An extremely energetic cosmic ray observed by a surface detector array

Cosmic rays are energetic charged particles from extraterrestrial sources, with the highest-energy events thought to come from extragalactic sources. Their arrival is infrequent, so detection requires instruments with large collecting areas. In this work, we report the detection of an extremely energetic particle recorded by the surface detector array of the Telescope Array experiment. We calculate the particle's energy as [Formula: see text] (~40 joules). Its arrival direction points back to a void in the large-scale structure of the Universe. Possible explanations include a large deflection by the foreground magnetic field, an unidentified source in the local extragalactic neighborhood, or an incomplete knowledge of particle physics.

Comparison of Body Composition Methods for Estimating Body Fat Percentage in Lower Limb Prosthesis Users

BACKGROUND

There is a dearth of literature evaluating the accuracy of Air Displacement Plethysmography (ADP) compared to Dual-energy X-ray Absorptiometry (DXA) for assessing body composition in individuals with lower limb amputations. Validity of ADP in persons with lower limb amputations must be established.

OBJECTIVE

The objective of this study was to compare body composition in persons with lower limb amputations using the BOD POD® and DXA.

METHODOLOGY

Body composition was performed on eleven lower limb prosthesis users (age 53.2±14.3 years, weight 81.9±22.3kg) using ADP and DXA with and without prosthesis.

FINDINGS

Repeated measures ANOVA indicated no significant difference in body composition among and between trials, F(3,8)= 3.36, p= 0.075. There were no significant differences in Body Fat (BF) percentage with and without prostheses on the BOD POD (28.5±15.7% and 33.7±12.1%, respectively) nor the DXA (32.9±10.6% and 32.0±9.9%, respectively). Association between the BOD POD and DXA were greatest when prostheses were not worn compared to when they were worn. Bland-Altman plots indicate agreement between BOD POD® and DXA was greatest while wearing the prosthesis.

CONCLUSION

This study is a first to compare total body fat percent between the BOD POD® and DXA in lower limb prosthesis users. BOD POD® report valid indices of BF%. Future work will utilize the BOD POD® in intervention studies for monitoring body composition changes across the continuum of rehabilitation.

Characterizing behavior change techniques used in the self-management of binge eating and weight: Applying a user-centered design approach

User-centered design methods aim to increase intervention engagement by focusing on consumers' needs and preferences. We conducted a needs assessment (the first step in user-centered design) via a digital diary study to understand how individuals with recurrent binge eating (≥12 episodes in 3 months) and obesity (BMI ≥30 kg/m2) manage these problems in their day-to-day lives and the approaches they use to change their behavior. Specifically, we applied the Behavior Change Technique (BCT)-Taxonomy to characterize which standardized BCTs individuals use to change binge eating and health-related behaviors and their motivations to use them, to inform the design of a mobile intervention. We analyzed qualitative data from 22 adults (64% female, 32% White) who submitted 176 diary entries. For each entry, we coded the BCTs used, motivation for use, and whether the BCT(s) were perceived as beneficial for behavior change. Across participants, investigators identified 50 of the 93 standardized BCTs (54%). Each participant used an average of 12 (SD = 4) BCTs, most commonly Behavior Substitution (72.3%), Distraction (68.2%), Goal Setting (Behavior) (63.6%), Action Planning (59.1%) and Adding Objects to the Environment (59.1%). More BCTs were coded as beneficial (49%) versus detrimental (24%) or neutral (27%). Techniques were most commonly motivated by preventing binge eating (95.5%), losing weight (95.5%), reducing unhealthy food choices (90.9%), or managing stress (59.1%). Results help inform how interventions could be designed to support consumers in changing binge eating and weight-related behaviors, although such designs would need to be tested for their impact on engagement and outcomes.

