Modeling Respiratory Syncytial Virus Adult Vaccination in the United States With a Dynamic Transmission Model.

BACKGROUND: Respiratory syncytial virus (RSV) is shown to cause substantial morbidity, hospitalization, and mortality in infants and older adults. Population-level modeling of RSV allows to estimate the full burden of disease and the potential epidemiological impact of novel prophylactics. METHODS: We modeled the RSV epidemiology in the United States across all ages using a deterministic compartmental transmission model. Population-level symptomatic RSV acute respiratory tract infection (ARI) cases were projected across different natural history scenarios with and without vaccination of adults aged ≥60 years. The impact of vaccine efficacy against ARIs, infectiousness and vaccine coverage on ARI incidence were assessed. The impact on medical attendance, hospitalization, complications, death, and other outcomes was also derived. RESULTS: Without a vaccine, we project 17.5-22.6 million symptomatic RSV ARI cases annually in adults aged ≥18 years in the US, with 3.6-4.8 million/year occurring in adults aged ≥60 years. Modeling indicates that up to 2.0 million symptomatic RSV-ARI cases could be prevented annually in ≥60-year-olds with a hypothetical vaccine (70% vaccine efficacy against symptomatic ARI and 60% vaccine coverage) and that up to 0.69 million/year could be prevented in the nonvaccinated population, assuming 50% vaccine impact on infectiousness. CONCLUSIONS: The model provides estimated burden of RSV in the US across all age groups, with substantial burden projected specifically in older adults. Vaccination of adults aged ≥60 years could significantly reduce the burden of disease in this population, with additional indirect effect in adults aged <60 years due to reduced transmissibility.

Are the dynamic response characteristics of brachial artery flow-mediated dilation sensitive to the magnitude of increase in shear stimulus?

The purpose of this study was to determine the dynamic characteristics of brachial artery dilation in response to step increases in shear stress [flow-mediated dilation (FMD)]. Brachial artery diameter (BAD) and mean blood velocity (MBV) (Doppler ultrasound) were obtained in 15 healthy subjects. Step increases in MBV at two shear stimulus magnitudes were investigated: large (L; maximal MBV attainable), and small (S; MBV at 50% of the large step). Increase in shear rate (estimate of shear stress: MBV/BAD) was 76.8 +/- 15.6 s(-1) for L and 41.4 +/- 8.7 s(-1) for S. The peak %FMD was 14.5 +/- 3.8% for L and 5.7 +/- 2.1% for S (P < 0.001). Both the L (all subjects) and the S step trials (12 of 15 subjects) elicited a biphasic diameter response with a fast initial phase (phase I) followed by a slower final phase. Relative contribution of phase I to total FMD when two phases occurred was not sensitive to shear rate magnitude (r(2) = 0.003, slope P = 0.775). Parameters quantifying the dynamics of the FMD response [time delay (TD), time constant (tau)] were also not sensitive to shear rate magnitude for both phases (phase I: TD r(2) = 0.03, slope P = 0.376, tau r(2) = 0.04, slope P = 0.261; final phase: TD r(2) = 0.07, slope P = 0.169, tau r(2) = 0.07, slope P = 0.996). These data support the existence of two distinct mechanisms, or sets of mechanisms, in the human conduit artery FMD response that are proportionally sensitive to shear stimulus magnitude and whose dynamic response is not sensitive to shear stimulus magnitude.

Invited article: design techniques and noise properties of ultrastable cryogenically cooled sapphire-dielectric resonator oscillators.

We review the techniques used in the design and construction of cryogenic sapphire oscillators at the University of Western Australia over the 18 year history of the project. We describe the project from its beginnings when sapphire oscillators were first developed as low-noise transducers for gravitational wave detection. Specifically, we describe the techniques that were applied to the construction of an interrogation oscillator for the PHARAO Cs atomic clock in CNES, in Toulouse France, and to the 2006 construction of four high performance oscillators for use at NMIJ and NICT, in Japan, as well as a permanent secondary frequency standard for the laboratory at UWA. Fractional-frequency fluctuations below 6 x 10(-16) at integration times between 10 and 200 s have been repeatedly achieved.

