Times Higher Rate Research Articles

Pan-Canadian estimates of the prevalence and risks associated with critical wandering among home care clients.

We used clinical assessment records to provide pan-Canadian estimates of the prevalence and risks associated with recent (within the last 3 days) critical wandering among home care clients, with and without dementia. The data source is interRAI Home Care (interRAI HC) assessments. The population was all long-stay home care clients assessed between 2004 and 2021 in seven Canadian provinces and territories (N=1,598,191). We tested associations between wandering and cognition and dementia diagnoses using chi-square tests and logistic regression. Approximately 84% of the sample was over the age of 65. The overall rate of recent wandering was 3.0%. Dementia diagnosis was strongly associated with two to four times higher rates in the prevalence of recent critical wandering. InterRAI HC offers insights into the wandering risk of home care clients. This information should be used to manage risks in the community and could be shared with first responders. In all the study regions combined, the rate of recent wandering is 3.0%. Dementia was associated with 18 times greater prevalence of recent critical wandering. Home care clients at risk of wandering have complex clinical profiles that pose important risks for their health and well-being. Collaboration and information sharing between search and rescue and health professions is essential for managing risks related to critical wandering.

Linking data across multiple sectors to reduce health inequities among justice-involved young people in Australia

BackgroundA scarcity of evidence on the health and social needs of justice-involved young people contributes to persistent health and social inequities. Linking data from multiple sectors provides an opportunity to improve the health, justice, and social systems that this group interacts with, with a view to reducing these inequities. MethodsWe established two population-level cohorts of justice-involved young people using multi-sectoral data linkage: (1) we linked youth justice records in Queensland from 1993-2014 for 48,670 young people to adult correctional records, death records, and coronial records; (2) we linked all youth justice records in Australia from 2000-2019 for 88,110 young people with national emergency department, hospital, primary care, pharmaceutical, and death records. We calculated mortality rates among young people exposed to the youth justice system and compared them with the age- and sex-matched general population. ResultsJustice-involved young people in Queensland died at a 4.1 times higher rate than their non-justice-involved peers. Approximately one-third (34.6%) of deaths were from suicide. There was a 67% increased rate of death due to non-communicable diseases compared to the general population. ConclusionsThe national cohort will fill evidence gaps on health needs and health care use after justice system contact. These two cohorts provide the first comprehensive look into the health of justice-involved young people in Australia and internationally. They form the foundation for routine monitoring and reporting on health needs and trajectories. Multi-sectoral data linkage is essential for sustainable, timely, and evidence-informed decision-making to improve systems, health, and mortality outcomes.

ВЛИЯНИЯ ЛОЯЛЬНОСТИ ПЕРСОНАЛА НА ПРОЦЕСС ЭФФЕКТИВНОГО ФУНКЦИОНИРОВАНИЯ ОРГАНИЗАЦИИ

The study is devoted to the urgent problem of studying the influence of staff loyalty on the process of effective functioning of an organization in the dynamic turbulent socio-economic situation of recent years in the Russian Federation. In a period of insufficient personnel caused by demographic reasons and at the same time high rates of staff turnover, the study of the influence of staff loyalty on the process of effective functioning of the organization comes to the fore. A theoretical analysis of the influence of staff loyalty on the process of effective functioning of the company was carried out. The study presents the main aspects of the influence of staff loyalty on the process of effective functioning of the organization. Attitudinal and behavioral approaches to the definition of “loyalty” of personnel are outlined. A formulation is given to the basic concept of “loyalty” of personnel, which is revealed as the quality of an employee’s personality, determined by the willingness to adhere to the principles and established rules of the company, and the attitude towards the performance of job duties at a high level to maintain the functioning of the organization. The criteria for staff loyalty are highlighted, for example, such as: level of staff satisfaction with the conditions and results of work; emotional attachment to the organization (external and internal manifestations); degree of trust between management and employees. A description is given and the results of a practical study of the influence of staff loyalty on the process of effective functioning of the organization are presented. Of particular empirical importance are practical recommendations for the HR manager to determine the influence of staff loyalty, based on the use of methods for assessing the level of loyalty; research into the relationship between loyalty and company performance; analysis of received materials during feedback; monitoring of key indicators of the company’s operational efficiency and effectiveness.