CSL112 (human apolipoprotein A-I) infusion rapidly increases apoA-I exchange rate (AER) when administered to patients post myocardial infarction

Background

Cholesterol efflux capacity (CEC) measured using patient serum and cultured macrophages is considered a biomarker of high-density lipoprotein (HDL) functionality. This parameter is inversely related to incident cardiovascular events and declines in the days post-acute myocardial infarction (AMI). The apolipoprotein A-I (apoA-I) exchange rate (AER) may represent an alternative, clinically amenable cell-free measure of CEC, which has also been associated with incident cardiovascular events (1).

Purpose

To characterise the effects of human apoA-I (CSL112) infusion on AER over 48 hours when administered post AMI.

Methods

This analysis included 50 patients with available samples from the AEGIS-I (ApoA-I Event Reducing in Ischemic Syndromes I) randomized, double-blind, placebo-controlled, phase 2b pharmacokinetic/pharmacodynamic sub-study (2). Patients were randomized to receive four weekly infusions of either placebo (n=16), 2g (n=19) or 6g (n=15) CSL112 post AMI. Blood samples were drawn at baseline and at 2, 4, 6, 12, 24 and 48 hours post the first and fourth infusion for measurement of AER (1) as well as CEC (total, ABCA1 dependent and ABCA1 independent CEC) as previously described (3).

Results

CSL112 infusion increased AER dose-dependently, peaking at 2h (end of infusion) and returning to baseline by 24h post infusion (Figure 1). AER was significantly correlated with CEC (total, ABCA1 dependent and independent), HDL-cholesterol, apoA-I and phosphatidylcholine across all timepoints and similarly after both infusions (Table 1).

Conclusion

Infusion of CSL112 increased AER in a dose-dependent manner post AMI and may represent a clinically amenable biomarker of HDL functionality.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): CSL Ltd, Parkville, Australia Figure 1. Left: Time course data expressed as mean ± SEM and adjusted for baseline prior to each infusion. Using a linear mixed model for repeated measures, the 6g dose increased AER from baseline at timepoints from 2–12 hours (p<0.001), whereas the 2gm dose only increased AER between 2–6 hours (p<0.05). Right: Boxplots showing median, quartiles and min/max of Area Under the Curve (AUC) from 0–24 hours post infusion. Using one-way ANOVA the 6 g dose was significantly higher than placebo (p<0.05).Table 1

Development and feasibility of a Configurable Assessment Messaging Platform for Interventions (CAMPI)

INTRODUCTION

Short message service (SMS) is a widely accepted telecommunications approach used to support health informatics, including behavioral interventions, data collection, and patient-provider communication. However, SMS delivery platforms are not standardized and platforms are typically commercial "off-the-shelf" or developed "in-house." As a consequence of platform variability, implementing SMS-based interventions may be challenging for both providers and patients. Off-the-shelf SMS delivery platforms may require minimal development or technical resources from providers, but users are often limited in their functionality. Conversely, platforms that are developed in-house are often specified for individual projects, requiring specialized development and technical expertise. Patients are on the receiving end of programming and technical specification challenges; message delays or lagged data affect quality of SMS communications. To date, little work has been done to develop a generalizable SMS platform that can be scaled across health initiatives.

OBJECTIVE

We propose the Configurable Assessment Messaging Platform for Interventions (CAMPI) to mitigate challenges associated with SMS intervention implementation (e.g., programming, data collection, message delivery).

METHOD

CAMPI aims to optimize health data captured from a multitude of sources and enhance patient-provider communication through a technology that is simple and familiar to patients. Using representative examples from three behavioral intervention case studies implemented among diverse populations (pregnant women, young sexual minority men, and parents with young children), we describe CAMPI capabilities and feasibility.

CONCLUSION

As a generalizable SMS platform, CAMPI can be scaled to meet the priorities of various health initiatives, while reducing unnecessary resource utilization and burden on providers and patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation

Background

Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management.

Objective

This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system.

Methods

A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability.

Results

Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements.

Conclusions

Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform.