Epidemiology and Management of the 2013-16 West African Ebola Outbreak.

The 2013-16 West African Ebola outbreak is the largest, most geographically dispersed, and deadliest on record, with 28,616 suspected cases and 11,310 deaths recorded to date in Guinea, Liberia, and Sierra Leone. We provide a review of the epidemiology and management of the 2013-16 Ebola outbreak in West Africa aimed at stimulating reflection on lessons learned that may improve the response to the next international health crisis caused by a pathogen that emerges in a region of the world with a severely limited health care infrastructure. Surveillance efforts employing rapid and effective point-of-care diagnostics designed for environments that lack advanced laboratory infrastructure will greatly aid in early detection and containment efforts during future outbreaks. Introduction of effective therapeutics and vaccines against Ebola into the public health system and the biodefense armamentarium is of the highest priority if future outbreaks are to be adequately managed and contained in a timely manner.

Measurement of left ventricular mass in vivo using gated nuclear magnetic resonance imaging.

Alterations of left ventricular mass occur in a variety of congenital and acquired heart diseases. In vivo determination of left ventricular mass, using several different techniques, has been previously reported. Problems inherent in some previous methods include the use of ionizing radiation, complicated geometric assumptions and invasive techniques. We tested the ability of gated nuclear magnetic resonance imaging to determine in vivo left ventricular mass in animals. By studying both dogs (n = 9) and cats (n = 2) of various sizes, a broad range of left ventricular mass (7 to 133 g) was examined. With a 0.5 tesla superconducting nuclear magnetic resonance imaging system the left ventricle was imaged in the transaxial plane and multiple adjacent 10 mm thick slices were obtained. Endocardial and epicardial edges were manually traced in each computer-displayed image. The wall area of each image was determined by computer and the areas were summed and multiplied by the slice thickness and the specific gravity of muscle, providing calculated left ventricular mass. Calculated left ventricular mass was compared with actual postmortem left ventricular mass using linear regression analysis. An excellent relation between calculated and actual mass was found (r = 0.95; SEE = 13.1 g; regression equation: magnetic resonance mass = 0.95 X actual mass + 14.8 g). Intraobserver and interobserver reproducibility were also excellent (r = 0.99). Thus, gated nuclear magnetic resonance imaging can accurately determine in vivo left ventricular mass in anesthetized animals.

Cost analysis of Down syndrome screening in advanced maternal age.

OBJECTIVE: To analyze the potential cost and efficacy of Down syndrome screening in the population with advanced maternal age. METHODS: Three screening methods defining Down syndrome risk for women with advanced maternal age were analyzed: advanced maternal age; advanced maternal age and maternal serum triple screen; and advanced maternal age, maternal serum triple screen and genetic sonogram. Costs for all tests and procedures were estimated. Procedure-related loss for amniocentesis was assumed to be 1:200. Efficacy was defined as: number of amniocenteses performed, number of Down syndrome cases detected, procedure-related losses, Down syndrome cases detected per fetal loss, cost per Down syndrome case detected and total cost of screening. RESULTS: In 1999 in the USA, there were 530,610 women with advanced maternal age at 16 weeks' gestation carrying an estimated 4,043 fetuses with Down syndrome. Screening by maternal age alone would result in the 100% detection of Down syndrome cases, but would require over 530,000 amniocenteses and result in 2,653 procedure-related losses. Combining age with serum screen and genetic sonogram would detect 97.6% of Down syndrome cases, but would require only 119,791 amniocenteses and result in 599 procedure-related losses. The projected cost per Down syndrome case detected using age screening is 219,109 dollars versus 155,992 dollars using serum screen and genetic sonogram. CONCLUSIONS: The combination of advanced maternal age, maternal serum screen and genetic sonogram would result in the fewest procedure-related losses and lowest cost per Down syndrome case detected.

Cryogenic microwave amplifiers for precision measurements.

The noise performance of two cryogenic HEMT amplifiers has been studied. The effective noise temperature for each amplifier is shown to be close to the 6 K thermodynamic temperature before a power threshold of about -70 dBm is achieved.

Novel interferometric frequency discriminators for low noise microwave applications.

