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In response to the COVID-19 pandemic, countries have sought to control SARS-CoV-2 transmission by restricting population movement through social distancing interventions, thus reducing the number of contacts. Mobility data represent an important proxy measure of social distancing, and here, we characterise the relationship between transmission and mobility for 52 countries around the world. Transmission significantly decreased with the initial reduction in mobility in 73% of the countries analysed, but we found evidence of decoupling of transmission and mobility following the relaxation of strict control measures for 80% of countries. For the majority of countries, mobility explained a substantial proportion of the variation in transmissibility (median adjusted R-squared: 48%, interquartile range - IQR - across countries [27–77%]). Where a change in the relationship occurred, predictive ability decreased after the relaxation; from a median adjusted R-squared of 74% (IQR across countries [49–91%]) pre-relaxation, to a median adjusted R-squared of 30% (IQR across countries [12–48%]) post-relaxation. In countries with a clear relationship between mobility and transmission both before and after strict control measures were relaxed, mobility was associated with lower transmission rates after control measures were relaxed indicating that the beneficial effects of ongoing social distancing behaviours were substantial., Social distancing policies aiming to reduce COVID-19 transmission have been reflected in reductions in human mobility. Here, the authors show that reduced mobility is correlated with decreased transmission, but that this relationship weakened over time as social distancing measures were relaxed.

As of 1st June 2020, the US Centres for Disease Control and Prevention reported 104,232 confirmed or probable COVID-19-related deaths in the US. This was more than twice the number of deaths reported in the next most severely impacted country. We jointly model the US epidemic at the state-level, using publicly available death data within a Bayesian hierarchical semi-mechanistic framework. For each state, we estimate the number of individuals that have been infected, the number of individuals that are currently infectious and the time-varying reproduction number (the average number of secondary infections caused by an infected person). We use changes in mobility to capture the impact that non-pharmaceutical interventions and other behaviour changes have on the rate of transmission of SARS-CoV-2. We estimate that Rt was only below one in 23 states on 1st June. We also estimate that 3.7% [3.4%–4.0%] of the total population of the US had been infected, with wide variation between states, and approximately 0.01% of the population was infectious. We demonstrate good 3 week model forecasts of deaths with low error and good coverage of our credible intervals., High numbers of COVID-19-related deaths have been reported in the United States, but estimation of the true numbers of infections is challenging. Here, the authors estimate that on 1 June 2020, 3.7% of the US population was infected with SARS-CoV-2, and 0.01% was infectious, with wide variation by state.

Highlights • COVID-19 measures were applied at similar dates across provinces in China • Hubei showed much greater disease severity compared to other provinces • Provincial data on epidemics and interventions are available for further research, Objectives This data collation effort aims to provide a comprehensive database to describe the epidemic trends and responses during the first wave of coronavirus disease 2019 (COVID-19) across main provinces in China. Methods From mid-January to March 2020, we extracted publicly available data on the spread and control of COVID-19 from 31 provincial health authorities and major media outlets in mainland China. Based on these data, we conducted a descriptive analysis of the epidemics in the six most-affected provinces. Results School closures, travel restrictions, community-level lockdown, and contact tracing were introduced concurrently around late January but subsequent epidemic trends were different across provinces. Compared to Hubei, the other five most-affected provinces reported a lower crude case fatality ratio and proportion of critical and severe hospitalised cases. From March 2020, as local transmission of COVID-19 declined, switching the focus of measures to testing and quarantine of inbound travellers could help to sustain the control of the epidemic. Conclusions Aggregated indicators of case notifications and severity distributions are essential for monitoring an epidemic. A publicly available database with these indicators and information on control measures provides a useful source for exploring further research and policy planning for response to the COVID-19 epidemic.

Highlight We estimated SARS-CoV-2 infection prevalence in cohorts of repatriated citizens from Wuhan to be 0.44% (95% CI: 0.19%–1.03%). Although not representative of the wider population we believe these estimates are helpful in providing a conservative estimate of infection prevalence in Wuhan City, China, in the absence of large-scale population testing early in the epidemic.

