new PCCP, 300 feet of 54-inch was slip-lined and 16 sections of 54-inch pipe were repaired with CFCS. In Baltimore City, 11 sections of 54-inch main were repaired with CFCS. In Howard County 33 sections of 36-inch pipe were repaired with carbon fiber, and in Anne Arundel County, 600 feet of 48-inch pipe was repaired by steel slip-lining, and 8 sections of 36-inch main were repaired using CFCS. This paper provides a perspective from the firsthand viewpoint of two inspectors who were responsible for implementing the quality control procedures that were followed for the repair of 68 sections of 54- and 36-inch PCCP with CFCS. It reviews the methodology employed to conduct quality control inspections of the CFCS repairs, identifies specialized equipment developed for use in the inspections and highlights difficulties that can be encountered depending on the type and size of pipe being repaired. The paper concludes with a review of especially significant inspection procedures, problems and other quality control considerations.

This paper presents a new method for real-time tracking of target signal parameters in passive underwater acoustics. The method provides a recursive, closed-loop αβ tracking algorithm, in which gains α and β adapt automatically in a continuous-valued, instantaneous manner, to both received target signal-to-noise ratio variation, and target dynamical maneuvers.

Purpose. This article describes different options for the esthetic treatment of anterior teeth, starting with minimally invasive procedures, such as facial surface bleaching and bonding with composites. Methods. The importance of metal ceramic restorations, porcelain shoulder techniques, and metal free ceramics are also emphasized. The options are carefully demonstrated to identify advantages and limitations of each technique. (J Prosthet Dent 1997;78:437-40.)

Preschool-age children show a very strong tendency to map a novel noun onto an unfamiliar rather than a familiar object. This so-called disambiguation effect has been interpreted as evidence that youngers expect object labels to be mutually exclusive. In Experiment 1, 4-year-olds were observed to map a novel verb onto an unfamiliar action about twice as often as they mapped it onto a familiar one. When the unfamiliar action had been preexposed, but the familiar one had not, the mapping preference was eliminated. In Experiment 2, 4-year-olds mapped a novel noun onto an unfamiliar object about five times as often as they mapped it onto a familiar object, and this tendency was not affected by preexposure. Even when action embedding and question complexity were controlled, the disambiguation effect was stronger for object than for action words. An account is presented in which two lexical principles, Mutual Exclusivity and Feeling of Novelty, are hypothesized to apply differently to action than to object words.

In this single-subject study, an evaluation was completed to determine the effect of occupational therapy intervention on the oral intake of 3 children who had their nutritional needs met by nonoral methods prior to the administration of an oral feeding program. Treatment consisted of a gradual increase of food presentation with the application of behavioral management methods and the presentation of developmentally appropriate play activities. Oral intake was measured during baseline and intervention phases to establish the effect of intervention. An analysis indicated an increase in oral intake in the intervention phase in 2 of the 3 children. The results, that occupational therapy intervention can increase the oral intake of children in transition from nonoral to oral feeding, might be strengthened through the replication of this study on larger populations.

Little is known about the systematic impact of blur on reading performance. The purpose of this study was to quantify the effect of dioptric blur on reading performance in a group of normally sighted young adults. We measured monocular reading performance and visual acuity for 19 observers with normal vision, for five levels of optical blur (no-blur, 0.5, 1, 2, and 3D). Dioptric blur was induced using convex trial lenses placed in front of the testing eye, with the pupil dilated and in the presence of a 3 mm artificial pupil. Reading performance was assessed using eight versions of the MNREAD Acuity Chart. For each level of dioptric blur, observers read aloud sentences on one of these charts, from large to small print. Reading time for each sentence and the number of errors made were recorded and converted to reading speed in words per minute. Visual acuity was measured using 4-orientation Landolt C stimuli. For all levels of dioptric blur, reading speed increased with print size up to a certain print size and then remained constant at the maximum reading speed. By fitting nonlinear mixed-effects models, we found that the maximum reading speed was minimally affected by blur up to 2D, but was ∼23% slower for 3D of blur. When the amount of blur increased from 0 (no-blur) to 3D, the threshold print size (print size corresponded to 80% of the maximum reading speed) increased from 0.01 to 0.88 logMAR, reading acuity worsened from -0.16 to 0.58 logMAR, and visual acuity worsened from -0.19 to 0.64 logMAR. The similar rates of change with blur for threshold print size, reading acuity and visual acuity implicates that visual acuity is a good predictor of threshold print size and reading acuity. Like visual acuity, reading performance is susceptible to the degrading effect of optical blur. For increasing amount of blur, larger print sizes are required to attain the maximum reading speed. © 2007 Elsevier Ltd. All rights reserved., link_to_OA_fulltext

The past years have seen a change of emphasis in process control languages. Most of the software for the early process automation systems developed at the General Electric Process Computer Department was implemented in assembly language. Today, FORTRAN is being used at least partially in many of our applications. Some of our experiences in this area are briefly reviewed and evaluated and an opinion is expressed on what direction future efforts might be expected to take.

