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This review paper describes the energy-upgraded Continuous Electron Beam Accelerator Facility (CEBAF) accelerator. This superconducting linac has achieved 12 GeV beam energy by adding 11 new high-performance cryomodules containing 88 superconducting cavities that have operated cw at an average accelerating gradient of 20 MV/m. After reviewing the attributes and performance of the previous 6 GeV CEBAF accelerator, we discuss the upgraded CEBAF accelerator system in detail with particular attention paid to the new beam acceleration systems. In addition to doubling the acceleration in each linac, the upgrade included improving the beam recirculation magnets, adding more helium cooling capacity to allow the newly installed modules to run cold, adding a new experimental hall, and improving numerous other accelerator components. We review several of the techniques deployed to operate and analyze the accelerator performance and document system operating experience and performance. In the final portion of the document, we present much of the current planning regarding projects to improve accelerator performance and enhance operating margins, and our plans for ensuring CEBAF operates reliably into the future. For the benefit of potential users of CEBAF, the performance and quality measures for the beam delivered to each of the experimental halls are summarized in the Appendix.

BackgroundSleep problems are common and costly in the US military. Yet, within the military health system, there is a gross shortage of trained specialist providers to address sleep problems. As a result, demand for sleep medicine care far exceeds the available supply. Telehealth including telemedicine, mobile health, and wearables represents promising approaches to increase access to high-quality and cost-effective care. ObjectiveThe purpose of this study was to evaluate patient engagement and provider perceived effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military. The platform includes a desktop web portal, native mobile app, and integrated wearable sensors (ie, a commercial off-the-shelf sleep tracker [Fitbit]). The goal of the remote monitoring assessment was to provide evidence-based sleep treatment recommendations to patients and providers. MethodsPatients with sleep problems were recruited from the Internal Medicine clinic at Walter Reed National Military Medical Center. Patients completed intensive remote monitoring assessments over 10 days (including a baseline intake questionnaire, daily sleep diaries, and 2 daily symptom surveys), and wore a Fitbit sleep tracker. Following the remote monitoring period, patients received assessment results and personalized sleep education in the mobile app. In parallel, providers received a provisional patient assessment report in an editable electronic document format. Patient engagement was assessed via behavioral adherence metrics that were determined a priori. Patients also completed a brief survey regarding ease of completion. Provider effectiveness was assessed via an anonymous survey. ResultsIn total, 35 patients with sleep problems participated in the study. There were no dropouts. Results indicated a high level of engagement with the sleep telehealth platform, with all participants having completed the baseline remote assessment, reviewed their personalized sleep assessment report, and completed the satisfaction survey. Patients completed 95.1% of sleep diaries and 95.3% of symptom surveys over 10 days. Patients reported high levels of satisfaction with most aspects of the remote monitoring assessment. In total, 24 primary care providers also participated and completed the anonymous survey. The results indicate high levels of perceived effectiveness and identified important potential benefits from adopting a sleep telehealth approach throughout the US military health care system. ConclusionsMilitary patients with sleep problems and military primary care providers demonstrated high levels of engagement and satisfaction with a novel sleep telehealth platform and remote monitoring assessment. Sleep telehealth approaches represent a potential pathway to increase access to evidence-based sleep medicine care in the US military. Further evaluation is warranted.

OBJECTIVE: Ubiquitous technologies can be leveraged to construct ecologically relevant metrics that complement traditional psychological assessments. This study aims to determine the feasibility of smartphone-derived real-world keyboard metadata to serve as digital biomarkers of mood. MATERIALS AND METHODS: BiAffect, a real-world observation study based on a freely available iPhone app, allowed the unobtrusive collection of typing metadata through a custom virtual keyboard that replaces the default keyboard. User demographics and self-reports for depression severity (Patient Health Questionnaire-8) were also collected. Using >14 million keypresses from 250 users who reported demographic information and a subset of 147 users who additionally completed at least 1 Patient Health Questionnaire, we employed hierarchical growth curve mixed-effects models to capture the effects of mood, demographics, and time of day on keyboard metadata. RESULTS: We analyzed 86 541 typing sessions associated with a total of 543 Patient Health Questionnaires. Results showed that more severe depression relates to more variable typing speed (P

