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Summary: Here, we present a case of mass ventilator failure due to contaminated medical air. Multiple ventilators failed routine tests, including almost all of the ventilators in our intensive care unit. A faulty air compressor had led to water contamination of our centre's supply of medical air. Water entered the pipeline supply of air and, hence the ventilators and anaesthetic machines. The disruption of the machines' proportional mixer valve resulted in unreliable delivery of fresh gas flow. This malfunction was discovered during routine pre‐use checks, and backup ventilators were available to replace the faulty ventilators. A shortage of equipment was averted due to a serendipitous availability of ventilator stockpiles prepared for the COVID‐19 pandemic. Ventilator shortages are commonly described in mass casualty and pandemic scenarios. While there are multiple strategies described in literature to augment and maximise equipment available for mechanical ventilation, stockpiling equipment remains an expensive but necessary component of disaster contingency planning. [ABSTRACT FROM AUTHOR]

Background: To date, there have been no studies evaluating adherence to clozapine with electronic adherence monitoring (EAM) such as the Medication Event Monitoring System (MEMS®). Methods: In outpatients with schizophrenia, we conducted a 3‐month prospective study investigating antipsychotic adherence with EAM (eCAP®). Participants were treated with different oral antipsychotics, including clozapine, and blind to EAM monitoring; all were on antipsychotic monotherapy administered once daily. Outcome measures included adherence rate, missed dose, and medication gap. Adherence trajectory patterns were also analyzed for clozapine vs. other antipsychotics collectively. Results: A total of 111 patients were included in the study; 33 and 78 patients received clozapine or other antipsychotics, respectively. Adherence rates, defined as proportion of days that the subject took the medication at the prescribed time ± 3 h and proportion of subjects with ≥80% adherence, were numerically higher in patients receiving clozapine vs. other antipsychotics (72.0% vs. 65.1%, P = 0.10; 49.5% vs. 35.7%, P = 0.11, respectively). Along similar lines, some of the missed dose and medication gap outcomes were significantly better in patients receiving clozapine vs. other antipsychotics. Three adherence trajectory patterns were identified for both clozapine and other antipsychotics, with two shared by both groups (i.e., low adherence with a slight decrease over time; high and stable adherence). Conclusion: Findings suggest that in patients with schizophrenia clozapine adherence is at least comparable, if not slightly better, compared with other antipsychotics. [ABSTRACT FROM AUTHOR]

Aim: To identify the barriers and facilitators to start insulin in patients with type 2 diabetes.Method: This was a systematic review. We conducted a systematic search using PubMed, EMBASE, CINAHL and Web of Science (up to 5 June 2014) for original English articles using the terms 'type 2 diabetes', 'insulin', and free texts: 'barrier' or 'facilitate' and 'initiate'. Two pairs of reviewers independently assessed and extracted the data. Study quality was assessed with Qualsyst.Results: A total of 9740 references were identified: 41 full-text articles were assessed for eligibility. Twenty-five articles (15 qualitative, 10 quantitative) were included in the review. Good inter-rater reliability was observed for the Qualsyst score (weighted kappa 0.7). Three main themes identified were as follows: patient-related, healthcare professional and system factors. The main patient-related barriers were fear of pain and injection (n = 18), concerns about side effects of insulin (n = 12), perception that insulin indicated end stage of diabetes (n = 11), inconvenience (n = 10), difficulty in insulin administration (n = 7), punishment (n = 7) and stigma and discrimination (n = 7). Healthcare professionals' barriers were as follows: poor knowledge and skills (n = 9), physician inertia (n = 5) and language barriers (n = 4). System barriers included lack of time (n = 5). The most common facilitators were understanding the benefits of insulin (n = 7), not being afraid of injections (n = 5), and patient education and information (n = 5).Conclusion: Major barriers to insulin initiation persist despite availability of newer and safer insulin. Healthcare professionals should explore and address these barriers. Targeted interventions should be developed to overcome these barriers. [ABSTRACT FROM AUTHOR]

