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A new technique of generating turbulence in large-eddy simulations (LES) has been investigated and results compared with previous studies for validation. The proposed gridInlet technique uses a grid pattern on the inlet boundary patch to produce grid-generated turbulence as used in wind tunnel experiments. This allows the turbulence integral length scale to be controlled by changing the grid size, while the turbulence intensity is controlled by changing the inlet distance. The objective of this paper is to investigate domain and mesh requirements to implement the gridInlet technique. This technique is most suited to studies on the influence of high-intensity isotropic turbulence on objects, particularly if comparisons are to be made to experimental data obtained with grid-generated turbulence. [ABSTRACT FROM AUTHOR]

A multi-spectral rainfall estimation algorithm has been developed for the Sahel region of West Africa with the purpose of producing accumulated rainfall estimates for drought monitoring and food security. Radar data were used to calibrate multi-channel SEVIRI data from MSG, and a probability of rainfall at several different rain-rates was established for each combination of SEVIRI radiances. Radar calibrations from both Europe (the SatPrecip algorithm) and Niger (TAMORA algorithm) were used. 10 day estimates were accumulated from SatPrecip and TAMORA and compared with kriged gauge data and TAMSAT satellite rainfall estimates over West Africa. SatPrecip was found to produce large overestimates for the region, probably because of its non-local calibration. TAMORA was negatively biased for areas of West Africa with relatively high rainfall, but its skill was comparable to TAMSAT for the low-rainfall region climatologically similar to its calibration area around Niamey. These results confirm the high importance of local calibration for satellite-derived rainfall estimates. As TAMORA shows no improvement in skill over TAMSAT for dekadal estimates, the extra cloud-microphysical information provided by multi-spectral data may not be useful in determining rainfall accumulations at a ten day timescale. Work is ongoing to determine whether it shows improved accuracy at shorter timescales. [ABSTRACT FROM AUTHOR]

The article reports on the influenza A (H1N1) virus which was first observed in the U.S. and Mexico in 2009. The virus was imported into New Zealand by a group of high school students returning from Mexico in April 2009. The students went through isolation quarantine which was conducted by government and health officials and other medical groups. The officials are closely monitoring the influenza A H1N1 virus to check if it would spread further to other countries.

Recent conflicts have seen the increased use of Information Operations (Info Ops) and furthered our understanding of their utility within the context of the overall campaign plan. This trend will continue due to their particular utility within an asymmetric context, providing a commander with an important force multiplier. Nevertheless the resourcing of Info Ops is still not sufficient to allow their full potential to be realised. Having reviewed the UK Info Ops doctrine, several areas of MOE were assessed by a combination of interviews and literary research with a view to assessing their future utility and informing the wider Info Ops debate. The article concludes that only by quantifying the effect of Info Ops within the overall campaign by the identification of robust Measures of Effectiveness (MOE) will a true assessment of their value become apparent and resourcing priorities change to reflect this. [ABSTRACT FROM AUTHOR]

Let g be the genus of the Hermitian function field H/Fq²and let L(D1mQ∞) be a typical Hermitian code of length n. In [Des. Codes Cryptogr., to appear], we determined the dimension/length profile (DLP) lower bound on the state complexity of CL (D1 mQ∞). Here we determine when this lower bound is tight and when it is not. For in ⩽ n-2/2 or m ⩾ n-2/2 + 2g, the DLP lower bounds reach Wolf's upper bound on state complexity and thus are trivially tight. We begin by showing that for about half of the remaining values of in the DLP bounds cannot be tight. In these cases, we give a lower bound on the absolute state complexity of CL ( 1mQ∞), which improves the DLP lower bound. Next we give a "good" coordinate order for CL (D1mQ∞). With this good order, the state complexity of CL (D1mQ∞ achieves its DLP bound (whenever this is possible). This coordinate order als provides an upper bound on the absolute state complexity of CL 1mQ∞) (for those values of in for which the DLP bounds cannot be tight). Our bounds on absolute state complexity do not meet for some of these values of in, and this leaves open the question whether our coordinate order is best possible in these cases. A straightforward application of these results is that if CL (D1mQ∞) is self-dual, then its state complexity (with respect to the lexicographic coordinate order) achieves its DLP bound of n/2 q2/4 and, in particular, so does its absolute state complexity. [ABSTRACT FROM AUTHOR]

Traces writer Orson Scott Card's development of the military paradigm and that of the warrior who lives inside it, focusing particularly on his novel `Ender's Game.' Arms and the child; Character personification; War in peaces; Analysis of the book.

