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Science is key to developing sustainable products and solutions. But scientists also need to work more with governments, industry and society to help implement those solutions.

Infections after placement of cardiac implantable electronic devices (CIEDs) are associated with substantial morbidity and mortality. There is limited evidence on prophylactic strategies, other than the use of preoperative antibiotics, to prevent such infections.We conducted a randomized, controlled clinical trial to assess the safety and efficacy of an absorbable, antibiotic-eluting envelope in reducing the incidence of infection associated with CIED implantations. Patients who were undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator were randomly assigned, in a 1:1 ratio, to receive the envelope or not. Standard-of-care strategies to prevent infection were used in all patients. The primary end point was infection resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death, within 12 months after the CIED implantation procedure. The secondary end point for safety was procedure-related or system-related complications within 12 months.A total of 6983 patients underwent randomization: 3495 to the envelope group and 3488 to the control group. The primary end point occurred in 25 patients in the envelope group and 42 patients in the control group (12-month Kaplan-Meier estimated event rate, 0.7% and 1.2%, respectively; hazard ratio, 0.60; 95% confidence interval [CI], 0.36 to 0.98; P = 0.04). The safety end point occurred in 201 patients in the envelope group and 236 patients in the control group (12-month Kaplan-Meier estimated event rate, 6.0% and 6.9%, respectively; hazard ratio, 0.87; 95% CI, 0.72 to 1.06; P0.001 for noninferiority). The mean (±SD) duration of follow-up was 20.7±8.5 months. Major CIED-related infections through the entire follow-up period occurred in 32 patients in the envelope group and 51 patients in the control group (hazard ratio, 0.63; 95% CI, 0.40 to 0.98).Adjunctive use of an antibacterial envelope resulted in a significantly lower incidence of major CIED infections than standard-of-care infection-prevention strategies alone, without a higher incidence of complications. (Funded by Medtronic; WRAP-IT ClinicalTrials.gov number, NCT02277990.).

Prevalence was reduced, and early evidence indicates herd immunity., In 2008, a national human papillomavirus (HPV) immunization program using a bivalent vaccine against HPV types 16 and 18 was implemented in Scotland along with a national surveillance program designed to determine the longitudinal effects of vaccination on HPV infection at the population level. Each year during 2009–2013, the surveillance program conducted HPV testing on a proportion of liquid-based cytology samples from women undergoing their first cervical screening test for precancerous cervical disease. By linking vaccination, cervical screening, and HPV testing data, over the study period we found a decline in HPV types 16 and 18, significant decreases in HPV types 31, 33, and 45 (suggesting cross-protection), and a nonsignificant increase in HPV 51. In addition, among nonvaccinated women, HPV types 16 and 18 infections were significantly lower in 2013 than in 2009. Our results preliminarily indicate herd immunity and sustained effectiveness of the bivalent vaccine on virologic outcomes at the population level.

There is significant interest in optical fibers whose cross sections contain more than one single-mode core. Optical fibers are normally spliced together by removing the coating, cleaving the fiber ends so that their end faces are flat and perpendicular to the fiber axis and butting them together in a V-groove. The near field refers to the field of a fiber or waveguide on the far end face in air. The far field of a fiber or waveguide is the field emerging from its far end into air as measured at a sufficiently large distance from the end face. For single-mode fibers and waveguides with relatively small core sizes of the order of a few wavelengths of the source light, the far field is diffracted at the end face. Waveguides and fibers are illuminated by a variety of sources, including lasers, LEDs, or light propagating out of another fiber or waveguide.

