There is a continuing debate on relative benefits of various mitigation and suppression strategies aimed to control the spread of COVID-19. Here we report the results of agent-based modelling using a ...fine-grained computational simulation of the ongoing COVID-19 pandemic in Australia. This model is calibrated to match key characteristics of COVID-19 transmission. An important calibration outcome is the age-dependent fraction of symptomatic cases, with this fraction for children found to be one-fifth of such fraction for adults. We apply the model to compare several intervention strategies, including restrictions on international air travel, case isolation, home quarantine, social distancing with varying levels of compliance, and school closures. School closures are not found to bring decisive benefits unless coupled with high level of social distancing compliance. We report several trade-offs, and an important transition across the levels of social distancing compliance, in the range between 70% and 80% levels, with compliance at the 90% level found to control the disease within 13-14 weeks, when coupled with effective case isolation and international travel restrictions.
Chimeric antigen receptors (CARs) are versatile synthetic receptors that provide T cells with engineered specificity. Clinical success in treating B-cell malignancies has demonstrated the therapeutic ...potential of CAR-T cells against cancer, and efforts are underway to expand the use of engineered T cells to the treatment of diverse medical conditions, including infections and autoimmune diseases. Here, we review current understanding of the molecular properties of CARs, how this knowledge informs the rational design and characterization of novel receptors, the successes and shortcomings of CAR-T cells in the clinic, and emerging solutions for the continued improvement of CAR-T cell therapy.
Even with a long lifetime of 25–30 years of green energy production, end-of-life treatment of solar photovoltaic modules can negatively impact the environment if not handled properly. This is ...particularly urgent when the use of photovoltaics has grown at an unprecedented rate, generating clean energy all over the world. Therefore, it is essential to develop commercially viable end-of-life recycling technologies to guarantee a sustainable future for the photovoltaic technology.
Silicon photovoltaic modules, the most popular photovoltaic technology, have been shown to be economically unattractive for recycling - the materials are mixed and difficult to separate, and have low value, so that the cost of recycling is hardly recovered. In this paper, we review the state-of-art recycling technology and associate it with a quantitative economic assessment to breakdown the cost structure and better understand the presented economic barrier. The techno-economic review allows us to identify essential framework and technology changes required to overcome the current barrier to implementing commercial-scale recycling. (i) The authority may impose price signal to impress direct landfill of end-of-life modules while proactively establish an effective collection network. (ii) The local recyclers may aim at value recovery as a step beyond mass recovery, especially targeting at recovery of intact silicon wafers and silver to guarantee the recycling revenue. Meanwhile, efforts should be put on reducing the recycling processing cost. (iii) Photovoltaic module manufacturers may take end-of-life responsibilities and up-design the product to facilitate end-of-life recycling, which includes features for simple disassembly, recycling, and reducing or eliminating the use of toxic components.
•Sustainable photovoltaic technology requires proper end-of-life management.•The techno-economic analysis reveals new insights to overcome the economic barrier.•Photovoltaic module recycling is a collaborative action among all stakeholders.•Upcycling can achieve maximum environmental and economic benefits.•Further technologies should aim at value recovery and up-front eco-design.
Summary
The epidemiology and health‐related quality of life associated with functional gastrointestinal disorders are reviewed, with particular emphasis on irritable bowel syndrome and functional ...dyspepsia. The literature supports the significant world‐wide prevalence of functional gastrointestinal disorders, including irritable bowel syndrome (IBS), functional dyspepsia and chronic constipation. An increased female prevalence has been demonstrated in most studies in patients with IBS and chronic constipation, but not functional dyspepsia. The female to male ratio appears to be greater in the health care‐seeking population than in community populations. However, some differences in the reported general prevalence and gender‐related prevalence of functional gastrointestinal disorders may be due to cultural factors and study methodology. A significant health care burden is associated with IBS, with increased out‐patient services, abdominal and pelvic surgeries, and gastrointestinal‐ and non‐gastrointestinal‐related physician visits and health care costs. Health‐related quality of life is impacted significantly in patients with functional gastrointestinal disorders, such as functional dyspepsia and IBS, compared with the general healthy population, as well as patients with other chronic medical conditions, such as gastro‐oesophageal reflux disease and asthma. Impaired health‐related quality of life has been demonstrated, in particular, in patients with moderate to severe disease seen in referral settings. The health‐related quality of life appears to improve in treatment responders, or correlates with symptom improvement, with at least some treatment modalities studied in functional gastrointestinal disorders, but further studies are needed. Predictors of health‐related quality of life in patients with functional gastrointestinal disorders include psychosocial factors, such as early adverse life events, and symptoms related to visceral perception, e.g. pain and chronic stress. The presence of extra‐intestinal symptoms appears to have a major if not greater impact on health care visits, excess health care costs and health‐related quality of life in patients with functional gastrointestinal disorders.