Sediment flux variation as a record of climate change in the Late Quaternary deep‐water active Corinth Rift, Greece

AbstractThe value of deep‐water sedimentary successions as reliable records of environmental change has been questioned due to their long response times and sediment pathways leading to complex responses to climatic change and tectonic signals over differing timescales. We studied the Gulf of Corinth, Greece, to test the value of deep‐water stratigraphic successions as records of external controls on sediment flux in a setting with short response times and transport distances. The confinement of the rift basin allows for a near‐complete accounting of clastic sediment volumes. The recent acquisition of high‐resolution seismic reflection data, utilisation of International Ocean Discovery Programme Expedition 381 cores and a robust chronological framework, enable evaluation of the stratigraphy at a high temporal resolution. Combining borehole and high‐resolution seismic reflection data, distinct seismic units can be correlated to multiple paleoenvironmental proxies, permitting quantification of sediment flux variation across successive glacial–interglacial cycles at ca. 10 kyr temporal resolution. Trends in average sediment flux since ca. 242 ka show ca. 2–9 times greater sediment flux in cooler glacials compared to warmer interglacial conditions. The Holocene is an exception to low sediment flux for the interglacials, with ca. 5 times higher rates than previous interglacials. The short and steep configuration of the Sythas canyon and its fan at the base of an active submarine normal fault results in deep‐sea deposition at all sea‐level stands. In contrast, adjacent canyon systems shut down during warm intervals. When combined with palynology, results show that periods of distinct vegetation re‐organisation correlate to sediment flux changes. The temporal correlation of sediment flux to palynology in the Gulf of Corinth over the last ca. 242 kyr is evidence that variability of sediment supply is largely governed by climate‐related changes in hinterland catchments, with sea‐level and tectonics being second‐order controls on sediment flux variability.

Rate and risk factors of kidney function decline among South Asians with type 2 diabetes: analysis of the CARRS Trial

IntroductionPeople with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates...

Ongoing burden and recent trends in severe hospitalised hypoglycaemia events in people with type 1 and type 2 diabetes in Scotland: A nationwide cohort study 2016–2022

AimsWe examined severe hospitalised hypoglycaemia (SHH) rates in people with type 1 and type 2 diabetes in Scotland during 2016–2022, stratifying by sociodemographics. MethodsUsing the Scottish National diabetes register (SCI-Diabetes), we identified people with type 1 and type 2 diabetes alive anytime during 2016–2022. SHH events were determined through linkage to hospital admission and death registry data. We calculated annual SHH rates overall and by age, sex, and socioeconomic status. Summary estimates of time and stratum effects were obtained by fitting adjusted generalised additive models using R package mgcv. ResultsRates for those under 20 with type 1 diabetes reached their minimum at the 2020–2021 transition, 30% below the study period average. A gradual decline over time also occurred among 20–49-year-olds with type 1 diabetes. Overall, females had 15% higher rates than males with type 2 diabetes (rate ratio 1.15, 95% CI 1.08–1.22). People in the most versus least deprived quintile experienced 2.58 times higher rates (95% CI 2.27–2.93) in type 1 diabetes and 2.33 times higher (95% CI 2.08–2.62) in type 2 diabetes. ConclusionsDespite advances in care, SHH remains a significant problem in diabetes. Future efforts must address the large socioeconomic disparities in SHH risks.

Should Glucokinase be Given a Chance in Diabetes Therapeutics? A Clinical-Pharmacological Review of Dorzagliatin and Lessons Learned So Far.

