Field-resolved high-order sub-cycle nonlinearities in a terahertz semiconductor laser

The exploitation of ultrafast electron dynamics in quantum cascade lasers (QCLs) holds enormous potential for intense, compact mode-locked terahertz (THz) sources, squeezed THz light, frequency mixers, and comb-based metrology systems. Yet the important sub-cycle dynamics have been notoriously difficult to access in operational THz QCLs. Here, we employ high-field THz pulses to perform the first ultrafast two-dimensional spectroscopy of a free-running THz QCL. Strong incoherent and coherent nonlinearities up to eight-wave mixing are detected below and above the laser threshold. These data not only reveal extremely short gain recovery times of 2 ps at the laser threshold, they also reflect the nonlinear polarization dynamics of the QCL laser transition for the first time, where we quantify the corresponding dephasing times between 0.9 and 1.5 ps with increasing bias currents. A density-matrix approach reproducing the emergence of all nonlinearities and their ultrafast evolution, simultaneously, allows us to map the coherently induced trajectory of the Bloch vector. The observed high-order multi-wave mixing nonlinearities benefit from resonant enhancement in the absence of absorption losses and bear potential for a number of future applications, ranging from efficient intracavity frequency conversion, mode proliferation to passive mode locking.

Closing the preparedness-response gap in time: Operational readiness at points of entry in Europe

Background

As points of entry (POE) - ports, airports and ground-crossings - are important structures for international travel and trade, their timely activated capacity to respond to infectious disease threats is of utmost importance. How can POE timely adjust their capacity from generic preparedness to specific response?

Methods

We developed a conceptual framework for public health response at POE, based on a military used model, leading to a step-wise approach from preparedness to response. Subsequently, our framework has been used to analyze interview data of professionals working at European ports (n = 12), airports (n = 15) and ground-crossings (n = 4) in 11 European countries in June - August 2020 covering the activation of the response to COVID-19.

Results

By integrating the military model, we learned that in preparedness frameworks the pre-defined time expected to activate required capacity is missing. While combining time with capacity creates the possibility of defining a readiness range for different capacity requirements. E.g. information provision to passengers is arranged within hours, while entry-screening may take up to days to be operational. We hypothesized that this readiness range provides the opportunity to split strategic thinking from operational readiness, and may support proactive thinking. The interviews confirmed a very implicit and non-formalized reference to the time needed to activate the response. POE differed highly as regards proactive or reactive response strategies. A much stated problem was fast and often changing strategies on measures, leading to extreme required flexibility and workload in operations.

Conclusions

Explicitly acknowledging the time needed to activate appropriate capacity during the transition from preparedness to response can contribute to a better definition of the operational consequences of readiness. These findings may also be of added value in other public health area than POE.

Effective training in cross-border infection prevention and response

Introduction

Competent personnel at points of entry is important to prevent international spreading of disease. Education, training and exercises (ETE) are commonly used to secure this competency. We studied what effective training looks like, by conducting a literature review on effective ETE, conducting a training needs assessment.

Methodology

A systematic search in Embase, Medline, Web of Science, ERIC, Cinahl, and PsycInfo, to identify effective ETE on infectious disease control was performed. We integratively analysed effectiveness of ETE methods on different outcome levels: satisfaction, learning, behavior and organizational performance. Also, we assessed training needs and -preferences among professionals involved in infectious disease control at points of entry in Europe. They completed a digital questionnaire about previously received ETE, importance of topics, highest training needs, and their preferred ETE methodologies.

Results

We identified a range of effective ETEs in 62 studies. However, details on specific ETE methodologies are scarce, thwarting to link effectiveness to methodology. Also, long term and high level outcomes like behavioral change or public health system performance are reported less frequently than mere satisfaction or knowledge change, while these former often have higher relevance in real practice. Respondents (n = 59) had highest training needs concerning handling ill or exposed persons, and design and use of the contingency plan. Training needs correlated with importance of topics. Highest preferred training methods were presentations and e-modules.

Conclusions

We call for more extensive evaluations of education, training and exercises in infectious disease control, with measurement of high level outcomes and long term effects. Results from the current review and training needs from the field could be combined to design most effective ETE at points of entry.

Strong dose response after immunotherapy with PQ grass using conjunctival provocation testing

Background

Pollinex Quattro Grass (PQ Grass) is an effective, well-tolerated, short pre-seasonal subcutaneous immunotherapy to treat seasonal allergic rhinoconjunctivitis (SAR) due to grass pollen. In this Phase II study, 4 cumulative doses of PQ Grass and placebo were evaluated to determine its optimal cumulative dose.