Translating evidence-based parenting programs for primary care: Stakeholder recommendations for sustainable implementation

AIMS

To translate evidence-based programs (EBP) for a new setting, attention must be given to the characteristics of the intervention and the local setting, as well as evidence that is compelling to decision-makers. This paper describes the history of a partnership and stakeholder recommendations to inform the adaptation of an EBP for primary care.

METHODS

We established a community advisory board (CAB) consisting of stakeholders with expertize in primary care delivery. A thematic analysis was conducted with fieldnotes and transcriptions from CAB meetings and regular meetings with participating clinics.

RESULTS

We found that (a) parenting programs with a focus on behavioral and physical health are appropriate for this setting, (b) variability in the structure of primary care means implementation must be tailorable, and (c) financial and organizational outcomes are compelling for decision-makers.

CONCLUSION

Factors related to the content and structure of evidence-based programs are uniquely related to distinct implementation outcomes of interest to key stakeholders.

PM2.5 on the London Underground

INTRODUCTION

Despite the London Underground (LU) handling on average 2.8 million passenger journeys per day, the characteristics and potential health effects of the elevated concentrations of metal-rich PM2.5 found in this subway system are not well understood.

METHODS

Spatial monitoring campaigns were carried out to characterise the health-relevant chemical and physical properties of PM2.5 across the LU network, including diurnal and day-to-day variability and spatial distribution (above ground, depth below ground and subway line). Population-weighted station PM2.5 rankings were produced to understand the relative importance of concentrations at different stations and on different lines.

RESULTS

The PM2.5 mass in the LU (mean 88 μg m-3, median 28 μg m-3) was greater than at ambient background locations (mean 19 μg m-3, median 14 μg m-3) and roadside environments in central London (mean 22 μg m-3, median 14 μg m-3). Concentrations varied between lines and locations, with the deepest and shallowest submerged lines being the District (median 4 μg m-3) and Victoria (median 361 μg m-3 but up to 885 μg m-3). Broadly in agreement with other subway systems around the world, sampled LU PM2.5 comprised 47% iron oxide, 7% elemental carbon, 11% organic carbon, and 14% metallic and mineral oxides. Although a relationship between line depth and air quality inside the tube trains was evident, there were clear influences relating to the distance from cleaner outside air and the exchange with cabin air when the doors open. The passenger population-weighted exposure analysis demonstrated a method to identify stations that should be prioritised for remediation to improve air quality.

CONCLUSION

PM2.5 concentrations in the LU are many times higher than in other London transport Environments. Failure to include this environment in epidemiological studies of the relationship between PM2.5 and health in London is therefore likely to lead to a large exposure misclassification error. Given the significant contribution of underground PM2.5 to daily exposure, and the differences in composition compared to urban PM2.5, there is a clear need for well-designed studies to better understand the health effects of underground exposure.

Implementation Research Methodologies for Achieving Scientific Equity and Health Equity

Implementation science has great potential to improve the health of communities and individuals who are not achieving health equity. However, implementation science can exacerbate health disparities if its use is biased toward entities that already have the highest capacities for delivering evidence-based interventions. In this article, we examine several methodologic approaches for conducting implementation research to advance equity both in our understanding of what historically disadvantaged populations would need-what we call scientific equity-and how this knowledge can be applied to produce health equity. We focus on rapid ways to gain knowledge on how to engage, design research, act, share, and sustain successes in partnership with communities. We begin by describing a principle-driven partnership process between community members and implementation researchers to overcome disparities. We then review three innovative implementation method paradigms to improve scientific and health equity and provide examples of each. The first paradigm involves making efficient use of existing data by applying epidemiologic and simulation modeling to understand what drives disparities and how they can be overcome. The second paradigm involves designing new research studies that include, but do not focus exclusively on, populations experiencing disparities in health domains such as cardiovascular disease and co-occurring mental health conditions. The third paradigm involves implementation research that focuses exclusively on populations who have experienced high levels of disparities. To date, our scientific enterprise has invested disproportionately in research that fails to eliminate health disparities. The implementation research methods discussed here hold promise for overcoming barriers and achieving health equity.