As of 1st June 2020, the US Centers for Disease Control and Prevention reported 104,232 confirmed or probable COVID-19-related deaths in the US. This was more than twice the number of deaths reported in the next most severely impacted country. We jointly modelled the US epidemic at the state-level, using publicly available death data within a Bayesian hierarchical semi-mechanistic framework. For each state, we estimate the number of individuals that have been infected, the number of individuals that are currently infectious and the time-varying reproduction number (the average number of secondary infections caused by an infected person). We used changes in mobility to capture the impact that non-pharmaceutical interventions and other behaviour changes have on the rate of transmission of SARS-CoV-2. Nationally, we estimated 3.7% [3.4%-4.0%] of the population had been infected by 1st June 2020, with wide variation between states, and approximately 0.01% of the population was infectious. We also demonstrated that good model forecasts of deaths for the next 3 weeks with low error and good coverage of our credible intervals.

BackgroundEngland has experienced one of the highest rates of confirmed COVID-19 mortality in the world. SARS-CoV-2 virus has circulated in hospitals, care homes and the community since January 2020. Our current epidemiological knowledge is largely informed by clinical cases with far less understanding of community transmission.MethodsThe REal-time Assessment of Community Transmission (REACT) study is a nationally representative prevalence survey of SARS-CoV-2 virus swab-positivity in the community in England. We recruited participants regardless of symptom status.ResultsWe found 159 positives from 120,610 swabs giving an average prevalence of 0.13% (95% CI: 0.11%,0.15%) from 1st May to 1st June 2020. We showed decreasing prevalence with a halving time of 8.6 (6.2, 13.6) days, implying an overall reproduction number R of 0.57 (0.45, 0.72). Adults aged 18 to 24 yrs had the highest swab-positivity rates, while those >64 yrs had the lowest. Of the 126 participants who tested positive with known symptom status in the week prior to their swab, 39 reported symptoms while 87 did not, giving an estimate that 69% (61%,76%) of people were symptom-free for the 7 days prior testing positive in our community sample. Symptoms strongly associated with swab-positivity were: nausea and/or vomiting, diarrhoea, blocked nose, loss of smell, loss of taste, headache, chills and severe fatigue. Recent contact with a known COVID-19 case was associated with odds of 24 (16, 38) for swab-positivity. Compared with non-key workers, odds of swab-positivity were 7.7 (2.4, 25) among care home (long-term care facilities) workers and 5.2 (2.9, 9.3) among health care workers. However, some of the excess risk associated with key worker status was explained by recent contact with COVID-19 cases. We found no strong evidence for geographical variability in positive swab results.ConclusionOur results provide a reliable baseline against which the impact of subsequent relaxation of lockdown can be assessed to inform future public health efforts to control transmission.

With the tremendous rise in the aging population around the world, the prevalence of Major Neurocognitive Disorders is skyrocketing. In the same manner, the burden of the morbidity and mortality associated with the such disorders has been a global health problem. Most of the time, the cause of Major Neurocognitive Disorder is unknown. Our review article is an attempt to summarize the likely modifiable risk factors associated with the disorder. In this manner there could be insight into further confirmatory and exploratory evidence based studies of these factors for early intervention to prevent and delay the progression of full blown disease. Among the modifiable risk factors, the ones that have been discussed here are smoking, activity both physical and cognitive, cardiovascular risk factors, depression, traumatic brain injury and sleep.J Psychiatrists’ Association of Nepal Vol. 6, No. 2, 2017, Page: 3-7

Background: Increasing antibiotic resistance in a location may be mitigated by changes in treatment policy, or interventions to limit transmission of resistant bacteria. Therefore, accurate forecasting of the distribution of antibiotic resistance could be advantageous. Two previously published studies addressed this, but neither study compared alternative forecasting algorithms or considered spatial patterns of resistance spread. Methods: We analysed data describing the annual prevalence of antibiotic resistance per country in Europe from 2012 – 2016, and the quarterly prevalence of antibiotic resistance per clinical commissioning group in England from 2015 – 2018. We combined these with data on rates of possible covariates of resistance. These data were used to compare the previously published forecasting models, with other commonly used forecasting models, including one geospatial model. Covariates were incorporated into the geospatial model to assess their relationship with antibiotic resistance. Results: For the European data, which was recorded on a coarse spatiotemporal scale, a naïve forecasting model was consistently the most accurate of any of the forecasting models tested. The geospatial model did not improve on this accuracy. However, it did provide some evidence that antibiotic consumption can partially explain the distribution of resistance. The English data were aggregated at a finer scale, and expected-trend-seasonal (ETS) forecasts were the most accurate. The geospatial model did not significantly improve upon the median accuracy of the ETS model, but it appeared to be less sensitive to noise in the data, and provided evidence that rates of antibiotic prescription and bacteraemia are correlated with resistance. Conclusion: Annual, national-level surveillance data appears to be insufficient for fitting accurate antibiotic resistance forecasting models, but there is evidence that data collected at a finer spatiotemporal scale could be used to improve forecast accuracy. Additionally, incorporating antibiotic prescription or consumption data into the model could improve the predictive accuracy.