The US Centers for Disease Control and Prevention (CDC) supports international partners in introducing vaccines, including those against SARS-CoV-2 virus. CDC contributes to the development of global technical tools, guidance, and policy for COVID-19 vaccination and has established its COVID-19 International Vaccine Implementation and Evaluation (CIVIE) program. CIVIE supports ministries of health and their partner organizations in developing or strengthening their national capacities for the planning, implementation, and evaluation of COVID-19 vaccination programs. CIVIE’s 7 priority areas for country-specific technical assistance are vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation. We discuss CDC’s work on global COVID-19 vaccine implementation, including priorities, challenges, opportunities, and applicable lessons learned from prior experiences with Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions.

The influence of environmental factors on the development of autoimmune disease is being broadly investigated to better understand the multifactorial nature of autoimmune pathogenesis and to identify potential areas of intervention. Areas of particular interest include the influence of lifestyle, nutrition, and vitamin deficiencies on autoimmunity and chronic inflammation. In this review, we discuss how particular lifestyles and dietary patterns may contribute to or modulate autoimmunity. We explored this concept through a spectrum of several autoimmune diseases including Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE) and Alopecia Areata (AA) affecting the central nervous system, whole body, and the hair follicles, respectively. A clear commonality between the autoimmune conditions of interest here is low Vitamin D, a well-researched hormone in the context of autoimmunity with pleiotropic immunomodulatory and anti-inflammatory effects. While low levels are often correlated with disease activity and progression in MS and AA, the relationship is less clear in SLE. Despite strong associations with autoimmunity, we lack conclusive evidence which elucidates its role in contributing to pathogenesis or simply as a result of chronic inflammation. In a similar vein, other vitamins impacting the development and course of these diseases are explored in this review, and overall diet and lifestyle. Recent work exploring the effects of dietary interventions on MS showed that a balanced diet was linked to improvement in clinical parameters, comorbid conditions, and overall quality of life for patients. In patients with MS, SLE and AA, certain diets and supplements are linked to lower incidence and improved symptoms. Conversely, obesity during adolescence was linked with higher incidence of MS while in SLE it was associated with organ damage. Autoimmunity is thought to emerge from the complex interplay between environmental factors and genetic background. Although the scope of this review focuses on environmental factors, it is imperative to elaborate the interaction between genetic susceptibility and environment due to the multifactorial origin of these disease. Here, we offer a comprehensive review about the influence of recent environmental and lifestyle factors on these autoimmune diseases and potential translation into therapeutic interventions.

The Journal of Genetic Psychology, established in 1891, is the first scholarly journal dedicated to developmental psychology. Despite its name, the term "Genetic" does not refer to genetics in the modern sense, but rather to development. The journal focuses on research and theory within the field of developmental psychology, with an emphasis on a life-span approach. A recent study conducted a scientometric analysis of the journal's publications, identifying major thematic domains and influential documents. The analysis revealed clusters of research on topics such as prosocial behavior, moral judgment, and gender differences. The article presents the findings of this analysis, discussing 13 major thematic clusters in the literature, covering topics such as cognition, gender roles, and parental behavior. The article highlights the journal's commitment to diversity and its representation of authors from different countries. [Extracted from the article]

Abstract Background Simulation exercises can functionally validate World Health Organization (WHO) International Health Regulations (IHR 2005) core capacities. In 2018, the Vietnam Ministry of Health (MOH) conducted a full-scale exercise (FSX) in response to cases of severe viral pneumonia with subsequent laboratory confirmation for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) to evaluate the country’s early warning and response capabilities for high-risk events. Methods An exercise planning team designed a complex fictitious scenario beginning with one case of severe viral pneumonia presenting at the hospital level and developed all the materials required for the exercise. Actors, controllers and evaluators were trained. In August 2018, a 3-day exercise was conducted in Quang Ninh province and Hanoi city, with participation of public health partners at the community, district, province, regional and national levels. Immediate debriefings and an after-action review were conducted after all exercise activities. Participants assessed overall exercise design, conduction and usefulness. Results FSX findings demonstrated that the event-based surveillance component of the MOH surveillance system worked optimally at different administrative levels. Detection and reporting of signals at the community and health facility levels were appropriate. Triage, verification and risk assessment were successfully implemented to identify a high-risk event and trigger timely response. The FSX identified infection control, coordination with internal and external response partners and process documentation as response challenges. Participants positively evaluated the exercise training and design. Conclusions This exercise documents the value of exercising surveillance capabilities as part of a real-time operational scenario before facing a true emergency. The timing of this exercise and choice of disease scenario was particularly fortuitous given the subsequent appearance of COVID-19. As a result of this exercise and subsequent improvements made by the MOH, the country may have been better able to deal with the emergence of SARS-CoV-2 and contain it.

