Effects of hospital delivery during off-hours on perinatal outcome in several subgroups: a retrospective cohort study.

BACKGROUND: Studies have demonstrated a higher risk of adverse outcomes among infants born or admitted during off-hours, as compared to office hours, leading to questions about quality of care provide during off-hours (weekend, evening or night). We aim to determine the relationship between off-hours delivery and adverse perinatal outcomes for subgroups of hospital births. METHODS: This retrospective cohort study was based on data from the Netherlands Perinatal Registry, a countrywide registry that covers 99% of all hospital births in the Netherlands. Data of 449,714 infants, born at 28 completed weeks or later, in the period 2003 through 2007 were used. Infants with a high a priori risk of morbidity or mortality were excluded. Outcome measures were intrapartum and early neonatal mortality, a low Apgar score (5 minute score of 0-6), and a composite adverse perinatal outcome measure (mortality, low Apgar score, severe birth trauma, admission to a neonatal intensive care unit). RESULTS: Evening and night-time deliveries that involved induction or augmentation of labour, or an emergency caesarean section, were associated with an increased risk of an adverse perinatal outcome when compared to similar daytime deliveries. Weekend deliveries were not associated with an increased risk when compared to weekday deliveries. It was estimated that each year, between 126 and 141 cases with an adverse perinatal outcomes could be attributed to this evening and night effect. Of these, 21 (15-16%) are intrapartum or early neonatal death. Among the 3100 infants in the study population who experience an adverse outcome each year, death accounted for only 5% (165) of these outcomes. CONCLUSION: This study shows that for infants whose mothers require obstetric interventions during labour and delivery, birth in the evening or at night, are at an increased risk of an adverse perinatal outcomes.

In-conduit capture of sub-micron volcanic ash particles via turbophoresis and sintering.

Ash emission in explosive silicic eruptions can have widespread impacts for human health, agriculture, infrastructure, and aviation. Estimates of the total grainsize distribution (TGSD) generated during explosive magma fragmentation underpins eruption models and ash dispersal forecasts. Conventionally, the TGSD constrained via erupted deposits is assumed to match the TGSD produced at explosive fragmentation. Here we present observations from within the vent of a recent rhyolitic eruption (Cordón Caulle, Chile, 2011-2012), demonstrating that fine (<63 µm diameter) and ultra-fine (<2.5 µm diameter) ash particles are captured and sintered to fracture surfaces, and thus sequestered in the shallow subsurface, rather than emitted. We establish a conceptual model-uniquely contextualised through a combination of syn-eruptive observations and detailed post-eruption field investigation-in which turbophoresis (particle migration towards zones of lower turbulence) and rapid sintering create an inverse relationship between particle size and the probability of its subsurface capture. Such size-dependent capture efficiency preferentially removes submicron-diameter ash from the erupted componentry, decoupling the erupted size distribution from magmatic source conditions and potentially playing an important role in modulating eruption dynamics.

A theoretical model of Surtseyan bomb fragmentation.

Surtseyan eruptions are an important class of mostly basaltic volcanic eruptions first identified in the 1960s, where erupting magma at an air-water interface interacts with large quantities of slurry, a mixture of previously ejected tephra that re-enters the crater together with water. During a Surtseyan eruption, hot magma bombs are ejected that initially contain pockets of slurry. Despite the formation of steam and anticipated subsequent high pressures inside these bombs, many survive to land without exploding. We seek to explain this by building and solving a simplified spherical mathematical model that describes the coupled evolution of pressure and temperature due to the flashing of liquid to vapour within a Surtseyan bomb while it is in flight. Analysis of the model provides a criterion for fragmentation of the bomb due to steam pressure build-up, and predicts that if diffusive steam flow through the porous bomb is sufficiently rapid the bomb will survive the flight intact. This criterion explicitly relates fragmentation to bomb properties, and describes how a Surtseyan bomb can survive in flight despite containing flashing liquid water, contributing to an ongoing discussion in volcanology about the origins of the inclusions found inside bombs.

Testing behaviour and positivity for SARS-CoV-2 infection: insights from web-based participatory surveillance in the Netherlands.

