Interactive effects of age and respiratory virus on severe lower respiratory infection.

We investigated risk factors for severe acute lower respiratory infections (ALRI) among hospitalised children 8 months were at greater risk from influenza-associated ICU admissions and long hospital stay. Children with ADV had increased LOS across all ages. In the first 2 years of life, the effects of different viruses on ALRI severity varies with age. Our findings help to identify specific ages that would most benefit from virus-specific interventions such as vaccines and antivirals.

Experimental Bayesian Quantum Phase Estimation on a Silicon Photonic Chip.

Quantum phase estimation is a fundamental subroutine in many quantum algorithms, including Shor's factorization algorithm and quantum simulation. However, so far results have cast doubt on its practicability for near-term, nonfault tolerant, quantum devices. Here we report experimental results demonstrating that this intuition need not be true. We implement a recently proposed adaptive Bayesian approach to quantum phase estimation and use it to simulate molecular energies on a silicon quantum photonic device. The approach is verified to be well suited for prethreshold quantum processors by investigating its superior robustness to noise and decoherence compared to the iterative phase estimation algorithm. This shows a promising route to unlock the power of quantum phase estimation much sooner than previously believed.

60 dB high-extinction auto-configured Mach-Zehnder interferometer.

Imperfections in integrated photonics manufacturing have a detrimental effect on the maximal achievable visibility in interferometric architectures. These limits have profound implications for further technological developments in photonics and in particular for quantum photonic technologies. Active optimization approaches, together with reconfigurable photonics, have been proposed as a solution to overcome this. In this Letter, we demonstrate an ultrahigh (>60 dB) extinction ratio in a silicon photonic device consisting of cascaded Mach-Zehnder interferometers, in which additional interferometers function as variable beamsplitters. The imperfections of fabricated beamsplitters are compensated using an automated progressive optimization algorithm with no requirement for pre-calibration. This work shows the possibility of integrating and accurately controlling linear-optical components for large-scale quantum information processing and other applications.

Incidence and viral aetiologies of acute respiratory illnesses (ARIs) in the United States: a population-based study.

We conducted prospective, community-wide surveillance for acute respiratory illnesses (ARIs) in Rochester, NY and Marshfield, WI during a 3-month period in winter 2011. We estimated the incidence of ARIs in each community, tested for viruses, and determined the proportion of ARIs associated with healthcare visits. We used a rolling cross-sectional design to sample participants, conducted telephone interviews to assess ARI symptoms (defined as a current illness with feverishness or cough within the past 7 days), collected nasal/throat swabs to identify viruses, and extracted healthcare utilization from outpatient/inpatient records. Of 6492 individuals, 321 reported an ARI within 7 days (4·9% total, 5·7% in Rochester, 4·4% in Marshfield); swabs were collected from 208 subjects. The cumulative ARI incidence for the entire 3-month period was 52% in Rochester [95% confidence interval (CI) 42-63] and 35% in Marshfield (95% CI 28-42). A specific virus was identified in 39% of specimens: human coronavirus (13% of samples), rhinovirus (12%), RSV (7%), influenza virus (4%), human metapneumovirus (4%), and adenovirus (1%). Only 39/200 (20%) had a healthcare visit (2/9 individuals with influenza). ARI incidence was ~5% per week during winter.

Effectiveness of seasonal influenza vaccine in preventing influenza primary care visits and hospitalisation in Auckland, New Zealand in 2015: interim estimates.

Preliminary results for influenza vaccine effectiveness (VE) against acute respiratory illness with circulating laboratory-confirmed influenza viruses in New Zealand from 27 April to 26 September 2015, using a case test-negative design were 36% (95% confidence interval (CI): 11-54) for general practice encounters and 50% (95% CI: 20-68) for hospitalisations. VE against hospitalised influenza A(H3N2) illnesses was moderate at 53% (95% CI: 6-76) but improved compared with previous seasons.

Reference-frame-independent quantum-key-distribution server with a telecom tether for an on-chip client.

We demonstrate a client-server quantum key distribution (QKD) scheme. Large resources such as laser and detectors are situated at the server side, which is accessible via telecom fiber to a client requiring only an on-chip polarization rotator, which may be integrated into a handheld device. The detrimental effects of unstable fiber birefringence are overcome by employing the reference-frame-independent QKD protocol for polarization qubits in polarization maintaining fiber, where standard QKD protocols fail, as we show for comparison. This opens the way for quantum enhanced secure communications between companies and members of the general public equipped with handheld mobile devices, via telecom-fiber tethering.