New configurations of interferometric frequency discriminators (FD) for frequency stabilization of microwave oscillators are examined. The new FDs are arranged in single directional (SD) (patented), bi-directional (BD) (patent pending), and dual reflection (DR) (patent pending) configurations. In the SD configuration, the signals reflected off and transmitted through the resonator separately pass through different arms of the interferometer. In the BD configuration, microwaves pass in both directions through each arm of the interferometer. In the DR configuration, microwaves are reflected from the resonator as well as the compensating arm. The FD sensitivity is compared with that for the conventional interferometric FD and found to be 6 dB greater in the BD configuration. Because no circulator is required within the interferometer in either the BD or the DR FD, the discriminator's phase noise floor is not limited by the circulator contribution.

High-Q sapphire-rutile frequency-temperature compensated microwave dielectric resonators.

A sapphiro-rutile composite resonator was constructed from a cylindrical sapphire monocrystal with two thin disks of monocrystal rutile held tightly against the ends. Because rutile exhibits low loss and an opposite temperature coefficient of permittivity to sapphire, it is an ideal material for compensating the frequency-temperature dependence of a sapphire resonator. Most of the electromagnetic modes in the composite structure exhibited turning points (or compensation points) in the frequency-temperature characteristic. The temperatures of compensation for the WG quasi TM modes were measured to be below 90 K with Q-factors of the order of a few million depending on the mode. For WG quasi TE modes, the temperatures of compensation were measured to be between 100 to 160 K with Q-factors of the order of a few hundreds of thousands, depending on the mode. The second derivatives of the compensation points were measured to be of the order 0.1 ppm/K(2 ), which agreed well with the predicted values.

Frequency-temperature compensation in Ti(3+) and Ti(4+ ) doped sapphire whispering gallery mode resonators.

A new method of compensating the frequency-temperature dependence of high-and monolithic sapphire dielectric resonators near liquid nitrogen temperature is presented. This is achieved by doping monocrystalline sapphire with Ti(3+) ions. This technique offers significant advantages over other methods.

Analysis of the rutile-ring method of frequency-temperature compensating a high-Q whispering gallery sapphire resonator.

The rutile-ring method of dielectrically frequency-temperature compensating a high-Q whispering gallery (WG) sapphire resonator is presented. Two and three-dimensional finite element (FE) analysis has been implemented to design and analyze the performance of such resonators, with excellent agreement between theory and experiment. A high-Q factor of 30 million at 13 GHz and compensation temperature of 56 K was obtained. It is shown the frequency-temperature compensation can occur either because the rutile adds a small perturbation to the sapphire resonator or because of a mode interaction with a resonant mode in the rutile. The characteristics of both of these methods are described, and it is shown that for high frequency stability, it is best to compensate perturbatively.

Perceptual reactance and task performance.

57 female subjects participated in a study in which perceptual reactance was assessed by the kinesthetic figural aftereffects test. Subjects identified as augmenters were quicker than reducers on a disjunctive reaction time task and a significant interactive effect was found on a paired-associate task. Augmenters performed better on a similar list while reducers were more effective on a dissimilar list.

Perceptual reactance and melanic density.

Following assessment of eye color, a total of 108 college students (33 males and 75 females) estimated changes in sizes of standardized blocks while blindfolded. Subjects were classfied as perceptual augmenters, moderates or reducers as a function of their overestimation, accurate estimation, or underestimation, respectively, of the sizes of the blocks. A significant interaction of gender by perceptual reactance appeared, with augmenting males being rated the most dark-eyed and augmenting females being rated the most light-eyed. Interpretation of the findings was made in terms of attention to relevant cues.

The errant spouse: a study in person perception.

College students rated protagonists of vignettes involved in extra-marital affairs in two separate studies. In the first study, where the affair resulted in the errant spouse falling in love, both the husband and wife were perceived more favorably when they cheated than when they were being cheated. The results of the second study, where the affair did not involve love, were opposite from those of the first. The cheating spouse was viewed negatively. No significant differences were found between married and unmarried subjects' perceptions. Results indicated that the motivation for an extramarital affair may be crucial in evaluation. Implications of perceived competence of the spouse were considered.