Background: In Scotland, a national HPV immunisation programme began in 2008 for 12- to 13-year olds, with a catch-up campaign from 2008 to 2011 for those under the age of 18. To monitor the impact of HPV immunisation on cervical disease at the population level, a programme of national surveillance was established. Methods: We analysed colposcopy data from a cohort of women born between 1988 and 1992 who entered the Scottish Cervical Screening Programme (SCSP) and were aged 20–21 in 2008–2012. Results: By linking datasets from the SCSP and colposcopy services, we observed a significant reduction in diagnoses of cervical intraepithelial neoplasia 1 (CIN 1; RR 0.71, 95% CI 0.58 to 0.87; P=0.0008), CIN 2 (RR 0.5, 95% CI 0.4 to 0.63; P

The use of citizen science to obtain annotations from multiple annotators has been shown to be an effective method for annotating datasets in which computational methods alone are not feasible. The way in which the annotations are obtained is an important consideration which affects the quality of the resulting consensus annotation. In this paper, we examine three separate approaches to obtaining consensus scores for instances rather than merely binary classifications. To obtain a consensus score, annotators were asked to make annotations in one of three paradigms: classification, scoring and ranking. A web-based citizen science experiment is described which implements the three approaches as crowdsourced annotation tasks. The tasks are evaluated in relation to the accuracy and agreement among the participants using both simulated and real-world data from the experiment. The results show a clear difference in performance between the three tasks, with the ranking task obtaining the highest accuracy and agreement among the participants. We show how a simple evolutionary optimiser may be used to improve the performance by reweighting the importance of annotators.

1532-1827 Kavanagh, K Pollock, K G J Potts, A Love, J Cuschieri, K Cubie, H Robertson, C Donaghy, M Journal article Br J Cancer. 2014 Apr 15. doi: 10.1038/bjc.2014.198.; International audience; Background:In 2008, a national human papillomavirus (HPV) immunisation programme began in Scotland for 12-13 year old females with a three-year catch-up campaign for those under the age of 18. Since 2008, three-dose uptake of bivalent vaccine in the routine cohort aged 12-13 has exceeded 90% annually, while in the catch-up cohort overall uptake is 66%.Methods:To monitor the impact of HPV immunisation, a programme of national surveillance was established (pre and post introduction) which included yearly sampling and HPV genotyping of women attending for cervical screening at age 20. By linking individual vaccination, screening and HPV testing records, we aim to determine the impact of the immunisation programme on circulating type-specific HPV infection particularly for four outcomes: (i) the vaccine types HPV 16 or 18 (ii) types considered to be associated with cross-protection: HPV 31, 33 or 45; (iii) all other high-risk types and (iv) any HPV.Results:From a total of 4679 samples tested, we demonstrate that three doses (n=1100) of bivalent vaccine are associated with a significant reduction in prevalence of HPV 16 and 18 from 29.8% (95% confidence interval 28.3, 31.3%) to 13.6% (95% confidence interval 11.7, 15.8%). The data also suggest cross-protection against HPV 31, 33 and 45. HPV 51 and 56 emerged as the most prevalent (10.5% and 9.6%, respectively) non-vaccine high-risk types in those vaccinated, but at lower rates than HPV 16 (25.9%) in those unvaccinated.Conclusions:This data demonstrate the positive impact of bivalent vaccination on the prevalence of HPV 16, 18, 31, 33 and 45 in the target population and is encouraging for countries which have achieved high-vaccine uptake.British Journal of Cancer advance online publication, 15 April 2014; doi:10.1038/bjc.2014.198 www.bjcancer.com.

Aims: The IATPAD (Improvement in Access to Treatment for People with Alcohol and Drug Related Problems) study explored barriers and facilitators to accessing alcohol and drug treatment services in eight European countries.Methods: Results from individual interviews and focus group discussions with 246 service users who had experienced alcohol and drug treatment in Bulgaria, Greece, Italy, Poland, Slovakia, Slovenia, Spain and Scotland are described. Thematic analysis was used to interpret the data.Results: The study identified a number of consistent facilitating factors and barriers across all eight European countries, despite different health care systems. The results suggest that five main factors were implicated in the help-seeking behaviour of the service users interviewed. These were: information, service organisation, staff attitudes, significant others and personal disposition. All these factors could be viewed as both facilitators and barriers.Conclusions: To enhance access to alcohol and drug tre...