Nasopharyngeal aspirates and throat swab specimens were compared in a polymerase chain reaction (PCR)-based test for Mycoplasma pneumoniae. The pathogen was detected in 50 % and 45 % of throat swab specimens and aspirates, respectively. However, in specimens negative for Mycoplasma pneumoniae by PCR, amplification inhibitors were detected in 0 % and 36 % of throat specimens and aspirates, respectively. Further investigations confirmed that no throat specimens, but one-quarter of aspirates, are likely to be rejected for containing inadequate respiratory material or excess amplification inhibitors. Because rejection of most of the unsuitable specimens is possible only after PCR, the use of aspirates is less cost-effective. This, and the reluctance to subject patients to aspiration, make the aspirate an inferior specimen for detection of Mycoplasma pneumoniae by PCR. [ABSTRACT FROM AUTHOR]

SUMMARY Thick-walled pulmonary cavities are an uncommon manifestation of Pneumocystis carinii pneumonia (PCP). A case of PCP in a man with Acquired Immunodeficiency Syndrome (AIDS) presenting with a thick-walled pulmonary cavity and multiple smaller pulmonary air cysts is described. All of these lesions showed dramatic healing with therapy. A brief review of the recent literature is also presented. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Bloodstream infections in a secondary and tertiary care hospital setting," by Worth L.J., Slavin M.A. and Black J., in the 2007 issue.

Abstract Background Mier1 encodes a novel transcriptional regulator and was originally isolated as a fibroblast growth factor early response gene. Two major protein isoforms have been identified, MIER1α and β, which differ in their C-terminal sequence. Previously, we demonstrated that both isoforms recruit histone deacetylase 1 (HDAC1) to repress transcription. To further explore the role of MIER1 in chromatin remodeling, we investigated the functional interaction of MIER1 with the histone acetyltransferase (HAT), Creb-binding protein (CBP). Findings Using GST pull-down assays, we demonstrate that MIER1 interacts with CBP and that this interaction involves the N-terminal half (amino acids 1–283) of MIER1, which includes the acidic activation and ELM2 domains and the C-terminal half (amino acids 1094–2441) of CBP, which includes the bromo-, HAT, C/H3 and glutamine-rich domains. Functional analysis, using HEK293 cells, shows that the CBP bound to MIER1 in vivo has no detectable HAT activity. Histone 4 peptide binding assays demonstrate that this inhibition of HAT activity is not the result of interference with histone binding. Conclusion Our data indicate that an additional mechanism by which MIER1 could repress transcription involves the inhibition of histone acetyltransferase activity.

The psychological burden of type 1 diabetes (T1D) can negatively impact health outcomes. This study evaluates the prevalence of low mood (WHO-5), disordered eating (DEPS-R), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II), in a sample of 250 New Zealand adults (8.4% Māori/91.6% non-Māori; 43.6% female/56.4% male) with T1D using validated tools. Māori and female patients indicated low mood, with lower median WHO-5 scores than non-Māori ( p  = 0.027) and males ( p  = 0.002). Māori were more likely to score in the clinical range on the WHO-5, DEPS-R, PAID and HFS-II (all p  < 0.05). HbA1c was correlated with emotional well-being ( r s  = -0.189), diabetes distress ( r s  = 0.223) and disordered eating ( r s  = 0.389; all p  < 0.001) whilst DEPS-R correlated with age ( r s  = -0.232) and BMI ( r s  = 0.343; both p  ≤ 0.001). Thus, diabetes-related psychological distress is common in New Zealand adults with T1D, particularly for Māori, females and those with elevated HbA1c levels., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A prior analysis suggested that wound swab culture (WSC) results were driving unnecessary antibiotic use in patients who were not already receiving treatment. As a quality-improvement initiative, our laboratory introduced an "exception-reporting" protocol on 1 March 2023, whereby typical wound pathogens susceptible to recommended empiric therapy (flucloxacillin/cefalexin) were not reported, and a comment was provided, stating no significant resistant organisms had been detected. Full results were available to clinicians on request. Cultures falling outside protocol criteria were reported in the standard fashion. This analysis sought to assess the effect of exception-reporting on post-report antibiotic initiation (PRAI). All community WSC results were matched to antibiotic dispensing records from October 2021 to December 2023. Sampling without treatment pre-report was termed "test and wait" (TaW). Following TaW, PRAI was identified if antibiotics were started within 5 days post-report. There were 1,819 and 764 WSCs received in the pre-change and post-change periods, respectively, where an initial TaW approach had been taken and an organism eligible for exception-reporting had been isolated. In the post-change period, 407 (53.3%) met the criteria and were exception-reported. PRAI occurred in 901 (49.5%) pre-change samples, compared to 102 (25.1%, P < 0.01) with exception-reporting. There was no detectable increase in hospitalization or repeat WSC collection in the 30 days following exception-reporting. Exception-reporting was associated with a markedly reduced proportion of patients being initiated on antibiotics following WSC where an organism had been isolated. The naming of organisms in reports appears to drive unnecessary antibiotic prescribing in many patients. These results require confirmation in other jurisdictions., Importance: Wound swab culture is a high-volume test performed in clinical microbiology laboratories. In this analysis, we have shown that an alternative approach to reporting positive wound swab cultures has resulted in a large reduction in post-report antibiotic initiation, suggesting that the current standard method of reporting generates considerable unnecessary antibiotic use. If these findings are replicated elsewhere, wider adoption of this reporting would represent an opportunity for many clinical microbiology laboratories to have a significant impact on community antimicrobial stewardship., Competing Interests: The authors declare no conflict of interest.