OBJECTIVES: We aimed to identify populations at a high risk for SARS-CoV-2 infection but who are less likely to present for testing, by determining which sociodemographic and household factors are associated with a lower propensity to be tested and, if tested, with a higher risk of a positive test result. DESIGN AND SETTING: Internet-based participatory surveillance data from the general population of the Netherlands. PARTICIPANTS: Weekly survey data collected over a 5-month period (17 November 2020 to 18 April 2021) from a total of 12 026 participants who had contributed at least 2 weekly surveys was analysed. METHODS: Multivariable analyses using generalised estimating equations for binomial outcomes were conducted to estimate the adjusted ORs of testing and of test positivity associated with participant and household characteristics. RESULTS: Male sex (adjusted OR for testing (ORt): 0.92; adjusted OR for positivity (ORp): 1.30, age groups<20 (ORt: 0.89; ORp: 1.27), 50-64 years (ORt: 0.94; ORp: 1.06) and 65+ years (ORt: 0.78; ORp: 1.24), diabetics (ORt: 0.97; ORp: 1.06) and sales/administrative employees (ORt: 0.93; ORp: 1.90) were distinguished as lower test propensity/higher test positivity factors. CONCLUSIONS: The factors identified using this approach can help identify potential target groups for improving communication and encouraging testing among those with symptoms, and thus increase the effectiveness of testing, which is essential for the response to the COVID-19 pandemic and for public health strategies in the longer term.

Predicting the long-term prognosis of children with symptoms suggestive of asthma at preschool age.

BACKGROUND: Clinicians have difficulty in diagnosing asthma in preschool children with suggestive symptoms. OBJECTIVE: We sought to develop a clinical asthma prediction score for preschool children who have asthma-like symptoms for the first time. METHODS: The Prevalence and Incidence of Asthma and Mite Allergy birth cohort followed 3,963 children for 8 years. Between 0 and 4 years of age, 2,171 (55%) children reported "wheezing," "coughing at night without a cold," or both. In these children possible predictor variables for asthma were assessed at the age respiratory symptoms were first reported. Asthma was defined as wheezing, inhaled steroid prescription, or a doctor's diagnosis of asthma at both age 7 and 8 years of age. RESULTS: Eleven percent of children with symptoms at 0 to 4 years of age had asthma at 7 to 8 years of age. Eight clinical parameters independently predicted asthma at 7 to 8 years of age: male sex, postterm delivery, parental education and inhaled medication, wheezing frequency, wheeze/dyspnea apart from colds, respiratory infections, and eczema. In 72% of the cases, the model accurately discriminated between asthmatic and nonasthmatic children. A clinical risk score was developed (range, 0-55 points). Symptomatic children with a score of less than 10 points had a 3% risk, whereas children with a score of 30 points or greater had a 42% risk of asthma. CONCLUSION: A risk score based on 8 readily available clinical parameters at the time preschool children first reported asthma-like symptoms predicted the risk of asthma at 7 to 8 years of age.

Prediction of the ease of subdivision of scored tablets from their physical parameters.

At present, the ease of subdivision of scored tablets is estimated in vivo. In order to replace such in vivo testing and to develop a surrogate test which uses in vitro techniques, the association between physical parameters of scored tablets and their ease of subdivision was studied. The physical properties of 23 brands of scored tablets of which their ease of subdivision in vivo was known were established. Statistical modeling using a logistic regression model was used to fit the data and estimate the contribution of each physical parameter to the goodness of the fit. For scored oblong tablets, the critical parameters for their ease of subdivision are: diameter; diameter/width ratio; depth of score line and resistance to crushing. Criteria for each of these parameters were derived. All criteria need to be complied with to guarantee sufficient ease of subdivision of scored oblong tablets. For scored round tablets the critical parameters, in decreasing order of importance, for their ease of subdivision, are: resistance to crushing, diameter, score mark (one- or two-sided), and shape (flat or biconvex). A five-parameter predictive model was developed, showing excellent discrimination. For development, the proposed surrogate tests are sufficiently reliable. For release testing and stability studies, resistance to crushing of a scored tablet is a reliable predictor of its ease of subdivision.

Aerial strategies advance volcanic gas measurements at inaccessible, strongly degassing volcanoes.