Event-based surveillance (EBS) is the organised approach to the detection and reporting of ‘signals,’ defined as information that may represent events of public health importance, often through channels outside of routine surveillance systems. Signals can be designed to detect patterns of disease, such as clusters of similar illness in a community, or clusters of disease or death in animals. Signals can also include single cases of suspected high-priority events such a patient with viral haemorrhagic fever. EBS can be a key component of an effective early warning system, which enables countries to be better prepared for endemic and pandemic illness outbreaks. EBS uses an all-hazards approach that includes the principles of One Health. This review covers the concept and process of EBS, different sources for EBS data, and methods to obtain information from these sources. This overview will aid countries in implementing this important form of surveillance.

Abstract Background In 2016–2017, Vietnam’s Ministry of Health (MoH) implemented an event-based surveillance (EBS) pilot project in six provinces as part of Global Health Security Agenda (GHSA) efforts. This manuscript describes development and design of tools for monitoring and evaluation (M&E) of EBS in Vietnam. Methods A strategic EBS framework was developed based on the EBS implementation pilot project’s goals and objectives. The main process and outcome components were identified and included input, activities, outputs, and outcome indicators. M&E tools were developed to collect quantitative and qualitative data. The tools included a supervisory checklist, a desk review tool, a key informant interview guide, a focus group discussion guide, a timeliness form, and an online acceptability survey. An evaluation team conducted field visits for assessment of EBS 5–9 months after implementation. Results The quantitative data collected provided evidence on the number and type of events that were being reported, the timeliness of the system, and the event-to-signal ratio. The qualitative and subjective data collected helped to increase understanding of the system’s field utility and acceptance by field staff, reasons for non-compliance with established guidelines, and other factors influencing implementation. Conclusions The use of M&E tools for the EBS pilot project in Vietnam provided data on signals and events reported, timeliness of reporting and response, perceptions and opinions of implementers, and fidelity of EBS implementation. These data were valuable for Vietnam’s MoH to understand the function of the EBS program, and the success and challenges of implementing this project in Vietnam.

Summary: Hutchinson-Gilford progeria syndrome (HGPS) is a rare disorder caused by a point mutation in the Lamin A gene that produces the protein progerin. Progerin toxicity leads to accelerated aging and death from cardiovascular disease. To elucidate the effects of progerin on endothelial cells, we prepared tissue-engineered blood vessels (viTEBVs) using induced pluripotent stem cell-derived smooth muscle cells (viSMCs) and endothelial cells (viECs) from HGPS patients. HGPS viECs aligned with flow but exhibited reduced flow-responsive gene expression and altered NOS3 levels. Relative to viTEBVs with healthy cells, HGPS viTEBVs showed reduced function and exhibited markers of cardiovascular disease associated with endothelium. HGPS viTEBVs exhibited a reduction in both vasoconstriction and vasodilation. Preparing viTEBVs with HGPS viECs and healthy viSMCs only reduced vasodilation. Furthermore, HGPS viECs produced VCAM1 and E-selectin protein in TEBVs with healthy or HGPS viSMCs. In summary, the viTEBV model has identified a role of the endothelium in HGPS. : Atchison and colleagues produced hiPSC-derived vascular smooth muscle cells and vascular endothelial cells from healthy and progeria patients. These cells were used to fabricate functional tissue-engineered blood vessels that express key features of the progeria cardiovascular phenotype. This work provides a novel platform to study progeria and other cardiovascular diseases using iPSC-derived cells in an in vitro platform. Keywords: Hutchinson-Gilford progeria syndrome, tissue-engineered blood vessel, microphysiological system, induced pluripotent stem cells, vascular endothelium, smooth muscle cells, shear stress