Application of the Theoretical Domains Framework to identify factors that influence hand hygiene compliance in long-term care

BACKGROUND

Healthcare worker (HCW) hand hygiene compliance is key to patient safety; however, compliance is suboptimal. Nevertheless hand hygiene compliance is not well studied in the long-term care setting.

AIM

To apply a behaviour change framework, the Theoretical Domains Framework (TDF), to identify modifiable facilitators and barriers for HCW hand hygiene compliance in long-term care settings.

METHODS

HCW hand hygiene compliance facilitators and barriers were examined using a questionnaire for HCWs from long-term care homes in Ontario, Canada. The questionnaire was informed by the TDF, which is based on a synthesis of constructs from a number of relevant psychological theories of behaviour change.

FINDINGS

Barriers identified from the questionnaire aligned with the TDF domain environmental context and resources (time pressure, workload, and environmental controls). Facilitators identified from questionnaire results aligned with the TDF domains social/professional role and identity (it is what is expected of HCWs), and beliefs about consequences (risk of transmission of micro-organisms to self or others).

CONCLUSION

There are several barriers to hand hygiene compliance that persist in long-term care. A behaviour change theory-informed framework such as the TDF can be helpful to identify those barriers. This study identified several key behavioural constructs aligned with the TDF that can be targeted when developing novel hand hygiene interventions.

Recent H- diagnostics, plasma simulations, and 2X scaled Penning ion source developments at the Rutherford Appleton Laboratory

A vessel for extraction and source plasma analyses is being used for Penning H^- ion source development at the Rutherford Appleton Laboratory. A new set of optical elements including an einzel lens has been installed, which transports over 80 mA of H^- beam successfully. Simultaneously, a 2X scaled Penning source has been developed to reduce cathode power density. The 2X source is now delivering a 65 mA H^- ion beam at 10% duty factor, meeting its design criteria. The long-term viability of the einzel lens and 2X source is now being evaluated, so new diagnostic devices have been installed. A pair of electrostatic deflector plates is used to correct beam misalignment and perform fast chopping, with a voltage rise time of 24 ns. A suite of four quartz crystal microbalances has shown that the cesium flux in the vacuum vessel is only increased by a factor of two, despite the absence of a dedicated cold trap. Finally, an infrared camera has demonstrated good agreement with thermal simulations but has indicated unexpected heating due to beam loss on the downstream electrode. These types of diagnostics are suitable for monitoring all operational ion sources. In addition to experimental campaigns and new diagnostic tools, the high-performance VSim and COMSOL software packages are being used for plasma simulations of two novel ion thrusters for space propulsion applications. In parallel, a VSim framework has been established to include arbitrary temperature and cesium fields to allow the modeling of surface physics in H^- ion sources.

Autogenous Tensor Fascia Lata Graft Replacement of the Patellar Ligament in a Dog

This report documents a complicated trauma case in a dog that was successfully managed by substitution of a missing patellar ligament with an autogenous tensor fascia lata free graft. Important to the success of the case was the use of a careful postoperative regime of progressive controlled mobilization with the aid of the hinged transarticular external skeletal fixator. Because of the advantages provided by use of the autogenous tensor fascia lata graft and the hinged transarticular external skeletal fixator, patient morbidity was low and the end result was good.

An autogenous tensor fascia lata free graft was successfully used to completely substitute for a missing patellar ligament in a dog. Postoperative rehabilitation was facilitated by the use of the hinged transarticular external skeletal fixator. The technique is described along with the results. Complete substitution of the patellar ligament with a graft has not been reported in the dog.