Methods

Patients with grass pollen-induced SAR were randomised to either a cumulative dose of PQ Grass (5100, 14400, 27600 and 35600 SU) or placebo, administered as 6 weekly subcutaneous injections over 31-41 days (EudraCT number 2017-000333-31). Standardized conjunctival provocation tests (CPT) using grass pollen allergen extract were performed at screening, baseline and post-treatment to determine the total symptom score (TSS) assessed approximately 4 weeks after dosing. Three models were pre-defined (Emax, logistic, and linear in log-dose model) to evaluate a dose response relationship.

Results

In total, 95.5% of the 447 randomized patients received all 6 injections. A highly statistically significant (p < 0.0001), monotonic dose response was observed for all three pre-specified models. All treatment groups showed a statistically significant decrease from baseline in TSS compared to placebo, with the largest decrease observed after 27600 SU (p < 0.0001). The full course of 6 injections was completed by 95.5% of patients. Treatment-emergent adverse events were similar across PQ Grass groups, and mostly mild and transient in nature.

Conclusions

PQ Grass demonstrated a strong curvilinear dose response in TSS following CPT without compromising its safety profile.

Structural integration and performance of inter-sectoral public health-related policy networks: An analysis across policy phases

BACKGROUND

Inter-sectoral policy networks may be effective in addressing environmental determinants of health with interventions. However, contradictory results are reported on relations between structural network characteristics (i.e., composition and integration) and network performance, such as addressing environmental determinants of health. This study examines these relations in different phases of the policy process.

METHODS

A multiple-case study was performed on four public health-related policy networks. Using a snowball method among network actors, overall and sub-networks per policy phase were identified and the policy sector of each actor was assigned. To operationalise the outcome variable, interventions were classified by the proportion of environmental determinants they addressed.

RESULTS

In the overall networks, no relation was found between structural network characteristics and network performance. In most effective cases, the policy development sub-networks were characterised by integration with less interrelations between actors (low cohesion), more equally distributed distances between the actors (low closeness centralisation), and horizontal integration in inter-sectoral cliques. The most effective case had non-public health central actors with less connections in all sub-networks.

CONCLUSION

The results suggest that, to address environmental determinants of health, sub-networks should be inter-sectorally composed in the policy development rather than in the intervention development and implementation phases, and that policy development actors should have the opportunity to connect with other actors, without strong direction from a central actor.

The role of the general practitioner in the community care of people with HIV infection and AIDS: a comparative study of high- and low-prevalence areas in England

BACKGROUND

Policy for the care of people suffering from HIV and AIDS has changed over the past decade. Schemes for shared primary and secondary care have been met with varying success, and patients may be reluctant to become involved. No systematic evaluation comparing the views of primary care providers and users in areas of varying HIV prevalence has been published.

AIM

To examine the role of general practice in areas of England with low and high human immunodeficiency virus (HIV) prevalence and to compare barriers to general practice care in each area.

METHOD

We used focus groups, semistructured questionnaires and interviews in north London (high HIV prevalence) and Nottingham (low HIV prevalence).

RESULTS

Four focus groups took place in London. A total of 411 general practitioners (GPs) in London and 405 in Nottingham replied to postal questionnaires. Overall, 121 primary care staff in 40 London practices and 26 staff in five Nottingham practices were interviewed. In all, 54 people infected with HIV were interviewed in London and 20 in Nottingham. Providers and users regarded the 24-hour availability and the familiar environment of general practice as its key assets. Lack of expertise and time were its disadvantages. Providers were concerned about inadequate communication with specialist services. Although providers were concerned about confidentiality, whether they had liberal and sympathetic attitudes was more important in deciding whether people with HIV used the service. In the low-prevalence area, general practice involvement was the result of individual initiatives, and practices were not integrated into specialist care. In the high-prevalence area, HIV care was more usual in general practice, but there was also little integration with HIV services.

CONCLUSIONS

In high-prevalence districts, a strategy to make HIV care routine for all GPs may be appropriate. In low-prevalence areas, a network of selected, strategically located, relatively high-involvement practices may be more effective in meeting the primary care needs of people with HIV infection and acquired immunodeficiency syndrome (AIDS).

Radiofrequency catheter ablation of right ventricular tachycardia late after repair of congenital heart defects

BACKGROUND

Ventricular arrhythmias after repair of congenital heart defects are a common finding and possibly contribute to sudden death in these patients. Optimal antiarrhythmic management has not yet been defined.