Introduction: When Viet Nam launched the Expanded Programme on Immunization in 1981, it covered six vaccines, including measles. Subsequently, Viet Nam experienced a marked reduction in measles infections. A nationwide measles epidemic occurred in April 2014 and an investigation found that 86% of affected children aged 9 months to 10 years were not fully vaccinated; therefore, understanding the reasons for not vaccinating could improve vaccination coverage. Method: We performed a cross-sectional study to determine vaccination coverage and reasons for non-vaccination among children aged 9 months to 10 years in six districts in Ho Chi Minh City with the highest number of measles cases in 2014. Measles vaccination status of the youngest child in each household was determined and reasons for non-vaccination were investigated. A χ2 test and multiple logistic regression were used to identify independent predictors of full vaccination. Results: In total, 207 children were enrolled during the study period in 2014. Full measles vaccination coverage was 55% in these households, and 73% of parents were aware of the importance of measles vaccination to protect their children. We found that the father’s education level (under high school versus high school and above) and the site where the survey was conducted were significantly associated with vaccination status. Conclusion: The vaccination coverage was lower than the coverage reported by district preventive medicine centres of the seven study wards. Lack of the second vaccination was a key obstacle to eliminating the vaccination gap. A catch-up mass vaccination campaign or health promotion of measles vaccination directed towards parents should be considered to improve vaccination coverage.

Digital mental health interventions (DMHI) are scalable and cost-effective strategies for increasing access to mental health care; however, dropout rates associated with digital interventions are high, particularly for open-access digital interventions. While some studies have focused on predictors of dropout from digital mental health programs, few studies have focused on engagement features that might improve engagement. In this perspective article, we discuss whether monetary incentives (MI) are one avenue to increasing user engagement in DMHI. We begin by reviewing the literature on the effects of MI for behavior change in health domains (e.g., dietary behaviors, substance use, and medication adherence). Then, drawing on a pilot study we conducted to test the effects of different levels of MI on usage and improvement in subjective well-being among users of a DMHI (Happify), we discuss the potential applications of MI for DMHI, the potential drawbacks of financial incentives in this context, and open questions for future research.

Surveillance and outbreak reporting systems in Vietnam required improvements to function effectively as early warning and response systems. Accordingly, the Ministry of Health of Vietnam, in collaboration with the US Centers for Disease Control and Prevention, launched a pilot project in 2016 focusing on community and hospital event–based surveillance. The pilot was implemented in 4 of Vietnam’s 63 provinces. The pilot demonstrated that event-based surveillance resulted in early detection and reporting of outbreaks, improved collaboration between the healthcare facilities and preventive sectors of the ministry, and increased community participation in surveillance and reporting.

Object: There is an increasing interest in preoperative diffusion tensor imaging-based fiber tracking (DTI-FT) to preserve function during surgeries in motor eloquent brain regions. However, DTI tractography is challenged by inherent presumptions during particular tracking steps [e.g., deterministic vs. probabilistic DTI, fractional anisotropy (FA) and fiber length (FL) thresholding] and the missing “ground truth” information. In the present study, we intended to establish an objective, neurophysiology-driven approach for parameter selection during DTI-FT of the corticospinal tract integrating both imaging and neurophysiological information.Methods: In ten patients with lesions in eloquent motor areas, preoperative navigated transcranial magnetic stimulation (nTMS) was performed, followed by individual deterministic DTI-FT from a grid of cortical seed points. We investigated over 300 combinations of FA and FL thresholds and applied subsequently a multidimensional mathematical modeling of this empirical data. Optimal DTI parameters were determined by the relationship between DTI-FT (i.e., number of fibers, NoF) and nTMS (i.e., amplitudes of motor-evoked potentials) results. Finally, neurophysiological DTI parameters and the resulting tractography were compared to the current standard approaches of deterministic DTI fiber tracking with a 75% and 50% FA and a FL threshold of 110 mm as well as with intraoperative direct cortical and subcortical stimulation.Results: There was a good goodness-of-fit for the mathematical model (r2 = 0.68 ± 0 13; range: 0.59–0.97; n = 8) except of two cases. Neurophysiology-driven parameter selection showed a high correlation between DTI-FT and nTMS results (r = 0.73 ± 0.16; range: 0.38–0.93). In comparison to the standard approach, the mathematically calculated thresholds resulted in a higher NoF in 75% of patients. In 50% of patients this approach helped to clarify the exact tract location or to detect additional functional tracts, which were not identified by the standard approach. This was confirmed by direct cortical or subcortical stimulation.Conclusion: The present study evaluates a novel user-independent method to extract objective DTI-FT parameters that were completely based on neurophysiological data. The findings suggest that this method may improve the specificity and sensitivity of DTI-FT and thereby overcome the disadvantages of current approaches.