Belatacept and Eculizumab for Treatment of Calcineurin Inhibitor-induced Thrombotic Microangiopathy After Kidney Transplantation: Case Report

Thrombotic microangiopathy (TMA) after kidney transplantation is an uncommon and challenging cause of graft dysfunction and is associated with early graft loss. An idiosyncratic endothelial reaction to calcineurin inhibitors (CNIs) has been implicated as a frequent cause of TMA. This reaction is marked by uncontrolled activation of complement and subsequent cellular destruction. Usual therapy consists of withdrawal of the inciting drug and plasmapheresis to minimize levels of circulating complement. Recently, eculizumab, a monoclonal antibody to complement component C5, has been used for the treatment of atypical hemolytic uremic syndrome. Belatacept, an inhibitor of T cell costimulatory protein CTLA-4 has been used in immunosuppression strategies aimed at minimization of CNI. Here we report the first case of treatment of CNI-associated TMA/hemolytic uremic syndrome with withdrawal of tacrolimus and initiation of both belatacept and eculizumab. The case describes a favorable clinical course for both graft and patient, and is accompanied by a review of the literature.

Practical Rotary Encoder Accuracy Limits for Transmission Error Measurement

Errors of angular position on encoders used for transmission error measurement were investigated to determine the practical limits of accuracy. Computer correction can be used to eliminate consistent errors on the encoders but errors remain, attributable to electrical noise, bearing errors and friction effects. Practical limits on the calibration and usage of the encoders for individual harmonics of once per revolution frequency and for a given angular position were established.

Alias Errors in Precision Rotary Encoder Calibration

Discrepancies between errors measured by back-to-back tests on rotary encoders and the errors quoted by the manufacturers led to investigation of the causes for the difference. An error that was apparently at 96 cycles per revolution was found to be due to a much higher frequency which was well outside the normal operating range for transmission error work.

Comparison of Two US Sheep Scrapie Isolates Supports Identification as Separate Strains

Scrapie is a naturally occurring transmissible spongiform encephalopathy of sheep and goats. There are different strains of sheep scrapie that are associated with unique molecular, transmission, and phenotype characteristics. However, in the United States, very little is known about the potential presence of scrapie strains. Scrapie strain and PRNP genotype could both affect susceptibility, potential for transmission, incubation period (IP), and control measures required for eliminating scrapie from a flock. The investigators evaluated 2 US scrapie isolates, No. 13-7 and x124, after intranasal inoculation to compare clinical signs, IPs, spongiform lesions, and patterns of PrPSc deposition in sheep with scrapie-susceptible PRNP genotypes (QQ171). After inoculation with x124, susceptibility and IP were associated with valine at codon 136 (V136) of the prion protein: VV136 sheep had short IPs (6.9 months), those in AV136 sheep were 11.9 months, and AA136 sheep did not develop scrapie. All No. 13-7 inoculated sheep developed scrapie, with IPs of 20.1 months for AA136 sheep, 22.8 months for AV136 sheep, and 26.7 months for VV136 sheep. Patterns of immunoreactivity in the brain were influenced by inoculum isolate and host genotype. Differences in PrPSc profiles versus isolate were most striking when examining brains from sheep with the VV136 genotype. Inoculation into C57BL/6 mice resulted in markedly different attack rates (90.5% for x124 and 5.9% for No. 13-7). Taken together, these data demonstrate that No. 13-7 and x124 represent 2 distinct strains of scrapie with different IPs, genotype susceptibilities, and PrPSc deposition profiles.

Memantine augmentation in clozapine-refractory schizophrenia: a randomized, double-blind, placebo-controlled crossover study

BACKGROUND

Dysfunction of neuroplasticity due to N-methyl-d-aspartate (NMDA) receptor hypofunction may be a causal factor for memory and executive dysfunctioning in schizophrenia. Deregulation of NMDA transmission in the prefrontal cortex may also explain negative and positive symptoms. Clozapine augmentation with memantine targets altered NMDA receptor-mediated neurotransmission in schizophrenia and showed substantial beneficial effects on several symptom domains in a small proof-of-concept study. We evaluate effects of memantine add-on treatment to clozapine for memory and executive function, and negative and positive symptoms in schizophrenia.