Objectives: Existing fluoride concentration and consumption data were used to estimate fluoride intakes from the diet and toothpaste use, for New Zealand sub-populations, to identify any population groups at risk of high-fluoride intake. Methods: For each sub-population, two separate dietary intake estimates were made – one based on a non-fluoridated water supply (fluoride concentration of 0.1 mg/L), and the other based on a water supply fluoridated to a concentration of 1.0 mg/L. Fluoride concentration data were taken from historical surveys, while food consumption data were taken from national 24-hour dietary recall surveys or from simulated diets. Results: Mean and 95th percentile estimations of dietary fluoride intake were well below the upper level of intake (UL), whether intakes were calculated on the basis of a non-fluoridated or fluoridated water supply. The use of fluoride-containing toothpastes provides additional fluoride intake. For many of the population groups considered, mean fluoride intakes were below the adequate intake (AI) level for caries protection, even after inclusion of the fluoride contribution from toothpaste. Intake of fluoride was driven by consumption of dietary staples (bread, potatoes), beverages (particularly tea, soft drinks, and beer), and the fluoride status of drinking water. Conclusion: Estimates of fluoride intake from the diet and toothpaste did not identify any groups at risk of exceeding the UL, with the exception of infants (6-12 months) living in areas with fluoridated water supplies and using high-fluoride toothpaste. In contrast, much of the adult population may be receiving insufficient fluoride for optimum caries protection from these sources, as represented by the AI.

In addition to the large number of patients with isolated limb injuries, many patients with major blunt or penetrating trauma harbor extremity injuries as a component of their overall clinical picture. Extremity injuries range from gross deformities and amputations to more subtle injuries, potentially difficult to diagnose, or may escape detection in unconscious or intoxicated patients. However, many soft tissue and vascular injuries require time sensitive interventions to ensure salvage of the limb and the best outcome for the patient. This article reviews the acute management of vascular and soft tissue injuries in the emergency department.

Aims and MethodTo evaluate the first 3 years of a newly developed service for the homeless mentally ill in Aberdeen. All 86 referrals to the service between 1996 and 1999 were reviewed.ResultsThe majority of referrals came from social care staff and self-referrals.Half were diagnosed as having severe and enduring mental illness and of these one-quarter (11 cases) were engaged in long-term psychiatric care. A total of 744 in-patient days were required, only one admission was a compulsory detention.Clinical ImplicationsIt has proven possible to identify and engage with a number of homeless individuals who have untreated serious mental illness by setting up a small dedicated service that has close links with an established adult mental health team and which establishes close working relationships with colleagues in social care settings.

In September 2008, Scotland introduced a national human papillomavirus (HPV) immunisation programme with bivalent HPV vaccine, to prevent cervical cancer. This school-based programme routinely vaccinates girls aged between 12 and 13 years. A catch-up campaign, running over three years, also began at this time, offering vaccination to all girls aged 13 years to under 18 years old. The HPV immunisation campaign presented challenges due to this vaccine being targeted to girls in school and older girls who had left school. Following a long and comprehensive planning process, this campaign was successfully implemented across Scotland, delivering high vaccine uptake of 91.4% for three doses of vaccine in the first year (September 2008 to August 2009) for the routine cohort and 90.1% in the second year (September 2009 to August 2010) for the routine cohort. We describe the planning process, challenges and implementation strategies employed to achieve this high uptake.

The use of citizen science to obtain annotations from multiple annotators has been shown to be an effective method for annotating datasets in which computational methods alone are not feasible. The way in which the annotations are obtained is an important consideration which affects the quality of the resulting consensus estimates. In this paper, we examine three separate approaches to obtaining scores for instances rather than merely classifications. To obtain a consensus score annotators were asked to make annotations in one of three paradigms: classification, scoring and ranking. A web-based citizen science experiment is described which implements the three approaches as crowdsourced annotation tasks. The tasks are evaluated in relation to the accuracy and agreement among the participants using both simulated and real-world data from the experiment. The results show a clear difference in performance between the three tasks, with the ranking task obtaining the highest accuracy and agreement among the participants. We show how a simple evolutionary optimiser may be used to improve the performance by reweighting the importance of annotators.