After several international outbreaks of infectious diseases, including severe acute respiratory syndrome in 2003, all World Health Organization (WHO) Member States, including Vietnam, agreed to comply with the revised International [...]

The formulation of accurate clinical case definitions is an integral part of an effective process of public health surveillance. Although such definitions should, ideally, be based on a standardized and fixed collection of defining criteria, they often require revision to reflect new knowledge of the condition involved and improvements in diagnostic testing. Optimal case definitions also need to have a balance of sensitivity and specificity that reflects their intended use. After the 2009- 2010 H1N1 influenza pandemic, the World Health Organization (WHO) initiated a technical consultation on global influenza surveillance. This prompted improvements in the sensitivity and specificity of the case definition for influenza--i.e. a respiratory disease that lacks uniquely defining symptomology. The revision process not only modified the definition of influenza-like illness, to Include a simplified list of the criteria shown to be most predictive of influenza infection, but also clarified the language used for the definition, to enhance interpretability. To capture severe cases of influenza that required hospitalization, a new case definition was also developed for severe acute respiratory infection in all age groups. The new definitions have been found to capture more cases without compromising specificity. Despite the challenge still posed In the clinical separation of influenza from other respiratory infections, the global use of the new WHO case definitions should help determine global trends in the characteristics and transmission of influenza viruses and the associated disease burden. La formulation de definitions precises de cas cliniques fait partie integrente d'un processus efncace de surveillance de la sante publique. Alors que ees definitions devraient, dans l'ideal, s'appuyer sur un ensemble standardise et fixe de criteres de definition, elles necessitent souvent une revision pour tenir compte des nouvelles connaissances relatives a la maladie concernee et des ameliorations apportees aux tests diagnostiques. Pour etre optimales, les definitions de cas doivent aussi etablir un equilibre entre sensibilite et specificite qui reflete leur utilisation aux fins prevues. A la suite de la pandemie de grippe H1N1 de 2009-2010, l'Organisation mondiale de la Sante (OMS) a lance une consultation technique sur la surveillance mondiale de la grippe. Cela a conduit a des ameliorations concernant la sensibilite et la specificite de la definition de cas pour la grippe--c'est-a-dire une maladie respiratoire dont seule la symptomatologie reste a definir. Le processus de revision n'a pas seulement modifie la definition du syndrome de type grippal pour indure une liste simplifiee des criteres le mieux a meme de predire une infection grippale, il a egalement permis de clarifier le langage utilise dans la definition pour en ameliorer Interpretation. Par ailleurs, afin de tenir compte des cas severes de grippe qui necessitaient une hospitalisation, une nouvelle definition de cas a ete introduite concernant l'infection aigue severe des voies respiratoires dans tous les groupes d'age. Il a ete constate que les nouvelles definitions refletaient davantage de cas, sans pour autant compromettre la specificite. S'il est vral que la distinction clinique de la grippe des autres infections respiratoires continue de poser probleme, l'utilisation mondiale des nouvelles definitions de cas de l'OMS devralt permettre de degager des tendances mondiales concernant les caracteristiques et la transmission des virus grippaux ainsi que la charge de morbidite qui leur est associee. La elaboracion de definiciones precisas de los casos clinicos es una parte fundamental de un proceso efectivo de la vigilancia de la salud publica. Aunque tales definiciones deberian, idealmente, estar basadas en una recopilacion estandarizada y fija de criterios de definicion, a menudo necesitan una revision para reflejar el nuevo conocimiento de la enfermedad existente y las mejoras en las pruebas de diagnostico. Las definiciones optimas de los casos tambien deben tener un equilibrio entre sensibilidad y especificidad que refleje su uso previsto. Despues de la pandemia de gripe H1N1 en 2009-2010, la Organizacion Mundial de la Salud (OMS) inicio una consulta tecnica para la vigilancia mundial de la gripe. Esto dio lugar a mejoras en la sensibilidad y la especificidad de las definiciones de los casos de gripe, es decir, una enfermedad respiratoria que carece de una sintomatologia definitoria singular. El proceso de revision no solo modifico la definicion de las enfermedades similares a la gripe para incluir una lista simplificada de los criterios que demostraron ser mas predictivos de la infeccion por gripe, sino que tambien aclaro el lenguaje utilizado para la definicion, con el fin de mejorar su interpretacion. Para englobar los casos graves de gripe que requirieron hospitalizacion, tambien se desarrollo una nueva definicion de los casos de la infeccion respiratoria aguda grave en todos los grupos de edad. Se ha descubierto que las nuevas definiciones engloban mas casos sin comprometer la especificidad. A pesar del desafio que todavia plantea la separacion clinica de la gripe de otras infecciones respiratorias, el uso global de las nuevas definiciones de los casos de la OMS deberia ayudar a determinar las tendencias mundiales en las caracteristicas y transmision de los virus de la gripe y la carga de la enfermedad asociada., Introduction Case definitions form an important part of standardized systems for public health surveillance. They can be used in the reporting of the conditions under surveillance, the monitoring of geographical [...]