Volcanic emissions are a critical pathway in Earth's carbon cycle. Here, we show that aerial measurements of volcanic gases using unoccupied aerial systems (UAS) transform our ability to measure and monitor plumes remotely and to constrain global volatile fluxes from volcanoes. Combining multi-scale measurements from ground-based remote sensing, long-range aerial sampling, and satellites, we present comprehensive gas fluxes-3760 ± [600, 310] tons day-1 CO2 and 5150 ± [730, 340] tons day-1 SO2-for a strong yet previously uncharacterized volcanic emitter: Manam, Papua New Guinea. The CO2/ST ratio of 1.07 ± 0.06 suggests a modest slab sediment contribution to the sub-arc mantle. We find that aerial strategies reduce uncertainties associated with ground-based remote sensing of SO2 flux and enable near-real-time measurements of plume chemistry and carbon isotope composition. Our data emphasize the need to account for time averaging of temporal variability in volcanic gas emissions in global flux estimates.

Metagenome-derived clones encoding two novel lactonase family proteins involved in biofilm inhibition in Pseudomonas aeruginosa.

Here we report the isolation and characterization of three metagenome-derived clones that interfere with bacterial quorum sensing and degrade N-(3-oxooctanoyl)-l-homoserine lactone (3-oxo-C(8)-HSL). By using a traI-lacZ gene fusion, the metagenome-derived clones were identified from a soil DNA library and analyzed. The open reading frames linked to the 3-oxo-C(8)-HSL-degrading activities were designated bpiB01, bpiB04, and bpiB07. While the BpiB07 protein was similar to a known lactonase, no significant similarities were observed for the BpiB01 and BpiB04 proteins or the deduced amino acid sequences. High-performance liquid chromatography-mass spectrometry analyses confirmed that the identified genes encode novel lactone-hydrolyzing enzymes. The original metagenome-derived clones were expressed in Pseudomonas aeruginosa and employed in motility and biofilm assays. All clones were able to reproducibly inhibit motility in P. aeruginosa. Furthermore, these genes clearly inhibited biofilm formation in P. aeruginosa when expressed in P. aeruginosa PAO1. Thus, this is the first study in which metagenome-derived proteins have been expressed in P. aeruginosa to successfully inhibit biofilm formation.

Simultaneous vaccination with Prevenar and multicomponent vaccines for children: interference or no interference?

Multicomponent vaccines against as many as six infectious diseases are often given simultaneously with monovalent or multivalent vaccines against meningococcus and pneumococcus. Detailed analysis of simultaneous vaccinations, which can lead to suboptimal induced immune responses, should precede their combined use in national immunization programmes. By combining the results of the only two published studies evaluating simultaneous vaccinations with Infanrix hexa and Prevanar in a random-effect meta-analysis, we show that the one-sided 95% confidence interval of the HBV seroconversion rate includes the 95% limit that should be reached in universal programs. We advocate better assessment of potential interferences in immune responses after simultaneous vaccinations. Registration of new vaccines should include this assessment.

Ecological momentary assessment study of exposure to radiofrequency electromagnetic fields and non-specific physical symptoms with self-declared electrosensitives.

The main objective of the study is to determine if non-specific physical symptoms (NSPS) in people with self-declared sensitivity to radiofrequency electromagnetic fields (RF EMF) can be explained (across subjects) by exposure to RF EMF. Furthermore, we pioneered whether analysis at the individual level or at the group level may lead to different conclusions. By our knowledge, this is the first longitudinal study exploring the data at the individual level. A group of 57 participants was equipped with a measurement set for five consecutive days. The measurement set consisted of a body worn exposimeter measuring the radiofrequency electromagnetic field in twelve frequency bands used for communication, a GPS logger, and an electronic diary giving cues at random intervals within a two to three hour interval. At every cue, a questionnaire on the most important health complaint and nine NSPS had to be filled out. We analysed the (time-lagged) associations between RF-EMF exposure in the included frequency bands and the total number of NSPS and self-rated severity of the most important health complaint. The manifestation of NSPS was studied during two different time lags - 0-1 h, and 1-4 h - after exposure and for different exposure metrics of RF EMF. The exposure was characterised by exposure metrics describing the central tendency and the intermittency of the signal, i.e. the time-weighted average exposure, the time above an exposure level or the rate of change metric. At group level, there was no statistically significant and relevant (fixed effect) association between the measured personal exposure to RF EMF and NSPS. At individual level, after correction for multiple testing and confounding, we found significant within-person associations between WiFi (the self-declared most important source) exposure metrics and the total NSPS score and severity of the most important complaint in one participant. However, it cannot be ruled out that this association is explained by residual confounding due to imperfect control for location or activities. Therefore, the outcomes have to be regarded very prudently. The significant associations were found for the short and the long time lag, but not always concurrently, so both provide complementary information. We also conclude that analyses at the individual level can lead to different findings when compared to an analysis at group level.