Sinka, Katy Kavanagh, Kimberley Gordon, Ruth Love, John Potts, Alison Donaghy, Martin Robertson, Chris eng England 2013/08/30 06:00 J Epidemiol Community Health. 2014 Jan;68(1):57-63. doi: 10.1136/jech-2013-202620. Epub 2013 Aug 28.; International audience; BACKGROUND AND METHODS: The national immunisation records of over 220,000 girls offered vaccine in the routine or catch-up programme of the Human papillomavirus (HPV) programme in Scotland were analysed. Descriptive statistics and multilevel modelling were used to determine individual and organisational factors associated with uptake. Age, school year, school denomination, deprivation and, for school-leavers, mode of delivery were explored. Additional aggregate data were used to examine the effect of late uptake of missed doses in the routine vaccination programme. RESULTS: School-based delivery initially achieved over 80% uptake of complete courses in routine and catch-up age groups. Within this context of generally high coverage, there was an association between individual level deprivation and lower uptake, and a decline in in-year course completion over time. However, later uptake of missed doses in the following year substantially decreased these effects. There was no influence on uptake of the type of school (non-denominational/denominational). Vaccination of school-leavers in the catch-up campaign had lower coverage, with 50% starting and 30% completing the course in-year. There was no clear advantage of vaccination through general practice or through Board-run clinics in reaching this group. CONCLUSIONS: School-based vaccination can achieve high and equitable uptake of a multidose vaccine in a routine immunisation programme. Sustained high coverage with HPV vaccine across Scotland provides a stable platform for planning future strategies for cervical screening and understanding the impact of the vaccination at a population level.

As procalcitonin concentrations have been shown to be elevated in patients with septicemia and gram-negative infections in particular, we proceeded to investigate the effect of endotoxin, a product of gram-negative bacteria, on procalcitonin concentrations in normal human volunteers. Endotoxin from Escherichia coli 0113:H10:k, was injected i.v. at a dose of 4 mg/kg BW into these healthy volunteers. Blood samples were obtained before and 1, 2, 4, 6, 8, and 24 h after injection of the endotoxin. Each patient's cardiovascular and overall clinical status was monitored over this period. The patients developed chills and rigors, myalgia, and fever between 1-3 h. Tumor necrosis factor-alpha levels increased sharply at 1 h and peaked at 90 min, reaching the baseline concentration thereafter by 6 h. Interleukin-6 levels increased more gradually, peaking at 3 h and reaching the baseline concentration at 8 h. The procalcitonin concentration, which was undetectable (10 pg/mL) at 0, 1, and 2 h, was detectable at 4 h and peaked at 6 h, maintaining a plateau through 8 and 24 h (4 ng/mL). There was no elevation of calcitonin concentrations, which remained below 10 pg/mL, the lowest sensitivity of the assay. Procalcitonin was measured by a two-antibody immunoradiometric assay specific for this peptide, with no cross-reactivity with calcitonin, katacalcin, or calcitonin gene-related peptide. We conclude that endotoxin induces the release of procalcitonin systemically, that this increase is not associated with an increase in calcitonin, and that the increase in procalcitonin associated with septicemia in patients may be mediated through the effect of endotoxin described here. Whether procalcitonin participates in the mechanisms underlying inflammation remains to be investigated.

In 2013, Wales and England experienced large outbreaks of measles, a disease that has been targeted by the World Health Organisation for European elimination by 2015. Unfortunately, measles-mumps-rubella vaccine uptake declined to less than 80% in Wales and England after the Wakefield publicity and this resulted in increased population susceptibility to measles. In Scotland, measles-mumps-rubella vaccine uptake dropped to 87% in 2003. Scottish public health efforts in response to this decline aimed to maximise uptake of MMR1 by two years; ensure at least 95% uptake of one dose of measles-mumps-rubella before starting school at age five; and maximise uptake of the second dose of measles-mumps-rubella by age six. Although Scotland has not had any large outbreaks reported to date, transmission of measles from healthcare workers to patients has occurred and reiterates the importance of all healthcare workers accurately knowing their immune status and, when needed, to be fully immunised.

