Rotavirus infection is the global leading cause of diarrhea-associated morbidity and mortality among children younger than 5 years.
To examine the extent of rotavirus infection among children younger ...than 5 years by country and the number of deaths averted because of the rotavirus vaccine.
This report builds on findings from the Global Burden of Disease Study 2016, a cross-sectional study that measured diarrheal diseases and their etiologic agents. Models were used to estimate burden in data-sparse locations.
Diarrhea due to rotavirus infection.
Rotavirus-associated mortality and morbidity by country and year and averted deaths attributable to the rotavirus vaccine by country.
Rotavirus infection was responsible for an estimated 128 500 deaths (95% uncertainty interval UI, 104 500-155 600) among children younger than 5 years throughout the world in 2016, with 104 733 deaths occurring in sub-Saharan Africa (95% UI, 83 406-128 842). Rotavirus infection was responsible for more than 258 million episodes of diarrhea among children younger than 5 years in 2016 (95% UI, 193 million to 341 million), an incidence of 0.42 cases per child-year (95% UI, 0.30-0.53). Vaccine use is estimated to have averted more than 28 000 deaths (95% UI, 14 600-46 700) among children younger than 5 years, and expanded use of the rotavirus vaccine, particularly in sub-Saharan Africa, could have prevented approximately 20% of all deaths attributable to diarrhea among children younger than 5 years.
Rotavirus-associated mortality has decreased markedly over time in part because of the introduction of the rotavirus vaccine. This study suggests that prioritizing vaccine introduction and interventions to reduce diarrhea-associated morbidity and mortality is necessary in the continued global reduction of rotavirus infection.
We analyze biased ensembles of trajectories for diffusive systems. In trajectories biased either by the total activity or the total current, we use fluctuating hydrodynamics to show that these ...systems exhibit phase transitions into "hyperuniform" states, where large-wavelength density fluctuations are strongly suppressed. We illustrate this behavior numerically for a system of hard particles in one dimension and we discuss how it appears in simple exclusion processes. We argue that these diffusive systems generically respond very strongly to any nonzero bias, so that homogeneous states with "normal" fluctuations (finite compressibility) exist only when the bias is very weak.
Room-temperature ionic liquids (RTILs) are a class of organic salts that are liquid at room temperature. Their physiochemical properties, including low vapor pressure and wide electrochemical ...stability window, have driven their use as electrolytes in many electrochemical applications; however, the slow transport properties of many RTILs have limited their utility in some applications. This issue is often mitigated by solvating ionic liquids in neutral organic solvents. To date, however, solvent interactions have only been explored for a small number of solvents, particularly acetonitrile and propylene carbonate, at only a few compositions. In this work, we use molecular dynamics simulations in the context of a computational screening approach to study mixtures of ionic liquids in many different solvents at a range of concentrations. Building on prior work, we again find that ionic liquid diffusivity increases monotonically with greater solvent concentration. In contrast to prior work, we find that pure solvent diffusivity, not polarity, is the most influential solvent property on mixture behavior. We also explore the concentration dependence of ionic conductivity and find maxima at intermediate concentrations. Experimental conductivity measurements, inspired by the computational screening study, support this observation with qualitatively consistent results. These results can further guide the selection of solvents for electrochemical applications of RTILs.
A series of CdSe quantum dot (QD)-sensitized TiO2 heterostructures have been synthesized, characterized, and tested for the photocatalytic reduction of CO2 in the presence of H2O. Our results show ...that these heterostructured materials are capable of catalyzing the photoreduction of CO2 using visible light illumination (λ > 420 nm) only. The effect of removing surfactant caps from the CdSe QDs by annealing and using a hydrazine chemical treatment have also been investigated. The photocatalytic reduction process is followed using infrared spectroscopy to probe the gas-phase reactants and gas chromatography to detect the products. Gas chromatographic analysis shows that the primary reaction product is CH4, with CH3OH, H2, and CO observed as secondary products. Typical yields of the gas-phase products after visible light illumination (λ > 420 nm) were 48 ppm g−1 h−1 of CH4, 3.3 ppm g−1 h−1 of CH3OH (vapor), and trace amounts of CO and H2.
