Nationwide upsurge in invasive disease in the context of longitudinal surveillance of carriage and invasive Streptococcus pyogenes 2009-2023, the Netherlands: a molecular epidemiological study.

Since 2022, many countries have reported an upsurge in invasive group A streptococcal (iGAS) infections. We explored whether changes in Streptococcus pyogenes carriage rates or emergence of strains with potentially altered virulence, such as emm1 variants M1UK and M1DK, contributed to the 2022/2023 surge in the Netherlands. We determined emm (sub)type distribution for 2,698 invasive and 351 S. pyogenes carriage isolates collected between January 2009 and March 2023. Genetic evolution of emm1 was analyzed by whole-genome sequencing of 497 emm1 isolates. The nationwide iGAS upsurge coincided with a sharp increase of emm1.0 from 18% (18/100) of invasive isolates in Q1 2022 to 58% (388/670) in Q1 2023 (Fisher's exact test, P < 0.0001). M1UK became dominant among invasive emm1 isolates in 2016 and further expanded from 72% in Q1 2022 to 96% in Q1 2023. Phylogenetic comparison revealed evolution and clonal expansion of four new M1UK clades in 2022/2023. DNase Spd1 and superantigen SpeC were acquired in 9% (46/497) of emm1 isolates. S. pyogenes carriage rates and emm1 proportions in carriage isolates remained stable during this surge, and the expansion of M1UK in iGAS was not reflected in carriage isolates. During the 2022/2023 iGAS surge in the Netherlands, expansion of four new M1UK clades was observed among invasive isolates, but not carriage isolates, suggesting increased virulence and fitness of M1UK compared to contemporary M1 strains. The emergence of more virulent clades has important implications for public health strategies such as antibiotic prophylaxis for close contacts of iGAS patients.IMPORTANCEThis study describes the molecular epidemiology of invasive group A streptococcal (iGAS) infections in the Netherlands based on >3,000 Streptococcus pyogenes isolates from both asymptomatic carriers and iGAS patients collected before, during, and after the COVID-19 pandemic period (2009-2023) and is the first to assess whether changes in carriage rates or carried emm types contributed to the alarming post-COVID-19 upsurge in iGAS infections. We show that the 2022/2023 iGAS surge coincided with a sharp increase of emm1, particularly the toxicogenic M1UK variant, in invasive isolates, but not in carriage isolates. These findings suggest that increased virulence and fitness of M1UK likely contributes to an increased dissemination between hosts. The emergence of a more virulent and fit lineage has important implications for iGAS control interventions such as antibiotic prophylaxis for close contacts of iGAS patients and calls for a reappraisal of iGAS control interventions and guidelines.

Grinding of silicon carbide for optical surface fabrication. Part II. Subsurface damage.

This paper is the second part of a study of the grinding of three different grades of silicon carbide (SiC) under the same conditions. In this paper, subsurface damage is analyzed using magnetorheological finishing (MRF). The MRF ribbon is brought into contact with the surface and allowed to dwell for different lengths of time to produce dimples or spots at different depths. The roughness parameters are evaluated at the base of the spots. As the spot depth increases the roughness parameters decrease, eventually saturating at a steady-state value. The depth at which saturation occurs is much greater than the initial peak-to-value roughness of the surface and is therefore assumed to be correlated to the depth of subsurface damage in the material. Estimates of the damage depth are comparable to other estimates given in the literature. The validity of this technique is assessed across different grades of SiC under different grinding conditions, and limitations are identified. The study shows that the microstructure of the SiC grade is a major factor that affects the validity of the technique. The technique is suitable for SiC grades that have a more homogeneous microstructure such as chemical vapor deposited or chemical vapor composite grades. The presence of porosity as in the direct sintered grade, or the presence of a secondary phase, for example, silicon in the reaction-bonded and silicon-infiltrated grades, could hinder the technique from providing conclusive results.

Design, fabrication, and characterization of a tunable LED-based illuminator using refractive freeform arrays.

Dynamic illumination using tunable freeform arrays can enable spatial light distributions of variable size with high uniformity from non-uniform sources through relatively small opposing lateral shifts applied to the freeform components. We present the design, manufacturing, and characterization of a tunable LED-based illuminator using custom freeform Alvarez arrays with commercially available optics to shorten the manufacturing cycle. The optomechanical design and manufacturing of the Alvarez lens arrays and mounting parts are presented in detail. The optical performance of the system is evaluated and compared with simulation results using a custom camera-based test station. Experimental results demonstrate and confirm the dynamic illumination concept with good uniformity.

