This study presents novel findings on stochastic electron heating via a random electron cyclotron wave (ECW) in a spherical tokamak. Hard x ray measurements demonstrate the time evolution of hard x ray counts at different energy bands, consistent with predictions from the stochastic heating model. The ECW heating rate shows a positive correlation with applied power, confirming the effectiveness of stochastic heating. Remarkably, the ECW-driven plasma current remains insensitive to ECW incidence angle, consistent with model predictions. The observed stochastic heating of electrons offers potential for exploring innovative non-inductive current drive modes in spherical tokamaks. This research contributes to the understanding of plasma behaviour and motivates the development of new models for non-inductive current drive in fusion devices.

Unmanned aerial vehicle (UAV) swarm coverage is one of the key technologies for multi-UAV cooperation, which plays an important role in collaborative investigation, detection, rescue and other applications. Aiming at the coverage optimisation problem of UAV in the target area, a collaborative visual coverage control method under positioning uncertainty is presented. First, the visual perception area with imprecise localisation, UAV model and sensor model are created based on the given task environment. Second, a regional division algorithm for the target task area is designed based on the principle of Guaranteed Voronoi (GV) diagram. Then a visual area coverage planning algorithm is designed, in which the task area is allocated to the UAV according to the corresponding weight coefficient of each area, and the input control law is adjusted by the expected state information of the UAV, so that the optimal coverage quality target value and the maximum coverage of the target area can be achieved. Finally, three task scenarios for regional division and coverage planning are simulated respectively, the results show that the proposed area coverage planning algorithm can realise the optimal regional distribution and can obtain more than 90% coverage in different scenarios.

This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.

Phytase has long been used to decrease the inorganic phosphorus (Pi) input in poultry diet. The current study was conducted to investigate the effects of Pi supplementation on laying performance, egg quality and phosphate–calcium metabolism in Hy-Line Brown laying hens fed phytase. Layers (n = 504, 29 weeks old) were randomly assigned to seven treatments with six replicates of 12 birds. The corn–soybean meal-based diet contained 0.12% non-phytate phosphorus (nPP), 3.8% calcium, 2415 IU/kg vitamin D3 and 2000 FTU/kg phytase. Inorganic phosphorus (in the form of mono-dicalcium phosphate) was added into the basal diet to construct seven experimental diets; the final dietary nPP levels were 0.12%, 0.17%, 0.22%, 0.27%, 0.32%, 0.37% and 0.42%. The feeding trial lasted 12 weeks (hens from 29 to 40 weeks of age). Laying performance (housed laying rate, egg weight, egg mass, daily feed intake and feed conversion ratio) was weekly calculated. Egg quality (egg shape index, shell strength, shell thickness, albumen height, yolk colour and Haugh units), serum parameters (calcium, phosphorus, parathyroid hormone, calcitonin and 1,25-dihydroxyvitamin D), tibia quality (breaking strength, and calcium, phosphorus and ash contents), intestinal gene expression (type IIb sodium-dependent phosphate cotransporter, NaPi-IIb) and phosphorus excretion were determined at the end of the trial. No differences were observed on laying performance, egg quality, serum parameters and tibia quality. Hens fed 0.17% nPP had increased (P < 0.01) duodenum NaPi-IIb expression compared to all other treatments. Phosphorus excretion linearly increased with an increase in dietary nPP (phosphorus excretion = 1.7916 × nPP + 0.2157; R2 = 0.9609, P = 0.001). In conclusion, corn–soybean meal-based diets containing 0.12% nPP, 3.8% calcium, 2415 IU/kg vitamin D3 and 2000 FTU/kg phytase would meet the requirements for egg production in Hy-Line Brown laying hens (29 to 40 weeks of age).