Background: Since early March 2020, the COVID-19 epidemic across the United Kingdom has led to a range of social distancing policies, which have resulted in reduced mobility across different regions. Crowd level data on mobile phone usage can be used as a proxy for actual population mobility patterns and provide a way of quantifying the impact of social distancing measures on changes in mobility. Methods: Here, we use two mobile phone-based datasets (anonymised and aggregated crowd level data from O2 and from the Facebook app on mobile phones) to assess changes in average mobility, both overall and broken down into high and low population density areas, and changes in the distribution of journey lengths. Results: We show that there was a substantial overall reduction in mobility, with the most rapid decline on the 24th March 2020, the day after the Prime Minister’s announcement of an enforced lockdown. The reduction in mobility was highly synchronized across the UK. Although mobility has remained low since 26th March 2020, we detect a gradual increase since that time. We also show that the two different datasets produce similar trends, albeit with some location-specific differences. We see slightly larger reductions in average mobility in high-density areas than in low-density areas, with greater variation in mobility in the high-density areas: some high-density areas eliminated almost all mobility. Conclusions: These analyses form a baseline from which to observe changes in behaviour in the UK as social distancing is eased and inform policy towards the future control of SARS-CoV-2 in the UK.

The sonographic identification of the normal appendix is crucial to the success of ultrasound as an effective screening method for diagnosing acute appendicitis. The normal appendix can be challenging to identify on sonography, however, because it is a narrow tubular structure and has variable sonographic appearances. Moreover, the tip of the appendix can be quite variable in location. In this article, we review the various sonographic appearances of the normal appendix and highlight strategies to improve its visualization.

The purpose of this study was to analyze the multidetector computed tomography (MDCT) morphologic characteristics of non-aortic acute vascular injuries (AVI) in patients with blunt abdominopelvic trauma that predict treatment.CT scans of 65 trauma patients with non-aortic AVI were reviewed. AVI morphology was categorized as linear or round. The organ of involvement, location of hemorrhage, initial size of hematoma, and hemodynamic status were recorded. Expansion rates of the hematoma were calculated in 40 patients who had delayed imaging. Multivariate regression was used to analyze the morphologic features of AVI and treatment.Patients with linear AVI were four times more likely to require aggressive treatment (surgery or embolization) than those with a round morphology, independent of the hemodynamic status. There was no main effect of the organ involved, location of hemorrhage, initial bleed size, or expansion rate on the probability of aggressive treatment.The location, initial size, and expansion rate of AVI are not significant predictors of aggressive treatment with surgery or embolization. Linear morphology of AVI, however, is more likely to require aggressive treatment than round AVI, independent of the hemodynamic status. Linear AVI likely reflects a spurting jet of active extravasation, whereas round AVI likely represents a pseudoaneurysm or slow bleed.

Few studies have investigated the relationships between static, elementary neurocognitive functions, dynamic measures of learning potential and functional status in schizophrenia, despite the putative role of learning potential in models of the relationship between static neurocognitive function and functional status (e.g., Green et al., 2000). The current study sought to clarify these relationships. One-hundred and twenty-five outpatients with schizophrenia were administered the California Verbal Learning Test-II (CVLT-II), as an index of learning potential, along with measures of sustained attention, verbal prose recall, working memory, problem-solving and processing speed, and a capacity measure of everyday life skills (Study 1). A subset of 48 outpatients with schizophrenia who were impaired on the Wisconsin Card Sorting Test (WCST) were also administered a test-train-test version of the WCST as a second measure of learning potential (Study 2). As expected, several static, elementary neurocognitive measures were linked to measures of everyday life skills in both samples. There was no evidence, however, that either measure of learning potential contributed unique variance beyond that explained by elementary cognitive skill to measures of everyday life skills. Learning potential was also tested as a mediator and moderator of the relationship between static neurocognitive function and measures of everyday life skills. Neither learning potential measure mediated the relationship between static measures of neurocognition and everyday life skills. Learning potential, as measured by the CVLT-II, was found to moderate the relationship of processing speed and everyday life skills. Taken together, these findings raise questions as to the explanatory value of measures of learning potential as predictors of functional status in schizophrenia.