SUMMARY This paper presents lattice Boltzmann Bhatnagar-Gross-Krook (LBGK) model and incompressible LBGK model-based lattice Boltzmann flux solvers (LBFS) for simulation of incompressible flows. LBFS applies the finite volume method to directly discretize the governing differential equations recovered by lattice Boltzmann equations. The fluxes of LBFS at each cell interface are evaluated by local reconstruction of lattice Boltzmann solution. Because LBFS is applied locally at each cell interface independently, it removes the major drawbacks of conventional lattice Boltzmann method such as lattice uniformity, coupling between mesh spacing, and time interval. With LBGK and incompressible LBGK models, LBFS are examined by simulating decaying vortex flow, polar cavity flow, plane Poiseuille flow, Womersley flow, and double shear flows. The obtained numerical results show that both the LBGK and incompressible LBGK-based LBFS have the second order of accuracy and high computational efficiency on nonuniform grids. Furthermore, LBFS with both LBGK models are also stable for the double shear flows at a high Reynolds number of 105. However, for the pressure-driven plane Poiseuille flow, when the pressure gradient is increased, the relative error associated with LBGK model grows faster than that associated with incompressible LBGK model. It seems that the incompressible LBGK-based LBFS is more suitable for simulating incompressible flows with large pressure gradients. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Using hepatitis C virus (HCV) and interferon (IFN) resistance as a proof of concept, we have devised a new method for calculating the effect of a drug on a viral population, as well as the resistance of the population's individual intrahost variants. By means of next-generation sequencing, HCV variants were obtained from sera collected at nine time points from 16 patients during the first 48 h after injection of IFN-α. IFN-resistance coefficients were calculated for individual variants using changes in their relative frequencies, and for the entire intrahost viral population using changes in viral titer. Population-wide resistance and presence of IFN-resistant variants were highly associated with pegylated IFN-α2a/ribavirin treatment outcome at week 12 (P = 3.78 × 10−5 and 0.0114, respectively). This new method allows an accurate measurement of resistance based solely on changes in viral titer or the relative frequency of intrahost viral variants during a short observation time. [ABSTRACT FROM AUTHOR]

Introduction: Studies were conducted to investigate changes in the extent of human herpesvirus 8 (HHV-8) shedding and diversity of HHV-8 strains in the mouth of a renal allograft recipient who developed cutaneous post-transplantation Kaposi’s sarcoma. Methods: Matched oral and blood samples were obtained from a Saudi Arabian renal allograft recipient from 3 days before to 38 weeks after transplantation, and from his kidney donor. Polymerase chain reaction (PCR) protocols to amplify selected HHV-8 sub-genomic regions were applied to detect and quantify HHV-8 DNA. Sequence diversity was determined by cloning the PCR products and subjecting them to denaturing gradient gel electrophoresis and to nucleotide sequencing. Results: Before transplantation, the recipient was seropositive for anti-HHV-8 immunoglobulin G, but the donor was seronegative; HHV-8 DNA could be detected in the recipient’s blood, whole-mouth saliva (WMS) and buccal exfoliates, and the salivary viral load was estimated as 2.6 million genome-copies/ml. Post-transplantation, the recipient’s salivary viral load initially increased to 4.1 million genome-copies/ml, and thereafter declined precipitously, coinciding with an increase in the dosage of valaciclovir given; HHV-8 DNA was detected most often in WMS compared with parotid saliva, and buccal and palatal exfoliates. Carriage of multiple HHV-8 strains was evident in blood and oral samples; whereas before transplantation strains belonging to genotypes A1 and A5 were observed, after transplantation genotype A5 strains became dominant and A2 strains emerged. Conclusion: Immunosuppression and antiviral prophylaxis may interact to influence the spectrum of oral HHV-8 strains and the extent of post-transplantation HHV-8 shedding into the mouth. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Tracheal carcinoma ex pleomorphic adenoma: a rare tumour with potential problems in diagnosis," in previous issue of Histopathology.

Although autochthonous hepatitis E has been reported in developed countries, its extent and nature in the United Kingdom are unclear. The aim of the present study was to report the natural history, lifestyle risk factors and molecular epidemiology of autochthonous hepatitis E infection in southwest England. Three hundred and thirty-three patients with unexplained hepatitis were tested for markers of hepatitis E virus (HEV) infection over a 7-year period. HEV RNA isolated from the cases was amplified and characterized. Of the 333 patients, 21 had autochthonous hepatitis E. Patients were middle-aged or elderly and males were more commonly affected. Clinical manifestations ranged from asymptomatic infection to severe hepatitis. Of the 21 patients, 20 recovered within 6 weeks. None of the cases had travelled to an area endemic for HEV. None of the patients were vegetarian and all ate pork. Of the 21 cases, 20 occurred in the spring, summer and autumn months. All polymerase-chain-reaction-confirmed cases carried HEV genotype 3, which bore close sequence homology to HEV circulating in UK pigs. In the United Kingdom, autochthonous hepatitis E may be more common than previously recognized. Although the mode of transmission remains to be determined, it may be a zoonosis with pigs as a reservoir. Hepatitis E should be considered a public health issue in the United Kingdom. [ABSTRACT FROM AUTHOR]