The fatty acid composition of chicken’s meat is largely influenced by dietary lipids, which are often used as supplements to increase dietary caloric density. The underlying key metabolites and pathways influenced by dietary oils remain poorly known in chickens. The objective of this study was to explore the underlying metabolic mechanisms of how diets supplemented with mixed or a single oil with distinct fatty acid composition influence the fatty acid profile in breast muscle of Qingyuan chickens. Birds were fed a corn-soybean meal diet supplemented with either soybean oil (control, CON) or equal amounts of mixed edible oils (MEO; soybean oil : lard : fish oil : coconut oil = 1 : 1 : 0.5 : 0.5) from 1 to 120 days of age. Growth performance and fatty acid composition of muscle lipids were analysed. LC-MS was applied to investigate the effects of CON v. MEO diets on lipid-related metabolites in the muscle of chickens at day 120. Compared with the CON diet, chickens fed the MEO diet had a lower feed conversion ratio (P < 0.05), higher proportions of lauric acid (C12:0), myristic acid (C14:0), palmitoleic acid (C16:1n-7), oleic acid (C18:1n-9), EPA (C20:5n-3) and DHA (C22:6n-3), and a lower linoleic acid (C18:2n-6) content in breast muscle (P < 0.05). Muscle metabolome profiling showed that the most differentially abundant metabolites are phospholipids, including phosphatidylcholines (PC) and phosphatidylethanolamines (PE), which enriched the glycerophospholipid metabolism (P < 0.05). These key differentially abundant metabolites – PC (14:0/20:4), PC (18:1/14:1), PC (18:0/14:1), PC (18:0/18:4), PC (20:0/18:4), PE (22:0/P-16:0), PE (24:0/20:5), PE (22:2/P-18:1), PE (24:0/18:4) – were closely associated with the contents of C12:0, C14:0, DHA and C18:2n-6 in muscle lipids (P < 0.05). The content of glutathione metabolite was higher with MEO than CON diet (P < 0.05). Based on these results, it can be concluded that the diet supplemented with MEO reduced the feed conversion ratio, enriched the content of n-3 fatty acids and modified the related metabolites (including PC, PE and glutathione) in breast muscle of chickens.

Copy number variations (CNVs), as an important source of genetic variation, can affect a wide range of phenotypes by diverse mechanisms. The somatostatin receptor 2 (SSTR2) gene plays important roles in cell proliferation and apoptosis. Recently, this gene was mapped to a CNV region, which encompasses quantitative trait loci of cattle economic traits including body weight, marbling score, etc. Therefore, SSTR2 CNV may exhibit phenotypic effects on cattle growth traits. In the current study, distribution of SSTR2 gene CNVs was investigated in six Chinese cattle breeds (XN, QC, NY, JA, LX and PN), and the results showed higher CNV polymorphisms in XN, QC and NY cattle. Next, association analysis between growth traits and SSTR2 CNV was performed for XN, QC and NY cattle. In NY, individuals with fewer copies showed better performance than those with more copies. Further, the effects of SSTR2 CNV on the SSTR2 mRNA level were also investigated, but revealed no significant correlation in either muscle or adipose tissue of adult NY cattle. The results suggested the potential for use of SSTR2 CNV as a marker for the molecular breeding of NY cattle.

Choosing Wisely Canada (CWC) is a national initiative designed to encourage patient-clinician discussions about the appropriate, evidence-based use of medical tests, procedures and treatments. The Canadian Association of Emergency Physicians’ (CAEP) Choosing Wisely Canada (CWC) working group developed and released ten recommendations relevant to Emergency Medicine in June 2015 (items 1–5) and October 2016 (items 6–10). In November 2016, the CAEP CWC working group developed a process for updating the recommendations. This process involves: 1) Using GRADE to evaluate the quality of evidence, 2) reviewing relevant recommendations on an ad hoc basis as new evidence emerges, and 3) reviewing all recommendations every five years. While the full review of the CWC recommendations will be performed in 2020, a number of high-impact studies were published after our initial launch that prompted an ad hoc review of the relevant three of our ten recommendations prior to the full review in 2020. This paper describes the results of the CAEP CWC working group's ad hoc review of three of our ten recommendations in light of recent publications.