Fishways are a common tool for mitigating the effects of habitat fragmentation on fish, but their utility in low-gradient, sand-bed rivers of the Great Plains is not well studied. The Lincoln Street Fishway on the Arkansas River became operational in 2015 and was built specifically to pass small-bodied threatened fishes. We compared current and historical surveys up- and downstream of the barrier to test the effect of the fishway on community structure and conducted tagging experiments to test the ability of fishes to move into and through the fishway. Differences in community structure and species richness between communities up- and downstream of the dam were reduced following construction of the fishway. Surveys within the fishway revealed that 74% of species from the sampled community were using the fishway. Fishes marked with visible implant elastomer downstream of the dam were recaptured in the fishway, qualitatively showing that small-bodied fishes could move into and upstream within the fishway. We further quantified upstream movement for three species of small-bodied minnow tagged with passive integrated transponder tags during manipulations of flows through the fishway. Our results illustrate the potential for fishways to mitigate the effects of habitat fragmentation on fishes in sand-bed rivers. Si les passes migratoires constituent un outil repandu pour attenuer les effets de la fragmentation des habitats sur les poissons, leur utilite dans les rivieres a lit sablonneux de faible gradient des Grandes Plaines n'est pas bien etudiee. La passe migratoire de Lincoln Street sur la riviere Arkansas est entree en service en 2015 et a ete construite specialement pour permettre le passage de petits poissons menaces. Nous avons compare des donnees devaluations actuelles et passees en amont et en aval de la barriere pour verifier l'effet de la passe migratoire sur la structure de la communaute et realise des experiences de marquage pour verifier la capacite des poissons a entrer dans la passe migratoire et la traverser. Les differences sur le plan de la structure de la communaute et de la richesse specifique entre les communautes en amont et en aval du barrage etaient plus faibles apres la construction de la passe migratoire. Des releves dans la passe migratoire revelent que 74 % des especes de la communaute echantillonnee utilisaient la passe. Des poissons munis d'implants d'elastomere visible en aval du barrage ont ete repris dans la passe migratoire, ce qui demontre de maniere qualitative que des petits poissons peuvent entrer dans la passe migratoire et s'y deplacer vers l'amont. Nous avons egalement quantifie les deplacements vers l'amont pour trois especes de petits menes dotes de radio-etiquettes passives integrees durant des manipulations des debits dans la passe migratoire. Nos resultats illustrent le potentiel que presentent les passes migratoires pour attenuer les effets de la fragmentation des habitats sur les poissons dans les rivieres a lit sablonneux. [Traduit par la Redaction], Introduction Anthropogenic alterations such as dams and water extraction that fragment river networks and prevent the upstream dispersal of fishes have resulted in reductions in populations across the Great Plains [...]