Interim estimates of the effectiveness of seasonal trivalent inactivated influenza vaccine in preventing influenza hospitalisations and primary care visits in Auckland, New Zealand, in 2014.

We present preliminary results of influenza vaccine effectiveness (VE) in New Zealand using a case test-negative design for 28 April to 31 August 2014. VE adjusted for age and time of admission among all ages against severe acute respiratory illness hospital presentation due to laboratory-confirmed influenza was 54% (95% CI: 19 to 74) and specifically against A(H1N1)pdm09 was 65% (95% CI:33 to 81). For influenza-confirmed primary care visits, VE was 67% (95% CI: 48 to 79) overall and 73% (95% CI: 50 to 85) against A(H1N1)pdm09.

Kilovoltage energy imaging with a radiotherapy linac with a continuously variable energy range.

PURPOSE: In this paper, the effect on image quality of significantly reducing the primary electron energy of a radiotherapy accelerator is investigated using a novel waveguide test piece. The waveguide contains a novel variable coupling device (rotovane), allowing for a wide continuously variable energy range of between 1.4 and 9 MeV suitable for both imaging and therapy. METHOD: Imaging at linac accelerating potentials close to 1 MV was investigated experimentally and via Monte Carlo simulations. An imaging beam line was designed, and planar and cone beam computed tomography images were obtained to enable qualitative and quantitative comparisons with kilovoltage and megavoltage imaging systems. The imaging beam had an electron energy of 1.4 MeV, which was incident on a water cooled electron window consisting of stainless steel, a 5 mm carbon electron absorber and 2.5 mm aluminium filtration. Images were acquired with an amorphous silicon detector sensitive to diagnostic x-ray energies. RESULTS: The x-ray beam had an average energy of 220 keV and half value layer of 5.9 mm of copper. Cone beam CT images with the same contrast to noise ratio as a gantry mounted kilovoltage imaging system were obtained with doses as low as 2 cGy. This dose is equivalent to a single 6 MV portal image. While 12 times higher than a 100 kVp CBCT system (Elekta XVI), this dose is 140 times lower than a 6 MV cone beam imaging system and 6 times lower than previously published LowZ imaging beams operating at higher (4-5 MeV) energies. CONCLUSIONS: The novel coupling device provides for a wide range of electron energies that are suitable for kilovoltage quality imaging and therapy. The imaging system provides high contrast images from the therapy portal at low dose, approaching that of gantry mounted kilovoltage x-ray systems. Additionally, the system provides low dose imaging directly from the therapy portal, potentially allowing for target tracking during radiotherapy treatment. There is the scope with such a tuneable system for further energy reduction and subsequent improvement in image quality.

A low Z linac and flat panel imager: comparison with the conventional imaging approach.

Experimental and Monte Carlo simulations were conducted for an Elekta Ltd Precise Treatment System linac fitted with a low Z insert of sufficient thickness to remove all primary electrons. A variety of amorphous silicon based panels employing different scintillators were modelled to determine their response to a variety of x-ray spectra and produce an optimized portal imaging system. This study has shown that in a low Z configuration the vast majority of x-rays are produced in the nickel electron window, and with a combination of a carbon insert and caesium iodide based XVI-panel, significant improvement in the object contrast was achieved. For thin, head and neck-type geometries, contrast is 4.62 times greater for 1.6 cm bone in 5.8 cm water than the standard 6 MV/iViewGT system. For thicker, pelvis-type geometries contrast increases by a factor of 1.3 for 1.6 cm of bone in 25.8 cm water. To obtain images with the same signal-to-noise ratio as the 6 MV/iViewGT system, dose reductions of a factor of 15 and 4.2 are possible for 5.8 cm and 25.8 cm phantoms respectively. This design has the advantage of being easily implemented on a standard linac and provides a portal image directly from the therapy beam aperture.

Chip-based quantum key distribution.

Improvement in secure transmission of information is an urgent need for governments, corporations and individuals. Quantum key distribution (QKD) promises security based on the laws of physics and has rapidly grown from proof-of-concept to robust demonstrations and deployment of commercial systems. Despite these advances, QKD has not been widely adopted, and large-scale deployment will likely require chip-based devices for improved performance, miniaturization and enhanced functionality. Here we report low error rate, GHz clocked QKD operation of an indium phosphide transmitter chip and a silicon oxynitride receiver chip-monolithically integrated devices using components and manufacturing processes from the telecommunications industry. We use the reconfigurability of these devices to demonstrate three prominent QKD protocols-BB84, Coherent One Way and Differential Phase Shift-with performance comparable to state-of-the-art. These devices, when combined with integrated single photon detectors, pave the way for successfully integrating QKD into future telecommunications networks.