El presente artículo tiene como objetivo profundizar en cómo los estigmas sociales asociados al hecho de ser joven con consumo problemático de sustancias y antecedentes de infracción de ley, tiene implicancias directas en el proceso de construcción del autoconcepto y elección ocupacional. Para abordar dicha temática, se desarrolló una revisión sistemática de literatura, donde se exploró el autoconcepto como limitante de la elección ocupacional en esta población. Para el desarrollo de la investigación fueron incluidos treinta y cinco artículos, en los cuales existía relación entre las palabras claves propuestas. Aun cuando no fue posible encontrar bibliografía que respondiera directamente a la pregunta de investigación, a través de la articulación de los resultados recogidos fue posible afirmar el supuesto planteado.

A common account of the distinction between modern and classical regimes holds that classical regimes directly regulate human conduct, seeking to produce citizens consistent with a certain understanding of human virtue or excellence, whereas modern regimes use law only to keep people safe, leaving them free to pursue happiness as each individual understands it. However, such a distinction made with too fine a point neglects that a great deal of policy in modern society indirectly shapes human behavior by altering patterns of incentives and resources. The manner in which behavior responds to a given distribution of resources lies at the heart of economics. How one ought to behave under any circumstances is the subject matter of ethics. Therefore, if altering existing resources for the sake of foreclosing undesirable actions and inducing desirable actions is a goal of public policy, the study of policy necessarily takes place at the intersection of economics and ethics. In modern society, the policymaker's interest naturally turns to the market, and an interest in markets necessarily implies an interest in the private. The venue of market behavior is the private sector and the tools that enable or restrict market activity are, broadly speaking, private property or resources gained through property. More specifically, laws aimed at land use, taxation, regulatory policy, the relationship between employer and employee, and even social programs are all, to some extent, based on formulating rules regarding the acquisition, use, and transfer of property. Such an endeavor implies that those involved in policy making have an empirical understanding of the way existing rules influence behavior and that they have speculative knowledge of how altered rules would bring about better outcomes. Consequently, a great deal of public policy is based on tacit assumptions about the relationship between property and human nature: the policymaker assumes to know the needs that actuate the desire for property in the first place, the expectations regarding property's ability to satisfy those needs, and also the way those expectations shape people's interactions with one another. Yet, there seems to be little agreement on these matters, suggesting inadequate attention to the relationship between human nature and property. The relationship was a matter of great interest to one of the early liberal philosophers, John Locke. However, Locke offered no single, clear articulation of his understanding. Several commentaries reflect the disjointed nature of his presentation. Some note the difficulty in reconciling Locke's empiricist account of human nature in his Essay Concerning Human Understanding with the rationalistic account of ethics in his First and Second Treatises (Dunn 1969; Laslett 1988). These interpretations claim Locke had to depart from his teaching in the Essay in order to establish a better epistemological foundation for his political economy. Another writer attributes the apparent shift from the Essay to the Treatises to Locke's need to ground his political ideas in Natural Law and Christianity (Ashcraft 1986). Only one interpretation attempts to reconcile Locke's empiricism and his rationalism (Myers 1998), offering a much needed correction to John Yolton's interpretation of the Essay (1956, 1970). Yet the argument is confined to connecting the Essay's empiricism and the Treatises' politics, offering scant attention to the difference between the two accounts of human nature and ethics. Others have focused on the relationship between Locke's ethics and political economy within the Treatises, setting aside their relationship to the Essay. In this literature, the task becomes one of finding consistency between Locke's appeal to the Law of Nature and his account of private property. Some make the connection through a communitarian interpretation of Locke's doctrine of property, beginning with Tully (1980) and further developed by Sreenivasan (1995) and Kramer (1997). …

In The Unheavenly City, Edward Banfield argues that people form social classes based on their perception of time. The radically present oriented constitute a lower class whose presence explains soc...