Whether differences in the natural history of hepatitis C virus (HCV) can be explained by differences in the infecting HCV type is unknown. The aim of this study was to investigate whether the HCV type might influence the clinical outcome of infection. Study serum samples were assembled from 749 individuals enrolled into the UK HCV National Register from which data on clinical outcomes were extracted. HCV-RNA-positive specimens were genotyped and HCV-RNA-negative specimens serotyped. Logistic regression analysis was used to investigate the independent effect of HCV type on viral clearance by comparing patients who were HCV RNA negative ( n = 86) with those who were HCV RNA positive ( n = 508). The same method was used to investigate whether HCV type was associated with histological stage of liver disease. The prevalence of HCV type 1 among those who cleared infection was 69% and among those who remained HCV RNA positive was 51%: Type 1 infections were more likely to be HCV RNA negative than non-1 types (OR 0.47, 95% CI 0.29–0.78, P = 0.003). Type 1 infections were also more likely to be associated with histological stage scores above the median when compared with non-1 types (OR 2.03, 95% CI 1.07–3.83, P = 0.03). In conclusion, HCV type 1 infection was more often HCV RNA negative, suggesting that spontaneous clearance may occur more commonly with this type. Among the RNA-positive infections, type 1 infection may be more aggressive than types 2/3. [ABSTRACT FROM AUTHOR]

Indigenous hepatitis E is increasingly recognized in developed countries, where it may be a zoonosis. We describe the first case of transfusion-transmitted hepatitis E in the UK from a blood donor who had no history of recent travel abroad. Follow-up of the donor and recipients of the blood products was carried out using serological and molecular techniques. Acute hepatitis E was transmitted to one of two recipients. The infected patient would have received a larger volume of the donor's plasma. HEV subgenomic sequences carried by the donor and recipient were identical. This is the first case of post-transfusion hepatitis E in the UK. Secondary transmission of hepatitis E indigenous to a nonhyperendemic country may occur by blood transfusion. It is important that blood donors inform the transfusion service of all post-donation illnesses so that appropriate interventions can take place. [ABSTRACT FROM AUTHOR]

Severe dystonia or status dystonicus is a life threatening disorder that develops in patients with both primary and secondary dystonia. We present the case of a 9-year-old boy with Hallervorden-Spatz disease (HVS) who developed status dystonicus, failing to respond to high dose oral therapy with multiple antidystonic agents. High dose intravenous sedating agents combined with endotracheal intubation and mechanical ventilation were required to control the spasms. Alleviation of the spasms was achieved by a combination of temporary intrathecal baclofen infusions and bilateral pallidotomy. Although it could be argued this is a situation where only palliative measures should be used, we believe a relatively aggressive approach was justified. It relieved the intense pain associated with the spasms and allowed the child to be discharged home without the prolonged stay in intensive care, morbidity and mortality, which characterize status dystonicus. [ABSTRACT FROM AUTHOR]

There is a variable geographic distribution in the prevalence of hepatitis C virus (HCV)-related oral lichen planus (OLP), which appears unrelated to either HCV genotype or HCV epidemiology. The present study investigated whether hepatitis G virus (HGV) co-infection may be a feature of patients with HCV-related OLP, which might explain these phenomena. HGV co-infection was detected in 6 of 39 Italian patients with HCV-related OLP, but the presence of HGV did not influence the clinical presentation of OLP. It is concluded that HGV co-infection is unlikely to influence the clinical detection of HCV-related OLP. [ABSTRACT FROM AUTHOR]

The study reported compared the positions of the horizontal axis of rotation of the condyles when R.A.P. registrations were taken on seven subjects using; (1) An anterior jig with chinpoint guidance. (2) An anterior jig with chinpoint guidance and applied muscle force by the subject. (3) An anterior jig with bilateral manipulation (i.e. bilateral support of the body of the mandible by the operator). The results showed that the most superior positions were obtained with the technique using the anterior jig with chinpoint guidance and applied muscle force, which was also the most inconsistent technique. The technique using the anterior jig with chinpoint guidance was most consistent, and the mean difference between retruded axis position and intercuspal position using this technique was 0.31 mm on the right side and 0.34 mm on the left side. [ABSTRACT FROM AUTHOR]

The presence and distribution of Epstein-Barr Virus receptors (EBVR's) on a range of normal (n = 18), dysplastic (n = 10) and malignant (n = 20) oral mucosa were studied by immunocytochemical methods using the monoclonal antibodies (MAb s) l-1B5 and B2. EBVR s were demonstrated as membrane staining of the spinous layers of normal non- and parakeratinized epithelium. indicating that EBVR's are differentiation-linked. This distribution was retained in dysplastic epithelium. Tissue from oral squamous cell carcinomas (SCC's) showed variable reactivity of only a few cells scattered randomly within the samples. Furthermore, a sensitive in situ hybridization (ISH) technique was used to determine if Epstein- Barr virus (EBV) was present in normal (n= 15) and oral squamous cell carcinoma tissues (n=20). No EBV DNA was demonstrated within either normal or malignant epithelium, suggesting that the virus does not persist in normal oral stratified squamous epithelium nor is there any evidence for a role in oral carcinogenesis. [ABSTRACT FROM AUTHOR]