High serum C-reactive protein level is not an independent predictor for stroke: the Rotterdam Study.

BACKGROUND: Current guidelines recommend the assessment of C-reactive protein (CRP) levels with a high-sensitivity assay in cardiovascular risk prediction. Recent studies have put forward that although elevated CRP is a risk factor for cardiovascular disease, it is not helpful in the prediction of cardiovascular disease risk. We studied the importance of CRP as a risk factor and as a risk predictor of future stroke. METHODS AND RESULTS: The present study was based on 6430 participants of the Rotterdam Study who at baseline (1990-1993) were > or = 55 years of age, were stroke free, and had blood taken. Strokes were classified as hemorrhagic, ischemic, or unspecified. Ischemic strokes were further subclassified. Whether stroke risk varied with baseline CRP serum levels was assessed with Cox proportional hazards models. Whether CRP was helpful in the prediction of individual stroke risk was assessed with receiver operating characteristic curves and by comparing the distribution of strokes between predicted risk strata. During an average of 8.2 years of follow-up, 498 first-ever strokes occurred. High CRP levels were significantly associated with risk of any stroke (age- and sex-adjusted hazard ratio per SD, 1.14; 95% confidence interval, 1.04 to 1.24) and risk of ischemic stroke (age- and sex-adjusted hazard ratio per SD, 1.17; 95% confidence interval, 1.04 to 1.32). Taking CRP levels into account did not improve the individual stroke risk prediction, however, regardless of whether it was based on the Framingham stroke risk score or on age and sex only. CONCLUSIONS: Although CRP levels are associated with stroke risk, their use in the assessment of individual stroke risk seems limited.

Magmatic gas percolation through the old lava dome of El Misti volcano.

The proximity of the major city of Arequipa to El Misti has focused attention on the hazards posed by the active volcano. Since its last major eruption in the fifteenth century, El Misti has experienced a series of modest phreatic eruptions and fluctuating fumarolic activity. Here, we present the first measurements of the compositions of gas emitted from the lava dome in the summit crater. The gas composition is found to be fairly dry with a H2O/SO2 molar ratio of 32 ± 3, a CO2/SO2 molar ratio of 2.7 ± 0.2, a H2S/SO2 molar ratio of 0.23 ± 0.02 and a H2/SO2 molar ratio of 0.012 ± 0.002. This magmatic gas signature with minimal evidence of hydrothermal or wall rock interaction points to a shallow magma source that is efficiently outgassing through a permeable conduit and lava dome. Field and satellite observations show no evolution of the lava dome over the last decade, indicating sustained outgassing through an established fracture network. This stability could be disrupted if dome permeability were to be reduced by annealing or occlusion of outgassing pathways. Continued monitoring of gas composition and flux at El Misti will be essential to determine the evolution of hazard potential at this dangerous volcano.

Invasiveness in hepatocyte and fibroblast monolayers and metastatic potential of T-cell hybridomas in mice.

Fusion of noninvasive, nonmetastatic BW5147 T-lymphoma cells with normal T-lymphocytes usually resulted in highly invasive and metastatic T-cell hybridomas, apparently due to properties derived from the normal T-cell. Occasionally hybrids arose that were non- or low invasive, probably by loss of relevant genes upon chromosome segregation, since these cells contained much less DNA than highly invasive hybrids. The metastatic potential of 20 representative T-cell hybridomas was tested by tail vein injection in syngeneic mice and cells were found to be either nonmetastatic (NM), low metastatic (LM), or high metastatic (HM). NM hybrids were tumorigenic but did not form metastases and HM hybridomas caused wide-spread metastasis. LM cells formed metastases in a limited number of mice and predominantly in lymphoid tissues. In hepatocyte cultures, NM cell lines were found to be the least invasive, HM cells the most, whereas LM hybrids exhibited intermediate levels. Invasiveness was not only measured in rat hepatocyte cultures but also in rat embryo fibroblast monolayers, and the relative invasive capacity in both model systems correlated well. Pertussis toxin inhibited invasion in both systems to 20-30% of control values. This suggests that the mechanisms of invasion into hepatocyte and fibroblast cultures are at least partially similar and that the fibroblast invasion assay is a relevant model to study aspects of lymphoma metastasis. We conclude that invasive potential is a prerequisite for T-cell hybridomas to colonize tissues from the bloodstream and that a minimum level of invasiveness is necessary for extensive and wide-spread metastasis formation.

