In the isolated Aluoi Valley of central Viet Nam, very high levels of 2,3,7,8-tetrachlorodibenzo-
p-dioxin (TCDD) were measured in soil, fish fat, duck fat, pooled human blood and breast milk samples ...collected from A So village between 1996 and 1999. The village was situated on a former military base occupied by US Special Forces between 1963 and 1966. TCDD was a contaminant of the herbicide “Agent Orange”, aerially sprayed in the valley between 1965 and 1970, and stored at the A So base. Measured levels were lower near the sites of two other former US bases in the valley which had been occupied for shorter periods of time. In areas where Agent Orange had been applied by low-flying aircraft, levels of TCDD in soil, food and human samples were elevated, but lower than those near the three former US bases.
We confirm the apparent food chain transfer of TCDD from contaminated soil to cultured fish pond sediments to fish and duck tissues, then to humans as measured in whole blood and breast milk. We theorize that the Aluoi Valley is a microcosm of southern Viet Nam, where numerous reservoirs of TCDD exist in the soil of former military installations south of the former demilitarized zone. Large quantities of Agent Orange were stored at many sites, used in ground and aerial applications, and spilled. TCDD, through various forms of soil disturbance, can be mobilized from these reservoirs after decades below the surface, and subsequently, introduced into the human food chain.
To identify demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative chronic peptic ulcer disease.
Cross-sectional study of peptic ulcer disease in ...prospectively recruited PATIENTS undergoing gastroscopy.
277 consecutive patients referred for gastroscopy in 1996-1998.
Rapid urease test, culture and histological examination for H. pylori infection; anti-H. pylori IgG antibodies in serum; demographic data, intake of non-steroidal anti-inflammatory drugs (NSAIDs) in the preceding 3 months, and size, number and location of ulcers.
54 patients (19%) had evidence of peptic ulcer disease (34 gastric ulcer, 14 duodenal ulcer and 6 both gastric and duodenal ulcer); 45 had active chronic peptic ulcer disease and were analysed in detail. H. pylori was present in 25 (56%) of these patients; 10 (22%) had used NSAIDs and 7 of the NSAID group also had H. pylori infection. Of the patients with gastric ulcers, those with non-H. pylori, non-NSAID ulcers were significantly younger than both those with H. pylori-associated ulcers (mean age, 48 v. 65 years, P = 0.02) and those with NSAID-associated ulcers (mean age, 48 v 68 years, P = 0.02). The average size and number of gastric ulcers did not differ between patients with and without H. pylori infection. Of patients with duodenal ulcers, those with H. pylori infection had significantly fewer ulcers (1.1 v. 1.8, P = 0.04), although ulcer size was similar in the infected and uninfected groups.
Gastric ulcers may now be more common than duodenal ulcers. Gastric ulcers associated with H. pylori infection and/or NSAID use occurred mostly in older people, while non-H. pylori, non-NSAID gastric ulcers were more common in younger patients. In the duodenum, single ulcers were associated with H. pylori infection, and multiple ulcers were more frequent in the non-H. pylori, non-NSAID group.
BackgroundDiabetes, affecting 1 in 5 care home residents, may lead to ambulance call-outs and hospitalisation. We aimed to investigate the epidemiology of diabetes-related emergencies involving ...ambulance attendances to care home residents.MethodCross-sectional design investigating ambulance attendance to people presenting with diabetes-related emergencies in the East Midlands, UK, between 2012 and 2017. We analysed dispatch and ambulance clinical data with care home data, including call category, timing, location, care home type, clinical or physiological measures, treatments, conveyance (transport to hospital) and costs.ResultsOverall 2 19 722 (6.7% of 3.3 million) ambulances attended care homes over 6 years, with 12 080 (5.5%) to diabetes-related emergencies. Of 3152 care home patients categorised as having a ‘diabetic problem’, 1957 (62.1%) were conveyed to hospital, similar to that for community residents taking into account other factors. Factors associated with conveyance included reduced consciousness (OR 0.91, 95% CI 0.87–0.95), elevated heart (1.01, 1.01–1.02) or respiratory rate (1.08, 1.06–1.10), no treatment for hypoglycaemia (0.54, 0.34–0.86) or additional medical (but not psychiatric) problems. Ambulance costs were significantly lower when a patient was conveyed, by some £18 (95% CI £11.94–£24.12), but this would be outweighed by downstream hospital care costs. For a simulation in which all trusts’ mean NHS Reference Costs were used, conveyance was no longer significant in the cost model.ConclusionConveyance following diabetes-related emergencies was as common for care home as for other community residents despite access to trained staff, and more likely with impaired consciousness, abnormal physiological measures or lack of treatment for hypoglycaemia.Conflict of interestNone.FundingNational institute for Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, UK.