Aims. High-synchrotron peaked blazars (HSPs or HBLs) play a central role in very high-energy (VHE) γ-ray astronomy, and likely in neutrino astronomy. Currently, the largest compilation of HSP ...blazars, the 2WHSP sample, includes 1691 sources, but it is not complete in the radio or in the X-ray band. In order to provide a larger and more accurate set of HSP blazars that is useful for future statistical studies and to plan for VHE/TeV observations, we present the 3HSP catalogue, the largest sample of extreme and high-synchrotron peaked (EHSP; HSP) blazars and blazar candidates. Methods. We implemented several ways to improve the size and the completeness of the 2WHSP catalogue and reduced the selection biases to be taken into consideration in population studies. By discarding the IR constraint and relaxing the radio–IR and IR–X-ray slope criteria, we were able to select more sources with νpeak close to the 1015 Hz threshold and objects where the host galaxy dominates the flux. The selection of extra sources now commences with a cross-matching between radio and X-ray surveys, applying a simple flux ratio cut. We also considered Fermi-LAT catalogues to find reasonable HSP-candidates that are detected in the γ-ray band but are not included in X-ray or radio source catalogues. The new method, and the use of newly available multi-frequency data, allowed us to add 395 sources to the sample, to remove 73 2WHSP sources that were previously flagged as uncertain and could not be confirmed as genuine HSP blazars, and to update parameters obtained by fitting the synchrotron component. Results. The 3HSP catalogue includes 2013 sources, 88% of which with a redshift estimation, a much higher percentage than in any other list of HSP blazars. All new γ-ray detections are described in the First and Second Brazil ICRANet γ-ray blazar catalogues (1BIGB & 2BIGB) also taking into account the 4FGL list of γ-ray sources published by the Fermi Large Area Telescope (Fermi-LAT) team. Moreover, the cross-matching between the 2WHSP, 2FHL HSP, and IceCube neutrino positions suggests that HSPs are likely counterparts of neutrino events, which implies the 3HSP catalogue is also useful in that respect. The 3HSP catalogue shows improved completeness compared to its predecessors, the 1WHSP and 2WHSP catalogues, and follows the track of their increasing relevance for VHE astronomy.
We explore the correlation of γ-ray emitting blazars with IceCube neutrinos by using three very recently completed, and independently built, catalogues and the latest neutrino lists. We introduce a ...new observable, namely the number of neutrino events with at least one γ-ray counterpart, N
ν. In all three catalogues we consistently observe a positive fluctuation of N
ν with respect to the mean random expectation at a significance level of 0.4–1.3 per cent. This applies only to extreme blazars, namely strong, very high energy γ-ray sources of the high energy peaked type, and implies a model-independent fraction of the current IceCube signal ∼10–20 per cent. An investigation of the hybrid photon – neutrino spectral energy distributions of the most likely candidates reveals a set of ≈5 such sources, which could be linked to the corresponding IceCube neutrinos. Other types of blazars, when testable, give null correlation results. Although we could not perform a similar correlation study for Galactic sources, we have also identified two (further) strong Galactic γ-ray sources as most probable counterparts of IceCube neutrinos through their hybrid spectral energy distributions. We have reasons to believe that our blazar results are not constrained by the γ-ray samples but by the neutrino statistics, which means that the detection of more astrophysical neutrinos could turn this first hint into a discovery.
Aims. High synchrotron peaked blazars (HSPs) dominate the γ-ray sky at energies higher than a few GeV; however, only a few hundred blazars of this type have been cataloged so far. In this paper we ...present the 2WHSP sample, the largest and most complete list of HSP blazars available to date, which is an expansion of the 1WHSP catalogue of γ-ray source candidates off the Galactic plane. Methods. We cross-matched a number of multi-wavelength surveys (in the radio, infrared and X-ray bands) and applied selection criteria based on the radio to IR and IR to X-ray spectral slopes. To ensure the selection of genuine HSPs, we examined the SED of each candidate and estimated the peak frequency of its synchrotron emission (νpeak) using the ASDC SED tool, including only sources with νpeak > 1015 Hz (equivalent to νpeak > 4 eV). Results. We have assembled the largest and most complete catalogue of HSP blazars to date, which includes 1691 sources. A number of population properties, such as infrared colours, synchrotron peak, redshift distributions, and γ-ray spectral properties have been used to characterise the sample and maximize completeness. We also derived the radio log N–log S distribution. This catalogue has already been used to provide seeds to discover new very high energy objects within Fermi-LAT data and to look for the counterparts of neutrino and ultra high energy cosmic ray sources, showing its potential for the identification of promising high-energy γ-ray sources and multi-messenger targets.