METHODS AND RESULTS

The study population consisted of 16 patients in whom ventricular arrhythmias occurred 11 to 42 years after complete surgical repair of congenital heart defects. Fifteen patients had a history of symptomatic sustained or nonsustained ventricular tachycardia, and 1 had frequent nonsustained ventricular tachycardia. The diagnostic mapping procedure to identify the origin of the arrhythmia included pace mapping during sinus rhythm, activation mapping, and pacing interventions during ventricular tachycardia. Catheter ablation was carried out by means of radiofrequency energy in the temperature-controlled mode. The follow-up period was 6 to 33 months (mean, 16 months). A right ventricular origin of the tachycardia in the surgically corrected area could be determined in all patients. Catheter ablation was carried out without complications. Immediate noninducibility was achieved in 15 of the 16 patients. One patient in whom the tachycardia was again inducible at repeat stimulation 1 week later was successfully treated with amiodarone. Eleven patients were taken off antiarrhythmic drugs. During follow-up, none of them had a recurrence of the tachycardia that had been ablated.

CONCLUSIONS

In patients with symptomatic or frequent ventricular tachycardia late after complete surgical repair of congenital heart defects, catheter ablation by means of radiofrequency energy is feasible and safe and thus might be taken into consideration for these patients. Short-term follow-up results are promising.

Preservation of peristaltic reflex in hypertrophied ileum of guinea pig

Chronic obstruction of the guinea pig ileum leads to distension and muscular hypertrophy, but how this affects passive biomechanical and nerve-mediated contractions and clearance known as peristaltic reflex is unclear. Ileum of controls had a diameter of 3.0 +/- 1.1 mm and a circular muscle thickness of 37.2 +/- 11.2 microns; 4 wk after placement of a nonconstricting Gore-Tex band, the ileum was distended to 10.0 +/- 0.19 mm, and its muscle had hypertrophied to 195.0 +/- 61.2 microns. Hypertrophied segments exceeded controls in capacity (e.g., 5.1 +/- 1.1 vs. 1.1 +/0 0.2 ml at 6 cm), compliance, and hysteresis. Threshold volumes and pressures that triggered the reflex were 3.3 +/- 1.3 ml and 3.1 +/- 0.01 mmHg in hypertrophied vs. 0.7 +/- 0.2 ml and 1.5 +/- 0.2 mmHg in controls. The diameter increase that triggered the reflex was 1.4 +/- 0.1 mm in hypertrophied segments and 0.6 +/- 0.1 mm in controls. Hypertrophied segments generated fewer contractions of virtually double the amplitude and failed to generate a pressure differential between up- and downstream sites as controls did. Hypertrophied segments generated larger stroke volumes and cumulative clearance than controls. The ratio of antegrade to retrograde clearance was similar in hypertrophied and control segments. The length of the occluding segment in hypertrophied preparations exceeded that of controls. Control contractions indented the antimesenteric border and propagated antegrade from their site of origin; bizarre writhing movements of hypertrophied segments made their contractions difficult to monitor. Thus distension and muscular hypertrophy do not interfere with the ability of the chronically obstructed guinea pig ileum to generate a peristaltic reflex at least as readily and as powerful and as effective in clearing the lumen as controls.

Dynamic imaging of obstructed opossum esophagus. From altered load to altered contractility

We studied by barium contrast the dynamics of experimental obstruction in the opossum esophagus. Immediately after banding the gastroesophageal junction, entrapment of the bolus between the band and the peristaltic contraction led to esophageal bulging, forceful retropulsion of the bolus at the band, and the repeated triggering of peristaltic contractions by the retropelled bolus. In ensuing weeks, triggering of contractions became more difficult and contractions led to bizarre "corkscrew" movements of the increasingly distended and tortuous esophagus. A tight contraction ring that moved very slowly retrograde was occasionally observed in the chronically distended esophagus. Computer-assisted analysis showed that the area and perimeter of the bolus were abnormally large in chronic obstruction and that during its passage through the esophagus the compactness of the bolus increased no longer. Configurational analysis of the cone that the peristaltic contraction shapes at the tail of the barium column showed this to narrow progressively on passage through the normal esophagus and, paradoxically, to widen in both acute and chronic obstruction.

A controlled investigation of right hemispheric processing enhancement after restricted environmental stimulation (REST) with floatation

Two groups of 16 subjects, 8 of each gender, were examined on two occasions, one group before and after restricted environmental stimulation with floatation, and the other group without floatation was the control group. They were examined with a tactile object discrimination task carried out with each hand separately while blindfolded, and with a recognition memory test for words and unfamiliar faces, a test validated on neurological patients with left and right hemispheric lesions respectively. Consistent with both tasks the floatation group showed a significantly greater enhancement of right hemispheric processing after floatation than was found when retesting the controls. The results were distinguished from previous research on hypnosis where the same relative state of hemispheric imbalance was achieved with the same tasks, but largely through inhibitory influences on the left hemisphere.