Members of the Society of Photo-Optical Instrumentation Engineers-members of the cooperating organizations participating in this sym-posium-distinguised guests-ladies and gentlemen-good morning. It is a pleasure to welcome you here to this exchange of ideas. Forums such as these continue to play a vital role in focusing the growth of technology and we in the military consider them highly valuable resources for disseminating some of the technical details of our needs and problems. We are indebted to SPIE and its cooperating organizations for providing the means and mechanics for this forum. We are also indebted to Bob LaGesse of McDonnell Douglas Corpora-tion for the sparking of the idea of this symposium and for the work that he and Ed Muehleck of Fairchild Weston Systems, Incorporated did in putting it together.© (1980) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The process of extracting parameters from acoustic signals is called "estimation" when the parameters are presumed constant over the observation interval, and is called "tracking" when the parameters are dynamic functions of time and must be estimated in real time by a causal processor. The \alpha \beta tracker configuration has become increasingly popular for tracking dynamic signal parameters in submarine sonar applications. This selection is natural for a number of reasons. The design procedure is simple and easy to implement in a digital processor. The configuration estimates rate explicitly and corrects for the lag normally encountered in a smoothing process. Finally, for a number of classes of signal models, the configuration results from a Kalman Filter development with "optimum" gains defined from the model. However, for some applications important to modern passive sonar systems, the tracking scenario cannot be modeled as a stationary, statistical model encompassing both signal-and geometry-related parameters. The design of any tracker involves a trade-off between dynamic following error and (signal processing related) random error. An \alpha \beta configuration has only two design parameters which can be optimized at a single design point. This point can be chosen to provide a best compromise over some portion of the desired operating range. To extend the operating range, it is necessary to adapt the tracker constants ( \alpha and \beta ) to changes in the tracker scenario. This must be accomplished in real time through available measurements in conjunction with an a priori model which relates those measurements to the tracking scenario. This process entails some risk because "mistuning" can result in loss of track in the original operating range. Presented herein is a design philosophy for \alpha \beta trackers and an adaptation procedure based on a combination of nonparametric estimators and heuristic logical constraints. The presentation is tutorial in nature and develops the design tools through application to both a generic tracker model and a specific (time) delay locked-loop example which is typical of many operational and developmental sonar tracking systems. Typical dynamic models are presented and the "traps" often encountered in adapting tracker gains are indicated, along with solutions provided by the design procedure.

The experimental doppler radar and antenna positioning system was developed by Cornell Aeronautical Laboratory, Inc., (CAL) for the U.S. Air Force Flight Dynamics Laboratory (AFFDL), Wright-Patterson Air Force Base, Ohio, under Contract No. F33615-69-C-1018. The radar and antenna positioning system is intended for use as a diagnostic instrument for measuring gas flow velocity in the AFFDL 50-Megawatt Electrogasdynamics Facility, and for investigating radar backscatter characteristics of the hypersonic flow with variations in arc heater input parameters. The equipment is installed in the facility test chamber and control room. The equipment is separated functionally into two assemblies: (1) the radar system for measuring flow characteristics, and (2) the antenna positioning system for remotely setting the location where the gas flow characteristics are measured.

Although the breast is the external body part most frequently amputated, little has been written about breast phantoms. From an original 92 item questionnaire completed by 104 post-mastectomy patients, it was found that 24 (23%) reported having had phantom breast sensations[1]. Itching was the most common sensation. While phantom pain was reported by eight of those 24 patients, it was minor in nature with only 1 patient requiring a simple anodyne for relief. There was no typical pattern of appearance of the phantom sensation. It most frequently began two to six months after the operation.

The RF system of the Stanford Linear Collider in California is subjected to daily temperature cycles of up to 15/spl deg/C. This can result in phase variations of 15/spl deg/ at 3 GHz over the 3 km length of the main drive line system. Subsystems show local changes of the order of 3/spl deg/ over 100 meters. When operating with flat beams and normalized emittances of 0.3*10/sup -5/ m-rad in the vertical plane, changes as small as 0.5/spl deg/ perturb the wakefield tail compensation and make continuous tuning necessary. Different approaches to stabilization of the RF phases and amplitudes are discussed.

S W Amos 1981 Kent: Butterworth 329 pp price ?15 It is a great achievement to produce a dictionary of electronics which is all but pocketable. This is achieved partly by making this the most fundamental of four allied dictionaries, the other three being the dictionaries of audio, radio and video; electrical engineering; and telecommunications, respectively.

K. G. Irwin London: Weidenfeld and Nicolson. 1967. Pp. 240. Price £1 10s. This remarkable book traces the progress of physics from the time of Archimedes in an original and fascinating way. We are told a lot about the lives and surroundings of the famous inventors and discoverers, of whom about 80 (from Aristotle to Fermi) are given more than passing mention.