Rapid laccolith intrusion driven by explosive volcanic eruption.

Magmatic intrusions and volcanic eruptions are intimately related phenomena. Shallow magma intrusion builds subsurface reservoirs that are drained by volcanic eruptions. Thus, the long-held view is that intrusions must precede and feed eruptions. Here we show that explosive eruptions can also cause magma intrusion. We provide an account of a rapidly emplaced laccolith during the 2011 rhyolite eruption of Cordón Caulle, Chile. Remote sensing indicates that an intrusion began after eruption onset and caused severe (>200 m) uplift over 1 month. Digital terrain models resolve a laccolith-shaped body ∼0.8 km3. Deformation and conduit flow models indicate laccolith depths of only ∼20-200 m and overpressures (∼1-10 MPa) that likely stemmed from conduit blockage. Our results show that explosive eruptions may rapidly force significant quantities of magma in the crust to build laccoliths. These iconic intrusions can thus be interpreted as eruptive features that pose unique and previously unrecognized volcanic hazards.

Prognosis of Parkinson disease: risk of dementia and mortality: the Rotterdam Study.

BACKGROUND: Most prognostic studies on Parkinson disease have been hospital based or have applied register-based case-finding methods. Potential under-representation of mild cases may have given biased results. OBJECTIVE: To evaluate whether Parkinson disease is associated with an increased risk of dementia and death. DESIGN: Population-based cohort study. Parkinson disease and dementia were assessed through in-person examination at baseline (1990-1993) and 2 follow-up visits (1993-1994 and 1997-1999). Computerized linkage to medical and municipality records provided additional information on disease outcomes and mortality. SETTING: General population. PARTICIPANTS: A total of 6969 participants, including 99 prevalent and 67 incident cases of Parkinson disease. MAIN OUTCOME MEASURES: Incident dementia and death. Adjusted hazard ratios were calculated through Cox proportional hazards regression analysis. RESULTS: Patients with Parkinson disease had an increased risk of dementia (hazard ratio, 2.8; 95% confidence interval, 1.8-4.4), which was especially pronounced in participants carrying at least 1 apolipoprotein E gene (APOE) epsilon2 allele (13.5; 4.5-40.6). Parkinson disease was associated with an increased mortality risk (1.8; 1.5-2.3). The association consistently diminished when analyses were sequentially restricted to patients with shorter disease duration and after adjustment for the occurrence of dementia. CONCLUSIONS: Especially patients with Parkinson disease who carry an APOE epsilon2 allele have an increased risk of developing dementia. Increased mortality risk in Parkinson disease is dependent on disease duration and is only modest in the absence of dementia.

In vitro invasiveness of CTL clones and in vivo dissemination of CTL hybridomas.

Activated spleen T cells are invasive in hepatocyte and fibroblast cultures, and this property is dominantly expressed in T cell hybridomas. The invasive potential of the hybrids correlates with their capacity to disseminate in vivo. We have used this model to study the invasive and migratory properties of cytotoxic T lymphocytes (CTLs). Two murine CTL clones were highly invasive, independent of their state of activation. CTL hybridomas, derived from one of the clones, were similarly invasive. In vivo, CTL hybridoma cells disseminated to extravascular sites in the liver, kidneys, lungs, ovaria, tubae, uterus, and lymphoid, mesenchymal, and fat tissues. Within 7 to 14 days, 10(6) cells were lethal in 100% of mice. The adhesion molecules CD2, CD8, CD54, L-selectin, and CD49d (VLA-4 and LPAM-1 alpha-chain) were not expressed by all CTL hybridomas and therefore not indispensable for invasion in vitro and dissemination in vivo. In contrast, LFA-1 (CD11a/CD18), CD44, and VLA-6 (CD49f/CD29) were expressed on all hybrids. LFA-1 antibodies inhibited CTL hybridoma invasion in vitro, but antibodies inhibiting CD44-hyaluronate and VLA-6-laminin interaction had no effect. These results suggest that migration of cytotoxic T cells into noninflamed tissues is independent of their activation state and does not require L-selectin, LPAM-1, CD2, and VLA-4.