Despite advances in the management of type 2 diabetes mellitus (T2DM), one-third of patients with diabetes do not achieve the desired glycemic goal. Considering this inadequacy, many agents that activate glucokinase have been investigated over the last two decades but were withdrawn before submission for marketing permission. Dorzagliatin is the first glucokinase activator that has been granted approval for T2DM, only in China. As overstimulation of glucokinase is linked with pathophysiological disturbances such as fatty liver and cardiovascular issues and a loss of therapeutic efficacy with time. This review aims to highlight the benefits of glucokinase activators vis-à-vis the risks associated with chronic enzymatic activation. We discuss the multisystem disturbances expected with chronic activation of the enzyme, the lessons learned with glucokinase activators of the past, the major efficacy and safety findings with dorzagliatin and its pharmacological properties, and the status of other glucokinase activators in the pipeline. The approval of dorzagliatin in China was based on the SEED and the DAWN trials, the major pivotal phase III trials that enrolled patients with T2DM with a mean glycosylated hemoglobin of 8.3-8.4%, and a mean age of 53-54.5years from multiple sites in China. Patients with uncontrolled diabetes, cardiac diseases, organ dysfunction, and a history of severe hypoglycemia were excluded. Both trials had a randomized double-blind placebo-controlled phase of 24weeks followed by an open-label phase of 28weeks with dorzagliatin. Drug-naïve patients with T2DM with a disease duration of 11.7months were enrolled in the SEED trial while the DAWN trial involved patients with T2DM with a mean duration of 71.5months and receiving background metformin therapy. Compared with placebo, the decline in glycosylated hemoglobin at 24weeks was more with dorzagliatin with an estimated treatment difference of -0.57% in the SEED trial and -0.66% in the DAWN trial. The desired glycosylated hemoglobin (<7%) was also attained at more than two times higher rates with dorzagliatin. The glycemic improvement was sustained in the SEED trial but decreased over 52weeks in the DAWN trial. Hyperlipidemia was observed in 12-14% of patients taking dorzagliatin versus 9-11% of patients receiving a placebo. Additional adverse effects noticed over 52weeks with dorzagliatin included an elevation in liver enzymes, hyperuricemia, hyperlacticacidemia, renal dysfunction, and cardiovascular disturbances. Considering the statistically significant improvement in glycosylated hemoglobin with dorzagliatin in patients with T2DM, the drug may be given a chance in treatment-naïve patients with a shorter disease history. However, with the waning therapeutic efficacy witnessed in patients with long-standing diabetes, which was also one of the potential concerns with previously tested molecules, extended studies involving patients with chronic and uncontrolled diabetes are needed to comment upon the long-term therapeutic performance of dorzagliatin. Likewise, evidence needs to be generated from other countries, patients with organ dysfunction, a history of severe hypoglycemia, cardiac diseases, and elderly patients before extending the use of dorzagliatin. Apart from monitoring lipid profiles, long-term safety studies of dorzagliatin should involve the assessment of serum uric acid, lactate, renal function, liver function, and cardiovascular parameters.

Development of a Triple-GEM detector with strip readout and GEMINI chip for X rays and neutron imaging

Thermal neutron imaging can be a useful tool in the study of the internal structure of an object. The different attenuation properties of the materials with respect to X rays give rise to different interactions and the result is a complementary non-destructive analysis, which can provide important additional information. This technique has been successfully employed in different areas of work, especially in material science and cultural heritage studies. This paper describes the development of a new detection system and its characterization performed with X ray emissions. The system features the use of a gaseous detector, based on the Gas Electron Multiplier technology, and a fully digital electronic readout, with a combination of custom-made ASICs (called GEMINI) and FPGA boards, enabling fast single photon counting. The detector can be thus used directly for X ray imaging, while the addition of a suitable converter in its active volume will allow for detection of neutrons and for reconstruction of their tracks. The readout system is based on a x-y strip structure and features the reconstruction of single events through the center of mass methodology, allowing for accurate tomography, with sub-mm spatial resolution, in combination with sub-ms time resolution and high rate capabilities (up to MHz/mm2).

Long-term follow up of fecundability after ectopic pregnancy in Taiwan: a nationwide population-based study.

Ectopic pregnancy (EP) occurs when a fertilized ovum is implanted outside the uterine cavity. Its incidence is 2% of all pregnancies and is known to decrease fertility. This study aimed to measure pregnancy rates after EP, identify the various parameters influencing pregnancy, and compare these variables in women with and without a history of EP, as well as determine in which medical facilities women with EP seek medical help. The data was extracted from the National Health Insurance Research Database during 2000-2013. The study group included of women with a history of one EP (study group) and women without EP (control group). The chi-square/Fisher exact test was performed for categorical variables, and t-tests were used for continuous variables. The EP group had a higher cumulative pregnancy rate (41.55%) than the control group (37.14 %), and a 1.16 times higher rate in developing pregnancy (p < 0.001). While the pregnancy rate in the EP group was initially lower than in the control group during the first 5 years, it surpassed the control group's rate between the 10 th and 14 th years. Fecundability after EP was lower at the beginning but increased at long-term follow-up.