Inhibition of human erythrocyte inositol lipid metabolism by adriamycin.

Incubation of human erythrocytes with Adriamycin prevented their morphological transition from discocytes to echinocytes when they were either depleted of ATP or loaded with calcium. This effect was dependent upon drug concentration and cell density. Adriamycin (10(-5) M) prevented, by greater than 90%, the echinocytosis of 10(7) cells/ml (S. B. Chahwala and J. A. Hickman, Cancer Res., 45: 4986-4989, 1985), and 5 X 10(-4) M prevented that of 10(9) cells/ml. There was a poor correlation between the effects of Adriamycin as a modulator of this morphological transition and its potency as an inhibitor of calmodulin. Using inside-out red blood cell vesicles, Adriamycin inhibited calmodulin dependent Ca2+ uptake with a 50% inhibitory concentration of 5 X 10(-4) M. Adriamycin thus differs from other amphipathic drugs, such as those of the phenothiazine class, where inhibition of calmodulin correlated well with effects on erythrocyte morphology (G. A. Nelson, M. L. Andrews, and M. J. Karnovsky, J. Cell Biol., 96: 730-735, 1983). After 12 h of ATP depletion, levels of phosphatidylinositol 4,5-bisphosphate [PtdIns(4,5)P2] extracted from 10(9) erythrocytes/ml fell by 57% and after 48 h they fell by 97%, changes which were coincident with a 100% transition of morphology to echinocytes. Adriamycin, 5 X 10(-4) M-1 X 10(-3) M, maintained 10(9) cells/ml in a discocyte morphology and maintained PtdIns(4,5)P2 levels at 60-70% of the time zero controls, independently of the size of the fall in PtdIns(4,5)P2 levels. The data suggested that Adriamycin inhibited a discrete pool of PtdIns(4,5)P2 which may be responsible for the maintenance of a discocyte morphology. Neomycin, 10(-3) M, had no effect on the ATP depletion-induced discocyte-echinocyte transition of 10(9) erythrocytes/ml or on the fall in PtdIns(4,5)P2 levels. Adriamycin, like neomycin, prevented the calcium-induced breakdown of erythrocyte membrane vesicle PtdIns(4,5)P2 to inositol trisphosphate (50% inhibitory concentration, 7 X 10(-4) M) but, unlike neomycin (50% inhibitory concentration, 4.25 X 10(-4) M) it was able to inhibit breakdown by 100% at higher concentrations.

Elevation of leukemic cell intracellular calcium by the ether lipid SRI 62-834.

SRI 62-834 is a novel antineoplastic ether lipid which is currently undergoing a Phase 1 clinical trial in the United Kingdom. Its mechanism of action has not been defined. Incubation of 7.5 X 10(6)/ml HL-60 human myelomonocytic leukemia cells with between 10 and 50 microM SRI 62-834 brought about a concentration-dependent, biphasic rise in intracellular calcium, as measured by the calcium-sensitive fluorescent dye Quin-2 AM. Incubation with 30 microM SRI 62-834 elevated intracellular calcium from 110 to 415 nM after 10 min in a typical experiment; this concentration inhibited cell growth by greater than 90% (50% inhibition of growth was observed at 8 microM). The calcium channel blockers verapamil and prenylamine did not inhibit the SRI 62-834-induced elevation of intracellular calcium. Incubation of SRI 62-834 with K562 erythroblastic leukemia cells also brought about a rise in the intracellular calcium. The growth of K562 cells was less sensitive to SRI 62-834 (dose to produce 50% growth inhibition, 65 microM) compared to HL-60 cells, and significant intracellular calcium rises, which were monophasic, required greater than 40 microM SRI 62-834. At a concentration of SRI 62-834 which inhibited both HL-60 and K562 growth by 90% (30 and 140 microM, respectively) an equivalent rise in intracellular calcium was observed (circa 400 nM). Preincubation of HL-60 or K562 cells with 1 to 100 nM 12-O-tetradecanoylphorbol-13-acetate for 10 min prior to the addition of SRI 62-834 inhibited the rise in intracellular calcium in a concentration-dependent manner. It is suggested that SRI 62-834-induced changes in intracellular calcium may contribute to its cytotoxicity and that the rise is not due to an early and grossly disruptive effect of the agent on membrane structure.