Abstract Most previous studies have shown the prevalence of traumatic dental injuries in anterior teeth to increase with increasing overjet. This study identified 36 Singapore school children, age 7- 18 years, from a clinic population of 11,179, who had suffered dental trauma while playing contact or collision sports. A case control group of 36 children, matched for age, sex, race and sporting activities, but who had not suffered dental trauma, was selected from the same clinic population. Both groups were examined and the nature of injuries received, together with overjet measured to the nearest 0.3 mm were determined. The mean overjet for the trauma group was 3.42± 1.45 mm and for the injured group 3.42± 1.33 mm. These means were not statistically different (p= 1.00), neither did the distribution of overjet between the groups differ. These data were not in accord with the majority of studies correlating incisal overjet and dental trauma, and they suggested that overjet was not a positive correlate with traumatic dental injury iii Singapore school children. [ABSTRACT FROM AUTHOR]

In this article, the relation between the global optimization of joint velocity and local optimization of joint torque is investigated. The local minimization of the weighted joint torques can be matched to the global optimization of the corresponding weighted joint velocities when the weighted matrices satisfy certain sufficient conditions. A straightforward matching is obtained using the local optimization of the inertia inverse weighted dynamic torque and the global minimization of the kinetic energy. Another easy solution can be found, as will be shown later, if the inertia matrix is a constant and gravity is neglected. Based on that, it can be seen why a Cartesian robot, which has a constant inertia matrix, is always stable. [ABSTRACT FROM AUTHOR]

Examines the identification of Hepatitis C virus (HCV) for blood transfusion recipients in England. Factors influencing the outcome of HCV infection; Prevention of the risk of liver failure; Administration of long-term specialist management to transfusion recipients and blood donor with chronic hepatitis C infection.

Hepatitis C virus (HCV) has high genomic variability and since its discovery, six different "types" and an increasing number of "subtypes" have been reported. HCV genotype may influence viral replication, natural history of disease and response to therapy. Recently, an association between lichen planus (LP) and HCV infection has been suggested, as there is an increased frequency of HCV infection among some groups of patients with LP, in particular from Italy and Japan. These results have not been confirmed by other reports from different geographical areas. Since HCV genotypes have a heterogeneous geographical distribution, we have determined by restriction fragment length polymorphism the genotypes of 39 HCV-seropositive Italian patients with oral LP in order to establish whether the association between LP and HCV infection is influenced by HCV subtype. Of the 33 (84.6%) viraemic patients, 17 (51%) were infected by HCV subtype 1b, 9 (27%) were infected by HCV subtype 2a, 2 by subtype 1a and 1 by subtype 2b. In four cases the gel patterns were uninterpretable. This distribution of HCV genotypes is similar to that reported in recent studies of Italian HCV-seropositive patients of unknown LP status. It is concluded from this small sample that the association of lichen planus with HCV infection and its differential geographic distribution is unlikely to be due to infection by a particular HCV genotype. [ABSTRACT FROM AUTHOR]

The article discusses various reports on hepatitis E published within the issue.

We present a methodology for estimating the required dimensions of tunnel dryers used in the drying of agricultural products. The methodology incorporates a material model that describes the drying behaviour of the product based on the 'receding front' concept, and a formulation of the transfer processes in tunnel drying. The material model is first validated using experimental data before it is integrated into the dryer model The overall dryer model in finite-difference form is usedto simulate the performance of a tunnel dryer under varying conditions. The resulting simulation algorithm becomes an engineering tool for designers of tunnel dryers, enabling the estimation of required dimensions and the drying conditions and dryer performance. [ABSTRACT FROM AUTHOR]

This study compared the perceived sources of stress in the dental school environment between an American and a South East Asian (Singapore) dental school across their entire curricula (D1-D4 years). The dental environmental stress (DES) questionnaire was administered to 137 (98 percent) Singapore dental students and results were compared to a previous study conducted at an American school. Significant differences were found for 12 questionnaire items across the four classes for the American cohort as compared to 13 in the Singapore cohort. While the greatest stressor for Singapore students was completing graduation requirements, American students were most stressed by examinations and grades. The overall perception of stress by Singapore students was higher than for their American counterparts. The primary concern for both cohorts was, however, related to the different areas of their academic courses.