In response to a serious homeland security threat exemplified by chemical plants with on-site stores of dangerous substances, rendered vulnerable by their locations on public waterways, we have developed and described a viable approach to persistent optical surveillance for detecting and assessing attacking adversaries sufficiently early to permit probable interdiction by a responding guard force. Last year we outlined the technical challenges and described some of the attributes, of a "smart camera system" as a key part of the overall security solution. We described the relative strengths and weaknesses of various sensors as well as the benefits of software systems that add a degree of intelligence to the sensor systems. In this paper we describe and elaborate the actual hardware and software implementation and operating protocols of this smart camera system. The result is a modular, configurable, upgradeable, open architecture, night-and-day video system that is highly capable today and able to grow to expanded capability in the future.

Millions of citizens live and work in the dangerous proximity of chemical plants, at ports and along waterways, which are under-protected and whose security is under-regulated, according to findings of the Congressional Research Service (CRS). There is a new and intense focus on the security of the nation's critical infrastructure. Thanks to recent philosophy and policy shifts within our federal government, the alarming situations in which we find ourselves will be mitigated somewhat a) by setting priorities based on proper threat analysis that considers event likelihoods and consequential impacts, and b) by employing effective systems design and engineering that will make it possible to address the highest priority threats with affordable solutions. It is the latter concern that we address, especially as it is relates to design and engineering of solutions for maintaining vigilance night and day. We begin by reviewing the nature of the facilities we wish to protect, our assumptions, and an accepted framework for analysis. Next we outline a hypothetical design case involving a representative facility and a plausible design basis threat. We then derive requirements for surveillance and examine the interrelationships among key design variables. Finally, we describe a solution involving multiple sensor types coupled with intelligent video. The end result is a significant increase in interdiction probability with a minimum of required assets.

What was it that drove Weber, arguably even to this day the foremost theoretician of modern western society and its historical evolution, to embark on a far-reaching series of investigations of non-western cultures? The question arises inevitably when one considers the sheer scale of Weber's writings on the world religions, all but encyclopedic in scope and displaying an extraordinary capacity of the part of their author in ordering and synthesizing the detailed historical materials involved (a task made all the more impressive given the technical difficulties arising from the undeveloped state of the documentary and scholarly sources at the time). Was all this effort required to establish the correctness of the Protestant ethic thesis? Or, was something further involved that went beyond the earlier problematic and transformed it? In what follows we shall assume that Weber's studies of the orient, along with his Ancient Judaism , constitute key parts of what was a major expansion and enhancement of the Protestant ethic thesis and concerned the daunting task of grasping the rationalization of the modern world in the context of universal history. Whilst the original umbrella title of the monographs he began to publish in 1915, The Economic Ethic of the World Religions , suggests Weber remained preoccupied with demonstrating via counter-factual comparisons the validity of the Protestant ethic thesis, the contents of the writings subsequently presented as well as the inclusion of several crucial linking essays indicate the problematic had been modified in important ways.

This paper presents summarized descriptions and applications of engineering, intermediate, and high level missile aerodynamics prediction methods developed and/or used by NEAR. The engineering level method is represented by the M3HAX experimental data based code, the intermediate level method includes the analytical panel-method based SUPDL/SUBDL and modified linear theory VTXCHN codes, and the high level methods include the NEARZEUS space marching Euler flow solver. All of the methods contain models to account for fin and body vorticity effects in the aerodynamic loads. The engineering and intermediate level methods are applied to the prediction of high angle of attack pitch plane and lateral aerodynamic characteristics of missiles at arbitrary roll angle and aerodynamic loads acting on conventional and chined body shapes, and to assess effects of fin-body gap on fin loads. The intermediate level methods are also employed in the design of nonconvention al fin planforms for minimum hinge moment The Euler flow solver is applied to the prediction of rolling moments acting on a canard configuration. Comparisons with experimental data are presented It is concluded that the missile aerodynamicist and/or designer should be aware of the availability and utility of the various levels of missile aerodynamics prediction methodology.

Rather than providing an encyclopedic review of extremity injuries, this article reviews selected serious injuries of the extremities that can be missed in the emergency department, either because they are relatively uncommon or because they are subtle in their clinical and radiographic presentation. They include injuries to the scapula, the shoulder, the forearm, the femur and hip, the knee, the tibia (which is the most common long bone fracture), and the ankle and foot. Their various causes include sports injuries, falls, and motor vehicle accidents. Several of these injuries can result in emergent complications or have time-dependent outcomes. Consequently, these injuries often must be managed by emergency physicians before specialist expertise becomes available.