The Surtsey Magma Series.

The volcanic island of Surtsey (Vestmannaeyjar, Iceland) is the product of a 3.5-year-long eruption that began in November 1963. Observations of magma-water interaction during pyroclastic episodes made Surtsey the type example of shallow-to-emergent phreatomagmatic eruptions. Here, in part to mark the 50(th) anniversary of this canonical eruption, we present previously unpublished major-element whole-rock compositions, and new major and trace-element compositions of sideromelane glasses in tephra collected by observers and retrieved from the 1979 drill core. Compositions became progressively more primitive as the eruption progressed, with abrupt changes corresponding to shifts between the eruption's four edifices. Trace-element ratios indicate that the chemical variation is best explained by mixing of different proportions of depleted ridge-like basalt, with ponded, enriched alkalic basalt similar to that of Iceland's Eastern Volcanic Zone; however, the systematic offset of Surtsey compositions to lower Nb/Zr than other Vestmannaeyjar lavas indicates that these mixing end members are as-yet poorly contained by compositions in the literature. As the southwestern-most volcano in the Vestmannaeyjar, the geochemistry of the Surtsey Magma Series exemplifies processes occurring within ephemeral magma bodies on the extreme leading edge of a propagating off-axis rift in the vicinity of the Iceland plume.

Role of mineralizing cartilage in osteoclast and osteoblast recruitment.

Periost-free, live and/or devitalized cartilaginous long bone rudiments of fetal mice were transplanted under the renal capsule of adult syngeneic mice to study the role of cells and intercellular matrix in the recruitment and formation of osteoclasts and osteoblasts, both identified by means of enzyme- and immunohistochemical methods. Live bone rudiments recruited host-derived osteoclasts within 5 days after transplantation. Osteoblasts developed as rapidly as osteoclasts and participated in the modeling of the rudiments into hemopoietic bone marrow containing ossicles. Devitalized bone rudiments, killed before osteoclastic invasion had occurred, did not recruit osteoclasts or osteoblasts, and were not resorbed up till 35 days after transplantation. Co-transplantation of live and devitalized bone rudiments however resulted in osteoclastic resorption of the killed rudiments, starting 9 days after transplantation. Again the live rudiments were modeled into ossicles. Devitalized bone rudiments which had been invaded by osteoclasts before killing and transplantation, did recruit host osteoclasts, but at a slower rate than live rudiments, and depending on the number of resorption sites at the time of transplantation. Osteoblasts were not formed. These data suggest that in developing long bones chondrocyte activity is involved in the recruitment of osteoclasts as well as osteoblasts. Matrix components diffusing from resorbing surfaces seem to be involved in osteoclast recruitment.

Presentation of a pseudoaneurysm as a supravalvular aortic stenosis 20 years after aortic root reconstruction.

A 36-year-old patient was referred because of fatigue and decreased exercise tolerance 20 years after separate aortic valve replacement and aortic root reconstruction. The presence of a loud systolic ejection murmur and persistent left ventricular hypertrophy led to the diagnosis of severe supravalvular aortic flow obstruction by indirect compression of a large pseudoaneurysm.

A review of the Alberta certified preconditioned feeder program (1980-1987).

Data from the Alberta Certified Preconditioned Feeder Program (1980-1987) were reviewed retrospectively. Numbers of calves sold, price premiums realized, pre-and postsale performance, production and health performance of preconditioned and regular calves were examined. During the study period, the program showed marked expansion and consistently resulted in substantial premiums for preconditioned calves. Real net returns from efficient rates of gain, increased sale weights, better calf quality and improved health status (disease resistance) were realized at sale time. Feedlot data indicated that postsale morbidity and mortality were markedly reduced in groups of preconditioned calves.