Grinding of silicon carbide for optical surface fabrication, Part 1: surface analysis.

This paper presents a study of the grinding of three different grades of silicon carbide (SiC) under the same conditions. Surface topography is analyzed using coherent scanning interferometry and scanning electron microscopy. The study provides a baseline understanding of the process mechanics and targets effective selection of process parameters for grinding SiC optics with near optical level surface roughness, thus reducing the need for post-polishing. Samples are raster and spiral ground on conventional precision machines with metal and copper-resin bonded wheels under rough, medium, and finish grinding conditions. Material microstructure and grinding conditions affect attainable surface roughness. Local surface roughness of less than 3 nm RMS was attained in both chemical vapor deposition (CVD) and chemical vapor composite (CVC) SiC. The tool footprint is suitable for sub-aperture machining of a large freeform optics possibly without the need for surface finish correction by post-polishing. Subsurface damage will be assessed in Part 2 of this paper series.

Design, fabrication, and testing of convex reflective diffraction gratings.

The convex reflective diffraction grating is an essential optical component that lends itself to various applications. In this work, we first outline the design principles of convex diffraction gratings from wavefront quality and efficiency perspectives. We then describe a unique fabrication method that allows for the machining of convex diffraction gratings with variable groove structure, which is extendable to rotationally non-symmetric convex diffraction grating substrates. Finally, we demonstrate two quantitative wavefront measurement methods and respective experimental validation.

Reduced articular surface of one-piece cups: a cause of runaway wear and early failure.

BACKGROUND: Despite the clinical success of modern metal-on-metal articulations, concerns with wear-related release of metal ions persist. Evidence suggests metal ion release is related to the effective coverage of the head in the metal shell (the cup's functional articular arc). A recent study suggests a reduced functional articular arc is associated with increased ion release and the arc is a function of component design, size, and the abduction angle. QUESTIONS/PURPOSES: The purposes of this study were to (1) measure the functional articular arc in different sizes of currently available one-piece metal shells from several different manufacturers; and (2) compare the functional articular arc of these one-piece metal shells with the 180 masculine arc of conventional hip arthroplasty acetabular components. METHODS: We calculated the available articular surface arc for 33 one-piece metal cups using measurements of cup depth and internal cup radius. RESULTS: The arc of the articular surface varied among manufacturers and generally decreased with decreasing shell diameter. The mean functional articular arc was 160.5 degrees +/- 3.6 degrees (range, 151.8 degrees -165.8 degrees), which was less than the 180 degrees arc of a conventional acetabular component. CONCLUSIONS: Our data show certain cup designs are at higher risk for failure as a result of the decreased articular surface arc. This, along with analysis of abduction angles, supports the recent findings of bearing failure with vertically placed implants. Care must be taken when implanting these shells to ensure they are placed in less abduction to avoid edge loading and the potential for early bearing failure.

Adjacent segment disc pressures following two-level cervical disc replacement versus simulated anterior cervical fusion.

Anterior cervical fusion (ACF) has been shown to alter the biomechanics of adjacent segments of the cervical spine. The goal of total disc replacement is to address pathology at a given disc with minimal disruption of the operated or adjacent segments. This study compares the pressure within discs adjacent to either a two-level simulated ACDF or a two-level total disc replacement with the ProDisc-C. A special automated motion testing apparatus was constructed. Four fresh cadaveric cervical spine specimens were affixed to the test stand and tested in flexion and extension under specific loads. Intradiscal, miniature strain-gauge-based transducers were placed in the discs above and below the "treated" levels. The specimens were then tested in flexion and extension. Pressure and overall angular displacement were measured. In the most extreme and highest quality specimen the difference at C3/C4 registered 800 kPa and the difference at C6/C7 registered 50 kPa. This same quality specimen treated with the ProDisc reached a flexion angle at much lower moments, 24.3 degrees at 5 N-m, when compared to the the SACF 12.2 degrees at 8.6 N-m. Therefore, the moment needed to achieve 15 degrees of flexion with the SACF treatment was 5.5 N-m and the ProDisc treatment was only 2.9 N-m. This initial data would indicate that adjacent level discs experience substantially lower pressure after two-level disc replacement when compared to two-level SACF. Additional testing to further support these observations is ongoing.