Regional and racial disparities in major amputation rates among medicare beneficiaries with diabetes: a retrospective study in the southeastern USA

ObjectiveWhile rates for non-traumatic lower extremity amputations (LEA) have been declining, concerns exist over disparities. Our objectives are to track major LEA (MLEA) rates over time among Medicare beneficiaries residing...

Pressure correction study for the CMS iRPC detector

The improved Resistive Plate Chambers (iRPC) are designed using thin low resistivity High-Pressure Laminate (HPL) gaps. They are proposed to equip the very forward region of the Compact Muon Solenoid (CMS) detector, as they can stand rates ∼2kHz/cm2. To withstand 3 times higher rates than the installed CMS RPC chambers, the HPL electrode thickness was reduced from 2 mm to 1.4 mm. The gas gain of the detector is dependent on the gas pressure and temperature which requires correcting for the applied voltage to keep detector operational characteristics such as efficiency, cluster size and noise rate constant. Herein, we study the pressure correction at constant temperature for CMS iRPC and compare its correction coefficient with the one for the 2 mm RPC gap technology. Pressure correction parameters for both technologies are found compatible.

The burden of vestibular disorders among military health system (MHS) beneficiaries, fiscal years 2018-2019.

Vestibular disorders affect an estimated 33 million adults and 3.5 million children and adolescents in the United States. Previous research relying on self-reported symptoms versus actual diagnosis has limited the ability to provide prevalence estimates for specific vestibular disorders at the population level. This study seeks to describe the burden of vestibular disorders among children and working-age adult beneficiaries in the Military Health System (MHS). Using the MHS Data Repository (MDR), we conducted a cross-sectional study of all TRICARE Prime and Plus MHS beneficiaries aged 0 to 64 years from fiscal years (FY) 2018 to 2019. Study analyses included descriptive statistics of patient demographics and assessing the prevalence of vestibular disorders in pediatric and working-age adult beneficiaries. Of the 5,541,932 TRICARE Prime/Prime Plus MHS beneficiaries, 52,878 (0.95%) had a diagnosis of vestibular disorder during fiscal years 2018 to 2019, of which 1,359 were pediatric and adolescents (aged 0 to 17 years) and 51,519 were working-age adults (18 to 64 years). Vertigo was the most common diagnosis in both age-group populations (11.46 per 1,000 working-age adults; 0.52 per 1,000 children and adolescents), with benign vertigo being the most prevalent of the three diagnoses and occurring at a seven times higher rate in adults versus pediatric and adolescents. This study demonstrates the effectiveness of using medical claims data to estimate prevalence compared to self-reported survey data and supports prevalence estimates of vestibular disease in <1% of children overall, but indicate much higher prevalence for adolescents.

Geographic, sex and socioeconomic disparities in esophageal cancer incidence in China: A population-based study.

Geographic and sex differences in esophageal cancer have been reported in China, but data are lacking at the local level. We aimed to investigate geographic and sex disparities in esophageal cancer incidence among Chinese counties and whether county-level socioeconomic status was associated with these variations. We obtained esophageal cancer data from 2015 to 2017 for 782 counties from population-based cancer registries in China. We calculated age-standardized incidence rates and male-to-female incidence rate ratios (IRRs) by county. We performed hotspot analysis to identify geographical clusters. We used negative binomial regression models to analyze the association between incidence rates and county-level socioeconomic factors. There were significant geographic disparities in esophageal cancer incidence, with 8.1 times higher rate in the 90th-percentile county than in the 10th-percentile county (23.7 vs 2.9 per 100 000 person-years). Clusters of elevated rates were prominent across north-central China. Nationally, men had 2.9 times higher incidence of esophageal cancer than women. By county, the male-to-female IRRs ranged from 1.1 to 21.1. Clusters of high male-to-female IRRs were observed in northeast China. Rurality (IRR 1.16, 95% CI 1.10-1.22), per capita gross domestic product (IRR 0.95, 0.92-0.98) and percentage of people with a high school diploma (IRR 0.86, 0.84-0.87) in a county were significantly associated with esophageal cancer incidence. The male-to-female IRRs were higher in counties with higher socioeconomic status. Substantial differences in incidence rates and sex ratios of esophageal cancer exist between Chinese counties, and county-level socioeconomic status was associated with these variations. These findings may inform interventions to reduce these disparities.