Stimulation of protein synthesis and phospholipase D activity by vasopressin and phorbol ester in L6 myoblasts.

The effects of 12-O-tetradecanoylphorbol-13-acetate (TPA) and vasopressin on protein synthesis and phospholipase D (PLD) activity were investigated in L6 myoblasts. TPA stimulated a concentration-dependent increase in protein synthesis (EC50 approx. 10 nM) during a 90 min incubation, but had no effect after 6 h. The maximum increase was about 15% and was mediated through changes in translation, as TPA had no effect on RNA accretion and the response was not prevented by actinomycin D. TPA also stimulated PLD activity as measured by an 8-fold increase in the formation of phosphatidylbutanol (PtdBuOH) and the release of choline (EC50 5-10 nM). In contrast to TPA, vasopressin stimulated protein synthesis (maximum increase 30%, EC50 approx. 10 nM) and RNA accretion after 6 h, but had no effect after 90 min. Vasopressin also increased PtdBuOH production 4-5-fold (EC50 approx. 0.5 nM) and choline release (EC50 approx. 1 nM). The addition of a highly purified preparation of PLD (2-10 units/ml) from Streptomyces sp. to L6 cells stimulated a concentration-dependent increase in choline release and protein synthesis after both 90 min (maximum stimulation 13%) and 6 h (maximum stimulation 12%). PLD also stimulated RNA accretion after 6 h but not 90 min. The data support a role for PLD in the regulation of protein synthesis in L6 cells.

Insulin and insulin-like growth factor-I responsiveness and signalling mechanisms in C2C12 satellite cells: effect of differentiation and fusion.

In proliferating C2C12 myoblasts, serum and physiological concentrations of insulin and IGF-I stimulated protein synthesis and RNA accretion. After fusion, the multinucleated myotubes remained responsive to serum but not to insulin or IGF-I, even though both insulin and type-I IGF receptor mRNAs increased in abundance. Protein synthetic responses to insulin and IGF-I in myoblasts were not inhibited by dexamethasone, ibuprofen or Ro-31-8220, thus phospholipase A2, cyclo-oxygenase and protein kinase C did not appear to be involved in the signalling mechanisms. Neither apparently were polyphosphoinositide-specific phospholipase C or phospholipase D since neither hormone increased inositol phosphate, phosphatidic acid, choline or phosphatidylbutanol production. Only the phosphatidylinositol-3-kinase inhibitor, wortmannin, and the 70 kDa S6-kinase inhibitor, rapamycin, wholly or partially blocked the effects of insulin and IGF-I on protein synthesis. 2-deoxyglucose uptake remained responsive to insulin and IGF-I after fusion and was also inhibited by wortmannin. The results suggest that the loss of responsiveness after fusion is not due to loss of receptors, but to the uncoupling of a post-receptor pathway, occurring after the divergence of the glucose transport and protein synthesis signalling systems, and that, if wortmannin acts at a single site, this is prior to that point of divergence.

Cyclic AMP stimulates protein synthesis in L6 myoblasts and its effects are additive to those of insulin, vasopressin and 12-0-tetradecanoylphorbol-13-acetate. Possible involvement of mitogen activated protein kinase.

The role of cyclic AMP as a second messenger in the stimulation of protein synthesis and the potential involvement of mitogen activated protein (MAP) kinase in this response was studied in L6 myoblasts. Dibutyryl-cAMP (dbt-cAMP) increased protein synthesis at 90 min and 6 h in a concentration-dependent manner. The responses at 90 min were probably mediated by increased translation as they were not blocked by actinomycin D; effects at 6 h were accompanied by increases in RNA content implying a transcriptional component. 100 nM 12-0-tetradecanoylphorbol-13-acetate (TPA), 1 nM Insulin (90 min incubations) and 100 nM vasopressin (6 h incubation) also increased protein synthesis and these responses were additive with those of 500 micron dbt-cAMP. Responses to forskolin were similar to dbt-cAMP whilst 1,9-dideoxyforskolin had no effect. Cell extracts immunoblotted with MAP kinase antibody showed bands corresponding to approx. 42, 44, 54 and 83 kDa. 500 micron dbt-cAMP elicited an increase in activity of both the 42 and 44 kDa bands when assayed by the 'in gel' method and a similar response was also observed with forskolin. TPA and vasopressin also stimulated the activity of these two isoforms, but had no significant additive or inhibitory effects when added in combination with 500 micron dbt-cAMP. In contrast, although 1 nM insulin alone had no effect, a synergistic response in terms of MAP kinase activation was observed in the presence of dbt-cAMP. The data demonstrate that cAMP stimulates protein synthesis in L6 cells and suggest a role for MAP kinase in this event.