The effect of sucralfate on the bioavailability of ciprofloxacin hydrochloride was assessed in 12 healthy male volunteers. The study was a four-period crossover design where subjects were randomized to one of four treatment sequences at entry. Treatments A, B, and C included sucralfate 2 g q 12h for five doses. For treatment A, the fifth dose of sucralfate was administered concurrently with ciprofloxacin 750 mg. For treatment B, 750 mg of ciprofloxacin was administered two hours before the fifth dose of sucralfate. Treatment C consisted of ciprofloxacin 750 mg six hours before the fifth dose of sucralfate. A 750-mg dose of ciprofloxacin was administered alone for treatment D. Blood and urine samples were collected at predetermined time intervals for 24 hours. Ciprofloxacin concentrations were determined by HPLC. The area under the concentration versus time curve from zero to infinity and the urinary recovery of ciprofloxacin were used for determining relative bioavailability. Concurrent administration of ciprofloxacin and sucralfate (treatment A) resulted in a significant decrease (p

Kavanagh, Kimberley Sinka, Katy Cuschieri, Kate Love, John Potts, Alison Pollock, Kevin G J Cubie, Heather Donaghy, Martin Robertson, Chris eng Research Support, Non-U.S. Gov't England 2013/11/06 06:00 BMC Infect Dis. 2013 Nov 5;13:519. doi: 10.1186/1471-2334-13-519.; International audience; BACKGROUND: Estimation of pre-immunisation prevalence of HPV and distribution of HPV types is fundamental to understanding the subsequent impact of HPV vaccination. We describe the type specific prevalence of HPV in females aged 20-21 in Scotland who attended or defaulted from cervical screening using three specimen types; from attenders liquid based cytology and from defaulters urine or self-taken swabs. METHODS: Residual liquid based cytology samples (n = 2148), collected from women aged 20-21 attending for their first smear were genotyped for HPV. A sample (n = 709) from women who had defaulted from screening was also made available for HPV testing through the use of postal testing kits (either urine samples (n = 378) or self-taken swabs (n = 331)). Estimates of prevalence weighted by deprivation, and for the postal testing kit, also by reminder status and specimen type were calculated for each HPV type. The distribution of HPV types were compared between specimen types and the occurrence of multiple high-risk infections examined. The influence of demographic factors on high-risk HPV positivity and multiple infections was examined via logistic regression. RESULTS: The prevalence of any HPV in young women aged 20-21 was 32.2% for urine, 39.5% for self-taken swab, and 49.4% for LBC specimens. Infection with vaccine specific types (HPV 16, 18) or those associated with cross-protection (HPV 31, 33, 45, 51) was common. Individuals were more likely to test positive for high-risk HPV if they resided in an area of high deprivation or in a rural area. The overall distribution of HPV types did not vary between defaulters and attenders. Multiple infections occurred in 48.1% of high-risk HPV positive individuals. Excluding vaccine types the most common pairing was HPV 56 and 66. CONCLUSIONS: Understanding of the pre-immunisation prevalence of HPV in young women puts Scotland in a prime position to assess the early effect of vaccination as the first highly vaccinated cohorts of individuals enter the screening programme. Differences in results with different specimen types must be taken into account when monitoring the impact of vaccination programmes.

To the Editor.— The crab louse,Phthirus pubis, is commonly found on hairs in the pubic region, although it may also be found on the abdomen, thigh, eyelashes, eyebrows, axillae, trunk, and perianal area.1In 1918, Nuttall2refers to several earlier reports of crab lice occurring in the scalp hair and regarded such cases as very rare, especially in adults.Phthirus pubisscalp infestation without other body infestation is presumed even less common.3,4We describe an adult woman withP pubisscalp infestation in the absence of other body involvement. Report of a Case.— A 25-year-old woman complained of posterior scalp pruritus and irritation of one week's duration. She denied rashes, chills, fever, or sweats, and was feeling well otherwise. Several weeks earlier, her three school-aged children had similar complaints of posterior scalp pruritus, and were informed by school officials that they had "head lice."