Google Trends (GT) offers a historical database of global internet searches with the potential to complement conventional records of environmental hazards, especially in regions where formal ...hydrometeorological data are scarce. We evaluate the extent to which GT can discern heavy rainfall and floods in Kenya and Uganda during the period 2014 to 2018. We triangulate counts of flood searches from GT with available rainfall records and media reports to build an inventory of extreme events. The Spearman rank correlation (ρ) between monthly mean search interest for flooding and monthly Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) rainfall totals was ρ = +0.38 (p < 0.005) for Kenya and ρ = +0.64 (p < 0.001) for Uganda. Media reports of flooding were used to specify a threshold of detectability to give the same overall frequency of floods based on GT search interest. When the GT search index threshold was set at ≥15 and ≥29, the correct detection rate was 75% and 64% within a five‐day window of known flood events in Kenya and Uganda, respectively. From these preliminary explorations we conclude that GT has potential as a proxy data source, but greater skill may emerge in places with larger search volumes and by linking to historical information about environmental hazards at sub‐national scales. Wider applicability of the GT platform might be possible if there is greater transparency about how Google algorithms determine topics.
We evaluate the extent to which Google Trends (GT) can discern heavy rainfall and floods in Kenya and Uganda during the period 2014–2018. We triangulate counts of flood searches from GT with available rainfall records and media reports to build an inventory of extreme events. We achieve correct detection rates of 75% (Kenya) and 64% (Uganda) within a five‐day window of known flood events.
Major gaps exist in the routine initiation and dose up-titration of guideline-directed medical therapies (GDMT) for patients with heart failure with reduced ejection fraction. Without novel ...approaches to improve prescribing, the cumulative benefits of heart failure with reduced ejection fraction treatment will be largely unrealized. Direct-to-consumer marketing and shared decision making reflect a culture where patients are increasingly involved in treatment choices, creating opportunities for prescribing interventions that engage patients.
The EPIC-HF (Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction) trial randomized patients with heart failure with reduced ejection fraction from a diverse health system to usual care versus patient activation tools-a 3-minute video and 1-page checklist-delivered electronically 1 week before, 3 days before, and 24 hours before a cardiology clinic visit. The tools encouraged patients to work collaboratively with their clinicians to "make one positive change" in heart failure with reduced ejection fraction prescribing. The primary endpoint was the percentage of patients with GDMT medication initiations and dose intensifications from immediately preceding the cardiology clinic visit to 30 days after, compared with usual care during the same period.
EPIC-HF enrolled 306 patients, 290 of whom attended a clinic visit during the study period: 145 were sent the patient activation tools and 145 were controls. The median age of patients was 65 years; 29% were female, 11% were Black, 7% were Hispanic, and the median ejection fraction was 32%. Preclinic data revealed significant GDMT opportunities, with no patients on target doses of β-blocker, sacubitril/valsartan, and mineralocorticoid receptor antagonists. From immediately preceding the cardiology clinic visit to 30 days after, 49.0% in the intervention and 29.7% in the control experienced an initiation or intensification of their GDMT (
=0.001). The majority of these changes were made at the clinician encounter itself and involved dose uptitrations. There were no deaths and no significant differences in hospitalization or emergency department visits at 30 days between groups.
A patient activation tool delivered electronically before a cardiology clinic visit improved clinician intensification of GDMT. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334188.
•Alcohol use disorder occurs more frequently in sexual minorities compared to heterosexuals.•This gap in prevalence occurs at nearly all ages, until after age 50, when disparities decline.•Alcohol ...use disorder prevalence peaks at age ∼28 for sexual minorities.•For heterosexual individuals, that peak occurs at age ∼23.
Alcohol use disorders (AUD) occur frequently in sexual minority (SM) adults (identifying as gay, lesbian or bisexual). Age-specific prevalence estimates, particularly during middle and older ages, remain obscure. With questions for sexual identity recently included in the National Survey of Drug Use and Health (NSDUH), increased precision is possible. This study investigates the age-specific estimate for AUD in sexual minority versus sexual majority adults.
Analysis of the 2015–2017 NSDUH, ages 18-years-and-older (N = 128,740). We estimate age-specific, 12-month DSM-IV AUD prevalence and adjusted prevalence ratios (via Poisson regression) by sexual identity. Adjusted models control for demographic, social, and mental health variables. Post-hoc analysis included age-specific estimates after redefining SM to include any same-sex attraction.
The age-specific estimate showed peak AUD prevalence at age ∼28 for all SMs, compared to age ∼23 for heterosexuals. By subgroup, gay men ages 18–23, had the highest AUD prevalence at 18.8% (CI: 13.5%, 25.5%). Bisexual women ages 24–29 had the highest disparity, a prevalence ratio (reference heterosexual women) of 2.59 (CI: 2.15, 3.13). Above age 50, the definition of SM is salient: in this age group, prevalence of AUD converges for heterosexuals and SMs that include individuals with any same-sex attraction.