Summary Background Outbreaks of urinary tract infections (UTIs) due to contaminated ureteroscopes have been rarely reported. Aim To report such an outbreak at a regional teaching hospital in southern ...Taiwan. Methods From October to December 2010, ertapenem-resistant Enterobacter cloacae were identified from urine cultures of 15 patients who had undergone ureteroscopy prior to the infection. Three batches of surveillance cultures were obtained from the environmental objects and healthcare workers related to the procedures. Pulsed-field gel electrophoresis (PFGE) was used for bacterial typing. Antimicrobial susceptibility was assessed by disc diffusion and E-test methods. Polymerase chain reaction and sequencing were used to analyse β-lactamase genes. Findings A total of 70 specimens were obtained during the first surveillance operation. One ertapenem-resistant E. cloacae was isolated from a ureteroscope. Although the disinfection protocols for ureteroscopes were revised and implemented, seven additional UTI cases were identified thereafter. The pathogen was identified from two subsequent surveillance cultures and was not eliminated until ethylene oxide sterilization was added to the disinfection protocol. PFGE revealed that all 15 isolates from the patients and the three isolates from the ureteroscope shared a common pattern with minor variance. Most isolates were resistant to gentamicin, levofloxacin, ceftriaxone, ceftazidime, and ertapenem. All isolates were susceptible to amikacin, imipenem, and meropenem. SHV-12 and IMP-8 genes were simultaneously identified in 16 of the 18 isolates. Conclusion The outbreak of ertapenem-resistant E. cloacae was caused by a contaminated ureteroscope and was terminated by the implementation of a revised disinfection protocol for ureteroscopes.
Summary
Background: Chronic antigen exposure and/or ageing increases the frequency of T‐box expressed in T cells (T‐bet)‐expressing B‐lymphocytes in mice. The frequency and significance of B‐cell ...T‐bet expression during chronic hepatitis C (HCV) infection in human subjects has never been described. Methods: Healthy controls, cirrhotic and noncirrhotic HCV‐infected patients, and non‐HCV patients with cirrhosis were recruited. Peripheral blood mononuclear cells were phenotyped for expression of T‐bet and related markers by flow cytometry. In a subset of patients who underwent antiviral therapy and were cured of HCV infection (sustained virological response), the dynamics of T‐bet expression in B cells was monitored. After cure, convalescent B cells were tested for T‐bet expression after re‐exposure to infected plasma or recombinant HCV proteins. Results: Forty‐nine patients including 11 healthy donors, 30 hepatitis C‐infected individuals (nine with liver cancer, 13 with cirrhosis, eight without cirrhosis) and eight patients with cirrhosis due to non‐HCV‐related cause were recruited. We found that B cells in patients with chronic HCV exhibited increased frequency of T‐bet+ B cells relative to noninfected individuals (median 11.5% v. 2.2%, P<.0001) but that there were no significant differences between noncirrhotic, cirrhotic and cancer‐bearing infected individuals. T‐Bet+ B cells expressed higher levels of CD95, CXCR3, CD11c, CD267 and FcRL5 compared to T‐bet− B cells and predominantly exhibit a tissue‐like memory CD27−CD21− phenotype independent of HCV infection. T‐bet+ B cells in HCV‐infected patients were more frequently class‐switched IgD−IgG+ (40.4% vs. 26.4%, P=.012). Resolution of HCV infection with direct‐acting antiviral (DAA) therapy leads to a marked reduction in the frequency of T‐bet+ B cells (median 14.1% pretreatment v. 6.7% end of treatment v. 6.1% SVR12, P≤.01). Re‐exposure of convalescent (cured) B cells to viremic plasma and recombinant HCV E2 protein led to re‐expression of T‐bet. Conclusion: Chronic antigenemia in chronic HCV infection induces and maintains an antigen‐specific T‐bet+ B cell. These B cells share markers with tissue‐like memory B cells. Antigen‐driven T‐bet expression may be a critical suppressor of B‐cell activation in chronic HCV infection.
Summary
Due to the huge gap in the care of patients with osteoporosis and fragility fractures, we aimed to explore the effectiveness of the osteoporosis liaison service (OLS) in osteoporosis care. We ...found that OLS can improve osteoporosis care, including increasing medication compliance, increasing calcium/vitamin D/protein intake, and reducing fall rate.
Introduction
A significant gap exists in the care of patients with osteoporosis and fragility fractures. This study aimed to evaluate 1-year outcomes of an osteoporosis liaison service (OLS) program that includes two independent components: medication management services (MMS) to improve medication adherence and fracture liaison services (FLS) for secondary prevention.
Methods
Patients with new hip fracture or untreated vertebral fractures enrolled in the FLS program (
n
= 600), and those with osteoporosis medication management issues but not necessarily fragility fractures enrolled in the MMS program (
n
= 499) were included. To evaluate outcomes, care coordinators assessed baseline items adapted from the 13 Best Practices Framework (BPF) standards of the International Osteoporosis Foundation, with telephone follow-up every 4 months for 1 year.
Results
Mean age of this cohort was 76.2 ± 10.3 years, 78.8% were female. After 1-year participation in the program, all patients had received bone mineral density tests, and medication adherence for the entire cohort at 12 months was 91.9 ± 19.6%, with significant improvement in fall rates (23.4% reduction), exercise rates (16.8% increase), calcium intake (26.5% increase), vitamin D intake (26.4% increase), and adequate protein intake (17.3% increase) (all
p
< 0.05). After 1-year OLS program, the overall rates of mortality, incident fracture, and falls were 6.6%, 4.0%, and 24.3%, respectively.
Conclusions
The OLS program is associated with improved osteoporosis care, including increased medication adherence, calcium/vitamin D and protein intake, and reduced fall rate.
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