In this paper, we present and evaluate a novel Bayesian regime-switching zero-inflated multilevel Poisson (RS-ZIMLP) regression model for forecasting alcohol use dynamics. The model partitions individuals’ data into two phases, known as regimes, with: (1) a zero-inflation regime that is used to accommodate high instances of zeros (non-drinking) and (2) a multilevel Poisson regression regime in which variations in individuals’ log-transformed average rates of alcohol use are captured by means of an autoregressive process with exogenous predictors and a person-specific intercept. The times at which individuals are in each regime are unknown, but may be estimated from the data. We assume that the regime indicator follows a first-order Markov process as related to exogenous predictors of interest. The forecast performance of the proposed model was evaluated using a Monte Carlo simulation study and further demonstrated using substance use and spatial covariate data from the Colorado Online Twin Study (CoTwins). Results showed that the proposed model yielded better forecast performance compared to a baseline model which predicted all cases as non-drinking and a reduced ZIMLP model without the RS structure, as indicated by higher AUC (the area under the receiver operating characteristic (ROC) curve) scores, and lower mean absolute errors (MAEs) and root-mean-square errors (RMSEs). The improvements in forecast performance were even more pronounced when we limited the comparisons to participants who showed at least one instance of transition to drinking.

Functional montmorillonite can be dispersed in polymer coatings and organic species and polymers can be intercalated into the interlayer space or grafted onto the surface of the functional montmorillonite. The addition of functional montmorillonite into polymer-based coatings can significantly improve anti-corrosion, refractory, super-hydrophobicity, antibacterial activity, and absorption of solar radiation by the resulting montmorillonite/polymer coatings. Montmorillonite can be functionalized for this purpose by ion exchange, intercalation, exfoliation, or combinations of these treatments. The rigid montmorillonite layers interspersed within the polymer matrix inhibit the penetration of corrosive substances, minimize the impact of high-temperature airflow, and thereby lead to strong resistance of the coating to corrosion and fire. The combination of polymers and dispersed montmorillonite nanolayers, which are modified by metal ions, metal oxides, and hydrophobic organic species, allows the resulting  composite coating to have quite a rough surface and a much smaller surface free energy so that the montmorillonite/polymer coating possesses superhydrophobicity. The interlayer space of functional montmorillonite can also host or encapsulate antibacterial substances, phase-change materials, and solar energy-absorbing materials. Moreover, it can act as a template to make these guest species exist in a more stable and ordered state. Literature surveys suggest that future work on the functional montmorillonite/polymer coatings should be targeted at the manufacture of functional montmorillonite nanolayers by finding more suitable modifiers and tuning the dispersion and funtionalities of montmorillonite in the coatings.

Modification of the surfaces of montmorillonite (Mnt) by organic molecules is an effective method for improving their affinity toward non-aqueous substances, and has resulted in extensive industrial applications as rheological control agents, drilling fluids, and other functional materials used in applications ranging from environmental remediation to coatings. The present study reviewed recent progress in organo-modification of Mnt, and provides state-of-the-art insights into proposed modification mechanisms and the peculiar functionalities of the resulting organo-montmorillonite (OMnt). Several routes have been employed to modify Mnt, including ion exchange with organic ions, surface adsorption, and grafting of organics. Commonly used organic modifiers include cationic, anionic, zwitterionic, non-ionic, and polymeric species. Organo-modification is driven by multiple interactions: van der Waals forces, cation exchange, electrostatic interaction, hydrogen bonds, and ion–dipole interaction. OMnt, in general, exhibits synergistic and/or antagonistic effects when used in oil-based drilling fluids, environmental remediation, or layered silicate/polymer nanocomposites. The detailed mechanisms of non-ionic and zwitterionic modification of Mnt remain unclear. This literature survey suggests that future work should emphasize deeper understanding of interactions between the Mnt and the organic modifiers, and meanwhile expand the applications of OMnt into catalysis, drug carriers, and the biomedical field.

Blood-culture overutilization is associated with increased cost and excessive antimicrobial use. We implemented an intervention in the adult intensive care unit (ICU), combining education based on the DISTRIBUTE algorithm and restriction to infectious diseases and ICU providers. Our intervention led to reduced blood-culture utilization without affecting safety metrics.