We describe the case of an 11-month-old girl with a rare cerebellar glioblastoma driven by a NACC2-NTRK2 (Nucleus Accumbens Associated Protein 2-Neurotrophic Receptor Tyrosine Kinase 2) fusion. Initial workup of our case demonstrated homozygous CDKN2A deletion, but immunohistochemistry for other driver mutations, including IDH1 R132H, BRAF V600E, and H3F3A K27M were negative, and ATRX was retained. Tissue was subsequently submitted for personalized oncogenomic analysis, including whole genome and whole transcriptome sequencing, which demonstrated an activating NTRK2 fusion, as well as high PD-L1 expression, which was subsequently confirmed by immunohistochemistry. Furthermore, H3 and IDH demonstrated wildtype status. These findings suggested the possibility of treatment with either NTRK- or immune checkpoint- inhibitors through active clinical trials. Ultimately, the family pursued standard treatment that involved Head Start III chemotherapy and proton radiotherapy. Notably, at most recent follow upapproximately two years from initial diagnosis, the patient is in disease remission and thriving, suggesting favorable biology despite histologic malignancy. This case illustrates the value of personalized oncogenomics, as the molecular profiling revealed two actionable changes that would not have been apparent through routine diagnostics. NTRK fusions are known oncogenic drivers in a range of cancer types, but this is the first report of a NACC2-NTRK2 fusion in a glioblastoma.

The response of soil microbial communities to soil quality changes is a sensitive indicator of soil ecosystem health. The current work investigated soil microbial communities under different fertilization treatments in a 31-year experiment using the phospholipid fatty acid (PLFA) profile method. The experiment consisted of five fertilization treatments: without fertilizer input (CK), chemical fertilizer alone (MF), rice (Oryza sativa L.) straw residue and chemical fertilizer (RF), low manure rate and chemical fertilizer (LOM), and high manure rate and chemical fertilizer (HOM). Soil samples were collected from the plough layer and results indicated that the content of PLFAs were increased in all fertilization treatments compared with the control. The iC15:0 fatty acids increased significantly in MF treatment but decreased in RF, LOM and HOM, while aC15:0 fatty acids increased in these three treatments. Principal component (PC) analysis was conducted to determine factors defining soil microbial community structure using the 21 PLFAs detected in all treatments: the first and second PCs explained 89.8% of the total variance. All unsaturated and cyclopropyl PLFAs except C12:0 and C15:0 were highly weighted on the first PC. The first and second PC also explained 87.1% of the total variance among all fertilization treatments. There was no difference in the first and second PC between RF and HOM treatments. The results indicated that long-term combined application of straw residue or organic manure with chemical fertilizer practices improved soil microbial community structure more than the mineral fertilizer treatment in double-cropped paddy fields in Southern China.

Introduction: With the current opioid crisis in Canada, presentations of acute opioid withdrawal (AOW) to emergency departments (ED) are increasing. Undertreated symptoms may result in relapse, overdose and death. Buprenorphine/naloxone (bup/nal) is a partial opioid agonist/antagonist used to mitigate symptoms of AOW, approved by Health Canad in 2007 for opioid use disorder. It is superior to clonidine, and increases follow up with addiction treatment programs when initiated in the ED. Nevertheless, in our inner-city ED in 2014, bup/nal was rarely prescribed. We aimed to increase ED physician prescribing of bup/nal for AOW by 50% over a 26-month period. Methods: Commencing in 2014, an interprofessional team of ED physicians, nurses (RN), pharmacists and QI specialists collaborated to improve the care of patients with AOW. PDSA cycles included: (1) needs assessment of emergency physicians knowledge and practices in 2014; (2) Grand Rounds and a web based information sheet in 2015; (3) ED stocking of bup/nal; (4) convenience order set to standardize AOW management; (5) Grand Rounds in 2016 and (6) peer-coaching for RNs, including case-based discussions and pocket card cognitive aids. The outcome was the number of times bup/nal was prescribed per month by ED physicians between Sept, 2015 and Oct, 2017. Data included the prescriber and use of order set as the process measure. The balancing measure was the number of patients referred to the Addiction Medicine Team who subsequently received bup/nal. Results: Bup/nal was prescribed by ED physicians 70 times, and 14 times by the Addiction Medicine Team. With each PDSA cycle, there was an increase in prescribing, with no significant shifts or trends. By all physicians, the median number of prescriptions per month was 3, and increased from 2 to 4 prescriptions/month after nursing education. There was a smaller increase in the median from 2 to 3 prescriptions/month by ED physicians alone. The order set was used 97% of the time. Conclusion: Bup/nal is safe, effective, and increases follow up with addiction programs for comprehensive assessment and treatment planning. We met our goal of increasing bup/nal prescribing in the ED for AOW by 50%. Moreover, prescribing increased by 100% with the addition of patients who received bup/nal after a referral to the Addiction Medicine Team. The intervention with the greatest impact was RN education, demonstrating that peer-coaching and teaching by an interprofessional team is key to changing practice. Unfortunately, overall prescribing remains low, and ED physicians may still be hesitant to prescribe bup/nal and defer to the specialists. It is unclear if this is due to a low number of patients presenting with AOW, patients with contraindications to bup/nal, or ED physician factors. The next step is an audit of all patients with AOW to see what percentage of those eligible are treated with bup/nal. A follow up survey to determine ongoing barriers will inform further PDSA cycles.