This article considers the relationship between policy design and the pattern of interests attracted to the political arena. It examines legislation crafted by a large coalition of diverse interests that designed policy favorable to problem solving. This is the kind of policymaking that regime theorists identify with social production—but also one considered a rare circumstance. Previous attempts at passing similar legislation failed because the problem was defined narrowly and the political arena contained only two stakeholders, offering no opportunity to introduce a change that benefited one without harming the other. Success required redefining the problem and changing the nature of the political arena in a manner similar to that described by Schattschneider. By doing so, diverse interests discovered a way to benefit collectively. The present case therefore demonstrates the advantage of coupling the strategic insight of Schattschneider with the normative goals of regime theorists.

Ultrasonography is a useful imaging modality for assessing cervical lymphadenopathy in patients with head and neck carcinomas. Features of cervical lymph nodes using gray-scale and color and power Doppler ultrasonography can help to distinguish normal and reactive lymph nodes from potentially metastatic lymph nodes. The distinguishing features that separate abnormal from normal cervical lymph nodes include peripheral vascularity, shape, overall lymph node echogenicity, absence of hilus, presence of nodal microcalcifications, and cystic changes. Often, a combination of these features is needed to assign a cervical lymph node as being abnormal.

The management of thyroid nodules is a common clinical problem. Thyroid nodules are present in up to 50% of the adult population. However, thyroid malignancy is rare, occurring in only 5% to 15% of nodules. Although certain specific patterns on imaging are almost always indicative of benignity, there is considerable overlap between the sonographic appearances of benign and malignant nodules. Radiologists should be wary of applying pattern recognition approaches too liberally as some malignant nodules may exhibit sonographic features more commonly associated with benign nodules such as cystic change, comet-tail artifact, smooth margins, echogenic echotexture, hypoechoic halos, or peripheral calcifications. This article illustrates atypical imaging appearances of thyroid malignancies and reviews recent literature in an attempt to clarify nuances in the diagnosis of malignancy in benign-appearing nodules.

We study the diffusion of an atomic probe in materials used in restorative dentistry. We rely on computer simulation and on a version of transition state theory to access the diffusion regimes of interest. We find that the calculated logD values are in good agreement with reported results in other glassy polymeric materials. We report the effect of atomic mass and probe radius on the diffusion process.

We study the diffusion behavior of a probe, in monomers containing acryloxy and acrylate units that are commonly used in restorative dentistry. We apply a version of transition state theory with satisfactory results. Results show that transition state theory describes part of the underlying physics successfully thus reinforcing its applicability as a complement and extension to molecular dynamics simulations.

A broadband, active doubler based on asymmetrically biased differential pairs delivers conversion gain (CG) from DC to 100GHz. Measured CG is >10dB up to 50GHz, >6dB up to 80GHz, and >0dB up to 100GHz. Second-harmonic (4x the input) suppression is −28dBc at 50GHz. Implemented in a 90nm SiGe technology, the 0.371mm2 multiplier core consumes 25mA from a 4.5V supply.

Nonparametric regression techniques have been studied extensively in the literature in recent years due to their flexibility. In addition, robust versions of these techniques have become popular and have been incorporated into some of the standard statistical analysis packages. With new techniques available comes the responsibility of using them properly and in appropriate situations. Often, as in the case presented here, model-fitting diagnostics, such as cross-validation statistics, are not available as tools to determine if the smoothing parameter value being used is preferable to some other arbitrarily chosen value. We present not only a robust nonparametric regression technique that is a strong competitor to the current standard (Loess (Cleveland, 1979)), but also an adjusted cross-validation statistic that can be used to select the bandwidth when it can be assumed that outliers are contained in the data. We present the form of the estimators to be compared, the theoretical bias and variance calculations based on the underlying model that we assume, the cross-validation technique and the rationale for its components, and a simulation study (single regressor case) that is employed to compare the estimators across varying sample sizes and departures of the true curve from the assumed model. The robust local linear regression (RLLR) fitting procedure using the adjusted cross-validation statistic demonstrates superiority over currently available fitting techniques (Loess using the default bandwidth value provided by a popular statistical software package, and M-Regression) when there is a moderate to significant amount of curvature in the true underlying model. In addition, simulations indicate that the proposed technique may be the superior fitting method, based on mean squared error values averaged across simulated fits, for relatively small sample sizes (n < 50) across a varying amounts of curvature over Loess and M-Regression.