Background: Tuberculosis is an airborne disease caused by Mycobacterium Tuberculosis. Intracranial tuberculoma is a rare complication of extrapulmonary tuberculosis due to hematogenous spread to subpial and subependymal regions. Intracranial tuberculoma can occur with or without meningitis. Methods: A 3-year-old male who recently emigrated from Sudan presented to the emergency department with right-sided seizures lasting 30 minutes which were aborted with levetiracetam and midazolam. CT head revealed a multilobulated left supratentorial mass, with solid and cystic components measuring 8.0 x 4.8 x 6.5 cm. The patient had successful surgical resection of the mass which was positive for Mycobacterium Tuberculosis. He was started on rifampin, isoniazid, pyrazinamide, ethambutol, and fluoroquinolone and discharged home in stable condition. Results: Literature review on pediatric intracranial tuberculoma was performed which included 48 studies (n=49). The mean age was 8.8 ± 5.4 years with slight female predilection (59%). Predominant solitary tuberculomas (63%) were preferentially managed with both surgical resection and antitubercular therapy (ATT) compared to multifocal tuberculomas that were preferentially managed with ATT. Conclusions: Intracranial tuberculoma is a rare but treatable cause of space-occupying lesions in children. Clinicians should maintain high-level of suspicion in patients from endemic regions and involve infectious disease service early in patient’s care.

An onboard three-dimensional (3D) trajectory generation approach based on the reinforcement learning (RL) algorithm and deep neural network (DNN) is proposed for hypersonic vehicles in glide phase. Multiple trajectory samples are generated offline through the convex optimisation method. The deep learning (DL) is employed to pre-train the DNN for initialising the actor network and accelerating the RL process. Based on the offline deep policy deterministic actor-critic algorithm, a flight target-oriented reward function with path constraints is designed. The actor network is optimised by the end-to-end RL and policy gradients of the critic network until the reward function converges to the maximum. The actor network is considered as the onboard trajectory generator to compute optimal control values online based on the real-time motion states. The simulation results show that the single-step online planning time meets the real-time requirements of onboard trajectory generation. The significant improvement in terminal accuracy of the online trajectory and the better generalisation under biased initial states for hypersonic vehicles in glide phase is observed.

A relation among invariants of filtered velocity gradients with two different filter sizes is derived. Based on this relation and physical reasoning, it is shown analytically that strain self-amplification contributes more to energy transfer than vortex stretching in homogeneous turbulence, as observed in recent numerical investigations of homogeneous isotropic turbulence. We note that the invariant relation studied and hence the inequality between strain self-amplification and vortex stretching apply to all homogeneous flows, not restricted to isotropic turbulence.

The pulsed jet is a novel and effective active mixing enhancement approach. For the transverse pulsed jet in the supersonic crossflow, the frequency influence is investigated using the three-dimensional Reynolds-averaged Navier–Stokes (RANS) equations coupled with the SST k-ω turbulence model. The averaged flow field properties of the pulsed jet are better than those of the steady jet when considering mixing efficiency and jet penetration depth, especially for the case with the pulsed frequency being 50kHz. The flow field structures of the pulsed jet are connected with the time, with periodic wave structures generating in the flow field and moving downstream. The size of the wave structures and its distance are related to the frequency, namely the size and flow distance are relatively small at 50kHz, and it takes some time for the pulsed jet to establish its influence in the full flow field. At low frequencies, the flow field produces large fluctuations, and this may be detrimental to the stable operation of the engine.