Aim: Our antimicrobial guidelines (AGs) were changed in 2021 to recommend once-daily ceftriaxone in place of three-times-daily cefuroxime as preferred cephalosporin. This analysis sought to assess the effects of this on incidence of Clostridioides difficile infection (CDI), third-generation cephalosporin-resistant Enterobacterales (3GCR-E) and resource utilisation., Method: Before and after analysis of 30-day CDI and 3GCR-E incidence following receipt of cefuroxime/ceftriaxone pre- and post-AG change. Total nursing time and waste production relating to cefuroxime/ceftriaxone delivery were calculated pre- and post-change., Results: CDI incidence was 0.6% pre- and 1.0% post-change (adjusted odds ratio [aOR] 1.44, p=0.07) and 3GCR-E incidence 3.5% and 3.1% (aOR 0.90, p=0.33). Mean per-quarter estimated nursing administration time decreased from 2,065 to 1,163 hours (902 nurse-hour reduction) and antibiotic-related waste generation from 1,131kg to 748kg (383kg reduction). Overall days of therapy per-quarter of cefuroxime/ceftriaxone were unchanged between periods., Conclusion: This simplification of our AG from a three-times-daily to a once-daily antibiotic resulted in considerable savings for our hospital (roughly 1.7 full-time equivalent nurses and over a tonne of waste yearly), with no significant increases in CDI or 3GCR-E. The impact of dosing schedules on non-antibiotic-spectrum factors, such as nursing time and resource usage, is worthy of consideration when designing AGs., Competing Interests: The authors have no conflicts of interest to declare. This work was supported by internal departmental funds., (© PMA.)