A new multi-layer irrotational Boussinesq-type model is proposed for both linear and nonlinear surface water waves over mildly sloping seabeds. The model is formulated in terms of computational horizontal and vertical velocity components within each layer and satisfies exact kinematic and dynamic free-surface conditions as well as kinematic seabed conditions. Using a Stokes-type expansion, a theoretical analysis of the new multi-layer model is carried out to examine both linear and nonlinear properties, including wave celerity, velocity profiles, shoaling amplitude, second- and third-order transfer functions and amplitude dispersion. The dispersive coefficients in the governing equations are determined by optimizing the linear celerity or linear velocity profiles. For example, the four-layer model shows extremely high accuracy and is applicable up to $kh=667$ –800 (where $k$ is the wavenumber and $h$ is a typical water depth) with a 1 % error in wave phase celerity, and up to $kh=352$ –423 with a 1 % error in the linear velocity components. The super- and subharmonic transfer functions are extremely accurate up to $kh=300$ (1 % error), the third-order harmonics and amplitude dispersion are accurate up to $kh=477$ (1 % error), and the shoaling property is optimized to cover the range of $0<kh<300$ , which presents a 0.06 % tolerance error in shoaling amplitude. The high-accuracy nature of the model increases its suitability for simulating random wave propagation from extremely deep to shallow waters over mildly sloping topographies. The model is implemented numerically on a non-staggered grid via a composite fourth-order Adams–Bashforth–Moulton time integration. The numerical results show good agreement with both the analytical solutions and experimental data.

Bacillary dysentery continues to be a major health issue in developing countries and ambient temperature is a possible environmental determinant. However, evidence about the risk of bacillary dysentery attributable to ambient temperature under climate change scenarios is scarce. We examined the attributable fraction (AF) of temperature-related bacillary dysentery in urban and rural Hefei, China during 2006–2012 and projected its shifting pattern under climate change scenarios using a distributed lag non-linear model. The risk of bacillary dysentery increased with the temperature rise above a threshold (18·4 °C), and the temperature effects appeared to be acute. The proportion of bacillary dysentery attributable to hot temperatures was 18·74% (95 empirical confidence interval (eCI): 8·36–27·44%). Apparent difference of AF was observed between urban and rural areas, with AF varying from 26·87% (95% eCI 16·21–36·68%) in urban area to −1·90% (95 eCI −25·03 to 16·05%) in rural area. Under the climate change scenarios alone (1–4 °C rise), the AF from extreme hot temperatures (>31·2 °C) would rise greatly accompanied by the relatively stable AF from moderate hot temperatures (18·4–31·2 °C). If climate change proceeds, urban area may be more likely to suffer from rapidly increasing burden of disease from extreme hot temperatures in the absence of effective mitigation and adaptation strategies.