Media-based information display in university libraries based on a generalized differential equation numerical method

Abstract To solve the problems of time lag and high repetition rate of information released in the media-oriented information display of college libraries, this paper improves the media-oriented information display platform based on the numerical method of generalized differential equations. The intervals of the generalized differential equations solutions for the media-oriented information display of college libraries are discretized using a grid to obtain sub-intervals. The points on the grid for each subinterval are approximated continuously using the K-step edge-value method to obtain the information dissemination cycle solution. The bifurcated periodic solution is used to check the obtained information release period solution, and the final information update period is 7 days. The results of improving the media-based information display platform of university libraries and putting it into operation of university libraries show that: Using the information update cycle determined by the generalized differential function to improve the media-based information display platform of university libraries, the repetition rate of language information release decreases from 30% to 10%. The working hours of librarians were reduced from 5 hours per week to 3.5 hours per week. It can be seen that after improving the media-based information display platform of university libraries based on the numerical method of a generalized differential equation, the repetition rate of information release and the work efficiency of librarians of the platform is improved.

National Patterns in Utilization of Knee and Hip Arthroscopy: An Analysis of Racial, Ethnic, and Geographic Disparities in the United States.

Racial and ethnic disparities in the field of orthopaedic surgery have been reported extensively across many subspecialties. However, these data remain relatively sparse in orthopaedic sports medicine, especially with respect to commonly performed procedures including knee and hip arthroscopy. To assess (1) differences in utilization of knee and hip arthroscopy between White, Black, Hispanic, and Asian or Pacific Islander patients in the United States (US) and (2) how these differences vary by geographical region. Descriptive epidemiology study. The study sample was acquired from the 2019 National Ambulatory Surgery Sample database. Racial and ethnic differences in age-standardized utilization rates of hip and knee arthroscopy were calculated using survey weights and population estimates from US census data. Poisson regression was used to model age-standardized utilization rates for hip and knee arthroscopy while controlling for several demographic and clinical variables. During the study period, rates of knee arthroscopy utilization among White patients were significantly higher than those of Black, Hispanic, and Asian or Pacific Islander patients (ie, per 100,000, White: 180.5, Black: 113.2, Hispanic: 122.2, and Asian: 58.6). Disparities were even more pronounced among patients undergoing hip arthroscopy, with White patients receiving the procedure at almost 4 to 5 times higher rates (ie, per 100,000, White: 12.6, Black: 3.2, Hispanic: 2.3, Asian or Pacific Islander: 1.8). Disparities in knee and hip arthroscopy utilization between White and non-White patients varied significantly by region, with gaps in knee arthroscopy being most pronounced in the Midwest (adjusted rate ratio, 2.0 [95% CI, 1.9-2.1]) and those in hip arthroscopy being greatest in the West (adjusted rate ratio, 5.3 [95% CI, 4.9-5.6]). Racial and ethnic disparities in the use of knee and hip arthroscopy were found across the US, with decreased rates among Black, Hispanic, and Asian or Pacific Islander patients compared with White patients. Disparities were most pronounced in the Midwest and South and greater for hip than knee arthroscopy, possibly demonstrating emerging inequality in a rapidly growing and evolving procedure across the country.