Acritarch biostratigraphic and δ13C chemostratigraphic data from the Krol A Formation in the Solan area (Lesser Himalaya, northern India) are integrated to aid inter-basinal correlation of early–middle Ediacaran strata. We identified a prominent negative δ13C excursion (likely equivalent to EN2 in the lower Doushantuo Formation in the Yangtze Gorges area of South China), over a dozen species of acanthomorphs (including two new species—Cavaspina tiwariae Xiao n. sp., Dictyotidium grazhdankinii Xiao n. sp.), and numerous other microfossils from an interval in the Krol A Formation. Most microfossil taxa from the Krol A and the underlying Infra-Krol formations are also present in the Doushantuo Formation. Infra-Krol acanthomorphs support a correlation with the earliest Doushantuo biozone: the Appendisphaera grandis-Weissiella grandistella-Tianzhushania spinosa Assemblage Zone. Krol A microfossils indicate a correlation with the second or (more likely, when δ13C data are considered) the third biozone in the lower Doushantuo Formation (i.e., the Tanarium tuberosum-Schizofusa zangwenlongii or Tanarium conoideum-Cavaspina basiconica Assemblage Zone). The association of acanthomorphs with EN2 in the Krol Formation fills a critical gap in South China where chert nodules, and thus acanthomorphs, are rare in the EN2 interval. Like many other Ediacaran acanthomorphs assemblages, Krol A and Doushantuo acanthomorphs are distributed in low paleolatitudes, and they may represent a distinct paleobiogeographic province in east Gondwana. The Indian data affirm the stratigraphic significance of acanthomorphs and δ13C, clarify key issues of lower Ediacaran bio- and chemostratigraphic correlation, and strengthen the basis for the study of Ediacaran eukaryote evolution and paleobiogeography.

UUID: http://zoobank.org/5289fdb2-0e49-4b3b-880f-f5b21acab371.

Background: Phase 3 COMET trial (NCT02782741) compares avalglucosidase alfa (n=51) with alglucosidase alfa (n=49) in treatment-naïve LOPD. Methods: Primary objective: determine avalglucosidase alfa effect on respiratory muscle function. Secondary/other objectives include: avalglucosidase alfa effect on functional endurance, inspiratory/expiratory muscle strength, lower/upper extremity muscle strength, motor function, health-related quality of life, safety. Results: At Week 49, change (LSmean±SE) from baseline in upright forced vital capacity %predicted was greater with avalglucosidase alfa (2.89%±0.88%) versus alglucosidase alfa (0.46%±0.93%)(absolute difference+2.43%). The primary objective, achieving statistical non-inferiority (p=0.0074), was met. Superiority testing was borderline significant (p=0.0626). Week 49 change from baseline in 6-minute walk test was 30.01-meters greater for avalglucosidase alfa (32.21±9.93m) versus alglucosidase alfa (2.19±10.40m). Positive results for avalglucosidase alfa were seen for all secondary/other efficacy endpoints. Treatment-emergent adverse events (AEs) occurred in 86.3% of avalglucosidase alfa-treated and 91.8% of alglucosidase alfa-treated participants. Five participants withdrew, 4 for AEs, all on alglucosidase alfa. Serious AEs occurred in 8 avalglucosidase alfa-treated and 12 alglucosidase alfa-treated participants. IgG antidrug antibody responses were similar in both. High titers and neutralizing antibodies were more common for alglucosidase alfa. Conclusions: Results demonstrate improvements in clinically meaningful outcome measures and a more favorable safety profile with avalglucosidase alfa versus alglucosidase alfa. Funding: Sanofi Genzyme

Schistosomiasis has been subjected to extensive control efforts in the People's Republic of China (China) which aims to eliminate the disease by 2030. We describe baseline results of a longitudinal cohort study undertaken in the Dongting and Poyang lakes areas of central China designed to determine the prevalence of Schistosoma japonicum in humans, animals (goats and bovines) and Oncomelania snails utilizing molecular diagnostics procedures. Data from the Chinese National Schistosomiasis Control Programme (CNSCP) were compared with the molecular results obtained.

Sixteen villages from Hunan and Jiangxi provinces were surveyed; animals were only found in Hunan. The prevalence of schistosomiasis in humans was 1.8% in Jiangxi and 8.0% in Hunan determined by real-time polymerase chain reaction (PCR), while 18.3% of animals were positive by digital droplet PCR. The CNSCP data indicated that all villages harboured S. japonicum-infected individuals, detected serologically by indirect haemagglutination assay (IHA), but very few, if any, of these were subsequently positive by Kato-Katz (KK).

Based on the outcome of the IHA and KK results, the CNSCP incorporates targeted human praziquantel chemotherapy but this approach can miss some infections as evidenced by the results reported here. Sensitive molecular diagnostics can play a key role in the elimination of schistosomiasis in China and inform control measures allowing for a more systematic approach to treatment.