Women diagnosed with breast cancer must make important surgical decisions. The decision-making process for younger women is complex, with this group more likely to have an advanced diagnosis and life-stage considerations that can impact on treatment. This study investigated the decision-making process of women aged <50 years who had undergone breast cancer surgery within the preceding 12 months in Aotearoa New Zealand. Twelve women participated in semi-structured qualitative interviews to explore the factors that influenced treatment decisions. Thematic analysis resulted in three themes. Fear was the main concept identified as the primary influence on initial decision-making. Good quality shared decision-making between patient and clinician was found to provide essential support during the diagnosis to treatment period. In addition, women expressed a need for multi-modal presentation of medical information and more material reflecting younger women. These findings inform provision for younger women making surgical decisions when diagnosed with breast cancer., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In patients without ethnicity risk factors for acute rheumatic fever (ARF), our local guidelines recommend limiting antibiotic use following a positive throat swab culture (TSC). If symptoms are severe, a 5-7 day course is recommended. Despite this, most local patients with a positive TSC for group A Streptococcus (GAS) or Streptococcus dysgalactiae subsp. equisimilis (SDSE) were being prescribed 10 days of antibiotics. In response, we added comments to positive TSC reports recommending shorter treatment durations in those without ARF risk factors. No other antimicrobial stewardship initiatives were implemented., Objectives: To assess the effect of these comments on antibiotic course duration after positive TSC., Methods: All community TSC results from 1 October 2021 to 31 March 2023 (1 year pre- to 6 months post-change) were matched to antibiotic dispensing data. Patients who had been empirically dispensed an antibiotic prior to the culture report were excluded. The outcome of interest was the antibiotic duration dispensed in the 5 day period after the TSC report., Results: Following introduction of the comments, median course duration reduced from 10 (IQR 5-10) to 7 days (IQR 0-10; P < 0.01) and from 7 (IQR 0-10) to 0 days (IQR 0-5; P < 0.01) following GAS- and SDSE-positive TSC, respectively, in those without ARF risk factors. The percentage of people receiving 10 days of antibiotics decreased from 63.0% to 37.0% (P < 0.01) and 41.2% to 14.6% (P < 0.01) for GAS and SDSE, respectively., Conclusions: The introduction of comments providing direct prescribing advice to requestors appears to have been highly effective at improving guideline-compliant prescribing following positive TSC report., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Positive culture results from non-sterile sites (NSSs) are poorly predictive of clinical infection. Despite this, these results are often interpreted as an indication for antibiotics, even in patients with limited signs of infection. We sought to quantify the influence of NSS culture results on post-report antibiotic initiation (PRAI) in patients who had not been started on antibiotics pre-report., Methods: All community wound/skin swab and sputum cultures were matched to antibiotic dispensing records from February 2017 to July 2022. Prescribing behaviour was assessed pre- and post-report. Sampling without treatment pre-report was termed 'test-and-wait' (TaW). Following TaW, PRAI was identified if antibiotics were started within 5 days post-report., Results: There were 65 480 wound/skin swabs and 8126 sputum samples, with TaW occurring in 21 740 (35.1%) and 4185 (54.4%), respectively. Following a TaW approach PRAI occurred in 43.3% when an organism was reported, versus 10.8% (P < 0.01) for a 'no growth' report for wound/skin swabs. For the same comparison with sputum, PRAI occurred in 47.9% versus 10.8% (P < 0.01). On multivariate analysis reporting an organism remained strongly associated with PRAI., Conclusions: Reporting an organism in those not already on antibiotics was strongly associated with PRAI. We hypothesize that for many patients TaW suggests limited evidence of infection (i.e. insufficient to justify antibiotic treatment at time of sampling), meaning positive NSS results may be driving a considerable volume of potentially unnecessary antibiotic use. Further study on this topic is required, but strategies to reduce PRAI may offer laboratories an opportunity to meaningfully impact antimicrobial stewardship efforts., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Paramedics are increasingly being called to attend patients dying from advanced incurable conditions. However, confidence to deal with such calls varies, with many feeling relatively unskilled in this aspect of their role. A number of interventions have been piloted to improve their skills in end-of-life care (EoLC) but without a fully specified theoretical model. Theory of Change models can provide theoretical and testable links from intervention activities to proposed long-term outcomes and indicate the areas for assessment of effectiveness. This study aimed to develop an intervention for improving paramedic EoLC for patients in the community., Methods: A Theory of Change approach was used as the overarching theoretical framework for developing an intervention to improve paramedic end-of-life skills. Nine stakeholders - including specialist community paramedics, ambulance call handlers and palliative care specialists - were recruited to five consecutive online workshops, ranging between 60 and 90 min. Each workshop had 2-3 facilitators. Over multiple workshops, stakeholders decided on the desired impact, short- and long-term outcomes, and possible interventions. During and between these workshops a Theory of Change model was created, with the components shared with stakeholders., Results: The stakeholders agreed the desired impact was to provide consistent, holistic, patient-centred, and effective EoLC. Four potential long-term outcomes were suggested: (1) increased use of anticipatory and regular end-of-life medications; (2) reduced end-of-life clinical and medication errors; (3) reduced unnecessary hospitalisations; (4) increased concordance between patient preferred and actual place of death. Key interventions focused on providing immediate information on what to do in such situations including: appraising the situation, developing an algorithm for a treatment plan (including whether or not to convey to hospital) and how to identify ongoing support in the community., Conclusions: A Theory of Change approach was effective at identifying impact, outcomes, and the important features of an end-of-life intervention for paramedics. This study identified the need for paramedics to have immediate access to information and resources to support EoLC, which the workshop stakeholders are now seeking to develop as an intervention., (© 2023. The Author(s).)

Stepping between static and moving surfaces presents a locomotor challenge associated with increased injury frequency and severity in older adults. The current study evaluates younger and older adults' behaviours when overcoming challenges sampling moving walkway and escalator environments. Twelve younger adults (18-40 years, Male = 8) and 15 older adults (60-81 years, Male = 5) were examined using an integration of optoelectronic motion capture and mobile eye-tracking. Participants were investigated approaching and stepping onto a flat conveyor belt (static or moving; with or without surface (demarcation) lines). Specifically, the four conditions were: (i) static surface without demarcation lines; (ii) static surface with demarcation lines; (iii) moving surface without demarcation lines; and (iv) moving surface with demarcation lines. A two (age group) x two (surface-condition) x two (demarcation-condition) linear mixed-model revealed no main or interaction effects (p > .05) for perturbation magnitude, indicating participants maintained successful locomotion. However, different adaptive behaviours were identified between conditions with moving and accuracy demands (e.g., moving surfaces increased step length, demarcations reduced step length). Between subject effects identified differences between age groups. Older adults utilised different behaviours, such as earlier gaze transfer from the final approach walkway step location. Overall, the current study suggests that adaptive behaviours emerge relative to the environment's specific demands and the individual's action capabilities., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)