METHOD

Clozapine-treated patients with refractory schizophrenia were randomly assigned to 12 weeks of double-blind adjunctive treatment with memantine (n = 26) or placebo (n = 26). Crossover occurred after a 2-week placebo wash-out period. Primary endpoints were change from baseline to 12 weeks treatment and 14 weeks to 26 weeks treatment on memory and executive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression Severity Scale (CGI-S). Side effects were assessed using the Liverpool University Neuroleptic Side-Effect Rating Scale.

RESULTS

When compared with placebo, memantine improved a composite memory score comprising verbal recognition memory and paired associates learning task scores on the CANTAB (effect size = 0.30) and PANSS negative subscale score (effect size = 0.29). Side effects were mild and transient.

CONCLUSIONS

In patients with clozapine-treated refractory schizophrenia, memantine addition significantly improved verbal and visual memory and negative symptoms without serious adverse effects. These results justify further investigations on long-term memantine augmentation to clozapine in treatment-resistant schizophrenia.

Statin-induced expression change of INSIG1 in lymphoblastoid cell lines correlates with plasma triglyceride statin response in a sex-specific manner

Statins are widely prescribed to lower plasma low-density lipoprotein (LDL) cholesterol levels. They also modestly reduce plasma triglyceride (TG), an independent cardiovascular disease risk factor, in most people. The mechanism and inter-individual variability of TG statin response is poorly understood. We measured statin-induced gene expression changes in lymphoblastoid cell lines derived from 150 participants of a simvastatin clinical trial and identified 23 genes (false discovery rate, FDR=15%) with expression changes correlated with plasma TG response. The correlation of insulin-induced gene 1 (INSIG1) expression changes with TG response (rho=0.32, q=0.11) was driven by men (interaction P=0.0055). rs73161338 was associated with INSIG1 expression changes (P=5.4 × 10⁻⁵) and TG response in two statin clinical trials (P=0.0048), predominantly in men. A combined model including INSIG1 expression level and splicing changes accounted for 29.5% of plasma TG statin response variance in men (P=5.6 × 10⁻⁶). Our results suggest that INSIG1 variation may contribute to statin-induced changes in plasma TG in a sex-specific manner.

Boundary-Layer Effects on Acoustic Transmission Through Narrow Slit Cavities

We explore the slit-width dependence of the resonant transmission of sound in air through both a slit array formed of aluminum slats and a single open-ended slit cavity in an aluminum plate. Our experimental results accord well with Lord Rayleigh's theory concerning how thin viscous and thermal boundary layers at a slit's walls affect the acoustic wave across the whole slit cavity. By measuring accurately the frequencies of the Fabry-Perot-like cavity resonances, we find a significant 5% reduction in the effective speed of sound through the slits when an individual viscous boundary layer occupies only 5% of the total slit width. Importantly, this effect is true for any airborne slit cavity, with the reduction being achieved despite the slit width being on a far larger scale than an individual boundary layer's thickness. This work demonstrates that the recent prevalent loss-free treatment of narrow slit cavities within acoustic metamaterials is unrealistic.

Nosocomial Mycobacterial Pseudoinfection in a Georgia Hospital

Nosocomial pseudoepidemics may be detected when clustering of pseudoinfections occur or when artificial clusters of real infection are observed. Nontuberculous mycobacteria were reportedly isolated from specimens obtained from seven patients at one hospital from October 1980 to January 1981. Because the patients' clinical illnesses were not uniformly consistent with mycobacterial disease, we hypothesized that pseudoinfections had occurred and searched for a common source of contamination. The investigation suggested that specimen contamination was associated with one microbiology laboratory technician: 6 of 22 (27%) specimens processed by that person were positive compared with 1 of 103 (1%) specimens processed by the other five technicians. However, a specific mechanism of contamination was not identified. Nosocomial pseudoepidemics associated with false infections should be suspected and investigated when clinical features and laboratory findings do not agree.