Ultrafast review of ambulatory EEGs with deep learning

ObjectiveInterictal epileptiform discharges (IED) are hallmark biomarkers of epilepsy which are typically detected through visual analysis. Deep learning has shown potential in automating IED detection, which could reduce the burden of visual analysis in clinical practice. This is particularly relevant for ambulatory electroencephalograms (EEGs), as these entail longer review times. MethodsWe applied a previously trained neural network to an independent dataset of 100 ambulatory EEGs (average duration 20.6 h). From these, 42 EEGs contained IEDs, 25 were abnormal without IEDs and 33 were normal. The algorithm flagged 2 second epochs that it considered IEDs. The EEGs were provided to an expert, who used NeuroCenter EEG to review the recordings. The expert concluded if each recording contained IEDs, and was timed during the process. ResultsThe conclusion of the reviewer was the same as the EEG report in 97% of the recordings. Three EEGs contained IEDs that were not detected based on the flagged epochs. Review time for the 100 EEGs was approximately 4 h, with half of the recordings taking <2 minutes to review. ConclusionsOur network can be used to reduce time spent on visual analysis in the clinic by 50–75 times with high reliability. SignificanceGiven the large time reduction potential and high success rate, this algorithm can be used in the clinic to aid in visual analysis.

Recognition and location of marine animal sounds using two-stream ConvNet with attention

There are abundant resources and many endangered marine animals in the ocean. Using sound to effectively identify and locate them, and estimate their distribution area, has a very important role in the study of the complex diversity of marine animals (Hanny et al., 2013). We design a Two-Stream ConvNet with Attention (TSCA) model, which is a two-stream model combined with attention, in which one branch processes the temporal signal and the other branch processes the frequency domain signal; It makes good use of the characteristics of high time resolution of time domain signal and high recognition rate of frequency domain signal features of sound, and it realizes rapid localization and recognition of sound of marine species. The basic network architecture of the model is YOLO (You Only Look Once) (Joseph et al., 2016). A new loss function focal loss is constructed to strengthen the impact on the tail class of the sample, overcome the problem of data imbalance and avoid over fitting. At the same time, the attention module is constructed to focus on more detailed sound features, so as to improve the noise resistance of the model and achieve high-precision marine species identification and location. In The Watkins Marine Mammal Sound Database, the recognition rate of the algorithm reached 92.04% and the positioning accuracy reached 78.4%.The experimental results show that the algorithm has good robustness, high recognition accuracy and positioning accuracy.

Assessing the Role of Perioperative Nutritional Education in Improving Oral Intake after Oesophagectomy: A Retrospective Study.

This study aimed to determine whether nutritional education, from the preoperative to postoperative period, and nutritional management designed to improve nutritional status alone, could improve patients' health-related self-management and nutritional management skills during the postoperative period. We evaluated 101 hospitalised patients with oesophageal cancer who underwent surgery between 2015 and 2016 and received perioperative nutritional education (PERIO-N). The control group included 52 patients who underwent surgery between 2014 and 2015 and were supported only by normal interventions according to the Enhanced Recovery After Surgery protocol. The PERIO-N group paid specific attention to nutrition risk screening, nutrition assessment, nutrition monitoring, and lifestyle education. The patients in the PERIO-N group were 1.8 times more likely to be able to consume food orally than the control group (p=0.010). In the PERIO-N group, 50.5% of the patients could orally consume food, 42.6% received a combination of oral and enteral nutrition, and 6.9% only underwent enteral nutrition. In comparison, in the control group, 28.8% of the patients could orally consume food, 53.8% received a combination of oral and enteral nutrition, and 17.3% were only administered enteral nutrition (p=0.004). In addition, patients in the PERIO-N group were discharged at a 1.5 times higher rate than those in the control group (p=0.027). The readmission rate for malnutrition within 3 months was 4% in the PERIO group (5.4% for home discharge only) and 5.8% in the control group (10.5% for home discharge only) (p=0.61). This study found that perioperative nutrition education in patients who underwent oesophageal cancer surgery led to increase in the amount of oral intake at discharge. Moreover, the group that received nutrition education did not have an increased probability of hospitalisation due to the risk of malnutrition within 3 months after discharge.

Diagnosis of Respiratory Syncytial Virus in Adults Substantially Increases When Adding Sputum, Saliva, and Serology Testing to Nasopharyngeal Swab RT-PCR.