Injection drug users represent the largest cohort of patients with established hepatitis C virus (HCV) infection as well as the group that is at highest risk for new infections. Most published ...studies have focused on the clinical consequences of established HCV infection and have not examined the consequences of new infection. The aim of the current study was to measure the virological consequences of HCV in patients with ongoing injection drug use that might pose a risk for new and/or for superinfection with additional strains of HCV. We examined the following groups: (a) those with resolved HCV infection with ongoing injection drug use, (b) those with chronic infection who continued to inject and (c) those with chronic infection who no longer injected. Our study demonstrated a spectrum of responses. The majority of patients appeared to be ‘protected’ from new infection. None of six patients with resolved infection had detectable HCV RNA by quantitative or qualitative PCR when followed for 1 year. Similarly, despite ongoing injection drug use, no patient with persistent infection had a ‘switch’ in HCV genotype indicative of possible superinfection. Virological analysis of HCV quasispecies to detect possible infection with new variants of HCV in patients with apparently ‘stable’ infection, indicated divergence of virus over time, divergence that was unrelated to injection drug behaviour. Thus, patients with ongoing or prior HCV infection appear to develop immunity that protects against further infection with HCV despite repeated exposure.
Self-supervised learning aims to extract meaningful features from unlabeled data for further downstream tasks. In this paper, we consider classification as a downstream task in phase 2 and develop ...rigorous theories to realize the factors that implicitly influence the general loss of this classification task. Our theories signify that sharpness-aware feature extractors benefit the classification task in phase 2 and the existing data shift between the ideal (i.e., the ideal one used in theory development) and practical (i.e., the practical one used in implementation) distributions to generate positive pairs also remarkably affects this classification task. Further harvesting these theoretical findings, we propose to minimize the sharpness of the feature extractor and a new Fourier-based data augmentation technique to relieve the data shift in the distributions generating positive pairs, reaching Sharpness & Shift-Aware Contrastive Learning (SSA-CLR). We conduct extensive experiments to verify our theoretical findings and demonstrate that sharpness & shift-aware contrastive learning can remarkably boost the performance as well as obtaining more robust extracted features compared with the baselines.
Recent growth in broadband access and proliferation of small personal devices that capture images and videos has led to explosive growth of multimedia content available everywhere - from personal ...disks to the Web. While digital media capture and upload has become nearly universal with newer device technology, there is still a need for better tools and technologies to search large collections of multimedia data and to find and deliver the right content to a user according to her current needs and preferences. A renewed focus on the subjective dimension in the multimedia lifecycle, from creation, distribution, to delivery and consumption, is required to address this need beyond what is feasible today. Integration of the subjective aspects of the media itself - its affective, perceptual, and physiological potential (both intended and achieved), together with those of the users themselves will allow for personalizing the content access, beyond today's facility. This integration, transforming the traditional multimedia information retrieval (MIR) indexes to more effectively answer specific user needs, will allow a richer degree of personalization predicated on user intention and mode of interaction, relationship to the producer, content of the media, and their history and lifestyle. In this paper, we identify the challenges in achieving this integration, current approaches to interpreting content creation processes, to user modelling and profiling, and to personalized content selection, and we detail future directions. The structure of the paper is as follows: In Section I, we introduce the problem and present some definitions. In Section II, we present a review of the aspects of personalized content and current approaches for the same. Section III discusses the problem of obtaining metadata that is required for personalized media creation and present eMediate as a case study of an integrated media capture environment. Section IV presents the MAGIC system as a case stud- y of capturing effective descriptive data and putting users first in distributed learning delivery. The aspects of modelling the user are presented as a case study in using user's personality as a way to personalize summaries in Section V. Finally, Section VI concludes the paper with a discussion on the emerging challenges and the open problems.
Knowledge‐intensive approaches have been proposed to manage the variability in indigenous nutrient supplies (IS) in irrigated rice (Oryza sativa L.) systems. On‐farm experiments were conducted at 155 ...locations in seven domains of Asia to quantify the variability of soil properties, grain yield, and nutrient uptake in N, P, and K omission plots (0‐N, 0‐P, and 0‐K, respectively). Except for pH, coefficients of variation of soil properties within a domain ranged from 17 to 43%. Similar ranges were measured for grain yield and plant nutrient uptake in nutrient omission plots, which served as crop‐based estimates of indigenous N, P, and K supply. Soil properties showed little association with plant nutrient uptake or grain yield in nutrient omission plots. Mean grain yields in nutrient omission plots increased in the order 0‐N (3.9 Mg ha−1) < 0‐K (5.1 Mg ha−1) ≤ 0‐P (5.2 Mg ha−1). Soils, climate, and crop management caused large variability of IS among irrigated rice domains, years, growing seasons, and fields within a domain. Grain yield and nutrient uptake in omission plots were mostly higher in high‐yielding than in low‐yielding climatic seasons. No changes in indigenous N supply occurred for periods of 4 to 6 yr in the same seasons. Grain yields in nutrient omission plots were strongly correlated with each other and also with the yield in the fertilized farmers' fields. Fertilizer recommendations should be fine‐tuned to spatial domains with relatively uniform agroecological characteristics, cropping practices, and socioeconomic conditions. Within such domains, season‐specific management of the IS variability can include field‐specific approaches.
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