In this largest study to date, SMs have a high prevalence of AUD. A disparity in the age-by-age estimates emerges by age 25 when AUD occurrence declines in heterosexuals but increases in SMs. A prevalence disparity occurs with each successive age strata, but by age 50-and-older, the difference is null.
Warfarin use accounts for more medication-related emergency department visits among older patients than any other drug. Whether genotype-guided warfarin dosing can prevent these adverse events is ...unknown.
To determine whether genotype-guided dosing improves the safety of warfarin initiation.
The randomized clinical Genetic Informatics Trial (GIFT) of Warfarin to Prevent Deep Vein Thrombosis included patients aged 65 years or older initiating warfarin for elective hip or knee arthroplasty and was conducted at 6 US medical centers. Enrollment began in April 2011 and follow-up concluded in October 2016.
Patients were genotyped for the following polymorphisms: VKORC1-1639G>A, CYP2C9*2, CYP2C9*3, and CYP4F2 V433M. In a 2 × 2 factorial design, patients were randomized to genotype-guided (n = 831) or clinically guided (n = 819) warfarin dosing on days 1 through 11 of therapy and to a target international normalized ratio (INR) of either 1.8 or 2.5. The recommended doses of warfarin were open label, but the patients and clinicians were blinded to study group assignment.
The primary end point was the composite of major bleeding, INR of 4 or greater, venous thromboembolism, or death. Patients underwent a screening lower-extremity duplex ultrasound approximately 1 month after arthroplasty.
Among 1650 randomized patients (mean age, 72.1 years SD, 5.4 years; 63.6% women; 91.0% white), 1597 (96.8%) received at least 1 dose of warfarin therapy and completed the trial (n = 808 in genotype-guided group vs n = 789 in clinically guided group). A total of 87 patients (10.8%) in the genotype-guided group vs 116 patients (14.7%) in the clinically guided warfarin dosing group met at least 1 of the end points (absolute difference, 3.9% 95% CI, 0.7%-7.2%, P = .02; relative rate RR, 0.73 95% CI, 0.56-0.95). The numbers of individual events in the genotype-guided group vs the clinically guided group were 2 vs 8 for major bleeding (RR, 0.24; 95% CI, 0.05-1.15), 56 vs 77 for INR of 4 or greater (RR, 0.71; 95% CI, 0.51-0.99), 33 vs 38 for venous thromboembolism (RR, 0.85; 95% CI, 0.54-1.34), and there were no deaths.
Among patients undergoing elective hip or knee arthroplasty and treated with perioperative warfarin, genotype-guided warfarin dosing, compared with clinically guided dosing, reduced the combined risk of major bleeding, INR of 4 or greater, venous thromboembolism, or death. Further research is needed to determine the cost-effectiveness of personalized warfarin dosing.
clinicaltrials.gov Identifier: NCT01006733.
Reference standard NIST SRM 1633b and FA 345, a fly ash sample from an eastern U.S. coal power plant, were analyzed to determine and quantify the mineralogical association of rare earth elements ...(REE). These analyses were completed using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) and a scanning electron microscope, equipped with an energy-dispersive X-ray spectrometer (SEM-EDS). Internal standardization was avoided by quantifying elemental concentrations by normalizing to 100% oxides. Mineral grains containing elevated REE concentrations were found in diverse chemical environments, but were most commonly found in regions where Al and Si were predominant. Dividing the spot analyses into time segments yielded plots that showed the REE content changing over time as individual mineral grains were being ablated. SEM-EDS images of FA 345 confirmed the trends that were found in the LA-ICP-MS results. Small grains of apatite, monazite, or zircon were frequently observed as free mineral grains or embedded in amorphous aluminosilicate glass and were not associated with ferrous particles. This finding is consistent with previous reports that magnetic enrichment may be an effective way of concentrating non-magnetic REE phases. Furthermore, aggressive mechanical and chemical-based separation schemes will be required to separate and recover REE from aluminosilicate glass.
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•Mineral grains containing elevated REE were located within fly ash samples, usually in regions where Al and Si were predominant.•Dividing the LA-ICP-MS spots into time segments yielded plots showing REE content changing over time as individual mineral grains were ablated.•SEM-EDS images confirmed that small free REE mineral grains were frequently observed or embedded in amorphous glass, but not with ferrous particles.•Findings are consistent with previous reports that magnetic enrichment of fly ash may be an effective way of concentrating non-magnetic REE phases.
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