Nearly all existing respiratory syncytial virus (RSV) incidence estimates are based on real-time polymerase chain reaction (RT-PCR) testing of nasal or nasopharyngeal (NP) swabs. Adding testing of additional specimen types to NP swab RT-PCR increases RSV detection. However, prior studies only made pairwise comparisons and the synergistic effect of adding multiple specimen types has not been quantified. We compared RSV diagnosis by NP swab RT-PCR alone versus NP swab plus saliva, sputum, and serology. This was a prospective cohort study over two study periods (27 December 2021 to 1 April 2022 and 22 August 2022 to 11 November 2022) of patients aged ≥ 40years hospitalized for acute respiratory illness (ARI) in Louisville, KY. NP swab, saliva, and sputum specimens were collected at enrollment and PCR tested (Luminex ARIES platform). Serology specimens were obtained at acute and convalescent timepoints (enrollment and 30-60-day visit). RSV detection rate was calculated for NP swab alone and for NP swab plus all other specimen type/test. Among 1766 patients enrolled, 100% had NP swab, 99% saliva, 34% sputum, and 21% paired serology specimens. RSV was diagnosed in 56 (3.2%) patients by NP swab alone, and in 109 (6.2%) patients by NP swab plus additional specimens, corresponding to a 1.95 times higher rate [95% confidence interval (CI) 1.62, 2.34]. Limiting the comparison to the 150 subjects with all four specimen types available (i.e., NP swab, saliva, sputum, and serology), there was a 2.60-fold increase (95% CI 1.31, 5.17) compared to NP swab alone (3.3% versus 8.7%). Sensitivities by specimen type were: NP swab 51%, saliva 70%, sputum 72%, and serology 79%. Diagnosis of RSV in adults was several-fold greater when additional specimen types were added to NP swab, even with a relatively low percentage of subjects with sputum and serology results available. Hospitalized RSV ARI burden estimates in adults based solely on NP swab RT-PCR should be adjusted for underestimation.

Carbon and nitrogen uptake through photosynthesis and feeding by photosymbiotic Acantharia

Background: Mixotrophy, combining phagotrophy and photoautotrophy in order to acquire nutrients and energy, is a widespread trophic mode in marine protist plankton. Acantharia (Radiolaria) are ubiquitous, but still uncultured oceanic protists. Many of them are mixoplanktic by endosymbiotic relations with microalgae. Here we aimed at quantitatively assessing phototrophy (inorganic nutrients) and phagotrophy (organic nutrients) of photosymbiotic Acantharia, to understand their physiology, and thereby improve integrations of mixotrophy into ecological models of oceanic ecosystems. Methods: Freshly collected Acantharia were incubated with stable isotopes of inorganic carbon and nitrogen to determine photosynthetic uptake rates. Grazing experiments (prey disappearance) were done with different algal cultures as potential food organisms to measure the contribution of prey ingestion to the acantharian metabolism. Fluorescently (and isotopically) labelled prey was used to verify prey uptake, qualitatively. Results/Conclusions: Carbon uptake rates were unaffected by the nitrogen source (i.e., nitrate or ammonium). Total carbon inorganic uptake rate was 1112±82 pgC h-1 Acantharia‑1, 22.3±1.6 pgC h-1 symbiont cell-1assuming 50 symbionts per Acantharia, at ~155-μmol photons m−2 s−1 irradiance. The Acantharia studied could use both inorganic ammonium and nitrate, but ammonium was taken up at a ~5 times higher rate. Prey ingestion of the haptophyte, Isochrysis galbana, was detected using labelled algae. Significant grazing by Acantharia could only be established on the dinoflagellate Effrenium voratum, with a grazing rate of 728 prey Acantharia‑1 hour-1 (i.e., ~56.3 ngC h-1, 46% of total holobiont carbon content) at a ratio of 1.06x104 prey predator-1. Daily photosynthetic carbon uptake rates made up ~14.5% of the total holobiont carbon content (0.9% hourly). The extent to which photosynthates are used and assimilated by the acantharian cell and/or if it is used for catabolic processes to obtain energy is still to be studied. Isotopic ratios further suggests seasonal differences in the usage of each trophic mode.