Signalling pathways regulating protein turnover in skeletal muscle.

The protein content of skeletal muscle is determined by the relative rates of synthesis and degradation which must be regulated coordinately to maintain equilibrium. However, in conditions such as fasting where amino acids are required for gluconeogenesis, or in cancer cachexia, this equilibrium is disrupted and a net loss of protein ensues. This review, utilising studies performed in several situations, summarizes the current state of knowledge on the possible signalling pathways regulating protein turnover in skeletal muscle and highlights areas for future work.

Decoupling initial electron beam parameters for Monte Carlo photon beam modelling by removing beam-modifying filters from the beam path.

A new method is presented to decouple the parameters of the incident e(-) beam hitting the target of the linear accelerator, which consists essentially in optimizing the agreement between measurements and calculations when the difference filter, which is an additional filter inserted in the linac head to obtain uniform lateral dose-profile curves for the high energy photon beam, and flattening filter are removed from the beam path. This leads to lateral dose-profile curves, which depend only on the mean energy of the incident electron beam, since the effect of the radial intensity distribution of the incident e- beam is negligible when both filters are absent. The location of the primary collimator and the thickness and density of the target are not considered as adjustable parameters, since a satisfactory working Monte Carlo model is obtained for the low energy photon beam (6 MV) of the linac using the same target and primary collimator. This method was applied to conclude that the mean energy of the incident e- beam for the high energy photon beam (18 MV) of our Elekta SLi Plus linac is equal to 14.9 MeV. After optimizing the mean energy, the modelling of the filters, in accordance with the information provided by the manufacturer, can be verified by positioning only one filter in the linac head while the other is removed. It is also demonstrated that the parameter setting for Bremsstrahlung angular sampling in BEAMnrc ('Simple' using the leading term of the Koch and Motz equation or 'KM' using the full equation) leads to different dose-profile curves for the same incident electron energy for the studied 18 MV beam. It is therefore important to perform the calculations in 'KM' mode. Note that both filters are not physically removed from the linac head. All filters remain present in the linac head and are only rotated out of the beam. This makes the described method applicable for practical usage since no recommissioning process is required.

Qubit entanglement between ring-resonator photon-pair sources on a silicon chip.

Entanglement--one of the most delicate phenomena in nature--is an essential resource for quantum information applications. Scalable photonic quantum devices must generate and control qubit entanglement on-chip, where quantum information is naturally encoded in photon path. Here we report a silicon photonic chip that uses resonant-enhanced photon-pair sources, spectral demultiplexers and reconfigurable optics to generate a path-entangled two-qubit state and analyse its entanglement. We show that ring-resonator-based spontaneous four-wave mixing photon-pair sources can be made highly indistinguishable and that their spectral correlations are small. We use on-chip frequency demultiplexers and reconfigurable optics to perform both quantum state tomography and the strict Bell-CHSH test, both of which confirm a high level of on-chip entanglement. This work demonstrates the integration of high-performance components that will be essential for building quantum devices and systems to harness photonic entanglement on the large scale.

Do anorectics get well? Current research and future needs.

The authors review data from 12 major outcome studies of anorexia nervosa published in the 15 years since the last review article of Ziolko (1966). Across the 12 studies the mortality rate from self-starvation was 6%. On follow-up, well over half of the subjects continued to have eating difficulties, and close to half showed other signs of psychiatric impairment. In nonsymptomatic areas of adjustment there was a striking contrast between the 90% who were successfully employed and the 54% who made some minimal form of marital or social adjustment. The authors present a series of recommendations about the form and content of future research in the field.

Priorities in psychiatric residency training.

The authors surveyed 22 psychiatric educators to determine their views of the basic knowledge and skills that should be required for all psychiatric residents. A comprehensive document of educational objectives facilitated practical differentiation of responses. Diagnostic, problem-solving, and treatment-dispositional skills were particularly highly ranked. Such data may be useful in defining the profession of psychiatry as well as in curriculum planning.